bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of Outcomes Following Thrombolytic Therapy Among Patients With Prior Stroke and Diabetes in the Virtual International Stroke Trials Archive (VISTA)
Authors: Mishra Nishant Kumar , Davis Stephen M. , Kaste Markku , Lees Kennedy R. ,   for the VISTA Collaboration
Published: September 2010

OBJECTIVE

The use of alteplase in patients who have had a prior stroke and concomitant diabetes is not approved in Europe. To examine the influence of diabetes and prior stroke on outcomes, we compared data on thrombolysed patients with nonthrombolysed comparators.

RESEARCH DESIGN AND METHODS

We selected patients with ischemic stroke on whom we had data on age, pretreatment baseline National Institutes of Health Stroke Scale (b-NIHSS), and 90-day outcome measures (functional modified Rankin score [mRS]) and neurological measures [NIHSS]) in the Virtual International Stroke Trials Archive. We compared outcomes between thrombolysed patients and nonthrombolysed comparators in those with and without diabetes, those who have had a prior stroke, or both and report findings using the Cochran-Mantel-Haenszel (CMH) test and proportional odds logistic regression analyses. We report an age-adjusted and b-NIHSS–adjusted CMH P value and odds ratio (OR).

RESULTS

Rankin data were available for 5,817 patients: 1,585 thrombolysed patients and 4,232 nonthrombolysed comparators. A total 1,334 (24.1%) patients had diabetes, 1,898 (33.7%) patients have had a prior stroke, and 491 (8%) patients had both. Diabetes and nondiabetes had equal b-NIHSS (median 13; P = 0.3), but patients who have had a prior stroke had higher b-NIHSS than patients who have not had a prior stroke (median 13 vs. 12; P < 0.0001). Functional outcomes were better for thrombolysed patients versus nonthrombolysed comparators among both nondiabetic (P < 0.0001; OR 1.4 [95% CI 1.3–1.6]) and diabetic (P = 0.1; 1.3 [1.05–1.6 ]) subjects. Similarly, outcomes were better for thrombolysed patients versus nonthrombolysed comparators among who have not had a prior stroke (P < 0.0001; 1.4 [1.2–1.6 ]) and those who have (P = 0.02; 1.3 [1.04–1.6 ]). There was no interaction of diabetes and prior stroke with treatment (P = 0.8). Neurological outcomes were consistent with the mRS.

CONCLUSIONS

Outcomes from thrombolysis are better among patients with diabetes and/or those who have had a prior stroke than in control subjects. Withholding thrombolytic treatment from otherwise-eligible patients may not be justified.
Photocarrier transport in 2D macroporous silicon structures
Authors: Karachevtseva L. , Onyshchenko V. , Sachenko A.
Published: September 2010

The mechanisms of photocarrier transport through a barrier in the surface space-charge region (SCR) of 2D macroporous silicon structures have been studied at photon energies comparable to that of the silicon indirect band-to-band transition. It was found that the photoconductivity relaxation time was determined by the light modulation of barrier on the macropore surface; as a result, the relaxation itself obeyed the logarithmic law. The temperature dependence of the photoconductivity relaxation time was determined by the thermionic emission mechanism of the current transport in the SCR at temperatures T > 180 K, and by the tunnel current flow at T < 100 K, with temperature-independent tunnelling probability. The photo-emf was found to become saturated or reverse its sign to negative at temperatures below 130 K because of light absorption due to optical transitions via surface electronic states close to the silicon conduction band. In this case, the surface band bending increases due to the growth of a negative charge of the semiconductor surface. The equilibrium electrons in the bulk and photoexcited holes on the macropore surface recombine through the channel of multistage tunnel recombination between the conduction and valence bands.
Propagation of surface plasmon polaritons through gradient index and periodic structures
Authors: Váry T. , Markoš P.
Published: September 2010

We study propagation of surface electromagnetic waves along a metallic surface covered by various layered dielectric structures. We show that strong radiative losses, typical for scattering of a surface wave, can be considerably suppressed when a single dielectric step is substituted by gradient index or periodic layered structure.
Dependence of nonlinear refractive index of ZnSe on Be and Mg content
Authors: Derkowska B. , Firszt F. , Marasek A. , Sahraoui B.
Published: September 2010

The values of the nonlinear refractive index n2 and the two-photon absorption coefficient β of ternary and quaternary ZnSe-based mixed crystals were extracted from the standard backward degenerate four wave mixing (DFWM) and nonlinear transmission measurements at 532 nm, respectively. Studied crystals were grown by the modified high-pressure Bridgman method. We found that the value of the nonlinear refractive index n2 for Zn0.79Be0.21Se is higher than that for Zn0.80Mg0.20Se. However, the opposite behaviour was found in the case of two-photon absorption coefficient β for these compounds. We also found that the values of the nonlinear refractive index n2 and the two-photon absorption coefficient β for Zn0.83Be0.04Mg0.13Se are about five times lower and three times higher than that for Zn0.80Mg0.13Se, respectively. In the case of ternary ZnSe-based crystals we noticed that the value of the nonlinear refractive index n2 decreases with increasing Mg or Be content. However, the value of the two-photon absorption coefficient β increases with increasing Mg or Be content.
The overlap technique versus end‐to‐end approximation technique for primary repair of obstetric anal sphincter rupture: a randomized controlled study
Authors: Rygh Astrid Betten , Körner Hartwig
Published: September 2010

Objective. To compare the outcome of end‐to‐end approximation versus the overlap technique for primary repair of obstetric anal sphincter rupture (OASR) at 12 month follow‐up. Design. Prospective, randomized controlled study. Setting. University hospital. Sample. One hundred and twenty‐eight patients with grade 3b, 3c or 4 OASR were randomized; 119 (end‐to‐end 60, overlap 59) received the allocated treatment. We obtained information concerning fecal incontinence from 101 (85%) patients. Methods. The obstetric team on call performed the repairs. Wexner score, endoanal ultrasound (EAUS), and manometry were used to evaluate anal sphincter function at 12 months post‐surgery. Main outcome measures. Primary outcome was incidence of solid stool leakage at least once a week. Secondary outcomes were flatus incontinence, Wexner score, external anal muscle defect examined by EAUS, and anal manometry results. Results. One patient in the end‐to‐end group and none in the overlap group reported leakage of solid stool once a week or more. Fourteen patients in the end‐to‐end group and 10 in the overlap group reported flatus incontinence (p = 0.48). Mean Wexner score was similar in both groups, 2.4 versus 2.2. One patient in the end‐to‐end group and none in the overlap group had a Wexner score >10 (severe anal incontinence) (NS). External sphincter defect was found in 2/46 in the end‐to‐end group compared to 0/41 in the overlap group (NS). Anal manometry findings were similar in both groups. Conclusion. The overlap repair was not superior to the approximation technique with regard to fecal incontinence at 12 months.
A randomised clinical trial comparing the outcome of trabeculectomy using triangular versus rectangular scleral flaps
Authors: Sharma A , Das H , Adhikari S , Lavaju P , Shrestha BG
Published: September 2010

Background: Trabeculectomy is the standard surgical procedure for management of glaucoma. Objective: To compare the outcome of triangular and rectangular scleral flaps in trabeculectomy. Materials and methods: This study was carried out in the Department of Ophthalmology, BPKIHS, Dharan, over a period of one year. A total of 22 patients undergoing trabeculectomy were randomized to undergo either trabeculectomy with triangular scleral flap (Group A= 11 eyes) or trabeculectomy with rectangular flap (Group B =11 eyes). Outcome measurement: The parameters studied were intraocular pressure (IOP), anterior chamber depth (ACD), bleb characteristics and surgical complications. Statistics: P value of <0.05 was considered significant. All calculations were executed using SPSS 11.0 software program. Results: The age ranged between 40 to 76 years with the mean of 56.5±9.25 years. The most common preoperative diagnosis was angle closure glaucoma. The postoperative percentage of IOP reduction (Group A=68.9%; Group B=66.51%) was statically significant in both the groups (p=0.001). Trabeculectomy was almost equally effective with complete surgical success of 91% in group A, and 82% in group B (p=0.534). Final bleb scores were almost similar in both the groups with 3.27 ± 1.5 in group A and 3.36±1.21 in group B (p=0.877). Hypotony with the IOP less than 6 mmHg was found in the first post-operative day in 2 patients in Group A and in 1 in Group B. All of them improved spontaneously within a week. Conclusion: Both triangular and rectangular scleral flaps in trabeculectomy are equally effective in terms of post surgical IOP control, bleb characteristics and complications. Keywords: Trabeculectomy; glaucoma; intra ocular pressure; scleral flap DOI: 10.3126/nepjoph.v1i1.3669 Nep J Oph 2009;1(1):20-24
Implantation of collagen punctal plugs for the reduction of post-keratoplasty ametropia
Authors: Baskin D , Waller S
Published: September 2010

In 1995, a 46-year-old woman was referred for refractive surgery. Eleven years earlier, she had undergone an uncomplicated penetrating keratoplasty in her right eye to treat a dense corneal opacity caused by contact lens-related microbial keratitis. Due to high myopia in the graft, she was unable to achieve useful vision and declined contact lens use. After extensive counseling, she elected to undergo radial keratotomy (RK) and arcuate keratotomy (AK) in her right eye. We recommended the insertion of collagen punctal plugs into the keratotomy incisions to increase the RK effect. She also decided to have RK in her left eye. Postoperatively, her uncorrected visual acuity was 20/25 OD and 20/30 OS. We were able to contact her and her ophthalmologist eleven years later, and eight of eleven collagen plugs were still present in the incisions, with no signs of rejection or inflammation. Later, we learned that she underwent a repeat penetrating keratoplasty due to corneal graft failure after a phacoemulsification procedure. The pathologic examination of the intact plugs and graft also showed no rejection or inflammation. DOI: 10.3126/nepjoph.v1i1.3676 Nep J Oph 2009;1(1):72-74
Association between diabetic retinopathy and serum lipoproteins level
Authors: Shakya K , Shrestha JK , Joshi SN
Published: September 2010

Introduction: Diabetic retinopathy is the leading cause of blindness of working-age patients in the urban areas. Objective: To find out the association between diabetic retinopathy and serum lipoproteins in patients with diabetes mellitus Materials and methods: A community-based cross-sectional study involving 100 subjects with type II diabetes living in the cities of Kathmandu, Bhaktapur and Lalitpur of Nepal was carried out using a purposive sampling method. The retinopathy was classified according to the modified Airlie House classification of diabetic retinopathy. The patients with systolic hypertension were excluded. The blood sugar level was assessed by using glycosylated hemoglobin. The fasting serum lipoproteins were assessed by photometric enzymatic methods. Statistics: The SPSS version 10.0 software was used. The p value of <0.05 was considered significant. Results: The majority (n=91) of the patients were in the age group 31-60 years with the mean of 48.2 ± 9.5. The mean duration of diabetes mellitus in the patients with no-diabetic-retinopathy was 4 ±3.4 years and that in those with the retinopathy was 6.4 ± 4years, (p =0.006). The mean glycosylated hemoglobin level for no-diabetic-retinopathy group was 6.9 ±1.1 %, whereas for the diabetic retinopathy group, it was 7.7 ± 1.5% (p = 0.004). The mean values of serum lipoproteins when taken together were slightly higher in the diabetic retinopathy group than in the group with no-diabetic-retinopathy. The serum triglyceride value was higher in the group with diabetic retinopathy than in the group with no retinopathy. Serum triglyceride had a low degree of positive correlation with HbA1c value. Conclusion: There is no significant association between the serum lipoprotein levels and diabetic retinopathy in patients with type II diabetes mellitus. Serum triglyceride level has a low degree of positive correlation with HbA1c value. Keywords: diabetic retinopathy; lipoproteins; glycosylated hemoglobin DOI: 10.3126/nepjoph.v1i2.3684 Nep J Oph 2009;1(2):107-113
Wound infection after cataract surgery: a report of two cases
Authors: Singh SK , Bharali P , Winter I
Published: September 2010

Background: This is a report of 2 cases of fungal wound infection after cataract surgery (phacoemulsification). Both patients were noticed to have the fungal wound infection at the onemonth follow-up after the surgery. Observations: Although both patients had been advised to taper steroid containing antibiotic eye drops, they failed to do so. Despite intensive treatment with antifungal eye drops and oral antifungal agents, visual outcome was poor. Conclusion: Fungal infection of the wound may occur in cataract patients in the post-operative period. This infection is probably more common in patients who have had a temporal incision and who are from an agricultural background living in a hot and humid climate. Keywords: phacoemulsification; small incision cataract surgery; fungal infection DOI: 10.3126/nepjoph.v2i1.3706 Nep J Oph 2010;2(1) 59-63
Anatomical and functional outcomes of surgery of rhegmatogenous retinal detachment
Authors: Sharma H , Joshi SN , Shrestha JK
Published: September 2010

Introduction: Rhegmatogenous retinal detachment (RRD) is a potentially blinding condition. Objective: To evaluate the anatomical and functional outcome of surgery of RRD. Materials and methods: A prospective study of interventional case series was designed including 50 consecutive patients with RRD in a tertiary level eye center in Kathmandu. The patients underwent scleral buckling (SB) or pars plana vitrectomy (PPV) according to the proliferative vitreo-retinopathy (PVR) changes. All the patients had at least 3 months of follow-up. The anatomical and physiological outcome measures were primary retinal reattachment and improvement in visual acuity respectively. The surgery was considered successful when there was attachment of retina after the first surgery. Results: The mean age of these patients at the time of presentation was 46.24 ± 19.82 years. Of 50, sixty-six percent of the patients underwent SB and 34 % underwent PPV. Primary surgical success rate was 88 %. While comparing the initial best corrected visual acuity (BCVA) with the final, 72% had an improvement, 12 % unchanged and 16 % had a deteriorated visual acuity. Conclusion: The visual acuity improves and the anatomical success rate is high in the majority of the patients after surgery for rhegmatogenous retinal detachment. Keywords: rhegmatogenous retinal detachment; scleral buckling; pars plana vitrectomy; anatomical outcome; physiological outcome DOI: 10.3126/nepjoph.v2i2.3720 Nep J Oph 2010;2(2) 132-137
Knowledge, Skills, and Attitudes of Veterinary College Deans: AAVMC Survey of Deans in 2010
Authors: Haden N. Karl , Chaddock Michael , Hoffsis Glen F. , Lloyd James W. , Reed William M. , Ranney Richard R. , Weinstein George J.
Published: September 2010

The purposes of this Association of American Veterinary Medical Colleges (AAVMC) study was to develop a profile of deans to understand the knowledge, skills, and attitudes that current deans of schools and colleges of veterinary medicine consider important to job success and to inform the association's leadership development initiatives. Forty-two deans responded to an online leadership program needs survey, which found that knowledge, skills, and abilities related to communication, finance and budget management, negotiation, conflict management, public relations, and fundraising were recommended as the most important areas for fulfilling a deanship. Most respondents speculated that the greatest challenges for their institutions will be in the areas of faculty recruitment and retention and financing veterinary education. Reflecting on their experiences, respondents offered an abundance of advice to future deans, often citing the importance of preparation, communication, and leadership qualities as necessary for a successful and satisfying deanship. More than three-quarters of the respondents indicated moderate to high interest in an AAVMC multi-phase leadership training program to develop administrative leaders. A nearly equal number also indicated support for formal leadership training for current veterinary medical college and school deans. The study suggests leadership development topics that AAVMC could provide at existing meetings or through new programming. The study also suggests directions for individual institutions as they seek to implement leadership development activities at the local level.
Fostering Integrated Learning and Clinical Professionalism Using Contextualized Simulation in a Small-Group Role-Play
Authors: Baillie Sarah , Pierce Stephanie E. , May Stephen A.
Published: September 2010

Teaching and learning in a clinical setting is important in veterinary and medical training but presents many challenges, including providing enough hands-on experience while not putting patients (animal or human) at risk. Some of the issues have been addressed with the introduction of clinical skills laboratories and communication skills training using role play. However, in both instances skills are learned in isolation, whereas the real task requires the integration of many skills including technical competencies, effective communication, decision making, and professionalism. In our study, we trialed “contextualized simulation” by combining role play with a simulator, the haptic cow, in a small-group tutorial, the Simulated Fertility Visit. Students took turns as the veterinarian; they had to establish the cow's history from the farmer (a role player), palpate the simulation, make a diagnosis, and decide on treatment, if appropriate. We included scenarios varying from common cases to challenging situations. The tutorial was introduced in the farm-animal clinical rotation, and feedback was gathered from students by means of a questionnaire. The tutorial was attended by 178 students (98% of that year's students), and 151 questionnaires were returned (85% response rate). Students reported that the tutorial was a positive learning experience and recognized that it presented an opportunity to integrate the skills needed for clinical work. Student feedback suggests that contextualized simulation provides a valuable complement to clinical cases, and we recommend extending this teaching method to other clinical scenarios and species, particularly because it provides a safe environment in which to experience, and learn from, mistakes.
Teaching Veterinary Obstetrics Using Three-Dimensional Animation Technology
Authors: Scherzer Jakob , Buchanan M. Flint , Moore James N. , White Susan L.
Published: September 2010

In this three-year study, test scores for students taught veterinary obstetrics in a classroom setting with either traditional media (photographs, text, and two-dimensional graphical presentations) were compared with those for students taught by incorporating three-dimensional (3D) media (linear animations and interactive QuickTime Virtual Reality models) into the classroom lectures. Incorporation of the 3D animations and interactive models significantly increased students' scores on essay questions designed to assess their comprehension of the subject matter. This approach to education may help to better prepare students for dealing with obstetrical cases during their final clinical year and after graduation.
A Laparoscopic Surgical Skills Assessment Tool for Veterinarians
Authors: Fransson Boel A. , Ragle Claude A. , Bryan Margaret E.
Published: September 2010

Our aim in this study was to validate a test of laparoscopic surgical performance by determining the relation of scores from an objective structured assessment of technical skills performed in a canine abdominal model to experience and basic laparoscopic skills. The number of years the participants had performed rigid video-endoscopic procedures (VEP), using triangulation skills, correlated positively with both evaluators' total surgical performance scores for all three evaluation methods: global rating scale, visual analog scale (VAS) rating of overall performance, and operative component rating scale (OCRS). Experience of VEP without triangulation skills (i.e., flexible endoscopy, otoscopy) or video game experience did not correlate with surgical performance. A highly validated basic laparoscopic skills assessment (McGill University inanimate system for training and evaluation of laparoscopic skills, or MISTELS) score was strongly correlated with the VAS score for surgical performance and OCRS scores. Inter-rater reliability was high for the VAS and OCRS evaluation methods, and scores from the detailed OCRS method did not differ between evaluators. In conclusion, the surgical performance test correlated with VEP triangulation experience and basic laparoscopic skills. This type of test needs to be evaluated in a larger sample population including higher numbers of veterinary laparoscopic surgeons for further validation.
Vulgar Habits and Hume's Double Vision Argument
Authors: Butler Annemarie
Published: September 2010

In Treatise 1.4.2, David Hume seeks to explain how we come to believe in the external existence of bodies. He offers a complicated psychological account, where the imagination operates on the raw data of the senses to produce the ‘vulgar’ belief in the continued existence of the very things we sense. On behalf of philosophers, he presents a perceptual relativity argument that purports to show that the vulgar belief is false. I argue that scholars have failed to appreciate Hume's peculiar formulation of the perceptual relativity argument and its relation to his psychological account of the vulgar belief. On my interpretation, in order to account for all the premises that Hume explicitly offers, the argument is best interpreted as beginning with a reductio that opposes the effects of the senses and the imagination in the vulgar belief. Thus Hume can be interpreted as identifying an ‘antinomy’ in the habits of the vulgar mind that produce belief in bodies.
Effective Emotions: The Enactment of a Work Ethic in the Swedish Meeting Industry
Authors: Andersson Cederholm Erika
Published: September 2010

The meeting industry – an encompassing term for services related to various kinds of professional meetings, from mega-conventions to the ordinary work meetings – is increasingly consolidated and legitimated as a specific sector in the service industry. New professions such as meeting designers, meeting facilitators and meeting consultants are emerging, promoting new knowledge in this field. By focussing on processes and social interaction, and highlighting emotional dimensions of meetings, these professions pave the way for new modes of conceptualising and practising professional relationships. The intangible, emotional and playful dimensions of social interactions are promoted as effective means to achieve economic goals, thus highlighting a professional ideal that is here called “effective emotions”. The aim of this article is to show how the work ethic promoted by the meeting industry encourages new intersections, and tensions, between the idealisation of the tangible/measurable/rational on the one hand and the intangible/emotional/magical on the other hand, and between working life and intimate spheres. Through a discourse analysis of a Swedish corporate meeting magazine, it is shown how the distinction between work and leisure is dissolved in this specific work culture, and by this, it is discussed how the meeting profession acts as a normative regulator by reinforcing ideal ways of being and interacting with others. Creativity, personal growth, reflexivity and flexibility are enacted as idealised personal assets as well as moral imperatives in the discourse of the meeting profession and through the practices of various meeting techniques, thus reinforcing not merely a professional ethic but cultural ideals of being as a person as well. It is also suggested that this reinforcement may, under certain circumstances, turn into its opposite and undermine the promoted ideals, thus pointing at the importance to pinpoint the dynamic and situated tension between economic rationality and emotional intensity.
Hybrid biofunctional nanostructures as stimuli-responsive catalytic systems
Authors: Marten Gernot U , Gelbrich Thorsten , Schmidt Annette M
Published: September 2010

A novel active biocatalytic reaction system is proposed by covalently immobilizing porcine pancreas trypsin within the thermoresponsive polymer shell of superparamagnetic Fe3O4 nanoparticles.

Active ester-functional nanocarriers suitable for the immobilization of amino functional targets are obtained in a single polymerization step by grafting-from copolymerization of an active ester monomer from superparamagnetic cores. The comonomer, oligo(ethylene glycol) methyl ether methacrylate, has excellent water solubility at room temperature, biocompatibility, and a tunable lower critical solution temperature (LCST) in water. The phase separation can alternatively be initiated by magnetic heating caused by magnetic losses in ac magnetic fields.

The immobilization of porcine pancreas trypsin to the core–shell nanoparticles results in highly active, nanoparticulate biocatalysts that can easily be separated magnetically. The enzymatic activity of the obtained biocatalyst system can be influenced by outer stimuli, such as temperature and external magnetic fields, by utilizing the LCST of the copolymer shell.
Patient Self-Medication with ASA 81 mg
Authors: Taylor Jeff , Evans Charity , Blackburn David , Semchuck William
Published: September 2010

Purpose:

Low-dose acetylsalicylic acid (ASA) is an important therapy for decreasing cardiac events in patients at risk. The initiation of ASA therapy should involve physician assessment, but some people may choose to self-medicate. The purpose of this project was to determine the percentage of people taking ASA 81 mg without the recommendation of their doctor, as well as to estimate the proportion of users exhibiting an objective indication for daily use of ASA 81 mg, based on survey responses indicating the presence of established cerebrovascular disease (stroke or mini-stroke), coronary heart disease (CHD) (heart attack or prevention surgery), a CHD risk equivalent (diabetes) or at least 2 risk factors for CHD (age, smoking, high blood pressure, high cholesterol or positive family history).

Methods:

A 1-page survey was distributed to purchasers of ASA 81 mg at 52 community pharmacies in Saskatchewan. Respondents were asked who led them to start taking ASA for heart health and were asked for information on their age and health history. Estimates were made of the proportion of users exhibiting an objective indication for daily use of ASA 81 mg, defined as the presence of either established cerebrovascular disease (stroke or mini-stroke), coronary heart disease (CHD) (heart attack or prevention surgery), a CHD risk equivalent (diabetes) or at least 2 risk factors for CHD (age, smoking, high blood pressure, high cholesterol or positive family history).

Results:

Of the 481 respondents whose surveys were suitable for analysis, 417 (86.7%) were engaged in doctor-supervised care. Conversely, 13.1% did not seek a physician's advice prior to the initiation of therapy. Of the 69 respondents who were taking ASA but did not meet the indications for its use, the majority claimed to have started therapy based on the recommendation of a health care professional.

Conclusion

The use of ASA without physician intervention is of serious concern. In this study of Saskatchewan citizens, up to 13.1% did not involve their doctor for initiation of therapy, potentially exposing them to unnecessary risk.
The Effect of US Pharmaceutical Drug Importation on the Canadian Pharmaceutical Supply
Authors: Shepherd Marv
Published: September 2010

Background and objectives:

For over a decade, many US politicians have advocated that the US allow personal and commercial drug importation. Currently, the only entities that can legally import a pharmaceutical in the US are pharmaceutical manufacturers. Our objective was to compare the number of prescriptions dispensed in Canada with the US and estimate the effect US drug importation from Canada will have on the Canadian drug supply.

Methods:

A model was created to measure the potential effect on the Canadian drug supply. The model uses the number of US prescriptions being sourced from Canada and the number of prescriptions dispensed in Canada in 2007 as the baseline. The number of days to exhaust the 2007 Canadian drug supply was calculated.

Results:

The model found that if 10% of the US prescriptions were filled from Canadian sources (manufacturer, wholesale or retail), Canada's 2007 drug supply would be exhausted in 224 days. If the demand from the US reached 20%, the 2007 supply would be exhausted in 155 days. The model was redone focusing on brand name drugs, with generic drugs removed. It was found that with a US demand of 10% and 20%, the 2007 Canadian supply for brand name drugs would be exhausted in 268 and 201 days, respectively.

Conclusion:

US drug importation is a threat to Canada's drug supply. Even if the US demand were 10%, Canada would need to dramatically increase manufacturing, triple drug importation, or most likely control or halt pharmaceutical shipments to the US.
Temporal Association of Streptococcus, Staphylococcus, and Parainfluenza Pediatric Hospitalizations and Hospitalized Cases of Henoch-Schönlein Purpura
Authors: WEISS PAMELA F. , KLINK ANDREW J. , LUAN XIANQUN , FEUDTNER CHRIS
Published: September 2010

Objective.

To determine if hospitalizations for specific infectious exposures are associated with hospital admissions for Henoch-Schönlein purpura (HSP).

Methods.

We conducted a retrospective cohort study using administrative data of children admitted to 40 children’s hospitals between January 1, 2002, and December 31, 2008. We examined the association of standardized rates of group A ß-hemolytic Streptococcus (GABS), Staphylococcus aureus, parainfluenza, influenza, adenovirus, and respiratory syncytial virus (RSV)-associated hospital admissions with standardized rates of HSP hospital admissions on a month by month basis using autoregressive moving average process models to account for temporal autocorrelation and clustering by hospital.

Results.

Among the 3,132 admissions for HSP observed over the 7-year study period, hospital admissions were most frequent September through April, but with substantial variability between hospitals for each month. Accounting for these month by month differences within each hospital, the rate of HSP admissions in a given month increased significantly as the standardized rates of GABS (p = 0.01), S. aureus (p < 0.01), and parainfluenza (p = 0.03) admissions increased.

Conclusion.

Our results demonstrate a local month by month temporal association between hospitalization for GABS, S. aureus, and parainfluenza and hospitalization for HSP. Future investigations will be required to determine causality.
Incident Comorbidity Among Patients with Rheumatoid Arthritis Treated or Not with Low-dose Glucocorticoids: A Retrospective Study
Authors: MAZZANTINI MAURIZIO , TALARICO ROSARIA , DOVERI MARICA , CONSENSI ARIANNA , CAZZATO MASSIMILIANO , BAZZICHI LAURA , BOMBARDIERI STEFANO
Published: September 2010

Objective.

To assess the prevalence of comorbidity in a cohort of patients with rheumatoid arthritis (RA), treated or not with low-dose glucocorticoids (GC) and who have been followed for at least 10 years.

Methods.

This was a retrospective study by review of medical records.

Results.

We identified 365 patients: 297 (81.3%) were GC users (4–6 mg methylprednisolone daily) and 68 (18.7%) were nonusers. We found that fragility fractures occurred in 18.2% of GC users and in 6.0% of GC nonusers (p < 0.02); arterial hypertension in 32.3% of GC users and in 10.4% of GC nonusers (p < 0.0005); acute myocardial infarction in 13.1% of GC users and in 1.5% of the nonusers (p < 0.01). Prevalence of diabetes mellitus, cataract, and infections was comparable. We divided GC users into groups of different duration of GC therapy: < 2, 2–5, and > 5 years; the mean duration of GC treatment was 1.3 ± 0.5, 3.6 ± 1.1, and 12.1 ± 5.1 years, respectively. GC treatment for > 5 years was associated with significantly higher prevalence of fragility fractures (26.6%; p < 0.001 vs the other groups), arterial hypertension (36.7%; p < 0.0002 vs nonusers and GC users < 2 years), myocardial infarction (16.1%; p < 0.01 vs nonusers), and infections (9.7%; p < 0.005 vs the other groups). GC treatment for 2–5 years was associated with a significantly higher prevalence of arterial hypertension (30.0%; p < 0.01) compared to nonusers.

Conclusion.

Patients with RA treated with low-dose GC compared to patients never treated with GC show a higher prevalence of fractures, arterial hypertension, myocardial infarction, and serious infections, especially after 5 years of GC treatment. The high prevalence of myocardial infarction and fractures in patients with RA suggests that a more accurate identification of risk factors and prevention measures should be adopted when longterm GC treatment is needed.
La promotion sociale des femmes : le retournement d'une politique de formation d'adultes au milieu des années 1960
Authors: Laot Françoise F.
Published: September 2010

Résumé La politique de promotion sociale – selon la loi Debré de 1959 –, c’est-à-dire une politique de formation pour des adultes déjà au travail –, a d’abord été pensée par des hommes, pour des hommes. Fondé sur des archives, cet article montre comment, dans la mise en œuvre de cette politique, on a d’abord oublié les femmes comme de possibles destinataires des actions de formation. Il décrit ensuite les circonstances et les événements qui ont progressivement conduit, au plan national, à soulever la question de la promotion féminine dans les travaux de différents comités. Les discours commencent à changer à partir de la mi-1966. Les femmes vont y acquérir une nouvelle, mais éphémère, visibilité, en tant que public de la formation. Visibilité qu’elles vont perdre en se fondant dans la figure asexuée du « salarié » qui devient le bénéficiaire des nouveaux droits à la formation, qui se mettent en place au début des années 1970.
Place des psychothérapies dans l'accompagnement thérapeutique en addictologie. Théorie et pratique
Authors: Morel Alain
Published: September 2010

Résumé Les équipes spécialisées en addictologie adoptent généralement une conception multifactorielle de l’addiction et une conception individualisée du soin qui vise à intervenir sur les différents registres, cognitif, symbolique, biologique et social. Mais réaliser un tel objectif suppose : i) que les interventions des différents acteurs du soin, psychothérapeutes et autres, soient redéfinies et organisées dans la perspective d’un accompagnement transdisciplinaire ; ii) que l’alliance thérapeutique s’établisse à partir de l’expérience du patient, de ses choix, de ses ressources d’autochangement et de sa satisfaction propre. La présentation du programme thérapeutique du Centre résidentiel « Kairos » donne une illustration concrète de cette approche expérientielle combinant diverses modalités psychothérapeutiques, et interroge sur les perspectives d’évaluation de ces accompagnements thérapeutiques.
Recherche sur les psychothérapies des addictions. Comment y participer ?
Authors: Thurin Jean-Michel , Thurin Monique
Published: September 2010

Résumé La recherche en psychothérapie a toujours existé. Elle est devenue un enjeu majeur dans le contexte de l’Evidence-Based Practice qui inclut dans la définition d’un traitement son efficacité et s’inscrit dans la gestion des coûts de la maladie. Après une période où la psychothérapie a dû démontrer qu’elle était efficace comparativement aux traitements pharmacologiques et à l’absence de traitement, ce sont les conditions et les causes de cette efficacité qui sont interrogées. Cet objectif donne une nouvelle perspective aux études systématiques de cas qui, en articulant les effets avec le processus de la psychothérapie qui les sous-tend, permettent de prendre en compte les caractéristiques individuelles et les processus de changement. Ces études sont intéressantes pour les cliniciens qui peuvent y trouver à la fois une objectivation de la complexité de leur activité, de ses effets progressifs et des configurations de processus qui les sous-tendent. Le Réseau de Recherches Fondées sur les Pratiques Psychothérapiques ouvre un cadre de travail permettant de réunir les expériences individuelles et de les utiliser avec une approche qualitative et quantitative où la connaissance, la pratique et la démonstration de l’efficacité peuvent être réunies.
La paix du prince. Droit savant et pratiques féodales dans la construction de l'État en Provence (1250-1309)
Authors: Verdon Laure
Published: September 2010

Résumé Sur la base d’un dossier documentaire constitué d’enquêtes de la seconde moitié du xiii e  siècle relatives à des conflits de juridiction en Haute Provence et Provence rhodanienne ainsi que des ordonnances de 1289 et 1294 destinées à mettre fin aux aliénations non contrôlées de biens nobles, cet article reconsidère les relations établies entre le pouvoir souverain et les grands à l’aune de l’application des principes du droit féodal. La question centrale est celle de la paix, telle que définie lors de la diète de Roncaglia (1158), dont les Angevins vont tenter d’appliquer les principes dès leur accession au trône comtal provençal. La paix, qui repose sur le lien de fidélité noué entre puissants, sert de fil rouge à l’analyse qui cerne les origines de ces pratiques dans cette région par un nouveau regard porté sur le corpus des serments de fidélité des xi e  et xii e  siècle et en suit les évolutions jusqu’au début du xiv e  siècle, par une relecture proposée des ordonnances de 1289 et 1294.
Influenza A Virus Protein PB1-F2 Exacerbates IFN-β Expression of Human Respiratory Epithelial Cells
Authors: Le Goffic Ronan , Bouguyon Edwige , Chevalier Christophe , Vidic Jasmina , Da Costa Bruno , Leymarie Olivier , Bourdieu Christiane , Decamps Laure , Dhorne-Pollet Sophie , Delmas Bernard
Published: September 2010

The PB1-F2 protein of the influenza A virus (IAV) contributes to viral pathogenesis by a mechanism that is not well understood. PB1-F2 was shown to modulate apoptosis and to be targeted by the CD8+ T cell response. In this study, we examined the downstream effects of PB1-F2 protein during IAV infection by measuring expression of the cellular genes in response to infection with wild-type WSN/33 and PB1-F2 knockout viruses in human lung epithelial cells. Wild-type virus infection resulted in a significant induction of genes involved in innate immunity. Knocking out the PB1-F2 gene strongly decreased the magnitude of expression of cellular genes implicated in antiviral response and MHC class I Ag presentation, suggesting that PB1-F2 exacerbates innate immune response. Biological network analysis revealed the IFN pathway as a link between PB1-F2 and deregulated genes. Using quantitative RT-PCR and IFN-β gene reporter assay, we determined that PB1-F2 mediates an upregulation of IFN-β expression that is dependent on NF-κB but not on AP-1 and IFN regulatory factor-3 transcription factors. Recombinant viruses knocked out for the PB1-F2 and/or the nonstructural viral protein 1 (the viral antagonist of the IFN response) genes provide further evidence that PB1-F2 increases IFN-β expression and that nonstructural viral protein 1 strongly antagonizes the effect of PB1-F2 on the innate response. Finally, we compared the effect of PB1-F2 variants taken from several IAV strains on IFN-β expression and found that PB1-F2–mediated IFN-β induction is significantly influenced by its amino acid sequence, demonstrating its importance in the host cell response triggered by IAV infection.
Ability of IDO To Attenuate Liver Injury in α-Galactosylceramide–Induced Hepatitis Model
Authors: Ito Hiroyasu , Hoshi Masato , Ohtaki Hirofumi , Taguchi Ayako , Ando Kazuki , Ishikawa Tetsuya , Osawa Yosuke , Hara Akira , Moriwaki Hisataka , Saito Kuniaki , Seishima Mitsuru
Published: September 2010

IDO converts tryptophan to l-kynurenine, and it is noted as a relevant molecule in promoting tolerance and suppressing adaptive immunity. In this study, we examined the effect of IDO in α-galactosylceramide (α-GalCer)–induced hepatitis. The increase in IDO expression in the liver of wild-type (WT) mice administered α-GalCer was confirmed by real-time PCR, Western blotting, and IDO immunohistochemical analysis. The serum alanine aminotransferase levels in IDO-knockout (KO) mice after α-GalCer injection significantly increased compared with those in WT mice. 1-Methyl-d-tryptophan also exacerbated liver injury in this murine hepatitis model. In α-GalCer–induced hepatitis models, TNF-α is critical in the development of liver injury. The mRNA expression and protein level of TNF-α in the liver from IDO-KO mice were more enhanced compared with those in WT mice. The phenotypes of intrahepatic lymphocytes from WT mice and IDO-KO mice treated with α-GalCer were analyzed by flow cytometry, and the numbers of CD49b+ and CD11b+ cells were found to have increased in IDO-KO mice. Moreover, as a result of the increase in the number of NK cells and macrophages in the liver of IDO-KO mice injected with α-GalCer, TNF-α secretion in these mice was greater than that in WT mice. Deficiency of IDO exacerbated liver injury in α-GalCer–induced hepatitis. IDO induced by proinflammatory cytokines may decrease the number of TNF-α–producing immune cells in the liver. Thus, IDO may suppress overactive immune response in the α-GalCer–induced hepatitis model.
Langerhans Cells Serve as Immunoregulatory Cells by Activating NKT Cells
Authors: Fukunaga Atsushi , Khaskhely Noor M. , Ma Ying , Sreevidya Coimbatore S. , Taguchi Kumiko , Nishigori Chikako , Ullrich Stephen E.
Published: September 2010

Ultraviolet exposure alters the morphology and function of epidermal Langerhans cells (LCs), which play a role in UV-induced immune suppression. It is generally believed that UV exposure triggers the migration of immature LCs from the skin to the draining lymph nodes (LNs), where they induce tolerance. However, because most of the previous studies employed in vitro UV-irradiated LCs, the data generated may not adequately reflect what is happening in vivo. In this study, we isolated migrating LCs from the LNs of UV-irradiated mice and studied their function. We found prolonged LC survival in the LNs of UV-irradiated mice. LCs were necessary for UV-induced immune suppression because no immune suppression was observed in LC-deficient mice. Transferring LCs from UV-irradiated mice into normal recipient animals transferred immune suppression and induced tolerance. We found that LCs colocalized with LN NKT cells. No immune suppression was observed when LCs were transferred from UV-irradiated mice into NKT cell-deficient mice. NKT cells isolated from the LNs of UV-irradiated mice secreted significantly more IL-4 than NKT cells isolated from nonirradiated controls. Injecting the wild-type mice with anti–IL-4 blocked the induction of immune suppression. Our findings indicate that UV exposure activates the migration of mature LC to the skin draining LNs, where they induce immune regulation in vivo by activating NKT cells.
Endogenous IL-10 Attenuates Cisplatin Nephrotoxicity: Role of Dendritic Cells
Authors: Tadagavadi Raghu Kempegowda , Reeves William Brian
Published: September 2010

Sterile inflammation is associated with tissue injury and organ failure. Recent studies indicate that certain endogenous cytokines and immune cells may limit tissue injury by reducing immune-mediated inflammatory responses. Cisplatin is a commonly used anticancer chemotherapeutic agent but causes acute kidney injury and dysfunction. In a recent study, we showed that renal dendritic cells attenuate cisplatin-induced kidney injury by reducing inflammation. In this study, we investigated the effect of endogenous IL-10 and dendritic cell IL-10 in cisplatin-mediated kidney injury. Cisplatin treatment caused increases in renal IL-10R1 expression and STAT3 phosphorylation. In response to cisplatin treatment, IL-10 knockout mice showed more rapid and greater increases in blood urea nitrogen and serum creatinine compared with wild-type mice, indicating that endogenous IL-10 ameliorates kidney injury in cisplatin nephrotoxicity. Renal infiltration of IFN-γ–producing neutrophils was markedly increased in IL-10 knockout mice compared with wild-type mice. However, IFN-γ neutralization had no impact on renal dysfunction, suggesting IFN-γ–independent mechanisms of tissue injury in cisplatin nephrotoxicity. Renal dendritic cells showed high expression of IL-10 in response to cisplatin treatment. We further investigated the effect of dendritic cell-derived IL-10 in cisplatin nephrotoxicity using a conditional cell ablation approach. Mixed bone marrow chimeric mice lacking IL-10 in dendritic cells showed moderately greater renal dysfunction than chimeric mice positive for IL-10 in dendritic cells. These data demonstrate that endogenous IL-10 reduces cisplatin nephrotoxicity and associated inflammation. Moreover, IL-10 produced by dendritic cells themselves accounts for a portion of the protective effect of dendritic cells in cisplatin nephrotoxicity.
OX40 Ligand Regulates Inflammation and Mortality in the Innate Immune Response to Sepsis
Authors: Karulf Matthew , Kelly Ann , Weinberg Andrew D. , Gold Jeffrey A.
Published: September 2010

The initial phase of sepsis is characterized by massive inflammatory cytokine production that contributes to multisystem organ failure and death. Costimulatory molecules are a class of receptors capable of regulating cytokine production in adaptive immunity. Recent studies described their presence on neutrophils and monocytes, suggesting a potential role in the regulation of cytokine production in innate immunity. The purpose of this study was to determine the role for OX40–OX40 ligand (OX40L) interaction in the innate immune response to polymicrobial sepsis. Humans with sepsis demonstrated upregulation of OX40L on monocytes and neutrophils, with mortality and intensive care unit stay correlating with expression levels. In an animal model of polymicrobial sepsis, a direct role for OX40L in regulating inflammation was indicated by improved survival, decreased cytokine production, and a decrease in remote organ damage in OX40L−/− mice. The finding of similar results with an OX40L Ab suggests a potential therapeutic role for OX40L blockade in sepsis. The inability of anti-OX40L to provide significant protection in macrophage-depleted mice establishes macrophages as an indispensable cell type within the OX40/OX40L axis that helps to mediate the clinical signs of disease in sepsis. Conversely, the protective effect of anti-OX40L Ab in RAG1−/− mice further confirms a T cell-independent role for OX40L stimulation in sepsis. In conclusion, our data provide an in vivo role for the OX40/OX40L system in the innate immune response during polymicrobial sepsis and suggests a potential beneficial role for therapeutic blockade of OX40L in this devastating disorder.