bluuebunny/crossref_metadata_2025 huggingface dataset:
Estimated Burden of Rotavirus-Associated Diarrhea in Ambulatory Settings in the United States
Authors: Flores Anthony R. , Szilagyi Peter G. , Auinger Peggy , Fisher Susan G.
Published: January 2010

BACKGROUND:

Two vaccines to prevent disease from rotavirus among young children were recently approved in the United States. Although previous studies of the burden of rotaviral disease have focused on hospitalizations, the assessment of baseline disease burden in ambulatory settings is useful for evaluating the overall impact of the vaccine.

METHODS:

Outpatient and emergency department (ED) data for 1994–2006 were analyzed from 2 nationally representative databases: the National Ambulatory Medical Care Survey and the National Hospital Medical Care Survey. Visits by children (younger than 5 years) with acute gastroenteritis (AGE) were identified by using a defined set of International Classification of Diseases, Ninth Revision, Clinical Modification codes. Two previously described methods (the winter-residual-excess [WRE] and Brandt methods) were used to estimate the proportion of AGE attributable to rotavirus and to determine the annual number of visits, annual average visits, and annual visit rates in each setting.

RESULTS:

The estimated average annual number of rotavirus-associated visits over the 13-year period was 782 453 outpatient visits and 164 261 ED visits from the WRE method and 665 773 outpatient visits and 205 206 ED visits from the Brandt method. This resulted in an average of 39.1 and 33.3 outpatient visits per 1000 children and 8.2 and 10.3 ED visits per 1000 children for both the WRE and Brandt methods, respectively. The average annual proportion of visits for AGE attributed to rotavirus was 34.2% (29.1% from the Brandt method) in the outpatient setting and 21.8% (27.1% from the Brandt method) in the ED, with wide variations in individual years.

CONCLUSIONS:

Before the rotavirus vaccine, rotavirus seemed to be associated with a large number of outpatient and ED visits among young children. Rotavirus vaccine has the potential to reduce many outpatient and ED visits.
Use of a Homeopathic Preparation for “Infantile Colic” and an Apparent Life-Threatening Event
Authors: Aviner Shraga , Berkovitch Matitiahu , Dalkian Hedva , Braunstein Rony , Lomnicky Yossef , Schlesinger Menachem
Published: January 2010

OBJECTIVE:

An apparent life-threatening event (ALTE) caused by ingestion of drugs or toxins has been reported rarely among infants. None of these agents was homeopathic medication. We report 11 infants who presented with an ALTE after ingestion of Gali-col Baby, a homeopathic agent indicated for “infantile colic.”

METHODS:

A retrospective case-control study was conducted. Charts of all infants who were younger than 1 year and were admitted with an ALTE from January 2005 through August 2008 to the pediatric division at the Barzilai Medical Center were reviewed. Age-matched infants who were admitted on the same dates for a reason other than ALTE served as a control group. Information on medications administered before admission was recorded.

RESULTS:

During the study period, 36 635 children visited the pediatric emergency department of the Barzilai Medical Center. There were 11 057 admissions to the pediatric division during this period, 115 of which were because of an ALTE. Eleven of these infants received Gali-col Baby before the event as opposed to none in the control group (P < .005). Three infants received a significant overdose, compared with the manufacturer's recommended dosage. After a thorough investigation, no other presumptive causes for ALTE were found among the 11 infants.

CONCLUSIONS:

Gali-col Baby is associated with an ALTE in some infants. There are no published controlled trials on the efficacy or safety of its use; therefore, better control and supervision of Gali-col Baby and probably other homeopathic medications are needed to prevent possible serious adverse effects.
LDH Concentration in Nasal-Wash Fluid as a Biochemical Predictor of Bronchiolitis Severity
Authors: Laham Federico R. , Trott Amanda A. , Bennett Berkeley L. , Kozinetz Claudia A. , Jewell Alan M. , Garofalo Roberto P. , Piedra Pedro A.
Published: January 2010

OBJECTIVE:

Because the decision to hospitalize an infant with bronchiolitis is often supported by subjective criteria and objective indicators of bronchiolitis severity are lacking, we tested the hypothesis that lactate dehydrogenase (LDH), which is released from injured cells, is a useful biochemical indicator of bronchiolitis severity.

PATIENTS AND METHODS:

We retrospectively analyzed a study of children <24 months old presenting to the emergency department with bronchiolitis. Demographic, clinical information, nasal wash (NW), and serum specimens were obtained. NW samples were analyzed for respiratory viruses, caspase 3/7 activity, and a panel of cytokines and chemokines. Total LDH activity was tested in NW samples and sera.

RESULTS:

Of 101 enrolled children (median age: 5.6 months), 98 had NW specimens available. A viral etiology was found for 82 patients (83.6%), with respiratory syncytial virus (RSV) (66%) and rhinovirus (19%) being the most common viruses detected. Concentrations of LDH in NW specimens were independent from those in sera and were higher in children with RSV infection or with dual infection. Significant correlations were found between NW LDH and NW cytokines/chemokines. Similarly, NW LDH correlated with NW-caspase 3/7 activity (r = 0.75; P < .001). In a multivariate analysis, NW LDH concentration in the upper quartile was significantly associated with a reduced risk of hospitalization (odds ratio: 0.19 [95% confidence interval: 0.05–0.68]; P = .011).

CONCLUSIONS:

NW LDH levels in young children with bronchiolitis varied according to viral etiology and disease severity. Values in the upper quartile were associated with ∼80% risk reduction in hospitalization, likely reflecting a robust antiviral response. NW LDH may be a useful biomarker to assist the clinician in the decision to hospitalize a child with bronchiolitis.
Nutrition Menu Labeling May Lead to Lower-Calorie Restaurant Meal Choices for Children
Authors: Tandon Pooja S. , Wright Jeffrey , Zhou Chuan , Rogers Cara Beth , Christakis Dimitri A.
Published: January 2010

OBJECTIVE:

Our aim was to determine whether nutrition labeling on menus would lead to lower-calorie choices for children.

METHODS:

We performed a randomized, controlled experiment in a primary care pediatric clinic in Seattle, Washington. Parents of children 3 to 6 years of age presenting for an appointment were eligible. Parents were ineligible if they never ate fast food, if they were not English speaking, if their child was too sick, or if they had already participated. This was a convenience sample, with randomization performed in blocks of 6. Parents were presented with a McDonald's menu and were asked to select meals for themselves and their child. The menus were identical for both groups except for the presence of nutrition information for the intervention group.

RESULTS:

There were 99 participants, for a participation rate of 82%. There were no significant differences in demographic characteristics between the groups. Parents in the intervention arm ordered an average of 102 fewer calories for their children than did control subjects (567.1 cal vs 671.5 cal; P = .04). With adjustment for parent's gender, race, education, and BMI, fast food frequency, and child's BMI z score, the difference remained significant (P = .004). There was no difference in energy between the 2 groups in the parents' choices for themselves.

CONCLUSION:

This study is the first to suggest that labeled menus may lead to significantly lower calorie content in restaurant meals purchased for children.
Mixed-Handedness Is Linked to Mental Health Problems in Children and Adolescents
Authors: Rodriguez Alina , Kaakinen Marika , Moilanen Irma , Taanila Anja , McGough James J. , Loo Sandra , Järvelin Marjo-Riitta
Published: January 2010

OBJECTIVE:

Problems with language and symptoms of attention-deficit/hyperactivity disorder (ADHD) in childhood and adolescence are often strongly linked to low scholastic performance. Early recognition of children who are at increased risk is necessary. Our objective was to determine whether mixed-handedness, which is associated with atypical cerebral laterality, is associated with language, scholastic, and ADHD symptoms in childhood and adolescence.

METHODS:

Prospective data come from the Northern Finland Birth Cohort 1986, a longitudinal, population-based birth cohort with assessments when children were 7 to 8 and 16 years of age (N = 7871). Teacher, parent, and/or adolescent reports were used to assess language difficulties, scholastic performance, and mental health, including ADHD symptoms.

RESULTS:

Mixed-handed children, relative to right-handed, had approximately a twofold increase in odds of having difficulties with language and scholastic performance at the age of 8 years. Eight years later, as 16-year-olds, adolescents had twofold increase in odds concerning difficulties in school with language and with ADHD symptoms. Mixed-handed children were more likely to have scores indicating probable psychiatric disturbance, including ADHD symptoms. As adolescents, mixed-handed children with previous behavioral problems were at considerably higher risk for scoring within the range of probable ADHD-inattention or ADHD-combined case. Mixed-handedness was associated with greater symptom severity in children and adolescents (P = .01) concerning psychiatric disturbance and ADHD inattention but not ADHD hyperactivity.

CONCLUSIONS:

The results indicate that mixed-handed children have a greater likelihood of having language, scholastic, and mental health problems in childhood and that these persist into adolescence. Thus, these results suggest that mixed-handedness, particularly in the presence of difficulties, could aid in the recognition of children who are at risk for stable problems. Additional research is needed to understand the connections between neural substrates related to atypical cerebral asymmetry, mixed-handedness, and mental health problems including ADHD symptoms.
Burden of Influenza-Related Hospitalizations Among Children With Sickle Cell Disease
Authors: Bundy David G. , Strouse John J. , Casella James F. , Miller Marlene R.
Published: January 2010

OBJECTIVE:

Children with sickle cell disease (SCD) are considered to be at high risk for complications from influenza infection despite minimal published data that characterize the burden of influenza in this population. Our objectives were to (1) estimate the rate of influenza-related hospitalizations (IRHs) among children with SCD, (2) compare this rate with rates of children with cystic fibrosis (CF) and children with neither SCD nor CF, and (3) explore mechanisms that underlie these potentially preventable hospitalizations.

METHODS:

We analyzed hospitalizations from 4 states (California, Florida, Maryland, and New York) across 2 influenza seasons (2003–2004 and 2004–2005) from the Healthcare Cost and Utilization Project State Inpatient Databases. We included hospitalizations with a discharge diagnosis code for influenza in a child <18 years of age. We used census data and disease prevalence estimates to calculate denominators and compare rates of IRH among children with SCD, CF, and neither disease.

RESULTS:

There were 7896 pediatric IRHs during the 2 influenza seasons. Of these, 159 (2.0%) included a co-occurring diagnosis of SCD. Annual rates of IRHs were 112 and 2.0 per 10 000 children with and without SCD, respectively, across both seasons. Children with SCD were hospitalized with influenza at 56 times (95% confidence interval: 48–65) the rate of children without SCD. Children with SCD had approximately double the risk of IRH compared with children with CF (risk ratio: 2.1 [95% confidence interval: 1.5–2.9]). IRHs among children with SCD were not longer, more costly, or more severe than IRHs among children without SCD; they were also rarely nosocomial and co-occurred with a diagnosis of asthma in 14% of cases.

CONCLUSIONS:

IRHs are substantially more common among children with SCD than among those without the disease, which supports the potential importance of vigorous influenza vaccination efforts that target children with SCD.
Sibling Transmission of Vaccine-Derived Rotavirus (RotaTeq) Associated With Rotavirus Gastroenteritis
Authors: Payne Daniel C. , Edwards Kathryn M. , Bowen Michael D. , Keckley Erin , Peters Jody , Esona Mathew D. , Teel Elizabeth N. , Kent Diane , Parashar Umesh D. , Gentsch Jon R.
Published: January 2010

Although rotavirus vaccines are known to be shed in stools, transmission of vaccine-derived virus to unvaccinated contacts resulting in symptomatic rotavirus gastroenteritis has not been reported to our knowledge. We document here the occurrence of vaccine-derived rotavirus (RotaTeq [Merck and Co, Whitehouse Station, NJ]) transmission from a vaccinated infant to an older, unvaccinated sibling, resulting in symptomatic rotavirus gastroenteritis that required emergency department care. Results of our investigation suggest that reassortment between vaccine component strains of genotypes P7[5]G1 and P1A[8]G6 occurred during replication either in the vaccinated infant or in the older sibling, raising the possibility that this reassortment may have increased the virulence of the vaccine-derived virus. Both children remain healthy 11 months after this event and are without underlying medical conditions.
Recognizing and Treating Toilet-Seat Contact Dermatitis in Children
Authors: Litvinov Ivan V. , Sugathan Paramoo , Cohen Bernard A.
Published: January 2010

Toilet-seat contact dermatitis is a common condition around the world and is reemerging in the United States. It can be easily recognized and treated. However, few practitioners consider this diagnosis, which results in a delay in treatment and often exacerbation of the skin eruption. In the past, exposure to wooden toilet seats and associated varnish, lacquers, and paints led to the development of an allergic contact dermatitis on the buttocks and posterior thighs. In recent years, most public facilities have changed to plastic seats, resulting in a change in the clinical presentation of toilet-seat dermatitis. We present 5 cases of toilet-seat dermatitis in children from the United States and India and review the history, presentation, and clinical course of the disease. Our findings suggest that toilet-seat dermatitis is more common than previously recognized and should be considered in any child with a dermatitis that involves the buttocks and posterior thighs.
Children as Hematopoietic Stem Cell Donors
Authors:   COMMITTEE ON BIOETHICS
Published: January 2010

This Policy Statement was retired August 2018.

In the past half-century, hematopoietic stem cell transplantation has become standard treatment for a variety of diseases in children and adults, including selected hematologic malignancies, immunodeficiencies, hemoglobinopathies, bone marrow failure syndromes, and congenital metabolic disorders. There are 3 sources of allogeneic hematopoietic stem cells: bone marrow, peripheral blood, and umbilical cord blood; each has its own benefits and risks. Children often serve as hematopoietic stem cell donors, most commonly for their siblings. HLA-matched biological siblings are generally preferred as donors because of reduced risks of transplant-related complications as compared with unrelated donors. This statement includes a discussion of the ethical considerations regarding minors serving as stem cell donors, using the traditional benefit/burden calculation from the perspectives of both the donor and the recipient. The statement also includes an examination of the circumstances under which a minor may ethically participate as a hematopoietic stem cell donor, how the risks can be minimized, what the informed-consent process should entail, the role for a donor advocate (or some similar mechanism), and other ethical concerns. The American Academy of Pediatrics holds that minors can ethically serve as stem cell donors when specific criteria are fulfilled.
COMSEP: An Overview of Its History, Mission, and Relationship to Pediatrics
Authors: Raszka William V. , White Christopher B.
Published: January 2010

The reader may wonder, “What is COMSEP, and how does an article from COMSEP affect me?” COMSEP, the Council on Medical Student Education in Pediatrics, is a community of pediatric clerkship directors and other educators whose mission is to improve the health of children and their families by advancing the art and science of medical student education in pediatrics.1

This is the first in what is envisioned to be a quarterly report from the COMSEP to the readership of Pediatrics. In writing these articles, we hope to accomplish 3 key objectives. First, we want to keep the readership updated on trends that could affect both practice and pediatric education, whether they involve the rise of the pediatric hospitalist service or use of electronic medical records. Second, we hope to share educational techniques or strategies that allow for efficient and effective teaching, particularly in community practice settings. Third, we wish to be a voice for the huge number of pediatric practitioners who are critical not only as role models but also as mentors for the next generation of pediatric care providers. To better understand who and what COMSEP is, this first article is dedicated to the history, structure, and fundamental principles of the organization.
O imaginário urbano sobre fotografia e morte em Belo Horizonte, MG, nos anos finais do século XX
Authors: Koury Mauro Guilherme Pinheiro
Published: January 2010

Como responderiam à questão do uso da fotografia mortuária os habitantes urbanos moradores das capitais dos estados brasileiros no final do século vinte? É essa a pergunta principal deste artigo, tendo como limite geográfico a cidade de Belo Horizonte, capital do estado de Minas Gerais. Nele se busca traçar um perfil do comportamento urbano brasileiro e, aqui, especificamente, de Belo Horizonte, sobre a morte e o morrer no final do século vinte, bem como o papel da fotografia na lapida ção e direção desse contorno.
Role of Lactobacillus in the Prevention of Antibiotic‐Associated Diarrhea: A Meta‐analysis
Authors: Kale‐Pradhan Pramodini B. , Jassaly Harjot K. , Wilhelm Sheila M.
Published: January 2010

Study Objective. To evaluate the efficacy of a Lactobacillus probiotic singleagent regimen in preventing antibiotic‐associated diarrhea (AAD).

Design. Meta‐analysis of 10 randomized, blinded, placebo‐controlled trials.

Patients. A total of 1862 pediatric and adult patients who received a Lactobacillus single‐agent regimen or placebo for the prevention of AAD.

Measurements and Main Results. The MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials databases were searched from inception through May 2008 by two investigators independently using the following key words: probiotic, Lactobacillus, antibiotic‐associated diarrhea. Full reports published in English were included if the studies were randomized, blinded, and placebo‐controlled trials that evaluated the efficacy of Lactobacillus single‐agent regimens versus placebo in the prevention of AAD. Bibliographies of recent review articles and systematic reviews were hand searched. Quality of the studies was assessed by using the Jadad scoring system. Number of subjects, age, Lactobacillus regimen, follow‐up period, and occurrence of AAD were extracted into a standardized data collection form. Overall impact of Lactobacillus on AAD was compared with placebo by using a random‐effects model. Ten studies with a total of 1862 patients (50.4% male) met all criteria. Six studies included patients aged 18 years or older, whereas four included patients younger than 18 years (range 2 wks‐14 yrs). Jadad scores ranged from 2–5 (out of 5). The total daily dose of Lactobacillus ranged from 2 times 109 −4 times 1010 colony‐forming units and was administered throughout the entire antibiotic treatment (5–14 days) for all patients. The follow‐up period varied from 2 days‐3 months after the end of the probiotic regimen. The combined risk ratio (RR) of developing AAD was significantly lower with Lactobacillus compared with placebo (RR 0.35, 95% confidence interval [CI] 0.19‐0.67).

In a subgroup analysis, this held true for adults but not pediatric patients (RR 0.24, 95% CI 0.08‐0.75 and RR 0.44, 95% CI 0.18‐1.08, respectively).

Conclusion. Administration of a Lactobacillus single‐agent regimen as a prophylactic agent during antibiotic treatment reduced the risk of developing AAD compared with placebo in adults but not pediatric patients.
Effects of Oral Ziprasidone and Oral Haloperidol on QTc Interval in Patients with Schizophrenia or Schizoaffective Disorder
Authors: Miceli Jeffrey J. , Tensfeldt Thomas G. , Shiovitz Thomas , Anziano Richard , O'Gorman Cedric , Harrigan Rachel H.
Published: January 2010

Study Objective. To characterize the effect of oral ziprasidone and haloperidol on the corrected QT (QTc) interval under steady‐state conditions.

Design. Prospective, randomized, open‐label, parallel‐group study.

Setting. Inpatient clinical research facility.

Patients. Fifty‐nine adults (age range 25–59 yrs) with schizophrenia or schizoaffective disorder who had no clinically significant abnormality on electrocardiogram (ECG) at screening.

Intervention. During period 1 (days −10 to −4), antipsychotic and anticholinergic drugs were tapered. On the first day (day −3) of period 2, the drugs were discontinued, and placebo was given for the next 3 days (days −2 to 0). On the last day (day 0) of period 2, serial baseline ECGs were collected. During period 3 (days 1–16), patients received escalating oral doses of ziprasidone and haloperidol to reach steady state. Period 4 (days 17–19) allowed for study drug washout and initiation of outpatient antipsychotic therapy; safety assessments were also performed during this period.

Measurements and Results. At each steady‐state dose level, three ECGs and a serum or plasma sample were collected at the predicted time of peak exposure to the administered drug. Point estimates and 95% confidence intervals (CIs) were determined for the mean QTc interval at baseline and for the mean change from baseline in QTc at each steady‐state dose level. Mean changes from baseline in the QTc interval (msec) for ziprasidone were 4.5 (95% CI 1.9‐7.1), 19.5 (95% CI 15.5–23.4), and 22.5 (95% CI 15.7‐ 29.4) for steady‐state doses of 40, 160, and 320 mg/day, respectively; for haloperidol, −1.2 (95% CI −4.1‐1.7), 6.6 (95% CI 1.6–11.7), and 7.2 (95% CI 1.4–13.1) for steady‐state doses of 2.5, 15, and 30 mg/day. Although no patient in either treatment group experienced a QTc interval of 450 msec or greater, the QTc interval increased 30 msec or more in 11 and 17 ziprasidone‐treated patients at 160 and 320 mg/day, respectively, and in 3 and 5 haloperidol‐treated patients at 15 and 30 mg/day, respectively. Most treatment‐emergent adverse drug reactions were mild in intensity, and none were severe.

Conclusion. The QTc interval in ziprasidone‐and haloperidol‐treated patients increased with dose. Treatment with high doses of ziprasidone or haloperidol did not result in any patient experiencing a QTc interval of 450 msec or greater.
Defining the Risks for Cytomegalovirus Infection and Disease After Solid Organ Transplantation
Authors: Stratta Robert J. , Pietrangeli Carolynn , Baillie G. Mark
Published: January 2010

Cytomegalovirus continues to be one of the most clinically significant infections after solid organ transplantation. Classic definitions of patients at high risk for infection and tissue‐invasive disease are focused on recipient‐donor serostatus, type of organ transplanted, and overall level of immunosuppression. However, recent trends in clinical practice call for a reevaluation of cytomegalovirus infection risks after solid organ transplantation. Indeed, whereas early‐onset cytomegalovirus infection is usually controlled by antiviral prophylaxis with ganciclovir and derivatives, delayed‐and late‐onset cytomegalovirus infection can develop after the completion of a course of preventive therapy. In addition, indirect effects of cytomegalovirus infection may occur as a result of persistent low‐level viremia. Suboptimal dosing of antiviral drugs due to specific drug toxicities may result in the development of ganciclovir‐resistant cytomegalovirus disease. The relationship between organ allograft rejection and cytomegalovirus infection and disease has been recognized for some time. Transplantation of increasing numbers of extended‐criteria donor organs increases the risk of delayed graft function and acute rejection, prompting the use of more intensive immunosuppression. In addition, the trend to spare long‐term exposure to calcineurin inhibitors has contributed to a resurgence in the use of polyclonal T‐cell induction immunosuppressive agents, which may reduce host anticytomegalovirus immunity. We discuss the current trends in solid organ transplantation that provide a foundation for defining risks for cytomegalovirus infection and disease, including identification of patients who would benefit from more aggressive cytomegalovirus monitoring and prevention strategies.
Diverse Effects of Statins on Angiogenesis: New Therapeutic Avenues
Authors: Elewa Hazem F. , El‐Remessy Azza B. , Somanath Payaningal R. , Fagan Susan C.
Published: January 2010

Angiogenesis is an important process for a variety of physiologic and pathologic conditions. Different angiogenic modulating targets are under extensive investigation both experimentally and clinically. The 3‐hydroxy‐3‐methylglutaryl coenzyme A reductase inhibitors (statins) are the first‐line agents used in hypercholesterolemia. They are also characterized by having other benefits apart from their lipid‐lowering effects. Among these pleiotropic effects are the pro‐and antiangiogenic properties of statins. The pleiotropic effects of statins and how they modulate new blood vessel formation are discussed in this review. The currently available data from both animal and human studies regarding the effects of statins on angiogenesis in ischemic heart disease, stroke, ocular diseases, and cancer are also reviewed. Statins are safe, orally available agents that may acquire novel therapeutic indications through their angiogenic modulating effects.
A Clinical Review of Statins and Cancer: Helpful or Harmful?
Authors: Gonyeau Michael J. , Yuen Dayton W.
Published: January 2010

The 3‐hydroxy‐3‐methylglutaryl coenzyme A reductase inhibitors (statins) are the second most prescribed therapeutic drug class in the United States after analgesics. Although these agents are used predominantly to reduce cholesterol concentrations in patients with hyperlipidemia, numerous studies have investigated the pleiotropic effects of statins and their potential in the prevention and/or treatment of other disease states, including cancer. Many theories have been proposed as to how statins may affect the risk or development of malignancies, prompting a clinical review of the literature. Studies have revealed statins to be associated with both increased and decreased cancer risk. Most of the published studies have been observational and retrospective in nature, and most prospective trials evaluated cancer as a secondary end point or adverse event, making it difficult to determine causality. Although most of the available evidence suggests a possible beneficial effect of statins on cancer, further study is needed with better designed trials and/or increased efforts in evaluating cancer as secondary end points in all statin trials until definite conclusions regarding statin effects on cancer risk and occurrence can be made.
Understanding the Genetic Basis for Adverse Drug Effects: The Calcineurin Inhibitors
Authors: Bai Jane P. F. , Lesko Lawrence J. , Burckart Gilbert J.
Published: January 2010

The calcineurin inhibitors— cyclosporine and tacrolimus— are the mainstay of immunosuppressive therapy in solid organ transplantation. These drugs produce severe adverse drug effects (ADEs) such as nephrotoxicity, posttransplantation diabetes mellitus, and hypertension. Accumulated evidence suggests that the development of type 2 diabetes, hypertension, and renal failure may be associated with specific DNA genotypes. In this review, the genes involved with the development of these disease processes are compared with those implicated in calcineurin inhibitor‐induced ADEs. The renin‐angiotensin system genes, cytokine‐encoding genes, and plasminogen activator inhibitor type 1 genes have been implicated in calcineurin inhibitor‐induced nephrotoxicity, as well as in development of renal failure. A number of genes are implicated in contributing to diabetes, and these include the vitamin D receptor gene, VDR; hepatocyte nuclear factor genes, HNF; transcription factor 7‐like 2 gene, TCF7L2; angiotensin‐converting enzyme gene, ACE; cytokines; peroxisome proliferator‐activated receptor γ gene, PPARG; and others. Studies have suggested that the VDR, PPARG, HNF1A, and adenosine 5′‐triphosphate‐binding cassette ABCC8 (which encodes the sulfonylurea receptor) genes are associated with calcineurin inhibitor‐induced diabetes. The genes encoding for the angiotensin‐converting enzyme, endothelial constitutive nitric oxide synthase, and cytochrome P450 3A isoenzyme have been involved in the development of hypertension and in calcineurin inhibitor‐induced hypertension. The genetic study of disease states can be the stepping stones for thoroughly understanding the genetic basis of ADEs. Gene polymorphisms are implicated in the development of diseases and corresponding disease‐like ADEs. The disease‐associated genes provide candidate genes for exploring ADEs and may provide genomic biomarkers for assessing the risk for developing severe calcineurin inhibitor‐related ADEs as well as for developing preventive strategies.
Tamoxifen Malabsorption After Roux‐en‐Y Gastric Bypass Surgery: Case Series and Review of the Literature
Authors: Wills Shannon M. , Zekman Richard , Bestul Daniel , Kuwajerwala Nafisa , Decker David
Published: January 2010

Roux‐en‐Y gastric bypass is a gastric reduction duodenal switch with a combination of restrictive and malabsorptive procedures. It is the most common gastric bypass procedure performed in the United States. Malabsorption causing nutritional deficiencies does occur, yet a PubMed literature search (1955–2009) returned no reports of malabsorption of anticancer agents after gastric bypass. To our knowledge, this is the first report of three cases of malabsorption of the anticancer agent tamoxifen after this procedure. The first patient was a 58‐year‐old woman who underwent Roux‐en‐Y bypass for morbid obesity. Two years later, she developed estrogen receptor‐positive ductal carcinoma in situ of the breast, underwent lumpectomy and irradiation, and tamoxifen was started. Two years after that, she presented with concerns of potential malabsorption of the drug. Her plasma tamoxifen level was 28 ng/ml, which was below the lower limit of the therapeutic range (77–274 ng/ml for 10–30‐mg/day regimens). The second patient was a 51‐year‐old woman who sought medical advice on risk reduction for breast cancer after receiving a diagnosis of atypical ductal hyperplasia of the breast. She also had a history of morbid obesity and underwent Roux‐en‐Y bypass. Tamoxifen was started to reduce her risk of breast cancer; her plasma tamoxifen level was subtherapeutic at 14 ng/ml. The third patient was a 53‐year‐old woman with estrogen receptor‐positive breast cancer who underwent lumpectomy and was prescribed anastrozole, an aromatase inhibitor. She also underwent Roux‐en‐Y bypass for morbid obesity. As she experienced adverse effects while receiving anastrozole, the drug was discontinued, and tamoxifen 20 mg/day was started. Her tamoxifen plasma level was 52 ng/ml. Therefore, her tamoxifen dosage was increased to 20 mg twice/day. Six weeks later, her tamoxifen level was 120 ng/ml (therapeutic range 95–520 ng/ml for the increased dosage). These three cases suggest that steady‐state serum tamoxifen levels should be evaluated in patients who have undergone Roux‐en‐Y gastric bypass. Until adequate data suggest otherwise, parenteral anticancer alternatives should be considered when systemic therapy is needed in a patient with malabsorption.
Severe Lactic Acidosis After an Iatrogenic Propylene Glycol Overdose
Authors: Zosel Amy , Egelhoff Elizabeth , Heard Kennon
Published: January 2010

Propylene glycol is a diluent found in many intravenous and oral drugs, including phenytoin, diazepam, and lorazepam. Propylene glycol is eliminated from the body by oxidation through alcohol dehydrogenase to form lactic acid. Under normal conditions, the body converts lactate to pyruvate and metabolizes pyruvate through the Krebs cycle. Lactic acidosis has occurred in patients, often those with renal dysfunction, who were receiving prolonged infusions of drugs that contain propylene glycol as a diluent. We describe a 50‐year‐old man who experienced severe lactic acidosis after receiving an accidental overdose of lorazepam, which contains propylene glycol. The patient was acutely intoxicated, with a serum ethanol concentration of 406 mg/dl. He had choked on a large piece of meat and subsequently experienced pulseless electrical activity with ventricular fibrillation cardiac arrest. He was brought to the emergency department; within 2 hours, he was admitted to the intensive care unit for initiation of the hypothermia protocol. The patient began to experience generalized tonic‐clonic seizures 12 hours later, which resolved after several boluses of lorazepam. A lorazepam infusion was started; however, it was inadvertently administered at a rate of 2 mg/minute instead of the standard rate of 2 mg/hour. Ten hours later, the administration error was recognized and the infusion stopped. The patient's peak propylene glycol level was 659 mg/dl, pH 6.9, serum bicarbonate level 5 mEq/L, and lactate level 18.6 mmol/L. Fomepizole was started the next day and was continued until hospital day 3. Continuous renal replacement therapy was started and then replaced with continuous venovenous hemofiltration (CVVH) for the remainder of the hospital stay. The patient's acidosis resolved by day 3, when his propylene glycol level had decreased to 45 mg/dl. Fomepizole was discontinued, but the patient's prognosis was poor (anoxic brain injury); thus care was withdrawn and the patient died. Although the patient's outcome was death, his lactic acidosis was treated successfully with fomepizole and CVVH. Clinicians should be aware that an iatrogenic overdose of lorazepam may result in severe propylene glycol toxicity, which may be treated with fomepizole and CVVH. Key Words: propylene glycol, lorazepam, iatrogenic overdose, severe lactic acidosis, critical care, fomepizole.
Use of cement grinding aids to optimise clinker factor
Authors: Assaad J.J. , Asseily S.E. , Harb J.
Published: January 2010

A comprehensive research project was undertaken to evaluate the effect of grinding aids (GAs) on the percentage of clinker decrease and reduction of energy needed during the grinding process. Three GAs, based on amines, glycols and acids, were tested at various concentrations. The tested cement properties include water demand, Blaine fineness, sieve residue, setting time and compressive strength. The results showed that the use of higher concentrations of GAs can lead to significant improvements in the performance of grinding mills characterised by higher Blaine and lower sieve residue values. Compared with the control mix, setting times were found not to be significantly affected. However, the mortar compressive strength increased by 15, 8 and 7% when using GA based on amine, glycol and acid, respectively. A decrease in both clinker factor (up to 15·8%) and grinding energy (up to 4·5%) can be simultaneously achieved through substitution of clinker with pozzolan materials with lower Mohs hardness values and the incorporation of a relatively high concentration of GA.
Water film thickness, flowability and rheology of cement–sand mortar
Authors: Kwan A.K.H. , Fung W.W.S. , Wong H.H.C.
Published: January 2010

It is well known that the fresh properties of cement paste and cement–sand mortar are governed mainly by three parameters: water content, packing density and solid surface area. However, these parameters vary simultaneously upon any change in the mix composition and hence the evaluation of their individual and combined effects has been a difficult task. Recently, the authors have found that the effects of these parameters on the flowability and rheological properties of cement paste may be evaluated in terms of the water film thickness (WFT) of the solid–water mixture. Herein, this concept of WFT is extended to cement–sand mortar made of sand with a maximum size of 1·18 mm. A number of mortar samples proportioned with different water contents and different sand gradings were produced for packing density, flowability and rheological properties measurements. From the results, the WFT of each sample was determined and the effects of the WFT on the flowability and rheological properties of the mortar were investigated. The good correlations between the flowability and rheological properties with the WFT revealed that the concept of WFT is applicable also to cement–sand mortar.
Fracture behaviour of polymer concrete reinforced with carbon and nylon fibres
Authors: Park S.-K. , Jo B.-W. , Park J.-H. , Choi J.-S.
Published: January 2010

Methods to enhance the mechanical and fracture properties of polymer concrete were investigated by using carbon and nylon fibres and a silane agent. The strengths, stress intensity factor (KIC), and critical crack tip opening displacement (CTODC) were studied by varying the fibre and polymer contents. As a result, fracture toughness and mechanical properties increased with both increasing fibre and increasing resin contents. The silane agent improved the adhesion of polymer to aggregates and resulted in greater compressive strength, splitting tensile strength, and flexural strength and material resistance to crack extension. Adding fibres to the polymer concrete produced a bridging effect at the crack tip and hence slowed the crack propagation. For all specimens, the critical KIC and the critical CTODC values increased with increasing fibre content. Carbon fibre reinforcement increased KIC by 86·5% and CTODC by 321·7% of the original value of the unreinforced polymer concrete. Nylon fibre reinforcement increased KIC by 49·1% and CTODC by 219·5% of the original value of unreinforced polymer concrete. Carbon fibre reinforcement provided better flexural strength and fracture properties than nylon fibres, due to its superior mechanical properties.
A comparison of critical state models for sand under conditions of axial symmetry
Authors: RUSSELL A.R. , MUIR WOOD D.
Published: January 2010

Three constitutive models constructed within the spirit of critical state soil mechanics are summarised and compared under conditions of axial symmetry. The models have been calibrated using drained and undrained triaxial compression tests on Hostun sand. The quality of the individual simulations is strongly influenced by the shape chosen for the critical state line at high stresses. Stress response envelopes have been produced in order to contrast the incremental stiffnesses that the models predict for stress and strain paths other than those used for simulation. Plots of second-order work have also been presented for each model. Negative second-order work for certain strain paths indicates the potential for instability and bifurcation of response. Non-associated flow is a basic feature of these models and potentially unstable states were found to occur at mobilised friction angles lower than the peak of the stress–strain response. The hardening moduli of the models are similar, even though they were developed from different starting assumptions.
Experimental study on the shear strength of recycled aggregate concrete beams
Authors: Choi H.B. , Yi C.K. , Cho H.H. , Kang K.I.
Published: January 2010

In concrete beam design, the shear capacity of the concrete beam is of great interest because shear failure is associated with an abrupt failure mode that undermines the flexural performance of the beam. Recently, because of the increasing cost of natural resources and environmental concerns, the use of recycled aggregate (RA) in construction is becoming the standard practice. However, the effects of recycled aggregates on the shear strength of concrete have not been fully examined. In this study the effects of RA on concrete shear strength are studied experimentally by performing flexural tests on 20 RA concrete beams with various combinations of span-to-depth ratios (a/d = 1·50, 2·50, 3·25), longitudinal reinforcement ratios (s = 0·53%, 0·83%, 1·61%) and RA replacement ratios (0%, 30%, 50%, 100%). The test results indicate that the concrete shear strength diminishes by up to 30% at 100% replacement ratio compared with the natural aggregate concrete. The shear strengths of the RA concrete beams are also compared with those obtained from the existing models for natural aggregate concrete and some design considerations in using the recycled aggregate concrete are discussed.
Shrinkage of Hong Kong granite aggregate concrete
Authors: Kwan A.K.H. , Au F.T.K. , Wong H.H.C. , Ng P.L.
Published: January 2010

In the design of many concrete structures, it is important to assess the amount of shrinkage that could occur because shrinkage could lead to extensive cracking or substantial prestress loss. A number of shrinkage models have been developed all over the world but they differ widely from each other, indicating that the shrinkage of concrete is dependent on the characteristics of the materials used and the local conditions. Early experimental studies in Hong Kong suggested that the shrinkage of Hong Kong concrete is considerably larger than that estimated using shrinkage models developed elsewhere. This is probably due to the local granite aggregate used. In order to resolve this problem and develop a shrinkage model for Hong Kong, a comprehensive testing programme using fibre-optic strain gauges to measure the shrinkage strain was launched. The shrinkage measurement lasted over 3·5 years and covered concrete mixes with and without pulverised fuel ash added and with paste volume varying from 30 to 40%.
Air-blast-loaded, high-strength concrete beams. Part I: Experimental investigation
Authors: Magnusson J. , Hallgren M. , Ansell A.
Published: January 2010

The structural behaviour of concrete beams subjected to air blast loading was investigated. Beams of both high-strength concrete (HSC) and normal-strength concrete (NSC) were subjected to air blasts from explosives in a shock tube and for reference were also loaded statically. Concrete with nominal compressive strengths of 40, 100, 140, 150 and 200 MPa were used and a few beams also contained steel fibres. Furthermore, beams with two concrete layers of different strength were tested. All beams subjected to static loading failed in flexure. For some beam types, the failure mode in the dynamic tests differed from the failure mode in the corresponding static tests. In these cases, the failure mode changed from a ductile flexural failure in the static tests to a brittle shear failure in the dynamic tests. Beams without fibres and with high ratio of reinforcement exhibited shear failures in the dynamic tests. It was observed that the inclusion of steel fibres increased the shear strength and the ductility of the beams. The investigation indicates that beams subjected to air blast loading obtain an increased load capacity when compared with the corresponding beams subjected to static loading.
Flexural behaviour of RC beams strengthened with high-tension steel rod
Authors: Shin K.-J. , Lee S.-H.
Published: January 2010

The objective of this research is to provide flexural test results that are applicable to the actual strengthening design of reinforced concrete (RC) beams by investigating the flexural capacities of RC beams strengthened with unbonded high-strength bars. The advantages of the proposed strengthening method are the speed and simplicity of installation. Additionally, it is possible to acquire strengthened performance without skilled workers. A set of ten laboratory tests on RC beams strengthened with high-strength bars and unstrengthened RC beams as the control group were performed. The main test parameters are the diameter of high-strength bar and the ratio of tension reinforcement. The equivalent tension reinforcement ratio of the high-tension bars to the strength ratio of rebars is also considered. The test result indicates that the maximum strain of the high-strength bars pre-tensioned with 40% yield strain exceeds the nominal yield strain of high-strength bars. The deflection ratio of the strengthened RC beam within the serviceability limit state was less than 54% in comparison with that of unreinforced beams. Thus, it is possible to simplify the design equation by using the equivalent tension reinforcement ratio.
Pitting corrosion model for reinforced concrete structures in a chloride environment
Authors: Darmawan M.S.
Published: January 2010

Different types of corrosion may arise in steel reinforcement, such as general corrosion, pitting corrosion, hydrogen embrittlement, stress corrosion cracking and corrosion fatigue. However, corrosion of steel reinforcement in reinforced concrete (RC) structures can be classified into two categories: general (uniform) corrosion and pitting (localised) corrosion. In general, concrete researchers use uniform corrosion to study the effect of corrosion on RC structures. This approach is not accurate for concrete structures subjected to chloride attack, which usually experiences pitting corrosion. This paper describes an accelerated corrosion test used to obtain statistical parameters of maximum pit-depths distribution of corroded steel in a RC structure. Using probabilistic analysis, these statistical parameters are combined with statistical parameters of RC beams (i.e. beam dimensions, concrete strength, steel yield strength, cover thickness, workmanship quality, in situ strength factor, model error for flexure and shear and also corrosion rate) to determine the effect of corrosion on flexural and shear strength of RC beams. Using the proposed pitting corrosion model improves service life prediction of RC structures in a chloride environment.
Why Can't Americans See the State?
Authors: Sheingate Adam
Published: January 2010

This essay examines public-sector employment in order to grasp the distinctive character of the American state. Looked at comparatively, the American state is anything but small or weak. Rather, befitting a federal system, public authority in the United States is exercised largely through state and local government. What is distinctive about the American state is the concentration of public-sector employment in three areas: education, defense, and public safety. This pattern reflects a historical legacy of American state-building whereby the federal government frequently employed less visible, indirect forms of policy intervention while state and local government developed robust authority, particularly in matters that pertained to public and private morals. The result has been a set of institutions that hides or conceals public authority in various ways. Ultimately, the inability of Americans to see this state reinforces the very skepticism toward governmental authority that such a state-building strategy was meant to avoid.