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Critical Need (critical + need)
Selected AbstractsStagnation and the Critical Need for Hypertension SubtypingJOURNAL OF CLINICAL HYPERTENSION, Issue 3 2008Joseph L. Izzo Jr MD No abstract is available for this article. [source] Children and fighting forces: 10 years on from Cape TownDISASTERS, Issue 4 2009Lindsay Stark It is 10 years since the adoption of the Cape Town Principles and Best Practices on the Prevention of Recruitment of Children into the Armed Forces and on Demobilization and Social Reintegration of Child Soldiers in Africa. The field of programming for the reintegration of children associated with armed forces and armed groups has made significant strides in this period. However, important gaps in the knowledge base remain. This paper examines empirical evidence that supports lessons learned from work with children formerly connected with fighting forces. It evaluates what is known, where promising practice exists, and lacunae in five programming areas: psychosocial support and care; community acceptance; education, training and livelihoods; inclusive programming for all war-affected children; and follow-up and monitoring. While the 2007 Paris Commitments to Protect Children from Unlawful Recruitment or Use by Armed Forces or Groups mark an emerging consensus on many issues, there is still a critical need for more systematic studies to develop the evidence base supporting intervention in this area. [source] Microfluidic technologies for MALDI-MS in proteomicsELECTROPHORESIS, Issue 18 2006Don L. DeVoe Professor Abstract The field of microfluidics continues to offer great promise as an enabling technology for advanced analytical tools. For biomolecular analysis, there is often a critical need to couple on-chip microfluidic sample manipulation with back-end MS. Though interfacing microfluidics to MS has been most often reported through the use of direct ESI-MS, there are compelling reasons for coupling microfluidics to MALDI-MS as an alternative to ESI-MS for both online and offline analysis. The intent of this review is to provide a summary of recent developments in the integration of microfluidic systems with MALDI-MS, with an emphasis on applications in proteomics. Key points are summarized, followed by a review of relevant technologies and a discussion of outlook for the field. [source] Antioxidant Activity of Degradable Polymer Poly(trolox ester) to Suppress Oxidative Stress Injury in the CellsADVANCED FUNCTIONAL MATERIALS, Issue 1 2010Paritosh P. Wattamwar Abstract Oxidative stress is a pathological condition that has been implicated as a central player in a variety of diseases, including vascular and neurodegenerative diseases. More recently, oxidative stress has also been shown to be involved in the biological incompatibility of many materials, especially at the nanoscale. As such, there is a critical need for new biomaterials that can inhibit this response, improving the compatibility of medical devices. In this work, trolox, a synthetic antioxidant and water-soluble analogue of Vitamin E, is polymerized to form an oxidation active polymer as a new class of biomaterial. Synthesized poly(trolox ester) polymers were formulated into nanoparticles using a single emulsion technique, and their size was controlled by changing the polymer concentration in the organic solvent. Nanoparticle cytotoxicity, protective effects against cellular oxidative stress, and degradation kinetics were all evaluated. Poly(trolox ester) nanoparticles were found to have little to no cytotoxicity and were capable of suppressing cellular oxidative stress induced by cobalt nanoparticles. In vitro degradation studies of poly(trolox ester) nanoparticles indicate that the antioxidant activity of nanoparticles was derived from its enzymatic degradation to release active antioxidants. [source] Classification of liver and pancreatic traumaHPB, Issue 1 2006GABRIEL C. ONISCU Abstract The liver is the most frequently injured intra-abdominal organ and associated injury to other organs increases the risk of complications and death. This has highlighted the critical need for an accurate classification system as a basis for the clinical decision-making process. Several classification systems have been proposed in an attempt to incorporate the aetiology, anatomy and extent of injury and correlate it with subsequent clinical management and outcome. The widely accepted Organ Injury Scale is based on anatomical criteria that quantify the disruption of the liver parenchyma and defines six groups which may influence management strategies and relate to outcome. The less common pancreatic injury remains a major source of morbidity and mortality due to the likelihood of associated solid or hollow-organ injuries. The implication of a delay in diagnosis and management emphasizes the need for an accurate classification system. The Organ Injury Scale is widely used for pancreas trauma and recognizes the importance of progressive parenchymal injury and in particular ductal injury. Advances in imaging techniques have led to the development of newer radiological classification systems; however, validation of their accuracy remains to be proven. An accurate classification of liver and pancreatic trauma is fundamental for the development of treatment protocols in which clinical decisions are based on the severity of injury. [source] Interview with a Quality Leader: Paul Gluck, Immediate Past Chair, National Patient Safety FoundationJOURNAL FOR HEALTHCARE QUALITY, Issue 5 2009Pamela K. Scarrow Interviewer Abstract: Dr. Paul Gluck, MD, FACOG, has held many leadership positions. He served as the president/chair of the William A. Little OB/GYN Society, the Miami OB/GYN Society, the Florida OB/GYN Society, the Baptist Health Foundation, the Health Council of south Florida, the Florida Section of the American College of OB/GYN (ACOG), National Patient Safety Foundation, as well as the Dade County Medical Association. He is currently ACOG assistant secretary and serves on their Executive Committee. Dr. Gluck has an interest in access to healthcare. For his work in establishing a prenatal clinic in an area of critical need he received ACOG president's Service Award and Humanitarian of the Year Award from the South Florida Perinatal Network. He led the Florida initiative to promote depression screening and treatment in women recognized by the Wyeth National Section Award. He co-chaired the Governance Committee of the Mayor's Task Force charged with solving the problem of providing care for the over 450,000 uninsured residents of Miami-Dade County. [source] The Columbia Cooperative Aging Program: An Interdisciplinary and Interdepartmental Approach to Geriatric Education for Medical InternsJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 3 2006Mathew S. Maurer MD Although there is a critical need to prepare physicians to care for the growing population of older adults, many academic medical centers lack the geriatric-trained faculty and dedicated resources needed to support comprehensive residency training programs in geriatrics. Because of this challenge at Columbia University, the Columbia Cooperative Aging Program was developed to foster geriatric training for medical interns. For approximately 60 interns each year completing their month-long geriatric rotations, an integral part of this training now involves conducting comprehensive assessments with "well" older people, supervised by an interdisciplinary team of preceptors from various disciplines, including cardiology, internal medicine, occupational therapy, geriatric nursing, psychiatry, education, public health, social work, and medical anthropology. Interns explore individual behaviors and social supports that promote health in older people; older people's strengths, vulnerabilities, and risk for functional decline; and strategies for maintaining quality of life and independence. In addition, a structured "narrative medicine" writing assignment is used to promote the interns' reflections on the assessment process, the data gathered, and their clinical reasoning throughout. Preliminary measures of the program's effect have shown significant improvements in attitudes toward, and knowledge of, older adults as patients, as well as in interns' self-assessed clinical skills. For academic medical centers, where certified geriatric providers are scarce, this approach may be an effective model for fostering residency geriatric education among interns. [source] Guidelines for assessment of bone microstructure in rodents using micro,computed tomographyJOURNAL OF BONE AND MINERAL RESEARCH, Issue 7 2010Mary L Bouxsein Abstract Use of high-resolution micro,computed tomography (µCT) imaging to assess trabecular and cortical bone morphology has grown immensely. There are several commercially available µCT systems, each with different approaches to image acquisition, evaluation, and reporting of outcomes. This lack of consistency makes it difficult to interpret reported results and to compare findings across different studies. This article addresses this critical need for standardized terminology and consistent reporting of parameters related to image acquisition and analysis, and key outcome assessments, particularly with respect to ex vivo analysis of rodent specimens. Thus the guidelines herein provide recommendations regarding (1) standardized terminology and units, (2) information to be included in describing the methods for a given experiment, and (3) a minimal set of outcome variables that should be reported. Whereas the specific research objective will determine the experimental design, these guidelines are intended to ensure accurate and consistent reporting of µCT-derived bone morphometry and density measurements. In particular, the methods section for papers that present µCT-based outcomes must include details of the following scan aspects: (1) image acquisition, including the scanning medium, X-ray tube potential, and voxel size, as well as clear descriptions of the size and location of the volume of interest and the method used to delineate trabecular and cortical bone regions, and (2) image processing, including the algorithms used for image filtration and the approach used for image segmentation. Morphometric analyses should be based on 3D algorithms that do not rely on assumptions about the underlying structure whenever possible. When reporting µCT results, the minimal set of variables that should be used to describe trabecular bone morphometry includes bone volume fraction and trabecular number, thickness, and separation. The minimal set of variables that should be used to describe cortical bone morphometry includes total cross-sectional area, cortical bone area, cortical bone area fraction, and cortical thickness. Other variables also may be appropriate depending on the research question and technical quality of the scan. Standard nomenclature, outlined in this article, should be followed for reporting of results. © 2010 American Society for Bone and Mineral Research [source] Thiol oxidation of cell signaling proteins: Controlling an apoptotic equilibriumJOURNAL OF CELLULAR BIOCHEMISTRY, Issue 1 2004Janet V. Cross Abstract Studies of cell signal transduction have predominantly focused on regulation of protein function by phosphorylation. However, recent efforts have begun to uncover another layer of regulation mediated by direct oxidation of cysteine residues in signaling proteins. Typically induced during signaling responses accompanied by generation of reactive oxygen species, these thiol modifications have a variety of functional consequences for target proteins. Using specific signaling protein targets as examples, we discuss how thiol oxidation generally activates pro-apoptotic signaling pathways while inhibiting pathways that promote cell survival. We propose a model in which thiol oxidation acts to control the equilibrium between survival and apoptosis, fine tuning cellular responses that play a central role in the apoptotic decision-making process. We identify areas of focus for future work, including a better understanding of specificity in thiol oxidation events, and a critical need for approaches to examine these modifications under physiologically relevant signaling conditions. © 2004 Wiley-Liss, Inc. [source] COPD-intuition or template: nurses' stories of acute exacerbations of chronic obstructive pulmonary diseaseJOURNAL OF CLINICAL NURSING, Issue 6 2004Patricia Hill Bailey MHSc Study rational., A number of nurse-researchers have examined the experience of dyspnoea reduction during non-acute phases of the chronic obstructive pulmonary disease (COPD). However, nurses working on in-patient hospital units are frequently required to care for individuals suffering from acute exacerbations of their disease (AECOPD). These critically ill individuals present at health care institutions incapacitated by severe shortness of breath/dyspnoea that is frequently refractory to treatment. To date, little is known about the nurses' understanding of the care they provide for individuals hospitalized because of these acute episodes of their chronic illness. Study objectives., The research project was undertaken, in part, to develop an understanding of nurses' experience of caregiving for individuals hospitalized for in-patient care during an AECOPD. Methodological design., This focused ethnographic narrative examined the caregiving stories of 10 nurse caregivers. The 10 nurse caregivers were interviewed while caring for a patient and their family during an experience of an AECOPD characterized by incapacitating breathlessness. Results., The nurse caregivers told a number of caregiving stories that illustrated a common care template that appears to be based on intuition or pattern recognition focusing on anxiety sometimes to the exclusion of dyspnoea. Conclusions., Analysis of these stories emphasized the need to facilitate nurses individualization of standard templates. More importantly, this analysis illustrated the critical need to develop strategies to facilitate the reshaping of inaccurate templates in the presence of new knowledge. [source] Victim-reported risk factors for continued abusive behavior: Assessing the dangerousness of arrested batterersJOURNAL OF COMMUNITY PSYCHOLOGY, Issue 4 2003Lauren Bennett Cattaneo Policy changes have dramatically increased the number of domestic violence cases entering criminal courts, creating a critical need for competent risk assessment. This study adds to the knowledge base about risk factors important to consider in such assessments, using a prospective design and follow-up through victim interview. Participants were 169 primarily African American women who appeared at a court intake center following the arrest of an abusive partner. We reached over half of these participants for follow-up 3 months later. Questionnaires administered at intake elicited information about demographics, substance abuse, the history of physical and psychological abuse in the relationship, the batterer's general violence, and the victim's own assessment of her level of endangerment. All variables were measured through victim report, combined with official records when relevant. Significant predictors of continued abusive behavior were the batterer's history of alcohol abuse, the severity of abuse in the relationship, the batterer's general violence, the level of psychological abuse in the relationship, and, notably, the victim's own assessment of the dangerousness of her case. Most variables were stronger in their sensitivity, or ability to correctly identify reabusers, than their specificity, or ability to correctly identify nonreabusers. Implications for practice and research are discussed. © 2003 Wiley Periodicals, Inc. J Comm Psychol 31: 349,369, 2003. [source] Effects of environmental variables on fish feeding ecology: implications for the performance of baited fishing gear and stock assessmentJOURNAL OF FISH BIOLOGY, Issue 6 2004A. W. Stoner The effectiveness of baited fishing gear ultimately depends upon behaviour of the target species , activity rhythms, feeding motivation, and sensory and locomotory abilities. While any environmental parameter that mediates feeding or locomotion can have an important influence on the active space presented by the bait and fish catchability, few biologists have considered how such variation in behaviour might affect catch per unit effort (CPUE) and the resultant stock abundance estimates or population parameters. This review reveals that environment-related variation in feeding behaviour can act through four different mechanisms: metabolic processes, sensory limitations, social interactions and direct impacts. Water temperature, light level, current velocity and ambient prey density are likely to have largest effects on fish catchability, potentially affecting variation in CPUE by a factor of ten. Feeding behaviour is also density-dependent, with both positive and negative effects. Over time and geographic space a target species can occupy wide ranges of environmental conditions, and in certain cases, spatial and temporal variation in feeding biology could have a larger impact on CPUE than patterns of abundance. Temperature, light and current can be measured with relative facility and corrections to stock assessment models are feasible. Making corrections for biological variables such as prey density and bait competitors will be more difficult because the measurements are often not practical and relationships to feeding catchability are more complex and poorly understood. There is a critical need for greater understanding of how environmental variables affect feeding-related performance of baited fishing gear. A combination of field observations and laboratory experiments will be necessary to parameterize stock assessment models that are improved to accommodate variation in fish behaviour. Otherwise, survey data could reveal more about variation in behaviour than abundance trends. [source] Analysis of 5-fluorouracil in saliva using surface-enhanced Raman spectroscopyJOURNAL OF RAMAN SPECTROSCOPY, Issue 3 2005Stuart Farquharson Abstract The ability of surface-enhanced Raman spectroscopy (SERS) to measure the chemotherapy drug 5-fluorouracil in saliva is presented. A silver-doped sol,gel provided SERS and also some chemical selectivity. 5-Fluorouracil and physiological thiocyanate produced SERS, whereas large biochemicals, such as enzymes and proteins, did not, supporting the expectation that the larger molecules do not diffuse through the sol,gel to any appreciable extent. In addition, 5-fluorouracil samples of 2 µg ml,1 were easily measured, and an estimated limit of detection of 150 ng ml,1 in 5 min should provide sufficient sensitivity to perform pharmacokinetic studies and to monitor and regulate patient dosage. This would fill a critical need for this highly used drug, since genetic-based variations in its metabolism can range by as much as five-fold from one patient to another. Copyright © 2004 John Wiley & Sons, Ltd. [source] Delving into the "Institutional Black Box": Revealing the Attributes of Sustainable Urban Water Management Regimes,JOURNAL OF THE AMERICAN WATER RESOURCES ASSOCIATION, Issue 6 2009Susan J. Van De Meene van de Meene, Susan J. and Rebekah R. Brown, 2009. Delving into the "Institutional Black Box": Revealing the Attributes of Sustainable Urban Water Management Regimes. Journal of the American Water Resources Association (JAWRA) 45(6):1448-1464. Abstract:, This paper is based on the proposition that the transition to sustainable urban water management has been hampered by the lack of insight into attributes of a sustainable urban water regime. Significant progress has been made in developing technical solutions to advance urban water practice, however it is the co-evolution of the socio-institutional and technical systems that enable a system-wide transition. A systematic analysis of 81 empirical studies across a range of practice areas was undertaken to construct a schema of the sustainable urban water regime attributes. Attributes were identified and analyzed using a framework of nested management regime spheres: the administrative and regulatory system, inter-organizational, intra-organizational, and human resources spheres. The regime is likely to involve significant stakeholder involvement, collaborative inter-organizational relationships, flexible and adaptive organizational cultures, and motivated and engaging employees. Comparison of the constructed sustainable and traditional regime attributes reveals that to realize sustainable urban water management in practice a substantial shift in governance is required. This difference emphasizes the critical need for explicitly supported strategies targeted at developing each management regime sphere to further enable change toward sustainable urban water management. [source] Mapping ischemic risk region and necrosis in the isolated heart using EPR imagingMAGNETIC RESONANCE IN MEDICINE, Issue 6 2003Murugesan Velayutham Abstract Reperfusion of ischemic tissue is a common event in the treatment of heart attack and stroke. To study disease pathogenesis, methods are required to measure tissue perfusion and area at risk, as well as localized regions of injury. While histology can provide this information, its destructive nature precludes assessment of time course. Thus, there is a critical need for a noninvasive technique to obtain this information. To map myocardial redox state as a possible index of cellular ischemia and viability, electron paramagnetic resonance (EPR) imaging experiments were performed on isolated rat hearts before and after the onset of regional ischemia using nitroxide spin labels. With coronary artery occlusion, the EPR images clearly showed the risk region as a void of lower intensity that reversed upon reperfusion. The extent of risk region in the heart was similar in EPR imaging and histological measurements. The unique information obtained regarding the time course of changes in redox metabolism of the risk region and normal myocardium can provide important insights regarding the mechanisms of myocardial injury during and following ischemia. Magn Reson Med 49:1181,1187, 2003. © 2003 Wiley-Liss, Inc. [source] Modeling normal and pathological processes through skin tissue engineeringMOLECULAR CARCINOGENESIS, Issue 8 2007Marta Garcia Abstract Skin tissue engineering emerged as an experimental regenerative therapy motivated primarily by the critical need for early permanent coverage of extensive burn injuries in patients with insufficient sources of autologous skin for grafting. With time, the approach evolved toward a wider range of applications including disease modeling. We have established a skin-humanized mouse model system consisting in bioengineered human-skin-engrafted immunodeficient mice. This new model allows to performing regenerative medicine, gene therapy, genomics, and pathology studies in a human context on homogeneous samples. Starting from skin cells (keratinocytes and fibroblasts) isolated from normal donor skin or patient's biopsies, we have been able to deconstruct-reconstruct several inherited skin disorders including genodermatoses and cancer-prone diseases in a large number of skin humanized mice. In addition, the model allows conducting studies in normal human skin to gain further insight into physiological processes such as wound healing or UV-responses. © 2007 Wiley-Liss, Inc. [source] Knowledge Warfare in the 21ST Century: An Extension in PerformanceNAVAL ENGINEERS JOURNAL, Issue 2 2003Dr. Yvonne R. Masakowski ABSTRACT As we move into the 21st century, we are faced with a critical need to address the ways in which knowledge is generated and used to optimize system and human performance. Today, we are inundated with a plethora of information, emails, and ever-changing software. There is a dynamic relationship among humans, computers, expert systems and intelligent agent software that shapes the way we live, conduct business and participate in war. It is imperative that we master the critical components of knowledge management that will enhance their decision-making capacities and empower the warfighter. In the 21st century, knowledge management tools, intelligent agent architectures, robotics, and automated systems will facilitate expert performance necessary to fortify net-centric warfare. One of the principal metrics of performance will be our ability to reduce uncertainty and provide the most accurate information to the decision-maker at the right time. The importance of these goals becomes clear when considered within the context of images of the World Trade Center (WTC) crumbling to the ground. Now, we understand the cost of poor information in terms of life and freedom. This paper will provide an introduction to the importance of knowledge management and implications for future ship design. [source] Preventing War Through Nation-Building: A Self-Interested Approach to PeaceNEGOTIATION JOURNAL, Issue 4 2002David Hamburg The author, in this adaptation of his talk at the Hewlett Centers meeting, reflects on the post-September 11 world and the critical need to develop peacemaking processes in the 21st Century. One key area that needs attention is nation-building, or sharing the knowledge, skills, and democratic resources of the well-developed countries with less-developed nations. Such development activity is not only morally and ethically correct; it is in our own nation's self-interest as a security measure. Other important post-9/11 considerations include paying attention to what our critics are saying; understanding the media's pivotal role; working with NGOs; and encouraigng conflict resolution education. [source] Antiretroviral therapy adherence among patients living with HIV/AIDS in ThailandNURSING & HEALTH SCIENCES, Issue 2 2010Li Li phd Abstract The importance of antiretroviral therapy adherence for patients living with HIV/AIDS has been well documented. Despite this critical need, many do not follow prescribed regimens. To examine the barriers that lead to non-adherence, we used cross-sectional survey data from a randomized controlled intervention trial in northern and north-eastern Thailand. Of the 507 patients that were enrolled in the trial, we analyzed 386 patients on antiretroviral therapy in order to examine the barriers to adherence. In addition to demographic characteristics, depressive symptoms, physical health, access to care, social support, and internalized shame, HIV disclosure and family communication were examined. The correlation analysis revealed that adherence is significantly associated with internalized shame, access to care, depressive symptoms, and family communication. Based on the multiple logistic regression analysis, depressive symptoms, access to care, HIV disclosure, and family communication were significant predictors of adherence. Having depressive symptoms remains a significant barrier to adherence, while access to care, HIV disclosure, and family communication play important positive roles. Our findings underscore the critical importance of addressing these various challenges that can influence adherence to antiretroviral therapy. [source] Hemostatic complications of angiogenesis inhibitors in cancer patients,AMERICAN JOURNAL OF HEMATOLOGY, Issue 11 2008Francesca Elice Tumor vasculature and tumor-associated neo-angiogenesis have recently become major targets for rational drug design of antineoplastic agents. Five such agents with angiogenesis inhibiting activity (thalidomide, lenalidomide, bevacizumab, sunitinib, sorafenib) have already obtained US Food and Drug Administration approval for clinical use and many others have entered clinical trials. Vascular complications, including venous or arterial thromboembolism and hemorrhage, have emerged as relevant toxicities in several clinical trials with angiogenesis inhibitors. Given the well-known interplay between the blood clotting system, angiogenesis, and tumor growth, a better understanding of the impact of these new drugs on overall hemostatic balance is required. In this brief overview, we discuss the incidence of hemostatic complications, the likely pathogenetic mechanisms involved, and the critical need to establish in randomized clinical trials the usefulness of thrombosis prophylaxis to prevent these complications. Careful documentation of hemostatic complications during treatment with each of the new antiangiogenic drugs is warranted. Further studies are urgently required to better define the causal association of these new agents with hemostatic complications and to establish the best prophylactic strategy. Am. J. Hematol., 2008. © 2008 Wiley-Liss, Inc. [source] Latest news and product developmentsPRESCRIBER, Issue 10 2008Article first published online: 3 JUN 200 Glitazones more than double fracture risk An analysis of the UK General Practice Research Database has found that both glitazones increase the risk of fracture more than two-fold (Arch Intern Med 2008;168:820-5). Compared with nonusers, the odds ratio for fracture (mostly hip and wrist) was 2.59 for pioglitazone and 2.38 for rosiglitazone. The risk increased with dose but was unrelated to age and sex. Reduce antipsychotics in dementia patients Antipsychotics should be prescribed for patients with dementia only as a last resort at times of severe distress or critical need, the All-Party Parliamentary Group on Dementia has concluded. Its inquiry (available at www.alzheimers.org.uk) found that antipsychotics are being prescribed for patients with mild behavioural symptoms and for prolonged periods despite the limited benefits they offer and the risk of serious adverse effects such as stroke. Contributory factors include lack of training for staff, inadequate leadership and exclusion of family and friends from decisions about treatment. High-dose atorvastatin in chronic kidney disease High-dose atorvastatin (Lipitor) reduces cardiovascular events in patients with chronic kidney disease (CKD) more than a low dose , despite similar reductions in LDL-C (J Am Coll Cardiol 2008;51:1448-54). A post hoc subgroup analysis of the Treating-to-New-Targets study involving 10 001 patients with CHD, with or without CKD, found that atorvastatin 10 and 80mg per day reduced LDLC and triglycerides to similar levels; there was no change in HDL-C. After a median follow-up of five years, the incidence of cardiovascular events in patients with CKD was 9.3 per cent at 80mg per day and 13.4 per cent at 10mg per day (number needed to treat to prevent one event, NNT, 24). In patients with no CKD, the corresponding figures were 7.9 vs 9.2 per cent (NNT 74). There was no difference in all-cause mortality; adverse events were more frequent at the higher dose. COX-2 NSAIDs not more cost-effective An economic analysis of COX-2 selective NSAIDs has concluded that they are not more cost effective than older agents plus a proton pump inhibitor (PPI) in the treatment of osteoarthritis and rheumatoid arthritis (Health Technology Assessment 2008;12:No. 11). The analysis concluded that selective and nonselective NSAIDs were similarly effective but selective agents were associated with a lower risk of upper GI events and a higher risk of cardiovascular events. However, the available evidence includes only low numbers of events and further studies are needed. Compared with ibuprofen or diclofenac plus a PPI, the COX-2 selective NSAIDs look ,generally unattractive from a cost effectiveness point of view', even in high-risk patients with a history of peptic ulcer. There were insufficient data to allow a reliable comparison within the COX-2s. Naftidrofuryl helps intermittent claudication Naftidrofuryl increases pain-free walking distance (PFWD) in patients with intermittent claudication, a new Cochrane review has shown (Cochrane Database of Systematic Reviews 2008, Issue 2. Art. No.: CD001368. DOI: 10.1002/ 14651858.CD001368.pub3; also see page 49 in this issue). The meta-analysis of six trials involving a total of 1083 patients found that, compared with placebo, naftidrofuryl increased PFWD by over a third with a proportion successfully treated of 20 per cent (NNT 4.5). Coversyl Arginine To clarify any confusion following our recent news item (Perindopril brand switch, 19 April issue, page 12), Servier has asked us to reiterate that the new formulations Coversyl Arginine 2.5, 5 and 10mg are equivalent to 2, 4 and 8mg of the discontinued Coversyl formulation. Coversyl Arginine contains perindopril arginine, a salt that offers greater stability and a longer shelf-life. Prescriptions for the Coversyl brand of perindopril must in future be written as Coversyl Arginine in its revised strengths. Coversyl Plus has also been replaced by Coversyl Arginine Plus and the same revised dosages apply. Generic formulations of perindopril remain unaffected. Copyright © 2008 Wiley Interface Ltd [source] Violence Prevention in the Emergency Department: Future Research PrioritiesACADEMIC EMERGENCY MEDICINE, Issue 11 2009Debra Houry MD Abstract The 2009 Academic Emergency Medicine Consensus Conference working group session participants developed recommendations and research questions for violence prevention in the emergency department (ED). A writing group devised a working draft prior to the meeting and presented this to the breakout session at the consensus conference for input and approval. The recommendations include: 1) promote and facilitate the collection of standardized information related to violence victimization and perpetration in ED settings; 2) develop and validate brief practical screening instruments that can identify those at risk for perpetration of violence toward others or toward self; 3) develop and validate brief practical screening instruments that can identify victims at risk for violent reinjury and mental health sequelae; and 4) conduct efficacy, translational, and dissemination research on interventions for violence prevention. The work group emphasized the critical need and role of ED-based research to impact surveillance and prevention of future violence-related injury. [source] The structure of Cryptococcus neoformans thymidylate synthase suggests strategies for using target dynamics for species-specific inhibitionACTA CRYSTALLOGRAPHICA SECTION D, Issue 10 2005Robert H. O'Neil The ternary complex crystal structures of Cryptococcus neoformans and Escherichia coli thymidylate synthase (TS) suggest mechanisms of species-specific inhibition of a highly conserved protein. The 2.1,Å structure of C. neoformans TS cocrystallized with substrate and the cofactor analog CB3717 shows that the binding sites for substrate and cofactor are highly conserved with respect to human TS, but that the structure of the cofactor-binding site of C. neoformans TS is less constrained by surrounding residues. This feature might allow C. neoformans TS to form TS,dUMP,inhibitor complexes with a greater range of antifolates than human TS. 3,,3,,-Dibromophenol-4-chloro-1,8-naphthalein (GA9) selectively inhibits both E. coli TS and C. neoformans TS (Ki = 4,µM) over human TS (Ki >> 245,µM). The E. coli TS,dUMP,GA9 complex is in an open conformation, similar to that of the apoenzyme crystal structure. The GA9-binding site overlaps the binding site of the pABA-glutamyl moiety of the cofactor. The fact that human apoTS can adopt an unusual fold in which the GA9-binding site is disordered [Phan et al. (2001), J. Biol. Chem.276, 14170,14177] may explain the poor affinity of GA9 for the human enzyme. These observations highlight the critical need to incorporate multiple target conformations in any computational attempt to facilitate drug discovery. [source] Predictors of colorectal cancer screening from patients enrolled in a managed care health plan,CANCER, Issue 6 2008Melissa M. Farmer PhD Abstract BACKGROUND Despite the growing recognition of the importance of colorectal cancer (CRC) screening in reducing cancer mortality, national screening rates are low, indicating a critical need to understand the barriers and remedies for underutilization of CRC screening tests. METHODS Using results from independent cross-sectional telephone surveys with patients aged ,50 years performed before (2000; n = 498) and after (2003; n = 482) a quality improvement intervention for CRC screening within a large managed care health plan, the trends and predictors of CRC screening with fecal occult blood test (FOBT) and/or endoscopy (flexible sigmoidoscopy/colonoscopy) were examined from a patient perspective. RESULTS In 2000, patient reported screening rates within guidelines were 38% for any test, 23% for endoscopy, and 22% for FOBT. In 2003, screening rates increased to 50% for any test, 39% for endoscopy, and 24% for FOBT. Having discussed CRC with a doctor significantly increased the odds of being screened (FOBT: odds ratio [OR], 2.09 [95% confidence interval (95% CI), 1.47,2.96]; endoscopy: OR, 2.33 [95% CI, 1.67,3.26]; and any test: OR, 2.86 [95% CI, 2.06,3.96]), and reporting barriers to CRC in general decreased the odds of being screened (FOBT: OR, 0.76 [95% CI, 0.60,0.95]; endoscopy: OR, 0.74 [95% CI, 0.60,0.92]; and any test: OR, 0.66 [95% CI, 0.54,0.80]). CONCLUSIONS Although screening rates increased over the 3-year period, evidence was found of ongoing underutilization of CRC screening. The 2 strongest determinants of obtaining CRC screening were provider influence and patient barriers related to CRC screening in general, pointing to the need for multilevel interventions that target both the provider and patient. Cancer 2008. © 2008 American Cancer Society. [source] Fragile X-associated Tremor/Ataxia Syndrome (FXTAS)DEVELOPMENTAL DISABILITIES RESEARCH REVIEW, Issue 1 2004Paul J. Hagerman Abstract Carriers of fragile X mental retardation 1 (FMR1) premutation alleles (55 to 200 CGG repeats) are generally spared the more serious neurodevelopmental problems associated with the full-mutation carriers (>200 repeats) of fragile X syndrome. However, some adult male premutation carriers (55,200 repeats) develop a neurological syndrome involving intention tremor, ataxia, dementia, parkinsonism, and autonomic dysfunction. In excess of one-third of male premutation carriers over 50 years of age develop the fragile X- associated tremor/ataxia syndrome (FXTAS). FXTAS also represents a new form of inclusion disease, with eosinophilic intranuclear inclusions found throughout the brain in both neurons and astrocytes. Because FXTAS appears to be relatively specific to male premutation carriers, who are known to possess elevated levels of FMR1 mRNA, the neuropathology may arise as a consequence of a toxic gain-of-function of the mRNA itself, although this proposal requires additional direct testing. One of the critical needs at present is a better estimate for the prevalence of this disorder, because FXTAS is likely to be underdiagnosed in the adult movement disorders clinics. MRDD Research Reviews 2004;10:25,30. © 2004 Wiley-Liss, Inc. [source] | ||||||||||||||||||||||||||||||||||