bluuebunny/crossref_metadata_2025 huggingface dataset:
Major Depression, Adjustment Disorders, and Post-Traumatic Stress Disorder in Terminally Ill Cancer Patients: Associated and Predictive Factors
Authors: Akechi Tatsuo , Okuyama Toru , Sugawara Yuriko , Nakano Tomohito , Shima Yasuo , Uchitomi Yosuke
Published: May 2004

Purpose

Few studies have been conducted to elucidate the psychological distress of terminally ill cancer patients. This study attempted to determine the prevalence of adjustment disorders (AD), major depression (MD), and post-traumatic stress disorder (PTSD) among terminally ill cancer patients, to identify factors that contribute to them, and to determine how they change longitudinally.

Patients and Methods

Consecutive terminally ill cancer patients were recruited. Patients were assessed for psychiatric disorders by structured clinical interview twice: once at the time of their registration with a palliative care unit (baseline), and again at the time of their palliative care unit admission (follow-up). Possible contributed biomedical and psychosocial factors were evaluated.

Results

The proportions of patients diagnosed with AD, MD, and PTSD at baseline (n = 209) were 16.3%, 6.7%, and 0% respectively, whereas at follow-up (n = 85), 10.6% were diagnosed with AD and 11.8% with MD. Lower performance status, concern about being a burden to others, and lower satisfaction with social support were significantly associated with AD/MD at baseline. There were changes in the diagnosis of AD and MD in 30.6% of the patients. Only the Hospital Anxiety and Depression Scale at the baseline was significantly predictive of AD/MD at follow-up.

Conclusion

The factors underlying psychological distress are multifactorial. Early intervention to treat subclinical anxiety and depression may prevent subsequent psychological distress.
Low Molecular Weight Heparin, Therapy With Dalteparin, and Survival in Advanced Cancer: The Fragmin Advanced Malignancy Outcome Study (FAMOUS)
Authors: Kakkar Ajay K. , Levine Mark N. , Kadziola Zbigniew , Lemoine Nicholas R. , Low Vanessa , Patel Heman K. , Rustin Gordon , Thomas Michael , Quigley Mary , Williamson Robin C.N.
Published: May 2004

Purpose

In experimental systems, interference with coagulation can affect tumor biology. Furthermore, it has been suggested that low molecular weight heparin therapy may prolong survival in patients with cancer. The primary aim of this study was to assess survival at 1 year of patients with advanced cancer.

Patients and Methods

Patients with advanced malignancy (N = 385) were randomly assigned to receive either a once-daily subcutaneous injection of dalteparin (5,000 IU), a low molecular weight heparin, or placebo for 1 year.

Results

The Kaplan-Meier survival estimates at 1, 2, and 3 years after randomization for patients receiving dalteparin were 46%, 27%, and 21%, respectively, compared with 41%, 18%, and 12%, respectively, for patients receiving placebo (P = .19). In an analysis not specified a priori, survival was examined in a subgroup of patients (dalteparin, n = 55; and placebo, n = 47) who had a better prognosis and who were alive 17 months after randomization. In these patients, Kaplan-Meier survival estimates at 2 and 3 years from randomization were significantly improved for patients receiving dalteparin versus placebo (78% v 55% and 60% v 36%, respectively, P = .03). The rates of symptomatic venous thromboembolism were 2.4% and 3.3% for dalteparin and placebo, respectively, with bleeding rates of 4.7% and 2.7%, respectively.

Conclusion

Dalteparin administration did not significantly improve 1-year survival rates in patients with advanced malignancy. However, the observed improved survival in a subgroup of patients with a better prognosis suggests a potential modifying effect of dalteparin on tumor biology.
Prognostic Indicators and Survival in Patients With Stage IIIB Inflammatory Breast Carcinoma After Dose-Intense Chemotherapy
Authors: Somlo George , Frankel Paul , Chow Warren , Leong Lucille , Margolin Kim , Morgan Robert , Shibata Stephen , Chu Peiguo , Forman Stephen , Lim Dean , Twardowski Przemyslaw , Weitzel Jeffrey , Alvarnas Joseph , Kogut Neil , Schriber Jeffrey , Fermin Eleanor , Yen Yun , Damon Lloyd , Doroshow James H.
Published: May 2004

Purpose

To improve treatment outcome for patients presenting with inflammatory breast cancer (IBC), we have sequentially developed and tested single and tandem dose-intense chemotherapy regimens (DICT). Tumor- and treatment-related factors were analyzed to generate a prognostic model.

Patients and Methods

Between May 1989 and April 2002, 120 patients received conventional-dose chemotherapy, surgery, and sequentially developed single- or tandem-cycle DICT. Disease- and treatment-specific features were subjected to univariate and multivariate analysis to correlate with outcome.

Results

At a median follow-up of 61 months (range, 21 to 161 months), estimated 5-year relapse-free survival (RFS) and overall survival (OS) were 44% (95% CI, 34% to 53%) and 64% (95% CI, 55% to 73%), respectively. In an age-adjusted multivariate analysis, RFS was better in patients with estrogen receptor (ER)/progesterone receptor (PR)–positive tumors (P = .002), for patients with fewer than four involved axillary nodes before DICT (P = .01), and in patients treated with radiation therapy (P = .001) and tandem DICT (P = .049). OS was improved in patients with ER/PR-positive tumors (P = .002), in those with fewer than four involved axillary nodes before DICT (P = .03), and in patients treated with radiation therapy (P = .002).

Conclusion

This retrospective analysis suggests that either single or tandem DICT can be administered safely and may benefit selected patients with stage IIIB IBC. Those with receptor-negative IBC and with four or more involved axillary nodes before DICT need improved neoadjuvant and postadjuvant intensification therapy. A prospective randomized trial of single versus tandem DICT would be required to confirm the potential benefit of tandem DICT in the setting of IBC.
Thiotepa-Based High-Dose Chemotherapy With Autologous Stem-Cell Rescue in Patients With Recurrent or Progressive CNS Germ Cell Tumors
Authors: Modak Shakeel , Gardner Sharon , Dunkel Ira J. , Balmaceda Casilda , Rosenblum Marc K. , Miller Douglas C. , Halpern Steven , Finlay Jonathan L.
Published: May 2004

Purpose

To evaluate the efficacy and toxicity of high-dose chemotherapy (HDC) followed by autologous stem-cell rescue (ASCR) in patients with relapsed or progressive CNS germ cell tumors (GCTs).

Patients and Methods

Twenty-one patients with CNS GCTs who experienced relapse or progression despite having received initial chemotherapy and/or radiotherapy were treated with thiotepa-based HDC regimens followed by ASCR.

Results

Estimated overall survival (OS) and event-free survival (EFS) rates for the entire group 4 years after HDC were 57% ± 12% and 52% ± 14%, respectively. Seven of nine (78%) patients with germinoma survived disease-free after HDC with a median survival of 48 months. One patient died as a result of progressive disease (PD) 39 months after HDC, and another died as a result of pulmonary fibrosis unrelated to HDC 78 months after ASCR without assessable disease. However, only four of 12 patients (33%) with nongerminomatous germ cell tumors (NGGCTs) survived without evidence of disease, with a median survival of 35 months. Eight patients with NGGCTs died as a result of PD, with a median survival of 4 months after HDC (range, 2 to 17 months). Patients with germinoma fared better than those with NGGCTs (P = .016 and .014 for OS and EFS, respectively). Patients with complete response to HDC also had significantly better outcome (P < .001 for OS and EFS) compared with patients with only a partial response or stable disease. There were no toxic deaths because of HDC.

Conclusion

Dose escalation of chemotherapy followed by ASCR is effective therapy for patients with recurrent CNS germinomas and might be effective in patients with recurrent NGGCTs with a low tumor burden.
The Effects of Sentence‐Level Context, Prior Word Knowledge, and Need for Cognition on Information Processing of Technical Language in Print Ads
Authors: Bradley Samuel D. , Meeds Robert
Published: May 2004

An experiment was conducted to examine the effects of sentence‐level context, prior word knowledge, and need for cognition on responses to print ads for technical products. Words and phrases that help readers understand technical language in context increased the supportive arguments generated in response to ads, whereas prior word knowledge and need for cognition primarily influenced neutral thoughts. Only explanatory language facilitated the comprehension of product information. Explanatory language led to an increase in attitudes and purchase intent. Need for cognition had a positive influence on attitude formation when the context language was ambiguous, but decreased attitude formation when the context language was explanatory. Results are consistent with predictions guided by a comprehension elaboration model of persuasion.
Coping With Negative Emotions in Purchase‐Related Situations
Authors: Yi Sunghwan , Baumgartner Hans
Published: May 2004

We investigate how consumers manage stressful emotional experiences in purchase‐related situations. Eight coping strategies that consumers may use to deal with stressful incidents are distinguished and hypotheses are formulated about which coping strategies are linked to each of four different negative emotions (anger, disappointment, regret, and worry). The findings indicate that distinct strategies are employed by consumers to cope with different emotions, or the problem that caused these emotions, and that the emotion‐coping relations are generalizable across two samples of respondents.
The Urge to Splurge Revisited: Further Reflections on Applying Terror Management Theory to Materialism and Consumer Behavior
Authors: Arndt Jamie , Solomon Sheldon , Kasser Tim , Sheldon Kennon M.
Published: May 2004

We respond to commentaries by Maheswaran and Agrawal (2004) and Rindfleisch and Burroughs (2004) on the application of terror management theory to understanding conspicuous consumption and consumer behavior. Specifically, we consider individual differences in terror management research; the possibility of cultural variation (or lack thereof) in terror management processes; the viability of materialism as a pathway to securing existential meaning; and the different and, at times possibly conflicting, motivations that may be evoked by the awareness of death.
Dogmas and controversies in the handling of nitrogenous wastes: Ureotely and ammonia tolerance in early life stages of the gulf toadfish,Opsanus beta
Authors: Barimo John F. , Steele Shelby L. , Wright Patricia A. , Walsh Patrick J.
Published: May 2004

The marine gulf toadfish (Opsanus beta) is an unusual teleost fish as it is able to switch between ammoniotelism and ureotelism in response to a variety of laboratory conditions. The present study integrates field work conducted in Biscayne and Florida Bays, USA with laboratory studies to examine ureotelism during the early life history stages of O. beta. Adult toadfish voluntarily nested in artificial shelters placed amongst seagrass beds and were found to be predominantly ureotelic under natural conditions as the internal shelter water had mean urea and ammonia concentrations(N=51) of 14.2±1.6 μmol N l–1 and 8.9±0.9 μmol N l–1, respectively. Toadfish successfully spawned in shelters, providing eggs, larvae and juvenile toadfish for laboratory study. In the lab, juvenile toadfish were also ureotelic and urea was excreted in pulsatile events that accounted for 62.0±5.9% of total urea-N excreted. Excretion rates of urea-N and ammonia-N were 1.018±0.084 μmol N h–1 g–1 and 0.235±0.095 μmol N h–1 g–1,respectively. Field-collected eggs, larvae and juveniles expressed significant levels of the ornithine–urea cycle enzymes carbamoyl-phosphate synthetase III, ornithine transcarbamylase and arginase and the accessory enzyme glutamine synthetase, all of which increased in activity as toadfish developed through early life stages. In juveniles, the ammonia 96-h LC50 value was 875 μmol N l–1 and there was a 3-fold increase in ornithine transcarbamylase activity in the 1000 μmol N l–1 NH4Cl treatment. The results are discussed in the context of the causal factor(s) for ureotelism in toadfish. Furthermore,the results of this study suggest it is unlikely that the adaptive significance of ureotelism in toadfish is a means to prevent fouling nests with ammonia and in turn poisoning offspring; however, additional study is warranted.
Structural colouration of mammalian skin: convergent evolution of coherently scattering dermal collagen arrays
Authors: Prum Richard O. , Torres Rodolfo H.
Published: May 2004

For more than a century, the blue structural colours of mammalian skin have been hypothesized to be produced by incoherent, Rayleigh or Tyndall scattering. We investigated the colour, anatomy, nanostructure and biophysics of structurally coloured skin from two species of primates – mandrill(Mandrillus sphinx) and vervet monkey (Cercopithecus aethiops) – and two species of marsupials – mouse opossum(Marmosa mexicana) and wooly opossum (Caluromys derbianus). We used two-dimensional (2-D) Fourier analysis of transmission electron micrographs (TEMs) of the collagen arrays in the primate tissues to test whether these structural colours are produced by incoherent or coherent scattering (i.e. constructive interference). The structural colours in Mandrillus rump and facial skin and Cercopithecus scrotum are produced by coherent scattering by quasi-ordered arrays of parallel dermal collagen fibres. The 2-D Fourier power spectra of the collagen arrays from Mandrillus and Cercopithecus reveal ring-shaped distributions of Fourier power at intermediate spatial frequencies,demonstrating a substantial nanostructure of the appropriate spatial frequency to produce the observed blue hues by coherent scattering alone. The Fourier power spectra and the observed reflectance spectra falsify assumptions and predictions of the incoherent, Rayleigh scattering hypothesis. Samples of blue Marmosa and Caluromys scrotum conform generally to the anatomy seen in Mandrillus and Cercopithecus but were not sufficiently well preserved to conduct numerical analyses. Colour-producing collagen arrays in mammals have evolved multiple times independently within the two clades of mammals known to have trichromatic colour vision. Mammalian colour-producing collagen arrays are anatomically and mechanistically identical to structures that have evolved convergently in the dermis of many lineages of birds, the tapetum of some mammals and the cornea of some fishes. These collagen arrays constitute quasi-ordered 2-D photonic crystals.
Effect of a half-toroidal continuously variable unit on the dynamics of a complete powertrain: A parametric free vibration analysis
Authors: Dutta-Roy T , Zhang N
Published: May 2004

The paper presents a simplified parametric model of a half-toroidal continuously variable unit (CVU) by using a finite element (FE) method in which the continuously variable speed unit is discretized into lumped masses and damper and spring elements. Linearized FE elements have been used to model the contact between the toroids and the rollers. All the FE elements, including the CVU model, are integrated into the complete powertrain system. Free torsional vibration analysis of the complete powertrain system has been carried out. Significant changes are observed in the natural frequencies as well as the modal shapes of the complete powertrain with respect to different gear ratios of the CVU and the various contact torsional stiffness. A potential problem with the powertrain system has also been identified, and remedial action has been proposed. The system characteristics have further been investigated with a lock-up clutch incorporated in the powertrain system.
Predicting boiling heat transfer using computational fluid dynamics
Authors: Hawley J G , Wilson M , Campbell N A F , Hammond G P , Leathard M J
Published: May 2004

A study has been undertaken to assess the capability of incorporating different empirical approaches in a computational ftuid dynamics (CFD) environment for predicting boiling heat transfer. The application is for internal combustion (IC) engine cooling galleries and experimental validation work has been undertaken. Three different boiling heat transfer models are described, one based on the principle of superposition (Chen) and two based on the partial boiling method (Thom and Cipolla). Overall, the Thom partial boiling approach was found to be the most representative of the three considered. However, numerous issues were found to be evident whatever approach was adopted and these are discussed in the paper. The partial boiling model was found to be the most simple to incorporate in the CFD model.
A modelling and experimental study of transient NOx emissions in turbocharged direct injection diesel engines
Authors: Cui Y , Deng K , Wu J
Published: May 2004

A working process model for turbocharged direct injection (DI) diesel engines was developed by intensively analysing the in-cylinder spray and combustion process. The model can be used to predict the comprehensive performance and NOx emission of turbocharged DI diesel engines under transient conditions. A transient test-bed was constructed, which was composed of a six- cylinder turbocharged DI diesel engine, a console, a measuring and control PC (personal computer) system for data collecting and exhaust gas sampling control in transient conditions and an exhaust gas sampling and measuring system. Tests of three types of transient operating conditions were carried out. These tests and model simulations show that the NOx emission laws are different during transient conditions and in some acceleration and load acceptance conditions NOx emissions are better than the corresponding steady state conditions.
Improvement of performance and reduction of pollutant emissions of a four-stroke spark ignition engine fuelled with a mixture of hydrogen and methane as a supplementary fuel to alcohol
Authors: Al-Baghdadi M A-R S
Published: May 2004

Owing to the energy crisis and pollution problems of today, investigations have concentrated on decreasing fuel consumption and on lowering the concentration of toxic components in combustion products by using non-petroleum, renewable, sustainable and non-polluting fuels. While conventional energy sources such as natural gas, oil and coal are non-renewable, hydrogen and alcohol can be coupled to renewable and sustainable energy sources. The usage of a mixture of hydrogen and methane as a supplementary fuel to an alcohol-air mixture for spark ignition engines results in a considerable improvement in engine performance and in the reduction of the toxic components in exhaust gases in comparison with the conventional spark ignition gasoline engine. In tests, the gas comprising 40 per cent H2 and 60 per cent CH4 by volume was added to alcohol as 0, 2, 4, 6, 8, 10 and 12 per cent by mass. Operating test results for a range of compression ratio (CR) and equivalent ratio are presented. Gasoline fuel was used as a basis for comparison. The important improvement in methane addition reduced the specific fuel consumption (s.f.c.) and CO emission of alcohol engines. The performance of the engine is enhanced when relatively small amounts of hydrogen are present with methane. This improvement in performance, which is especially pronounced at operational equivalence ratios that are much leaner than the stoichiometric value, can be attributed largely to the faster and cleaner burning characteristics of hydrogen in comparison with methane or alcohol. Moreover, the addition of hydrogen decreases the s.f.c. of the engine. The possibility of an engine power quality adjustment has also been studied.
Study on a Pre-mixed Charge Compression Ignition Engine by Dimethoxymethane Port Injection
Authors: Fang J , Huang Z , Qiao X , Zhong Y , Song J
Published: May 2004

This paper presents a study of premixed combustion in a compression ignition (CI) engine. An electrically controlled fuel injection system was installed in the intake manifold of the engine. Dimethoxymethane (DMM) fuel with a low cetane number and low boiling point was injected into the manifold. The homogeneous mixture was formed in the compression stroke and ignited by a small amount of injected diesel fuel near the TDC (top dead centre). The effects of pre-mixed fuel ratio, engine load, CO2 concentration in the intake gas and nozzle hole diameter on the engine combustion and emissions were investigated. The results show that the pre-mixed combustion by DMM fuel port injection exhibits a substantial reduction of NOx and smoke emissions simultaneously, which might make it possible to develop a technique for controlling diesel engine exhaust emissions.
Influence of variable valve timings on the gas exchange process in a controlled auto-ignition engine
Authors: Milovanovic N , Chen R , Turner J
Published: May 2004

The controlled auto-ignition (CAI) engine concept has the potential to be highly effcient and to produce low NOx and particulate matter emissions. However, the problem of controlling the combustion over the entire load/speed range limits its practical application. The CAI combustion is controlled by the chemical kinetics of the charge mixture, with no influence of the flame diffusion or turbulent propagation. Therefore, to achieve successful control of the CAI process, the composition, temperature and pressure of the charge mixture at the inlet valve closure (IC) point have to be controlled. The use of the variable valve timing strategy, which enables quick changes in the amount of trapped hot exchaust gases, shows the potential for control of CAI combustion. The aim of this paper is to analyse the influence of the variable valve timing strategy on the gas exchange process, the process between the first valve open event (EO) and the last valve closing event (IC), in a CAI engine fuelled with standard gasoline fuel (95RON). The gas exchange process affects the engine parameters and charge properties and therefore plays a crucial role in determining the control of the CAI process. Analysis is performed by experimental and modelling approaches. A single-cylinder research engine equipped with a fully variable valvetrain (FVVT) system was used for the experimental study. A combined code consisting of a detailed chemical kinetics code and one-dimensional fluid dynamics code was used for the modelling study. The results obtained indicate that the variable valve timing strategy has a strong influence on the gas exchange process, which in turn influences the engine parameters and the cylinder charge properties, and hence the control of the CAI process. The EC timing has the strongest effect, followed by the IO timing, while the EO and IC timings have minor effects.
Update on the National Cholesterol Education Program Adult Treatment Panel III Guidelines: Getting to Goal
Authors: McKenney James M.
Published: May 2004

Considerable data on the pathophysiology, epidemiology, and treatment of dyslipidemia‐induced coronary heart disease (CHD) have accumulated in recent years. These data have been assessed and incorporated into the guidelines of the National Cholesterol Education Program Expert Panel on the Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel [ATP] III). A major focus of the new guidelines is the assessment of the near‐term (i.e., 10‐yr) risk of experiencing a CHD event and matching the intensity of treatment to this risk. Patients with diabetes and those with a greater than 20% 10‐year risk of experiencing a CHD event have been elevated to the risk level of CHD equivalent. The ATP III guidelines also modify several lipid and lipoprotein classifications. A low‐density lipoprotein cholesterol (LDL) level below 100 mg/dl is now considered optimum for all individuals. In addition, high‐density lipoprotein cholesterol (HDL) and triglyceride cutoff points have been modified to reflect more accurately the risk associated with abnormalities in these lipoproteins. As with the previous guidelines, the primary target of therapy remains LDL. Therapeutic lifestyle changes consisting of diet, weight reduction, and increased physical activity should be included in all treatment regimens. Based on their potent LDL‐lowering properties and their proven ability to decrease mortality in a variety of patient populations, statins are generally the first choice for pharmacologic therapy. A secondary target of therapy includes non‐HDL goals for patients with high triglyceride levels and the metabolic syndrome, which is characterized by abdominal obesity, elevated triglyceride levels, low HDL levels, and insulin resistance. Management of these secondary targets includes weight reduction and increased physical activity, and treatment of the lipid and nonlipid risk factors. Overall, ATP III represents an aggressive approach to treating dyslipidemia, greatly extending the number of individuals who qualify for treatment.
Role of the Pharmacist in Establishing Lipid Intervention Programs
Authors: Ito Matthew K.
Published: May 2004

Despite the availability of the National Cholesterol Education Program Adult Treatment Panel (ATP) guidelines for the management of hyperlipidemia since 1988, most patients do not achieve their target low‐density lipoprotein cholesterol (LDL) goals. With the publication of the most recent guidelines (ATP III), which contain more aggressive treatment recommendations, the cholesterol treatment gap is likely to widen further. Factors responsible for patients not receiving adequate treatment include a lack of focus on asymptomatic diseases, time and reimbursement constraints, inadequate training, a reluctance to prescribe aggressive treatment regimens, and poor communication among health care professionals. Results of several studies evaluating intervention programs indicate that pharmacists can play a key role in improving cholesterol management whether in lipid clinics, community pharmacies, or hospitals. In these intervention programs, pharmacists provided a wide range of functions that included reviewing the medical history, monitoring laboratory values, selecting lipid‐lowering therapies, and educating patients regarding drug therapies and the importance of compliance. These interventions produced significant improvements in lipid parameters and in the number of patients who achieved LDL treatment goals. Most important, these interventions were associated with decreases in clinical events. Pharmacist intervention also was highly cost‐effective and time efficient. These results suggest that pharmacists are in a unique position and possess the requisite skills to improve the treatment of patients with hyperlipidemia.
Putting an Ecstasy Test Kit to the Test: Harm Reduction or Harm Induction?
Authors: Murray Rebecca A. , Doering Paul L. , Boothby Lisa A. , Merves Michele L. , McCusker Rachel R. , Chronister Chris W. , Goldberger Bruce A.
Published: May 2004

Objective. To evaluate the DanceSafe Complete Adulterant Screening Kit for Ecstasy with regard to its accuracy in identifying 3,4‐methylenedioxymeth‐amphetamine (MDMA) and methylenedioxyamphetamine (MDA) derivatives and its ability to detect certain contaminants.

Methods. In part I, 39 street‐grade tablets purported to be MDMA were tested with the Marquis, Mecke, and Simon's reagents provided by the DanceSafe testing kit. The tablets then were submitted to gas chromatography‐mass spectrometry for identification of active ingredients. In part II, seven known drugs of abuse were tested with the Marquis, Mecke, and Simon's reagents. These drugs were codeine, dextromethorphan, dihydrocodeine, ketamine, MDMA, morphine, and d‐norpropoxyphene.

Results. The Marquis, Mecke, and Simon's reagents did not differentiate pure MDMA from adulterated forms. They lacked both sensitivity and specificity for the purpose of MDMA identification when tested by persons unfamiliar with these reagents. Also, experienced toxicologists using this unfamiliar procedure generated false‐positive results.

Conclusions. Neither the Marquis, Mecke, nor Simon's reagents should be used by the public for harm reduction purposes. These agents do not help identify pure MDMA tablets. Gas chromatography‐mass spectrometry remains the most sensitive and specific testing method for identifying MDMA and its contaminants.
The Evolving Role of Nesiritide in Advanced or Decompensated Heart Failure
Authors: Zineh Issam , Schofield Richard S. , Johnson Julie A.
Published: May 2004

Nesiritide is a recombinant form of human brain natriuretic peptide (BNP) that is structurally and biochemically identical to endogenously produced BNP. In humans, BNP is important in hemodynamic and neurohormonal equilibrium, helping to maintain adequate vascular volume and pressure in response to volume overload. The pharmacodynamic effects of nesiritide mimic the biologic effects of BNP. The molecular biology and actions of nesiritide and BNP are reviewed, with the therapeutic rationale for nesiritide in patients with acute or advanced decompensated heart failure highlighted. In addition, recommendations for its administration are provided, and unresolved therapeutic considerations are discussed.
Advances in the Pharmacotherapy of Attention‐Deficit‐Hyperactivity Disorder: Focus on Methylphenidate Formulations
Authors: Markowitz John S. , Straughn Arthur B. , Patrick Kennerly S.
Published: May 2004

The psychostimulant dl‐methylphenidate (MPH) remains the most common drug therapy in child and adolescent psychiatry for the treatment of attention‐deficit‐hyperactivity disorder (ADHD). Evidence of a dopaminergic basis both for the actions of MPH and for the underlying neuropathology in ADHD continues to mount. Advances in the biopharmaceutics of MPH have been conspicuous. Novel approaches to formulation design have resulted in new MPH delivery options to overcome the short‐term actions of both immediate‐and sustained‐release MPH. New modified‐release MPH products offer the convenience of once‐daily administration while providing extended absorption profiles that better mimic those of standard schedules of immediate‐release MPH (i.e., the absorption phase of MPH better correlates with improved behavioral response than does the elimination phase). The oral bioavailability of MPH in females may be lower than in males. The l‐MPH isomer exhibits only negligible oral bioavailability and, further, possesses little intrinsic activity at the dopamine transporter. This notwithstanding, a single‐isomer d‐MPH immediate‐release product is now available for dosing recommended at one‐half that of dl‐MPH.
Impact of an Alcohol Withdrawal Syndrome Practice Guideline on Surgical Patient Outcomes
Authors: Stanley Karen M. , Amabile Celene M. , Simpson Kit N. , Couillard Deborah , Norcross E. Douglas , Worrall Cathy L.
Published: May 2004

Study Objective. To standardize treatment of alcohol withdrawal syndrome (AWS) in surgical patients using an AWS practice guideline with a symptom‐triggered approach.

Design. Prospective interventional (pilot group) and retrospective (comparison group).

Setting. University teaching hospital.

Patients. Thirty‐eight trauma, orthopedic, and general surgery patients identified at risk for AWS in the pilot group, and 34 patients who were managed using nonstandardized approaches.

Interventions. At‐risk patients in the pilot group were assessed using the AWS Type Indicator. They received lorazepam, clonidine, or haloperidol, based on AWS Type Indicator assessment and AWS practice guideline criteria.

Measurements and Main Results. A standardized symptom‐triggered approach to managing AWS was expected to decrease the use of benzodiazepines, avoid undertreatment of adrenergic hyperactivity and delirium, decrease the need for sitters and physical restraints, and reduce hospital length of stay. Pilot patients received a mean of 23 mg less benzodiazepine (p=0.01), 0.1 mg more clonidine (p=0.01), and 20 mg less haloperidol (p=0.06) than comparison patients. Pilot patients also required significantly fewer sitter hours (p=0.04) and hours of restraint use (p=0.09) than comparison patients. No significant differences were found between groups for length of stay (p=0.77).

Conclusions. This pilot project suggests that trauma, orthopedic, and general surgery patients at risk for AWS can be safely and effectively managed with a standardized, symptom‐triggered approach. Moreover, this approach decreased the amounts of benzodiazepines and haloperidol administered to patients at risk for AWS.
Assessment of Medication Errors That Involved Drug Allergies at a University Hospital
Authors: Jones T. Aaron , Como Jackson A.
Published: May 2004

Objectives. To determine the reporting accuracy of true patient‐related allergies to drugs in a large teaching institution (908 licensed beds), and to identify factors contributing to medication errors that involved drug allergies. Of particular interest was the accuracy of allergy information in the medical record and the occurrence of medication errors that involved penicillin antibiotics.

Methods. From a sample population of 340 patients, 50 adult patients admitted to our university‐affiliated hospital who met criteria and had an allergy to selected drugs that was documented in the hospitalwide computer system were randomly selected and interviewed to determine the timing, nature, and extent of the reaction. Furthermore, data were collected from identified Medication Error Reports when an agent was prescribed for a patient with a reported allergy to that agent or class. Prospective data collection was conducted from November 2000‐February 2001. Using the information obtained by the patient interview and chart documentation, we assessed the reported allergy. In addition, contributing factors for medication errors that involved drug allergies were identified.

Results. Of the sample population, 133 patients (39%) reported allergies to at least one drug. Allergies to β‐lactams, sulfonamides, and opioid narcotics were reported in 12.6% (43 patients), 9.1% (31), and 14.4% (49) of the sample population, respectively. Most agents involved in medication errors were β‐lactam antibiotics, with an overwhelming number of these errors due to piperacillin‐tazobactam (51.4%, 36 errors). Other drugs involved were ampicillin (10%, 7 errors), other β‐lactams (24.3%, 17 errors), opioid narcotics (10%, 7 errors), and sulfonamides (4.3%, 3 errors). Most contributing factors were classified as “MD [prescribing physician] not aware of allergy.”

Conclusion. These results suggest a need for ensuring that prescribers review each patient's allergy profile before order entry.
Thiazolidinedione Safety and Efficacy in Ambulatory Patients Receiving Hemodialysis
Authors: Manley Harold J. , Allcock Nicole M.
Published: May 2004

Study Objectives. To determine whether thiazolidinediones cause significant changes in intravascular volume, anemia, or chronic heart failure; to determine which thiazolidinedione, rosiglitazone or pioglitazone, has a greater propensity to cause these adverse effects; and to evaluate thiazolidinedione efficacy in patients with diabetes mellitus and end‐stage renal disease who require hemodialysis.

Design. Retrospective chart review.

Setting. Ambulatory hemodialysis clinic.

Patients. Forty ambulatory patients receiving hemodialysis.

Measurements and Main Results. Of the 40 patients (26 men, 14 women, mean ± SD age 64.8 ± 11.5 yrs), diabetes mellitus was the cause of end‐stage renal disease in 37 (92.5%). The men were older than the women (mean ± SD age 67.65 ± 11.43 yrs and 59.58 ± 10.6 yrs, respectively, p=0.03). Additional demographic data collected were start date and cause of end‐stage renal disease, comorbid conditions, drug profile, hospitalization dates, and reason for admission. Laboratory values were obtained for hematocrit, iron indexes (transferrin saturation and ferritin), mean corpuscular volume, and hemoglobin A1c (A1C); body weight before and after dialysis, and predialysis systolic and diastolic blood pressures were measured. All monitoring parameters were evaluated for 3 months before and after the start of therapy. Three patients were hospitalized for new or worsening chronic heart failure (two were receiving rosiglitazone therapy, one pioglitazone, p=0.555). Changes in A1C values were reviewed to determine thiazolidinedione efficacy; no statistical difference was observed between thiazolidinedione agents prescribed. Combined thiazolidinedione data yielded nonsignificant effects for all clinical and laboratory findings except A1C (‐0.61%, p=0.05) and blood pressure (systolic −5.57 ± 12.09 mm Hg, p=0.01; diastolic −3.24 ± 6.17 mm Hg, p=0.002).

Conclusion. Thiazolidinedione therapy is safe and effective for ambulatory patients receiving hemodialysis. However, as we found that these drugs reduced systolic and diastolic blood pressure, further investigation into this drug effect is warranted.
Coadministration of Milk Thistle and Indinavir in Healthy Subjects
Authors: DiCenzo Robert , Shelton Mark , Jordan Kelly , Koval Christine , Forrest Alan , Reichman Richard , Morse Gene
Published: May 2004

Study Objective. To determine if milk thistle (silymarin) alters the pharmacokinetics of indinavir.

Design. Sequential crossover trial.

Setting. General clinical research center.

Subjects. Ten healthy subjects.

Intervention. Indinavir 800 mg 3 times/day was given for four doses on days 1 and 2. Silymarin 160 mg 3 times/day was given on days 3–15. On day 16 and for one dose on day 17, both drugs were given at the same dosages.

Measurements and Main Results. Indinavir's pharmacokinetic parameters were evaluated at steady state both before and after administration of 14 days of silymarin. Blood samples were collected −0.25, 0.5, 1, 2, 3, 4, and 5 hours after indinavir dosing and assayed by high‐performance liquid chromatography. The final pharmacokinetic model had first‐order absorption after a lag time, and two compartments with first‐order elimination from the central compartment. When given alone and combined with silymarin, respectively, the geometric mean (95% confidence interval [CI]) steady‐state indinavir area under the plasma concentration‐time curve was 20.7 hr·mg/L (15.3–28.2 hr·mg/L) and 19.4 hr·mg/L (15.8–23.6 hr·mg/L) and the trough plasma concentration was 0.340 mg/L (0.232–0.497 mg/L) and 0.232 mg/L (0.129–0.419 mg/L).

Conclusion. Silymarin has no apparent effect on indinavir plasma concentrations.
Angiotensin‐Converting Enzyme Inhibitors and Type 2 Diabetic Nephropathy: A Meta‐Analysis
Authors: Hamilton Robert A. , Kane Michael P. , Demers Jason
Published: May 2004

Objective. To perform a meta‐analysis on studies evaluating the effect of angiotensin‐converting enzyme (ACE) inhibitors on diabetic nephropathy in patients with type 2 diabetes mellitus.

Methods. A computerized literature search was conducted for articles of studies comparing ACE inhibitors with a control in patients with diabetes, in which measurement of albuminuria or proteinuria was an outcome. Each article was abstracted by two of the authors. Data from the articles were presented as geometric or arithmetic means. The data were summarized separately by using standard techniques for meta‐analysis.

Main Results. Statistically significant reductions in albuminuria were observed regardless of whether data were described with geometric or arithmetic means. Both were associated with significant heterogeneity. When studies reporting geometric means were stratified and analyzed, the heterogeneity was lost and statistically significant reductions in albuminuria were observed. The same procedure was repeated for studies reporting arithmetic means, but heterogeneity remained.

Conclusion. The ACE inhibitors produce statistically significant reductions in albuminuria associated with significant heterogeneity of effect. Stratification reduces the heterogeneity and supports treatment with ACE inhibitors to reduce the progression of nephropathy in patients with type 2 diabetes mellitus.
A reliable control for the ammonia loop facing limit‐cycle and snowball effects
Authors: Rovaglio Maurizio , Manca Davide , Cortese Francesco
Published: May 2004

Autothermal catalytic reactors may show limit cycle behavior because of the simultaneous presence of inverse response and thermal feedback actions. In this study, a classical ammonia reactor (two beds, radial flow) was considered, and simulated together with the overall synthesis loop. Oscillations, caused by feed gas temperature disturbances, have been confirmed, whereas a pressure dependent hysteresis pattern appeared when the temperature is reset to the original design value. A more sensitive dynamic behavior is highlighted for the synthesis loop compared with the reactor alone, because of energy and material recycles. Finally, a control strategy extended to the overall synthesis loop has been tested in order to avoid dangerous dynamics and undesired reactor shutdown. The proposed control configuration, applied to the overall synthesis loop, is able to face and avoid both “snowball” effects and dangerous limit cycle conditions. © 2004 American Institute of Chemical Engineers AIChE J, 50: 1229–1241, 2004
FISH characterization of a dicentric Yq (p11.32) isochromosome in an azoospermic male
Authors: Codina‐Pascual M. , Oliver‐Bonet M. , Navarro J. , Starke H. , Liehr T. , Gutiérrez‐Mateo C. , Sánchez‐García J.F. , Arango O. , Egozcue J. , Benet J.
Published: May 2004

The most common structural rearrangements of the Y chromosome result in the production of dicentrics. In this work, we analyze an abnormal Y chromosome, detected as a mosaic in an azoospermic male ascertained for infertility. FISH with seven different DNA probes specific for Y chromosome sequences (Y α‐satellite, Y α‐satellite III, non‐α‐satellite centromeric Y, SRY gene, subtelomeric Yp, subtelomeric Yq, and PNA‐tel) and CGH analysis were performed. FISH results showed that the abnormal Y chromosome was a dicentric Yq isochromosome and that the breakpoint was distally in band Yp11.32. Lymphocyte chromosomes showed a mosaicism with 46,X,idicY(qter→p11.32::p11.32→qter) (51.7%), 46,XY (45.6%), and other cell lines (2.7%). In oral interphase cells, the mosaicism was 46,XidicY (62.8%), 46,XY (25.7%), 45,X (6.6%), and others (4.9%). The possible origin of this dicentric Yq isochromosome is discussed. Finally, we compare differences in mosaicism and phenotype among three reported cases with the breakpoint at Yp11.32 © 2004 Wiley‐Liss, Inc.
Gastropod egg mass deposition on a temperate, wave‐exposed coastline in New South Wales, Australia: implications for intertidal conservation
Authors: Benkendorff K. , Davis A.R.
Published: May 2004

The identification and protection of known breeding grounds is a high priority for the conservation of marine biodiversity. Here, we examine the intertidal habitats used by marine gastropods for the deposition of benthic egg masses along a wave‐exposed coastline in New South Wales, Australia.

A total of 200 surveys were conducted on 13 intertidal reefs. The egg masses of 46 species were identified, with a further eight distinct types recorded but remaining unidentified. Over half of the gastropods were found to deposit egg masses exclusively on the underside of boulders. Other intertidal substrata used for gastropod egg mass deposition included vertical and horizontal exposed rock surfaces, algal fronds and sand. Only eight species were found to attach their egg masses to more than one type of substratum.

Twelve reefs were classified into three categories according to exposure to wave action and habitat diversity. The mean number of species found depositing egg masses was compared using a standard eight surveys from each site. Sub‐maximally wave‐exposed reefs with maximal habitat diversity were found to support a significantly higher species richness of gastropod egg masses, compared with maximally wave‐exposed reefs with either maximal or sub‐maximal habitat diversity (p=0.000).

Gastropods that deposit egg masses on the underside of boulders were more likely to be found on sub‐maximally wave‐exposed reefs, whereas species that deposit egg masses in all other microhabitats were equally likely to be found breeding on sub‐maximally or maximally exposed reefs.

Gastropods with pelagic larvae tended to occur at a greater number of sites than those that hatch post‐metamorphosis. A significant difference was found between species grouped according to these two developmental modes for the mean number of sites at which egg masses were recorded (p=0.008).

Variation in the species richness of gastropods found depositing egg masses on different intertidal reefs appears to be influenced by the availability of suitable boulders and exposure to wave action. These factors should be taken into consideration during the selection of locations for intertidal protected areas.

Copyright © 2004 John Wiley & Sons, Ltd.
Are circle hooks an effective tool for conserving marine and freshwater recreational catch‐and‐release fisheries?
Authors: Cooke S.J. , Suski C.D.
Published: May 2004

Circle hooks have rapidly become popular among recreational anglers, based largely on the assumption that their use aids in the conservation of fisheries resources by reducing gut hooking, and hence mortality. In addition, circle hooks are intended to facilitate jaw hooking. Unfortunately, these assumptions have been perpetuated by anecdotal reports with very little rigorous scientific information to support these assertions.

A number of recently published, forthcoming, and grey literature reports provide an opportunity to review briefly and synthesize research conducted on circle hooks. We surveyed literature databases and also used questionnaires to solicit information from unpublished or in‐progress circle hook research.

Although among studies the results have been quite disparate, overall the mortality rates were consistently lower for circle hooks than J‐style hooks. In addition, circle hooks were more frequently hooked in the jaw, and less frequently hooked in the gut than conventional hook types. There is no doubt that in some marine fisheries, such as tuna, billfish, and striped bass, capture efficiency remains high and injury and mortality rates are drastically reduced. However, in other species (e.g. bluegill), injury can actually be more severe from circle hooks relative to some other hook types. In other species, such as largemouth bass, circle hooks have minimal conservation benefit, but have reduced capture efficiency relative to conventional hook designs.

Factors such as hook size, fishing style, fish feeding mode, and mouth morphology all appear to affect the effectiveness of circle hooks. For these reasons, it is difficult to promote the adoption of the use of circle hooks as a panacea for all fish and fisheries. Instead, we recommend that management agencies focus on recommending circle hooks only for instances for which appropriate scientific data exist.

The recent interest in circle hooks has been beneficial for stimulating interest and research on the role of hook designs in reducing hooking‐related injury and mortality. We encourage tackle manufacturers to continue to develop new hook designs that have the potential to provide conservation benefit to caught and released fish. This paper provides direction to management agencies and outdoor media for disseminating responsible information to anglers regarding the application of circle hooks for conserving fisheries resources.

Copyright © 2004 John Wiley & Sons, Ltd.
Overview of the OMRAS project: Online music retrieval and searching
Authors: Dovey Matthew J.
Published: May 2004

Until recently, most research on music information retrieval concentrated on monophonic music. Online Music Retrieval and Searching (OMRAS) is a three‐year project funded under the auspices of the JISC (Joint Information Systems Committee)/NSF (National Science Foundation) International Digital Library Initiative which began in 1999 and whose remit was to investigate the issues surrounding polyphonic music information retrieval. Here we outline the work OMRAS has achieved in pattern matching, document retrieval, and audio transcription, as well as some prototype work in how to implement these techniques into library systems.