Future Efforts (future + effort)

Distribution by Scientific Domains

Selected Abstracts

Show Us the Money: Lessons in Transparency from State Pharmaceutical Marketing Disclosure Laws

Susan Chimonas
Objective. To assess legislation requiring drug companies to report gifts to providers, and to evaluate the information obtained. Data Sources. Data included legislation in Vermont, Minnesota, Maine, Massachusetts, West Virginia, and the District of Columbia, and company disclosure data from Vermont. Study Design. We evaluated the strengths and weaknesses of state legislation. We also analyzed 4 years of company disclosures from Vermont, assessing the value and distribution of industry,provider exchanges and identifying emerging trends in companies' practices. Data Collection Methods. State legislation is publically available. We obtained Vermont's data through requests to the state's Attorney General's office. Principal Findings. Of the state laws, only Vermont's yielded robust, publically available data. These data show gifting was dominated by a few major corporations, and <2 percent of Vermont's prescribers received 69 percent of gifts and payments. Companies were especially generous to specialists in psychiatry, endocrinology/diabetes/metabolism, internal medicine, and neurology. Companies increasingly used loopholes in the law to avoid public scrutiny. Conclusions. Disclosure laws are an important first step in bringing greater transparency to physician,industry relationships. But flaws and weaknesses limit the states' ability to render physician,industry exchanges fully transparent. Future efforts should build on these lessons to render physician,industry relationships fully transparent. [source]

Immunopathogenesis of hepatitis C virus infection and hepatic fibrosis: New insights into antifibrotic therapy in chronic hepatitis C

Rosângela Teixeira
Fibrosis and cirrhosis represent the consequences of a sustained wound-healing response to chronic liver injury of any cause. Chronic hepatitis C virus (HCV) has emerged as a leading cause of cirrhosis in the USA and throughout the world. HCV may induce fibrogenesis directly by hepatic stellate cell activation or indirectly by promoting oxidative stress and apoptosis of infected cells. The ultimate result of chronic HCV injury is the accumulation of extracellular matrix with high density type I collagen within the subendothelial space of Disse, culminating in cirrhosis with hepatocellular dysfunction. The treatment of hepatitis C with the combination of pegylated interferon and ribavirin is still both problematic and costly, has suboptimal efficacy, serious side effects and a high level of intolerance, and is contraindicated in many patients. Hence, new approaches have assumed greater importance, for which there is an urgent need. The sustained progress in understanding the pathophysiology of hepatic fibrosis in the past two decades has increased the possibility of developing drugs specifically targeting the fibrogenic process. Future efforts should identify genetic markers associated with fibrosis risk in order to tailor the treatment of HCV infection based on genetically regulated pathways of injury and/or fibrosis. Such advances will expand the arsenal to overcome liver fibrosis, particularly in patients with hepatic diseases who have limited treatment options, such as those patients with chronic hepatitis C who have a high risk of fibrosis progression and recurrent HCV disease after liver transplantation. [source]

Costs of community-based public mental health services for older adults: variations related to age and diagnosis

Todd Gilmer
Abstract Background Several studies have examined service use among older adults although, to our knowledge, none has examined costs from a systems perspective. This study examined use and costs of mental health services among older adults in San Diego County in order to determine how expenditures and modes of service varied by age cohort and psychiatric diagnosis. Methods Utilization data from San Diego County Adult and Older Adult Mental Health Services (AOAMHS) were used to identify older adults (age,,,60) receiving services in the community during fiscal year 2003,2004. Cost data were derived from detailed examination of cost reports, and Medicaid fee schedules. Trends in demographic and clinical characteristics by six age cohorts were described. Multivariate models were used to estimate the relationships between costs, age, and clinical diagnosis while controlling for other demographic and clinical characteristics. Components of costs were also examined. Results Total expenditures declined from age cohorts 60,64 through ages 85 and over. Expenditures were similar, and greatest, for clients with schizophrenia and bipolar disorder, while outlays were lower for those with major depression, other psychotic disorder, other depression, anxiety, substance use disorder, and cognitive disorders. Clients diagnosed with cognitive disorder had high use of emergency services and little connection to outpatient services. Conclusions Expenditures were related to age and clinical diagnosis. Future efforts should investigate older adults' pathways to care, and should determine whether older adults presenting in emergency services would benefit from a specialized case management program providing linkages to community based resources. Copyright © 2006 John Wiley & Sons, Ltd. [source]

Predicting Cognitive Impairment in High-Functioning Community-Dwelling Older Persons: MacArthur Studies of Successful Aging

Joshua Chodosh MD, MSHS
OBJECTIVES: To examine whether simple cognitive tests, when applied to cognitively intact older persons, are useful predictors of cognitive impairment 7 years later. DESIGN: Cohort study. SETTING: Durham, North Carolina; East Boston, Massachusetts; and New Haven, Connecticut, areas that are part of the National Institute on Aging Established Populations for Epidemiological Studies of the Elderly. PARTICIPANTS: Participants, aged 70 to 79, from three community-based studies, who were in the top third of this age group, based on physical and cognitive functional status. MEASUREMENTS: New onset of cognitive impairment as defined by a score of less than 7 on the Short Portable Mental Status Questionnaire (SPMSQ) in 1995. RESULTS: At 7 years, 21.8% (149 of 684 subjects) scored lower than 7 on the SPMSQ. Using multivariate logistic regression, three baseline (1988) cognitive tests predicted impairment in 1995. These included two simple tests of delayed recall,the ability to remember up to six items from a short story and up to 18 words from recall of Boston Naming Test items. For each story item missed, the adjusted odds ratio (AOR) for cognitive impairment was 1.44 (95% confidence interval (CI) = 1.16,1.78, P < .001). For each missed item from the word list, the AOR was 1.20 (95% CI = 1.09,1.31, P < .001). The Delayed Recognition Span, which assesses nonverbal memory, also predicted cognitive impairment, albeit less strongly (odds ratio = 1.06 per each missed answer, 95% CI = 1.003,1.13, P = .04). CONCLUSIONS: This study identifies measures of delayed recall and recognition as significant early predictors of subsequent cognitive decline in high-functioning older persons. Future efforts to identify those at greatest risk of cognitive impairment may benefit by including these measures. [source]

Neoadjuvant strategies for the treatment of locally advanced esophageal cancer,

John R. Hyngstrom MD
Abstract Patients with locally advanced esophageal carcinoma have consistently poor survival following surgery with associated high systemic and local-regional failure rates. Neoadjuvant therapeutic strategies have been employed in an attempt to improve outcome with variable success. Randomized trials of either neoadjuvant chemotherapy or chemoradiotherapy have shown conflicting results regarding survival and local-regional control. Future efforts should focus on identifying novel agents and targets to improve therapeutic efficacy. J. Surg. Oncol. 2010; 101:299,304. © 2010 Wiley-Liss, Inc. [source]

Review article: from 1906 to 2006 , a century of major evolution of understanding of gastro-oesophageal reflux disease

Summary Background Our understanding of gastro-oesophageal reflux disease has undergone significant changes over the last century. Aim To trace the rise in understanding of gastro-oesophageal reflux disease and highlight remaining areas of uncertainty. Methods Literature review. Results In 1906, Tileston published his observations on ,peptic ulcer of the oesophagus'. Winkelstein, in 1934, first correlated symptoms of heartburn with acid regurgitation and reflux oesophagitis. In 1946, Allison described hiatus hernia as a causal factor in the development of gastro-oesophageal reflux disease. In 1958, Bernstein and Baker showed a direct relationship between oesophageal acidification and heartburn in patients with gastro-oesophageal reflux disease, irrespective of endoscopic findings, leading to the recognition of non-erosive gastro-oesophageal reflux disease. In the 1980s, continuous recordings of the lower oesophageal sphincter showed that episodes of reflux were related to transient relaxations of lower oesophageal sphincter tone. There is now increasing recognition that gastro-oesophageal reflux disease arises from the interaction of several anatomical and physiological factors. A turning point in the medical treatment of gastro-oesophageal reflux disease came with the introduction of the first proton pump inhibitor, omeprazole, in 1989. Conclusions Future efforts need to identify the multifactorial interactions of gastro-oesophageal junction anatomy and physiology in patients with gastro-oesophageal reflux disease. Increased understanding of the disease will guide development of new therapies. [source]

Developments in asbestos cancer risk assessment,

Michael A. Silverstein MD
Abstract Background Efforts have been made for 25 years to develop asbestos risk assessments that provide valid information about workplace and community cancer risks. Mathematical models have been applied to a group of workplace epidemiology studies to describe the relationships between exposure and risk. EPA's most recent proposed method was presented at a public meeting in July 2008. Methods Risk assessments prepared by USEPA, OSHA, and NIOSH since 1972 were reviewed, along with related literature. Results and Conclusions None of the efforts to use statistical models to characterize relative cancer potencies for asbestos fiber types and sizes have been able to overcome limitations of the exposure data. Resulting uncertainties have been so great that these estimates should not be used to drive occupational and environmental health policy. The EPA has now rejected and discontinued work on its proposed methods for estimating potency factors. Future efforts will require new methods and more precise and reliable exposure assessments. However, while there may be genuine need for such work, a more pressing priority with regard to the six regulated forms of asbestos and other asbestiform fibers is to ban their production and use. Am. J. Ind. Med. 52:850,858, 2009. © 2009 Wiley-Liss, Inc. [source]

Nonfatal work-related motor vehicle injuries treated in emergency departments in the United States, 1998,2002

Guang X. Chen MD
Abstract Background Current data on nonfatal work-related motor vehicle injuries are limited and fragmented, often excluding government workers, self-employed workers, and workers on small farms. This study seeks to bridge the present data gap by providing a national profile of nonfatal work-related motor vehicle injuries across all industries and occupations. Methods Study subjects were people who suffered nonfatal work-related motor vehicle injuries and were treated in a hospital emergency department in the United States. Subjects were identified from a stratified probability sample of emergency departments. National estimates and rates were computed. Results From 1998 to 2002, the average annual rate of nonfatal work-related motor vehicle injuries was 7 injuries per 10,000 full-time equivalents. The rate was three times higher in men than in women. The rates were higher in workers 15,19 years of age and in workers 70 years or older. Justice, public order, and safety workers had the largest number of injuries, and taxicab service employees had the highest injury rate of all industries. Truck drivers had the largest number of injuries, and police and detectives, public service employees had the highest injury rate of all occupations. Conclusion Future efforts need to develop and enhance the use of surveillance information at the federal and state level for work-related nonfatal motor vehicle injuries. Prevention efforts need to address occupational motor vehicle safety for both commercial truck/bus drivers and workers who are not commercial drivers but who drive light motor vehicles on the job. Am. J. Ind. Med. 52:698,706, 2009. © 2009 Wiley-Liss, Inc. [source]

Household smoking behaviours and exposure to environmental tobacco smoke among infants: are current strategies effectively protecting our young?

Justine B. Daly
Abstract Objective: To determine the prevalence of infant exposure to environmental tobacco smoke (ETS) among infants attending child health clinics in regional NSW; the association between such exposure and household smoking behaviours; and the factors associated with smoking restrictions in households with infants. Methods: Parents completed a computer-based questionnaire and infant urine samples were collected. Information was obtained regarding the smoking behaviours of household members and samples were analysed for cotinine. Results: Twenty seven per cent of infants had detectable levels of cotinine. Infant ETS exposure was significantly associated with the smoking status of household members, absence of complete smoking bans in smoking households and having more than one smoker in the home. Smoking households were significantly less likely to have a complete smoking ban in place. Conclusions: This study suggests that a significant proportion of the population group most vulnerable to ETS were exposed. Implications: Future efforts to reduce children's exposure to ETS need to target cessation by smoking parents, and smoking bans in households of infants where parents are smokers if desired reductions in childhood ETS-related illness are to be realised. [source]

Declining Antibiotic Prescriptions for Upper Respiratory Infections, 1993,2004

Stefan G. Vanderweil BA
Abstract Objectives: To examine antibiotic prescribing trends for U.S. emergency department (ED) visits with upper respiratory tract infections (URIs) between 1993 and 2004. Methods: Data were compiled from the National Hospital Ambulatory Medical Care Survey (NHAMCS). URI visits were identified by using ICD-9-CM code 465.9, whereas antibiotics were identified using the National Drug Code Directory class Antimicrobials. A multivariate logistic regression model revealed sociodemographic and geographic factors that were independently associated with receipt of an antibiotic prescription for URIs. Results: There were approximately 23.4 million ED visits diagnosed as URIs between 1993 and 2004. Although the proportion of URI diagnoses remained relatively stable (p trend = 0.26), a significant decrease in provision of antibiotic prescriptions for URIs occurred during this 12-year period, from a maximum of 55% in 1993, to a minimum of 35% in 2004. Patients who were prescribed antibiotics were more likely to be white than African American and to have been treated in EDs located in the southern United States. Conclusions: Antibiotic prescribing for URIs continues to decrease, a favorable trend that suggests that national efforts to reduce inappropriate antibiotic usage are having some success. Nevertheless, the frequency of antibiotic treatment for URI in the ED remains high (35%). Future efforts to reduce inappropriate antibiotic prescribing may focus on patients and physicians in southern U.S. EDs. Additional work is needed to address continued evidence of race-related disparities in care. [source]

Evaluation of a multifaceted intervention to limit excessive antipsychotic co-prescribing in schizophrenia out-patients

L. Baandrup
Baandrup L, Allerup P, Lublin H, Nordentoft M, Peacock L, Glenthoj B. Evaluation of a multifaceted intervention to limit excessive antipsychotic co-prescribing in schizophrenia out-patients. Objective:, To evaluate the effect of a multifaceted educational intervention on the frequency of antipsychotic co-prescribing in adult schizophrenia out-patients. Method:, Controlled quasi-experimental study performed in two Danish municipalities matched for baseline prevalence of antipsychotic polypharmacy, socioeconomic status and functional level of patients. The intervention was aimed at psychiatric healthcare providers and consisted of 1 day of didactic lectures, six 3-h educational outreach visits and an electronic reminder during drug prescribing. Results:, Between-group use of antipsychotic polypharmacy was compared at baseline (intervention group, N = 232/control group, N = 351) and after 1 year of intervention (intervention group, N = 216/control group, N = 386). The prevalence of antipsychotic polypharmacy at follow-up was not significantly different between treatment settings when adjusting for differences in case-mix (P = 0.07). Conclusion:, This multifaceted educational intervention failed to reduce the frequency of antipsychotic co-prescribing, but it suggested that future efforts to improve prescribing practice should address organizational barriers to implementation. [source]

Use of an empirically based marriage education program by religious organizations: Results of a dissemination trial,

Howard J. Markman
We present an evaluation of the extent to which an empirically based couples' intervention program was successfully disseminated in the community. Clergy and lay leaders from 27 religious organizations who were trained to deliver the Prevention and Relationship Enhancement Program (PREP) were contacted approximately yearly for 5 years following training to determine whether they still used PREP and which aspects were used. Results indicated that 82% continued to use at least parts of the program, especially parts dealing with communication and conflict management. Results also showed that clergy and lay leaders extended the use of the curriculum from premarital couples to married couples. We discuss implications for future efforts toward disseminating empirically based programs into community settings. [source]

Complexity of Family Life Among the Low-Income and Working Poor: Introduction to the Special Issue

Patricia Hyjer Dyk
Like all families, low-income and working-poor families need economic stability, safety, good health, and engagement in the larger community. However, the complexity of their lives is greatly impacted by limited economic resources. Three primary themes are explored by the 12 articles in this special issue: competing stressors and tensions, effective parenting, and economic stability and financial decision making. Key findings and program and policy implications identified by each set of authors are discussed. This body of work provides research-based practice and policy suggestions to guide future efforts in partnering with families to strengthen their families and communities for successful enhancement of child well-being. [source]

Second law analysis of two-stage compression transcritical CO2 heat pump cycle

Arif Emre Özgür
Abstract Because of the global warming impact of hydro fluorocarbons, the uses of natural refrigerants in automotive and HVAC industries have received worldwide attention. CO2 is the most promising refrigerant in these industries, especially the transcritical CO2 refrigeration cycle. The objective of this work is to identify the main factors that affect two-stage compression transcritical CO2 system efficiency. A second law of thermodynamic analysis on the entire two-stage CO2 cycle is conducted so that the exergy destruction of each system component can be deduced and ranked, allowing future efforts to focus on improving the components that have the highest potential for advancement. The inter-stage pressure is used as a variable parameter in the analysis study. The second law efficiency, coefficient of cooling performance and total exergy destruction of the system variations with the inter-stage pressure are presented graphically. It was concluded that there is an optimum inter-stage pressure that maximizes both first law and second law efficiencies. Copyright © 2008 John Wiley & Sons, Ltd. [source]

The current state of the center for the creation and dissemination of new Japanese nursing science: The 21st century Center of Excellence at Chiba University School of Nursing

Abstract Aim:, The Center of Excellence for the Creation and Dissemination of a New Japanese Nursing Science at Chiba University School of Nursing is now in its third year of operation. This center aims to develop nursing science that is appropriate for Japanese culture and to internationally disseminate the importance of culturally based care. Our project seeks to systematically transform the art of nursing practise into a nursing science. Method:, To date, multiple frameworks have been created through the qualitative meta-synthesis of research on effective nursing care. To create a nursing science, these frameworks derived from meta-synthesis must be verified and internalized in nursing practise. Results:, After three years of research, the following findings are emerging: professional care relationships in nursing practise in Japan are characterized by the bidirectional process between the nurse and the client, in which both gradually undergo a transformation in order to establish a collaborative, therapeutic relationship; Japanese nurses emphasize the importance of understanding adolescent clients' subjective understanding of their own life with self-care, as well as social support; and the priority for community health nurses in Japan is to create support systems in the community, regardless of whether the intended client is an individual, a family, a specific group, or the community as a whole. Conclusions:, Our future efforts will focus on verifying our findings through interdisciplinary and international comparative research and by integrating various frameworks in order to create a new Japanese nursing science. [source]

Existence of the School Health Coordinator in a Frontier State

Scott D. Winnail
Baseline data were collected soliciting the involvement of all 48 state school districts and the state girl's school (N = 49). Thirty-seven districts responded (75.5%). Identified school health coordinators were predominantly health and physical education teachers. Most coordinators spent minimal time (less than 10% of time) each week on school health coordination activities; nearly one half identified little or no coordination of school health efforts in their school districts; few identified personal involvement in budgetary matters concerning school health; and most identified their primary teaching responsibilities as the areas where the majority of their time was spent. Data collected help create a profile of the "typical" district level-school health coordinator in this frontier state and can assist in the development of future efforts aimed at school health coordination through the work of district-level school health coordinators. (J Sch Health. 2005;75(9):329,333) [source]


ABSTRACT The Lubricity Index (LI) is defined as a new parameter to quantitatively evaluate mouthfeel. Rheological data were collected using a helical ribbon mixer viscometer with commercial mayonnaise products. The LI is calculated from changes in apparent viscosity due to temperature and moisture variations that mirror those found in the mouth during mastication. The rate of change in apparent viscosity with moisture and temperature was much lower with a fat free product than regular products resulting in a low LI value. The LI provides a basis for future efforts to understand, and mathematically model, the complicated process of fluid food mastication. [source]

Actively regulating bioengineered tissue and organ formation

DJ Mooney
Structured Abstract Authors ,, Mooney DJ, Boontheekul T, Chen R, Leach K Objectives ,, Describe current and future approaches to tissue engineering, specifically in the area of bone regeneration. These approaches will allow one to actively regulate the cellular populations participating in this process. Design ,, Many approaches to actively regulate cellular phenotype are under exploration, and these typically exploit known signal transduction pathways via presentation of specific receptor-binding ligands, and may also deliver mechanical information via the physical bridge formed by the receptor-ligand interactions. Cellular gene expression may also be directly modulated utilizing gene therapy approaches to control tissue regeneration. Conclusions ,, Significant progress has been made to date in bone regeneration using inductive molecules and transplanted cells, and FDA approved therapies have resulted. While approaches to date have focused on delivery of single stimuli (e.g. one growth factor), future efforts will likely attempt to more closely mimic developmental processes by the delivery of multiple inputs to the cells in spatially and temporally regulated fashions. [source]

Occupational stress and work-related upper extremity disorders: Concepts and models,

Grant D. Huang MPH
Abstract Background While research has suggested that interventions targeted at occupational stress (job stress) factors may improve clinical and work outcomes related to work-related musculoskeletal disorders, the emerging hypotheses relating occupational stress to work-related upper extremity disorders (WRUEDs) are not particularly well known among occupational health providers and researchers. Methods Generic job stress and health models and multivariable models of WRUEDs were described and evaluated. Results Models on occupational stress and health/WRUEDs offer unique perspectives on the role of occupational stressors on WRUEDs. However, the limited support for the structure and proposed mechanisms of these models suggest that investigations examining and validating proposed biobehavioral pathways are still needed. Discussion Difficulties in conceptualizing occupational stress have, in the past, hindered its systematic incorporation into occupational health research and prevention/intervention strategies. The present paper provides a common basis for researchers and practitioners with diverse backgrounds to understand job stress and its relation to WRUEDs in order to enhance future efforts. Given the present limitations in the field and the need for comprehensive approaches to WRUEDs, there is great potential for occupational health researchers and clinicians to advance knowledge in this area. Am. J. Ind. Med. 41:298,314, 2002. © 2002 Wiley-Liss, Inc. [source]

Dihydropyrimidinase related protein-2 as a biomarker for temperature and time dependent post mortem changes in the mouse brain proteome

Bo Franzén
Abstract Proteome analysis in the central nervous system area represents a large and important challenge in drug discovery. One major problem is to obtain representative and well characterized tissues of high quality for analysis. We have used brain tissues from normal mice to study the effect of post mortem time (up to 32 h) and temperature (4°C and room temperature) on protein expression patterns. A number of proteins were identified using mass spectrometry and potential markers were localized. One of the proteins identified, dihydropyrimidinase related protein-2 (DRP-2), occurs as multiple spots in two-dimensional electrophoresis gels. The ratio between the truncated form of DRP-2 (fDRP-2) and full length DRP-2 is suggested as an internal control that can be used as a biomarker of post mortem time and post mortem temperature between unrelated brain protein samples. Results of this study may be useful in future efforts to detect disease specific alterations in proteomic studies of human post mortem brain tissues. [source]

In situ kinetic modelling of intestinal efflux in rats: functional characterization of segmental differences and correlation with in vitro results

Isabel González-Alvarez
Abstract The objective was to devise and apply a novel modelling approach to combine segmental in situ rat perfusion data and in vitro cell culture data, in order to elucidate the contribution of efflux in drug absorption kinetics. The fluoroquinolone CNV97100 was used as a model P-gp substrate. In situ intestinal perfusion was performed in rat duodenum, jejunum, ileum and colon to measure the influence of P-gp expression on efflux. Inhibition studies of CNV97100 were performed in the presence of verapamil, quinidine, cyclosporin A and p -aminohippuric acid. Absorption/efflux parameters were modelled simultaneously, using data from both in situ studies as well as in vitro studies. The maximal efflux velocity was modelled as a baseline value, corrected for each segment based on the expression level. CNV97100 passive diffusional permeability (Pdiff) and its affinity for the efflux carrier (Km) were assumed to be the same in all segments. The results indicate the new approach to combine in situ data and in vitro data succeed in yielding a unified, quantitative model for absorption/efflux. The model incorporated a quantitative relationship between P-gp expression level and the efflux functionality, both across in situ and in vitro systems, as well across different intestinal segments in the in situ studies. Permeability values decreased from duodenum to ileum in accordance with the increasing P-gp expression levels in rat intestine. The developed model reflects a strong correlation between in vitro and in situ results, including intrinsic differences in surface area. The successful application of a model approach to combine absorption data from two different experimental systems holds promise for future efforts to predict absorption results from one system to a second system. Copyright © 2007 John Wiley & Sons, Ltd. [source]

Epidemiology of Adverse Events in Air Medical Transport

Russell D. MacDonald MD
Abstract Objectives:, This observational study determined frequency and describes all-cause adverse event epidemiology in a large air medical transport system. Methods:, Records of a mandatory reporting system were reviewed and a data set containing all of the patient care records was searched to identify aviation- and non,aviation-related adverse events. Two reviewers independently identified adverse events and categorized them using an established taxonomy. Descriptive statistics were used to report adverse events, with frequency calculated per 1,000 flights and 1,000 hours flown. Results:, Between January 1, 2002, and June 30, 2005, there were 1,447 reports, of which 598 included an adverse event. Case-finding identified an additional 125. A complete report was available in 680 of 723 (94.1%) events. There were 58,956 flights and 103,632 hours flown during the study period, for a rate of 11.53 adverse events per 1,000 flights (95% CI = 10.7 to 12.4 adverse events) or 6.56 per 1,000 hours flown (95% CI = 6.1 to 7.1 adverse events). The frequencies of events by category were as follows: communication (229; 33.7%), transport vehicle (143; 21.0%), medical equipment (88; 12.9%), patient management (77; 11.4%), clinical performance (68; 10.0%), weather (30; 4.4%), unclassified (24; 3.5%), and patient factors causing death (21; 3.1%). There was possible patient harm in 117 events. Conclusions:, Air medical transport is associated with a low incidence of adverse events and possible patient harm. Communication problems were the most common cause of an event. Determining event epidemiology is necessary to identify modifiable factors, propose solutions to decrease the adverse events, and direct future efforts to improve safety. [source]

Female gametophyte development in Aristolochia labiata Willd. (Aristolochiaceae)

Piperales are an extremely diverse angiosperm lineage in terms of female gametophyte structure and, as such, an excellent candidate for comparative investigations of developmental evolution. In Piperales, Aristolochiaceae are sister to clades in which several divergent patterns of female gametophyte development are prevalent. Outgroup comparisons and explicit analyses of character evolution demonstrate that Polygonum -type female gametophyte development and structure in Aristolochiaceae appears to represent the plesiomorphic condition from which the divergent ontogenies of Piperales evolved. Here, we present detailed analyses of female gametophyte development in Aristolochia labiata that combine light and confocal microscopy with three-dimensional computer reconstruction. Our reconstructions demonstrate that, at the two-nucleate stage of development, separation of nuclei to opposite poles of the female gametophyte does not appear to be dependent on vacuolar expansion as generally hypothesized. We also found a decrease in antipodal volume following formation of the secondary nucleus. Our data provide a baseline for future efforts to describe developmental modifications responsible for evolutionary transitions in female gametophyte ontogeny throughout Piperales. © 2008 The Linnean Society of London, Botanical Journal of the Linnean Society, 2008, 158, 19,29. [source]

Spiro Skeletons: A Class of Privileged Structure for Chiral Ligand Design

Kuiling Ding Prof.
Abstract This Focus Review highlights the exciting results obtained in the area of asymmetric catalysis using spirobiindane- or spirobifluorene-based chiral ligands. The spiro, mono, and bidentate ligands have been successfully applied in a wide range of transition-metal-catalyzed asymmetric reactions, including hydrogenations, carbon,carbon and carbon,heteroatom coupling reactions, with superior or comparable enantioselectivities to those obtained by using the related ligands bearing other backbones, thus proving that the spiro skeleton is a type of privileged structure for chiral ligand design. It is expected that the spiro concept for chiral ligand design will stimulate the future efforts to understand the features that account for their broad applicability and to apply this understanding to seek new privileged chiral ligands and catalysts. [source]


Manolis Vavuranakis
SUMMARY 1Acute coronary syndromes are mostly the result of coronary plaque rupture. Diagnostic techniques focusing on the early detection of those plaques that are prone to rupture are still limited. Increased neovascularization in the adventitia and within the atherosclerotic plaque have recently been identified as common features of inflammation and plaque vulnerability. Contrast-enhanced intravascular imaging with microbubbles can be used to trace perfusion. 2In the present study, we examined the perivascular network of the left anterior descending coronary arteries and left circumflex arteries of four domestic, clinically healthy pigs using intracoronary ultrasound after injection of microbubbles with a differential imaging technique (ACESÔ; Computational Biomedicine Laboratory, University of Houston, Houston, TX, USA). Our aim was to detect blood flow into the coronary lumen and perivascular flow in contrast-enhanced images. Eleven regions of interest (ROI), including perivascular structures, were compared with regard to their grey scale level before and after the injection of SonoVue® (0.06 mL/kg; Bracco Diagnostics, Princeton, NJ, USA). 3A statistically significant (P = 0.018) enhancement was found in the echogenicity of the total perivascular space (adventitial region and perivascular vessels), as indicated by an increase in grey level intensity from 8.33 ± 0.80 (before) to 10.11 ± 0.88 (after microbubble injection). A significant enhancement of the 11 selected ROI (perivascular structures) was also recorded after the injection of microbubbles (from 7.92 ± 2.14 to 14.03 ± 2.44; P = 0.008). 4We believe that the detection of perivascular structures with contrast-enhanced intracoronary ultrasonography combined with proper image processing may reinforce our future efforts in the detection of vasa vasorum, an active participant in the creation of acute coronary events. [source]