bluuebunny/crossref_metadata_2025 huggingface dataset:
The effect of three different toe props on plantar pressure and patient comfort
Authors: Johnson Sarah , Branthwaite Helen , Naemi Roozbeh , Chockalingam Nachiappan
Published: August 2012

Background

Arthritic toe pathologies frequently lead to the development of painful apical pressure skin lesions that can compromise gait and affect quality of life. Historically conservative treatments involve the use of a toe prop with the intended aim of reducing plantar pressure from the apex of the digit. However, the effect of toe prop treatment on plantar digital pressure has not been investigated.

Method

Twenty two subjects were recruited with lesser digital deformities and associated apical skin lesions. Individual pressure sensors were placed on the apices of the lesser toes and pressure was recorded under three toe prop conditions (leather, gel and silicone mould). A modified comfort index was utilised to assess the comfort of each condition.

Results

Significant difference (p < 0.05) in mean peak pressure was observed at the apex of the 2nd toe when using the gel (p < 0.001) and silicone (p < 0.001) toe prop compared to no toe prop. There was also a significant difference in the mean pressure time integral at the apex of the 2nd toe when using gel (p < 0.001) and silicone (p < 0.004) toe props. There was no significant correlation between comfort and the recorded peak pressures. However, there was an indication that the silicone toe prop was more comfortable.

Conclusion

As compared to the leather and silicone mould toe props, gel toe props were found to be the most effective for reducing peak pressure and pressure time integral on the apex of the second digit in patients with claw or hammer toe deformity.
Effect of vitamin D on insulin resistance and anthropometric parameters in Type 2 diabetes; a randomized double-blind clinical trial
Authors: Heshmat Ramin , Tabatabaei-Malazy Ozra , Abbaszadeh-Ahranjani Shabnam , Shahbazi Samimeh , Khooshehchin Ghazal , Bandarian Fathemeh , Larijani Bagher
Published: August 2012

Background & the purpose of the study

Prevalence of type 2 diabetes mellitus (T2DM) is increasing worldwide. To reduce its risk and progression, preventive strategies are needed. Vitamin supplementation such as vitamin D is one of the strategies. This study was designed to investigate the effect of injection of vitamin D on insulin resistance and anthropometric parameters in T2DM.

Methods

This randomized double-blind clinical trial was conducted with 42 diabetic patients in two groups; intervention group with single intramuscular injection of 300,000 International Unit (IU) of vitamin D3 and the placebo group. After recording demographic and anthropometric factors (waist circumference, blood pressure and body mass index), fasting blood samples was taken for measurement of blood glucose, 25-hydroxyvitamin D3 (25-OHD3), insulin, glycosylated hemoglobin A1c (HbA1c) and estimation of Homeostasis Model Assessment Index (HOMA) in two times; before study and after three months.

Results

Two groups had similar baseline characteristics (each group = 21 subjects). Three months after vitamin D injection, HbA1c, anthropometric factors and HOMA index in intervention group stayed constant, however, serum 25- OHD3 was significantly increased (p = 0.007).

Conclusion

The present data is not convincing and further studies with large sample sizes are needed to show the definite effect of injection of vitamin D on control of diabetes and its risk.
Physical constraints on the establishment of intracellular spatial gradients in bacteria
Authors: Tropini Carolina , Rabbani Naveed , Huang Kerwyn Casey
Published: August 2012

Background

Bacteria dynamically regulate their intricate intracellular organization involving proteins that facilitate cell division, motility, and numerous other processes. Consistent with this sophisticated organization, bacteria are able to create asymmetries and spatial gradients of proteins by localizing signaling pathway components. We use mathematical modeling to investigate the biochemical and physical constraints on the generation of intracellular gradients by the asymmetric localization of a source and a sink.

Results

We present a systematic computational analysis of the effects of other regulatory mechanisms, such as synthesis, degradation, saturation, and cell growth. We also demonstrate that gradients can be established in a variety of bacterial morphologies such as rods, crescents, spheres, branched and constricted cells.

Conclusions

Taken together, these results suggest that gradients are a robust and potentially common mechanism for providing intracellular spatial cues.
Pigment epithelium-Derived Factor (PEDF) Varies with Body Composition and Insulin Resistance in Healthy Young People
Authors: Sunderland Kyle L. , Tryggestad Jeanie B. , Wang Joshua J. , Teague April M. , Pratt Lauren V. , Zhang Sarah X. , Thompson David M. , Short Kevin R.
Published: August 2012

Context:

Pigment epithelium-derived factor (PEDF) was recently implicated as a metabolic regulatory protein because plasma concentration was increased in obese or insulin resistant adults. To our knowledge, circulating PEDF values in children have not been reported. Because PEDF is a predictor of metabolic health in adults, it may have a similar impact on metabolic profiles in children.

Objective:

The objective of the study was to determine whether PEDF in normal-weight (NW) and overweight/obese (OW) children and young adults varies with age, sex, or body composition or is associated with clinical markers of metabolic disease.

Setting:

Volunteers were tested at the University of Oklahoma Health Sciences Center.

Participants:

Ninety-one NW (8–30 yr old) and 105 OW (8–35 yr old) males and females participated in the study.

Main Outcome Measures:

Body composition, blood pressure, arterial compliance, fasting plasma PEDF, glucose, insulin, (used for homeostasis model assessment of insulin resistance), triglycerides, cholesterol (total, low density lipoprotein, and high density lipoprotein), and C-reactive protein.

Results:

PEDF was 60% higher in the OW vs. NW participants but did not differ between males and females. PEDF was positively correlated with body mass, body mass index, fat and lean mass, fasting insulin, and homeostasis model assessment of insulin resistance in both the NW and OW groups. Multiple regression models revealed that fat and lean mass were significant predictors of circulating PEDF levels independent of age, sex, and body mass index category.

Conclusions:

Plasma PEDF is elevated in OW youth and is positively associated with insulin resistance. These findings suggest that PEDF may play a role in the development of cardiometabolic dysfunction in youth.
Attenuation of oxidative stress-induced vascular endothelial dysfunction by thymoquinone
Authors: El-Agamy Dina S , Nader Manar A
Published: August 2012

This study aimed to assess the effects of thymoquinone (TQ) on pyrogallol-induced endothelial dysfunction in isolated rabbit aorta. The protective effects of TQ were examined by incubating aortic rings in TQ concomitant with pyrogallol. The results revealed that pyrogallol produced significant enhancement of phenylephrine-induced contraction and impairment of acetylcholine-induced relaxation. Pyrogallol caused a significant increase in lipid peroxidation and reduction in the level of superoxide dismutase and reduced glutathione in the aortic homogenates. In addition, pyrogallol produced a significant decrease in nitrite/nitrate concentrations (NOx), constitutive nitric oxide synthase (cNOS) activity and an increase in inducible nitric oxide synthase (iNOS) activity in the aortic homogenates. These changes were counteracted by TQ co-incubation as TQ attenuated pyrogallol-induced impairment in vascular reactivity in a dose-dependent manner. Furthermore, TQ showed potent antioxidant activity as well as causing a significant increase in NOx and cNOS activity, and depression in iNOS activity. These results suggest that TQ can protect against pyrogallol-induced endothelial dysfunction which probably results from its potent antioxidant capacity that leads to an increase in NO production as well as its ability to enhance the generation and bioavailability of NO.
Association between World Health Organization categories of body mass index and relative risks for weight-related pregnancy outcomes: a retrospective cohort study
Authors: Zaballa Katrina , Liu Anthony , Peek Michael John , Mongelli Max , Nanan Ralph
Published: August 2012

Objective

To analyse the dose-dependent effect of body mass index (BMI) categories for common pregnancy outcomes.

Methods

A retrospective cohort study of all deliveries that occurred between 1 January 2005 and 31 December 2009 in a tertiary maternity centre, in Sydney Australia. Common pregnancy outcomes were analysed against World Health Organization (WHO) BMI categories using multiple logistic regression analysis.

Results

From a total of 18,304 pregnancies, 9087 singleton pregnancies with complete data-sets were identified. Of these pregnancies, 4000 (44%) had a normal BMI, 470 (5.2%) were underweight, 2293 (25.2%) were overweight, 1316 (14.5%) were obese class I, 630 (6.9%) were obese class II and 378 (4.2%) were obese class III. Using the normal BMI category as the reference, there was a clear dose effect of BMI categories for hypertension ( P < 0.001), pre-eclampsia ( P < 0.001), caesarean section ( P < 0.001), macrosomia ( P < 0.001), large for gestational age ( P < 0.001), small for gestational age ( P < 0.001) and neonatal respiratory distress ( P = 0.039). In contrast, despite a significant association with BMI ( P < 0.001), a dose-dependent effect was not found for gestational diabetes.

Conclusion

The results of our study have important clinical significance as the data, using WHO BMI categories, more accurately help stratify risk assessment in a clinically relevant dose-dependent relationship.
The local infiltration of analgesia following total knee replacement
Authors: Gibbs D. M. R. , Green T. P. , Esler C. N.
Published: August 2012

Controversy remains regarding the optimal post-operative analgesic regimen following total knee replacement. A delicate balance is required between the provision of adequate pain relief and early mobilisation. By reviewing 29 randomised trials we sought to establish whether local infiltration of analgesia directly into the knee during surgery provides better pain relief and a more rapid rehabilitation. Although we were able to conclude that local infiltration can provide improved post-operative pain relief, and to suggest the most promising technique of administration, there is no evidence that it reduces hospital stay.
Is adapted measured resection superior to gap-balancing in determining femoral component rotation in total knee replacement?
Authors: Luyckx T. , Peeters T. , Vandenneucker H. , Victor J. , Bellemans J.
Published: August 2012

Obtaining a balanced flexion gap with correct femoral component rotation is one of the prerequisites for a successful outcome after total knee replacement (TKR). Different techniques for achieving this have been described. In this study we prospectively compared gap-balancing versus measured resection in terms of reliability and accuracy for femoral component rotation in 96 primary TKRs performed in 96 patients using the Journey system. In 48 patients (18 men and 30 women) with a mean age of 65 years (45 to 85) a tensor device was used to determine rotation. In the second group of 48 patients (14 men and 34 women) with a mean age of 64 years (41 to 86), an ‘adapted’ measured resection technique was used, taking into account the native rotational geometry of the femur as measured on a pre-operative CT scan.

Both groups systematically reproduced a similar external rotation of the femoral component relative to the surgical transepicondylar axis: 2.4° (sd 2.5) in the gap-balancing group and 1.7° (sd 2.1) in the measured resection group (p = 0.134). Both gap-balancing and adapted measured resection techniques proved equally reliable and accurate in determining femoral component rotation after TKR. There was a tendency towards more external rotation in the gap-balancing group, but this difference was not statistically significant (p = 0.134). The number of outliers for our ‘adapted’ measured resection technique was much lower than reported in the literature.
Comparison of the Genesis II total knee replacement with oxidised zirconium and cobalt-chromium femoral components in the same patients
Authors: Kim Y-H. , Park J-W. , Kim J-S.
Published: August 2012

Despite many claims of good wear properties following total knee replacement (TKR) with an oxidised zirconium (OxZr) femoral component, there are conflicting clinical results. We hypothesised that there would be no difference in either the mid-term clinical and radiological outcomes or the characteristics of the polyethylene wear particles (weight, size and shape) in patients using an OxZr or cobalt-chrome (CoCr) femoral component. In all 331 patients underwent bilateral TKR, receiving an OxZr femoral component in one knee and a CoCr femoral component in the other. The mean follow-up was 7.5 years (6 to 8). Following aspiration, polyethylene wear particles were analysed using thermogravimetric methods and scanning electron microscopy. At the most recent follow-up, the mean Knee Society score, Western Ontario and McMaster Universities Osteoarthritis Index score, range of movement and satisfaction score were not significantly different in the two groups. The mean weight, size, aspect ratio and roundness of the aspirated wear particles were similar for each femoral component. Survivorship of the femoral, tibial and patellar components was 100% in both groups.

In the absence of evidence of an advantage in the medium term we cannot justify the additional expense of an OxZr femoral component.
Outcome of combined unicompartmental knee replacement and combined or sequential anterior cruciate ligament reconstruction
Authors: Weston-Simons J. S. , Pandit H. , Jenkins C. , Jackson W. F. M. , Price A. J. , Gill H. S. , Dodd C. A. F. , Murray D. W.
Published: August 2012

The Oxford unicompartmental knee replacement (UKR) is an established treatment option in the management of symptomatic end-stage medial compartmental osteoarthritis (MCOA), which works well in the young and active patient. However, previous studies have shown that it is reliable only in the presence of a functionally intact anterior cruciate ligament (ACL). This review reports the outcomes, at a mean of five years and a maximum of ten years, of 52 consecutive patients with a mean age of 51 years (36 to 57) who underwent staged or simultaneous ACL reconstruction and Oxford UKR. At the last follow-up (with one patient lost to follow-up), the mean Oxford knee score was 41 (sd 6.3; 17 to 48). Two patients required conversion to TKR: one for progression of lateral compartment osteoarthritis and one for infection. Implant survival at five years was 93% (95% CI 83 to 100). All but one patient reported being satisfied with the procedure. The outcome was not significantly influenced by age, gender, femoral or tibial tunnel placement, or whether the procedure was undertaken at one- or two-stages.

In summary, ACL reconstruction and Oxford UKR gives good results in patients with end-stage MCOA secondary to ACL deficiency.
The classification of degenerative hip disease
Authors: Hamilton H. W. , Jamieson J.
Published: August 2012

It is probable that both genetic and environmental factors play some part in the aetiology of most cases of degenerative hip disease. Geneticists have identified some single gene disorders of the hip, but have had difficulty in identifying the genetics of many of the common causes of degenerative hip disease. The heterogeneity of the phenotypes studied is part of the problem. A detailed classification of phenotypes is proposed. This study is based on careful documentation of 2003 consecutive total hip replacements performed by a single surgeon between 1972 and 2000. The concept that developmental problems may initiate degenerative hip disease is supported. The influences of gender, age and body mass index are outlined. Biomechanical explanations for some of the radiological appearances encountered are suggested. The body weight lever, which is larger than the abductor lever, causes the abductor power to be more important than body weight. The possibility that a deficiency in joint lubrication is a cause of degenerative hip disease is discussed. Identifying the phenotypes may help geneticists to identify genes responsible for degenerative hip disease, and eventually lead to a definitive classification.
Neurogenic claudication without spinal stenosis arising as a result of lumbar epidural varices
Authors: Dabasia H. , Rahim N. , Marshall R.
Published: August 2012

Neurogenic claudication is most frequently observed in patients with degenerative lumbar spinal stenosis. We describe a patient with lumbar epidural varices secondary to obstruction of the inferior vena cava by pathological lymph nodes presenting with this syndrome. Following a diagnosis of follicular lymphoma, successful chemotherapy led to the resolution of the varices and the symptoms of neurogenic claudication.

The lumbar epidural venous plexus may have an important role in the pathogenesis of spinal stenosis. Although rare, epidural venous engorgement can induce neurogenic claudication without spinal stenosis. Further investigations should be directed at identifying an underlying cause.
Results of the Latarjet procedure for recurrent anterior dislocation of the shoulder in patients with epilepsy
Authors: Raiss P. , Lin A. , Mizuno N. , Melis B. , Walch G.
Published: August 2012

A total of 12 epileptic patients (14 shoulders) with recurrent seizures and anterior dislocations of the shoulder underwent a Latarjet procedure and were reviewed at a mean of 8.3 years (1 to 20) post-operatively. Mean forward flexion decreased from 165° (100° to 180°) to 160° (90° to 180°) (p = 0.5) and mean external rotation from 54° (10° to 90°) to 43° (5° to 75°) (p = 0.058). The mean Rowe score was 76 (35 to 100) at the final follow-up. Radiologically, all shoulders showed a glenoid-rim defect and Hill-Sachs lesions pre-operatively. Osteo-arthritic changes of the glenohumeral joint were observed in five shoulders (36%) pre-operatively and in eight shoulders (57%) post-operatively. Re-dislocation during a seizure occurred in six shoulders (43%). Five of these patients underwent revision surgery using a bone buttress from the iliac crest and two of these patients re-dislocated due to a new seizure.

Due to the unacceptably high rate of re-dislocation after surgery in these patients, the most important means of reducing the incidence of further dislocation is the medical management of the seizures. The Latarjet procedure should be reserved for the well-controlled patient with epilepsy who has recurrent anterior dislocation of the shoulder during activities of daily living.
The outcome of scapulothoracic fusion for painful winging of the scapula in dystrophic and non-dystrophic conditions
Authors: Sewell M. D. , Higgs D. S. , Al-Hadithy N. , Falworth M. , Bayley I. , Lambert S. M.
Published: August 2012

Scapulothoracic fusion (STF) for painful winging of the scapula in neuromuscular disorders can provide effective pain relief and functional improvement, but there is little information comparing outcomes between patients with dystrophic and non-dystrophic conditions. We performed a retrospective review of 42 STFs in 34 patients with dystrophic and non-dystrophic conditions using a multifilament trans-scapular, subcostal cable technique supported by a dorsal one-third semi-tubular plate. There were 16 males and 18 females with a mean age of 30 years (15 to 75) and a mean follow-up of 5.0 years (2.0 to 10.6). The mean Oxford shoulder score improved from 20 (4 to 39) to 31 (4 to 48). Patients with non-dystrophic conditions had lower overall functional scores but achieved greater improvements following STF. The mean active forward elevation increased from 59° (20° to 90°) to 97° (30° to 150°), and abduction from 51° (10° to 90°) to 83° (30° to 130°) with a greater range of movement achieved in the dystrophic group. Revision fusion for nonunion was undertaken in five patients at a mean time of 17 months (7 to 31) and two required revision for fracture. There were three pneumothoraces, two rib fractures, three pleural effusions and six nonunions. The main risk factors for nonunion were smoking, age and previous shoulder girdle surgery.

STF is a salvage procedure that can provide good patient satisfaction in 82% of patients with both dystrophic and non-dystrophic pathologies, but there was a relatively high failure rate (26%) when poor outcomes were analysed. Overall function was better in patients with dystrophic conditions which correlated with better range of movement; however, patients with non-dystrophic conditions achieved greater functional improvement.
The ten-year survival of the Birmingham hip resurfacing
Authors: Murray D. W. , Grammatopoulos G. , Pandit H. , Gundle R. , Gill H. S. , McLardy-Smith P.
Published: August 2012

Recent events have highlighted the importance of implant design for survival and wear-related complications following metal-on-metal hip resurfacing arthroplasty. The mid-term survival of the most widely used implant, the Birmingham Hip Resurfacing (BHR), has been described by its designers. The aim of this study was to report the ten-year survival and patient-reported functional outcome of the BHR from an independent centre.

In this cohort of 554 patients (646 BHRs) with a mean age of 51.9 years (16.5 to 81.5) followed for a mean of eight years (1 to 12), the survival and patient-reported functional outcome depended on gender and the size of the implant. In female hips (n = 267) the ten-year survival was 74% (95% confidence interval (CI) 83 to 91), the ten-year revision rate for pseudotumour was 7%, the mean Oxford hip score (OHS) was 43 (sd 8) and the mean UCLA activity score was 6.4 (sd 2). In male hips (n = 379) the ten-year survival was 95% (95% CI 92.0 to 97.4), the ten-year revision rate for pseudotumour was 1.7%, the mean OHS was 45 (sd 6) and the mean UCLA score was 7.6 (sd 2). In the most demanding subgroup, comprising male patients aged < 50 years treated for primary osteoarthritis, the survival was 99% (95% CI 97 to 100).

This study supports the ongoing use of resurfacing in young active men, who are a subgroup of patients who tend to have problems with conventional THR. In contrast, the results in women have been poor and we do not recommend metal-on-metal resurfacing in women. Continuous follow-up is recommended because of the increasing incidence of pseudotumour with the passage of time.
A Systematic Comparison of Cockcroft-Gault and Modification of Diet in Renal Disease Equations for Classification of Kidney Dysfunction and Dosage Adjustment
Authors: Park Eun Jung , Wu Kunyi , Mi Zenghui , Dong Ting , Lawrence John P , Ko Chia-Wen , Huang Shiew-Mei , Zhang Lei , Crentsil Victor , Zhang Jialu , Xu Nancy N
Published: August 2012

BACKGROUND:

The dosing of drugs in patients with kidney dysfunction is often based on the estimates of kidney function.

OBJECTIVE:

To systematically compare the performance of the Modification of Diet in Renal Disease (MDRD) and Cockcroft-Gault (CG) equations for dosage adjustment.

METHODS:

We assessed agreement (concordance, kappa statistics [κ,κω]) between CG and MDRD using a Food and Drug Administration database to evaluate the effect of renal function on the pharmacokinetics of 36 approved drugs. Across the approved drugs, we compared the correlation between these 2 equations for renal drug clearance (Clren) and area under the concentration-time curve. For 26 approved drugs that require renal dose adjustment, we also compared dosing regimens and expected exposure using these equations. Sensitivity analyses were performed by adjusting the MDRD estimates for individualized body surface area and/or range of serum creatinine assay calibration errors.

RESULTS:

In the pharmacokinetic database with 973 subjects (age 18-95 years, weight 35-153 kg, female 33%), we found that the CG and the MDRD classification of renal function generally agreed (64.2%, κ = 0.54, κω = 0.73). Among the subjects studied for drugs requiring renal dose adjustment, dosages in 12% were changed to a higher or lower dosing category by the MDRD compared to the CG equation. In particular, using MDRD in place of CG for dosage modification yielded higher dosing recommendations for subjects with a combination of age >80 years, weight <55 kg, and serum creatinine >0.7 and ≤1.5 mg/dL; the coefficient of determination was also higher by CG than MDRD in trials that enrolled these or similar patients.

CONCLUSIONS:

For patients with advanced age, low weight, and modestly elevated serum creatinine, further work is needed before the MDRD equations can replace the CG equation for dose adjustment in the labeling.
Drug Interactions with Rivaroxaban following Total Joint Replacement Surgery
Authors: Kwong Louis M , Tong Lisa M
Published: August 2012

OBJECTIVE:

To evaluate potential drug-drug interactions with rivaroxaban in patients undergoing total hip replacement (THR) and total knee replacement (TKR) surgeries.

DATA SOURCES:

PubMed; January 2009-April 2012 abstract databases of major congresses for hematology and cardiovascular medicine.

STUDY SELECTION AND DATA EXTRACTION:

Searches were performed using the key words rivaroxaban and drug interaction. Studies were included if they evaluated interactions with drugs that are commonly used in patients undergoing THR or TKR, based on our clinical experience.

DATA SYNTHESIS:

A Phase 1 study found that coadministration of rivaroxaban and the nonsteroidal antiinflammatory drug (NSAID) naproxen significantly increased bleeding time. However, in a retrospective analysis of 4 large trials evaluating rivaroxaban in patients undergoing THR or TKR, the difference between major and clinically relevant nonmajor bleeding was not significantly different between NSAID users and nonusers. In addition, proton pump inhibitors, which are frequently coadministered with NSAIDs to prevent gastrointestinal toxicity, have not been demonstrated to cause any appreciable changes in rivaroxaban pharmacokinetics or pharmacodynamics. A Phase 2 study that evaluated several doses and administration intervals of rivaroxaban in combination with aspirin or both aspirin and clopidogrel in patients with acute coronary syndrome found that clinically significant bleeding events occurred in patients receiving rivaroxaban 10 mg daily (the dose approved for the orthopedic indication). However, this risk was not great enough to end the trial early.

CONCLUSIONS:

Phase 1 drug-drug interaction studies in healthy humans provided little insight into the pharmacodynamic drug interactions between rivaroxaban and NSAIDs or antiplatelet agents. A pooled analysis of the RECORD (Regulation of Coagulation in Orthopedic Surgery to Prevent Deep Vein Thrombosis and Pulmonary Embolism) trials and data from other large trials provides clinical evidence that these agents can be coadministered with rivaroxaban, as long as proper monitoring is instituted.
Improving Pharmacist Knowledge of Oral Chemotherapy in the Community
Authors: Charpentier Margaret M , Orr Katherine Kelly , Taveira Tracey H
Published: August 2012

BACKGROUND:

Approximately 10% of chemotherapy agents are administered orally, with anticipated annual growth of this practice. In the future, community pharmacy practitioners will potentially serve a larger role in the management of patients with cancer.

OBJECTIVE:

To improve pharmacist confidence, knowledge of oral chemotherapy agents, and dispensing behaviors through live continuing pharmacy education (CPE) programs.

METHODS:

A prospective cohort study of pharmacists attending live CPE programs in Rhode Island and Maine was conducted between March and May 2010. A survey was administered before and after the educational program; primary outcome measures included change in level of pharmacist confidence in oral chemotherapy knowledge, overall knowledge, and willingness to adjust behavior when dispensing oral chemotherapy agents in community pharmacy.

RESULTS:

Two hundred fifty-seven of the 410 pharmacists in attendance participated in the survey. Pharmacists significantly improved in confidence level, from no confidence to some confidence (p < 0.001). Counseling the family on the safe handling of oral chemotherapy increased from 37.1% pre-CPE program to 100% post-CPE program. Following the CPE program, behaviors such as (1) using a separate counting tray, (2) wearing gloves, and (3) requiring a double-check improved from 22.5%, 31.5%, and 29.4% baseline to 92.0%, 81.3%, and 81.8%, respectively. All responses to knowledge-based questions improved significantly.

CONCLUSIONS:

A live CPE program on oral chemotherapy designed to improve pharmacist confidence and knowledge, as well as inform about behaviors, is an effective method. Additional education to improve the knowledge of community-based practitioners to safely dispense and properly counsel patients receiving oral chemotherapy is required.
The Impact of Antiplatelet and Anticoagulant Therapies on Gastrointestinal Symptoms in Patients with Atrial Fibrillation: A Systematic Review
Authors: Sobieraj Diana M , White C Michael , Alikhanov Sabina , Winkler Sara , Mediouni Malek , Kluger Jeffrey , Coleman Craig I
Published: August 2012

BACKGROUND:

Patients with atrial fibrillation (AF) may be susceptible to gastrointestinal (GI) effects of medications used for thromboprophylaxis.

OBJECTIVE:

To determine the incidence of thromboprophylaxis discontinuation due to GI symptoms and GI events.

METHODS:

A systematic search of MEDLINE (1950-November 2011) and Cochrane Central (through third quarter of 2011) databases was conducted for randomized trials of adults with AF published in English full-text and reporting on discontinuation due to GI symptoms or the incidence of various GI symptoms.

RESULTS:

Of studies comparing oral direct thrombin inhibitors (DTIs) to vitamin K antagonists (VKAs), 67%, 100%, and 100% found significantly higher incidences of discontinuation due to GI symptoms, upper GI symptoms, and nondistinct GI symptoms with DTIs, respectively. When comparing aspirin to control therapy, 50% and 33% of trials found significantly higher incidences of discontinuation due to GI symptoms and nondistinct GI symptoms with aspirin, respectively. Aspirin significantly increased the incidence of upper GI symptoms compared to VKAs in 1 trial, but VKAs did not increase the incidence of discontinuation due to GI symptoms and nondistinct GI symptoms versus control. In the only trial comparing a factor Xa inhibitor to VKAs, no significant difference in diarrhea was seen, and when a factor Xa inhibitor was compared to aspirin, there was no significant difference in nondistinct GI symptoms. The incidence of discontinuation due to GI symptoms (4 trials) ranged from 0.0% to 0.4% for control, 0.0% to 2.4% for aspirin, 0.0% to 0.63% for VKA, and 1.2% to 4.7% for oral DTI recipients. The incidence of upper GI symptoms (2 trials) was 1.2% for aspirin, 0.0-5.8% for VKA, 4.2% for VKA plus aspirin, and 11.3-11.8% for DTI recipients. The incidence of nondistinct GI symptoms (7 trials) was 0.0-12.4% for control, 0.2-17.9% for aspirin, 0.0-14.1% for VKA, 23% for DTI, and 2.42% for factor Xa inhibitor recipients. Five trials evaluated diarrhea incidence, which ranged from 0.0% to 12.4% for VKA and 3.2% to 12.2% for oral DTI, and was 5.31% for factor Xa inhibitor recipients. One trial evaluated nausea, with incidences of 1.5% and 2.7% for VKA and DTI recipients, respectively.

CONCLUSIONS:

GI adverse events are common in AF trial populations. DTIs were associated with more discontinuations due to GI symptoms and aspirin appeared to increase the incidence of GI symptoms compared to control.
Deterring or Mobilizing? The Influence of Government Partisanship and Force on the Frequency, Lethality and Suicide Attacks of Terror Events
Authors: Koch Michael , Tkach Benjamin
Published: August 2012

The ability of a government to prevent violence and threats against the state and its citizens depends on the government’s ability to deter enemies from engaging in such tactics. Because deterrence relies on both capabilities and credibility it is not clear that governments that emerge within the same state are similarly effective at deterring attacks. We examine whether partisan politics and the decision to use force against an enemy or those thought to be associated with an enemy—in our case terrorists—affects successful deterrence. We test our expectations using data from the Israeli-Palestine conflict between the years 1979 and 2003. The results suggest that governments of the right are more effective at using force to deter future terrorist attacks.
The Impact of Employment in Israel on the Palestinian Labor Force
Authors: Etkes Haggay
Published: August 2012

This study provides circumstantial evidence for the impact of permits for employment in Israel on the Palestinian labor force in the West Bank during the late Intifada period and its aftermath (2005–2008). The study utilizes a unique dataset that merges data from the Palestinian Labor Force Survey with Israeli administrative data on permits for employment in Israel. The study quantifies the increase in Palestinian employment in the Israeli and Palestinian economies and the decrease in Palestinian unemployment, as well as the drop in the return to schooling in a West Bank governorate, which coincided with an increase in the number of permits issued for residents of that governorate. These results reflect the short-run benefits for the un-skilled Palestinian labor force as well as the adverse long-run effects of Palestinian employment in Israel on human capital accumulation.
External Benefits of Brownfield Redevelopment: An Applied Urban General Equilibrium Analysis
Authors: Vermeer Niels , Vermeulen Wouter
Published: August 2012

Does brownfield redevelopment warrant government support? We explore several external benefits in an urban general equilibrium framework. Preferences are modelled such that demand for housing units in the city is downward sloping, which yields a more general setup than the extreme open and closed city cases. We shed light on the relative importance of general equilibrium effects of nonmarginal redevelopment projects and we isolate the external benefits of the removal of a local nuisance, the exploitation of agglomeration economies and the preservation of open space at the urban fringe. A numerical application indicates that local nuisance and agglomeration effects may push social returns significantly beyond the value of redeveloped land that accrues to its owner. However, depending on the price elasticity of urban housing demand and the strength of agglomeration economies, the amount of preserved greenfield land may be small and it only generates additional benefits to the extent that direct land use policies fail to internalize its value as open space.
Taking “All Men Are Created Equal” Seriously: Toward a Metric for the Intergroup Comparison of Utility Functions Through Life Values
Authors: Courard-Hauri David , Lauer Stephen A.
Published: August 2012

The use of wage differential techniques to estimate the value of a statistical life (VSL) leads to the conclusion that willingness to pay for risk reduction increases with income. However, the use of this result in policy-relevant calculations, such as benefit-cost analysis, has led to criticism among ethicists and the lay public, at the same time as it has been defended in the economic literature. In this paper, we argue that differential valuation measures not a differential value that individuals place upon their own lives, but a differential value that they place upon marginal economic resources. Using two sets of VSL estimates from metastudies, we provide an initial estimate of the relative marginal value of income, allowing interpersonal comparison at the societal level. With these results, we propose an empirically determined, ethically justifiable social welfare function that can be easily incorporated into benefit-cost analysis and that has important implications for development economics, although more work is necessary to provide a robust estimate.
The Economic Cost of Conscription and an Upper Bound on the Value of a Statistical Life: Hedonic Estimates from Two Margins of Response to the Vietnam Draft
Authors: Rohlfs Chris
Published: August 2012

This study estimates the cost of the Vietnam draft by applying hedonic methods to the decision to attend college and the decision to voluntarily enlist. In 2009 dollars, the estimated cost of the draft is roughly $115,000 for the marginal military recruit. For the marginal college student, the estimated cost is only $30,000 and probably understates the true amount because men were credit-constrained and college required an upfront cost. Supposing that the costs other than fatality risk were positive, our preferred specifications produce an upper bound on the Value of a Statistical Life ranging from $7 million to $12 million.
The diversity and importance of fungi associated with marine sponges
Authors: Suryanarayanan Trichur S.
Published: August 2012

A few recent investigations have established that marine-derived fungi associated with sponges are an excellent source of novel bioactive metabolites with the potential to function as drugs or drug leads. Given the high species diversity and wide distribution of sponges, it is reasonable to expect that they harbour marine-derived fungi with the ability to produce diverse secondary metabolites. For a more complete realisation of their technological potential, a thorough knowledge of the different taxa of marine-derived fungi associated with sponges is essential. There is scarce information on the interplay between sponges and associated marine-derived fungi and between the marine-derived fungi and other sponge endosymbionts. Unravelling such interactions could be useful in recreating the sponge microcosm conditions in vitro for harvesting novel fungal metabolites. This is essential as many genes of fungal secondary metabolism are inactive in axenic cultures. This review addresses these issues by focusing on the isolation, identification, nature of association, secondary metabolites and potential interactions of marine-derived fungi of sponges and presents some future prospects regarding the bioprospecting of these fungi.
Congenital midgut malrotation causing intestinal obstruction in midpregnancy managed by prolonged total parenteral nutrition: case report and review of the literature
Authors: Young Bruce K. , Kurtz Angela , Fraser Candice
Published: August 2012

Background: A review of the English literature from 1980 to 2010 revealed only six gravidas managed by total parenteral nutrition (TPN) for at least 16 weeks of pregnancy. We found only two gravidas with obstruction due to malrotation, both managed surgically.

Case: We report a unique case of bowel obstruction presenting in the second trimester due to congenital malrotation of the small intestine that was conservatively managed by prolonged TPN, with the delivery of a healthy term baby girl. Surgical correction was delayed until the patient was not pregnant.

Conclusion: Intestinal obstruction in pregnancy is rare, and malrotation of the small bowel as the cause is extremely rare. This is the first case of intestinal obstruction in midtrimester in which prolonged TPN was employed when surgery was contraindicated. TPN may be considered if surgery cannot be performed, with an excellent outcome likely.
Exploring structurally conservative blocks as universal templates for modeling eukaryotic cytochrome P450s
Authors: Tu Youbin
Published: August 2012

Background: An increasing number of crystal structures for eukaryotic P450s have been published, which provided the chance to explore more structural features and construct some knowledge-based methods to facilitate modeling.

Methods: The crystal structures of 14 cytochrome P450s (CYP450) were selected to extract generic spatial anchors typical for three-dimensional (3D) structures of eukaryotic P450s. Multiple sequence alignment and structural superimposition were applied to recognize evolutionarily conserved regions.

Results: Regions containing uninterrupted helical components were identified as structurally conservative blocks (SCBs). The reliability and robustness of the SCBs were further evaluated by sequence entropy and structural deviation. Finally, these SCBs were applied and tested directly in constructing the homology model of the P450 1B1.

Conclusions: SCBs could potentially be applied as universal template to standardize the homology modeling procedure and help predict drug metabolism preferences for eukaryotic P450s.
Synthesis and fungicidal activity of dehydroabietyl-1,2,4-triazolo-thiazolidinones
Authors: Xu Xue-Tang , Ma Xian-Li , Duan Wen-Gui , Chen Li , Cen Bo , Mo Qi-Jin , Wang Jian-Yi
Published: August 2012

In search of novel potent bioactive compounds, a series of novel dehydroabietic acid derivatives bearing 1,2,4-triazolo-thiazolidinone moieties were designed and synthesized. Seven compounds were synthesized of the type 6-substituted benzylidene-3-dehydroabietyl-thiazolo[2,3-c][1,2,4]triazol-5-ones. To this purpose a condensation reaction was performed with 3-dehydroabietyl-thiazolo[2,3-c][1,2,4]triazol-5-one and various aromatic aldehydes. All the title compounds were analyzed and characterized by means of IR, MS, 1H NMR, 13C NMR, and elemental analysis. A preliminary bioassay showed that, at a concentration of 50 μg ml-1, the target compounds exhibited the best fungicidal activity against Fusarium graminearum (F. graminearum) of the five fungi tested (F. oxysporum f. cucumerinum, Alternaria solani, Physalospora piricola, Cercospora arachidicola, and F. graminearum).
Wood capillarity and deacetylation during eucalyptus alkaline impregnation. Sulphidity effects and comparison between transverse directions
Authors: Inalbon María Cristina , Montagna Pablo N. , Galván María Verónica , Demonte Luciano , Zanuttini Miguel A.
Published: August 2012

The relative ion transport capacity of wood – the “effective capillary cross sectional area" (ECCSA) – is determined in this work, based on the analogy with the relation between the electrical conductivities of wood and liquid medium. Wood was treated under different conditions and then the corresponding ECCSAA (the index A is for alkali) is estimated from the value obtained in an inert solution at room temperature (ECCSAInert). The difference between radial and tangential ECCSAA values is constant irrespective of pH, time, temperature and the presence of sodium sulfide in the treatment liquor. The results show that ECCSAA is dependent on the degree of removal of native acetyl groups from hardwood O-acetyl-glucuronoxylan. A kinetic expression for Eucalyptus wood deacetylation is validated and used to establish the relationship between the acetyl content and ECCSAA in both anatomical directions.
On the existence of global saturation for spectral regularization methods with optimal qualification
Authors: Mazzieri Gisela L. , Spies Ruben D. , Temperini Karina G.
Published: August 2012

A family of real functions defining a spectral
regularization method with optimal qualification is considered. Sufficient condition on the family and on the optimal
qualification guaranteeing the existence of saturation are
established. Appropriate characterizations of both the saturation
function and the saturation set are found and some examples are
provided.
How safe is preterm operative vaginal delivery and which is the instrument of choice?
Authors: Corcoran Siobhan , Daly Niamh , Eogan Maeve , Holohan Mary , Clarke Tom , Geary Michael
Published: August 2012

Objective: The objective of this study was to determine neonatal outcomes in preterm operative vaginal delivery given the current paucity of data available to guide clinicians.

Study design: A retrospective review of 64 cases was conducted, and neonatal outcomes were compared to spontaneous vaginal deliveries in similar gestations. The primary outcomes studied were death and occurrence of intraventricular haemorrhage. Secondary outcomes included admission to NICU, Apgar <3 at 5 min, ventilation requirement, jaundice requiring treatment, culture-proven sepsis and necrotising enterocolitis. The study was conducted in a stand-alone maternity unit of approximately 9000 deliveries per year.

Results and conclusions: We concluded that although vacuum delivery is avoided in preterm infants, outcomes were similar to forceps deliveries of similar gestations.
Defining hypoxic ischemic encephalopathy in newborn infants: benchmarking in a South African population
Authors: Horn Alan R. , Swingler George H. , Myer Landon , Harrison Michael C. , Linley Lucy L. , Nelson Candice , Tooke Lloyd , Rhoda Natasha R. , Robertson Nicola J.
Published: August 2012

Objectives: There are few population-based studies of hypoxic ischemic encephalopathy (HIE) in sub-Saharan Africa, and the published criteria that are used to define and grade HIE are too variable for meaningful comparisons between studies and populations. Our objectives were (1) to investigate how the incidence of HIE in our region varies with different criteria for intrapartum hypoxia and (2) to determine how encephalopathy severity varies with different grading systems.

Method: We reviewed the records of infants with a diagnosis of HIE born between September 2008 and March 2009 in public facilities in the Southern Cape Peninsula, South Africa. The incidence of HIE was calculated according to four definitions of intrapartum hypoxia and graded according to three methods.

Results: Depending on which defining criteria were applied, the incidence of HIE varied from 2.3 to 4.3 per 1000 live births, of mild HIE ranged from 0.4 to 1.3 per 1000 live births, and of moderate-severe HIE ranged from 1.5 to 3.7 per 1000 live births. Ninety-seven of the 110 (88%) infants reviewed had at least one intrapartum-related abnormality. Only 62 (56%) infants had a blood gas performed in the first hour of life.

Conclusion: The incidence and grade of HIE can vary more than 2-fold in the same population, depending on which defining criteria are used. Consensus definitions are needed for benchmarking.
p300/CBP-Associated Factor Selectively Regulates the Extinction of Conditioned Fear
Authors: Wei Wei , Coelho Carlos M. , Li Xiang , Marek Roger , Yan Shanzhi , Anderson Shawn , Meyers David , Mukherjee Chandrani , Sbardella Gianluca , Castellano Sabrina , Milite Ciro , Rotili Dante , Mai Antonello , Cole Philip A. , Sah Pankaj , Kobor Michael S. , Bredy Timothy W.
Published: August 2012

It is well established that the activity of chromatin-modifying enzymes is crucial for regulating gene expression associated with hippocampal-dependent memories. However, very little is known about how these epigenetic mechanisms influence the formation of cortically dependent memory, particularly when there is competition between opposing memory traces, such as that which occurs during the acquisition and extinction of conditioned fear. Here we demonstrate, in C57BL/6 mice, that the activity of p300/CBP-associated factor (PCAF) within the infralimbic prefrontal cortex is required for long-term potentiation and is necessary for the formation of memory associated with fear extinction, but not for fear acquisition. Further, systemic administration of the PCAF activator SPV106 enhances memory for fear extinction and prevents fear renewal. The selective influence of PCAF on fear extinction is mediated, in part, by a transient recruitment of the repressive transcription factor ATF4 to the promoter of the immediate early genezif268, which competitively inhibits its expression. Thus, within the context of fear extinction, PCAF functions as a transcriptional coactivator, which may facilitate the formation of memory for fear extinction by interfering with reconsolidation of the original memory trace.