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Selected AbstractsRegulation of the Flexibility of Planar Chiral [2.2]Paracyclophane Ligands and Its Significant Impact on Enantioselectivity in Asymmetric Reactions of Diethylzinc with Carbonyl Compounds.CHEMINFORM, Issue 51 2004Xun-Wei Wu Abstract For Abstract see ChemInform Abstract in Full Text. [source] Anthropology in the Public Sphere, 2008: Emerging Trends and Significant ImpactsAMERICAN ANTHROPOLOGIST, Issue 2 2009Melissa Checker ABSTRACT The themes, trends, and significant events of 2008 demonstrate that anthropology has established a new foothold in the public sphere,one that makes the most of novel forms of communication to reach far beyond the ivory tower to disseminate knowledge widely and freely. This review focuses on six topical areas of robust anthropological research in 2008 that also addressed some of the year's most pressing problems and issues, including the following: (1) war and peace; (2) climate change; (3) natural, industrial, and development-induced disaster recovery; (4) human rights; (5) health disparities; and (6) racial understanding, politics, and equity in the United States. It concludes by addressing some emerging issues in 2009 that especially require anthropological attention and insight, if we are to move beyond "business as usual."[Keywords: practicing anthropology, public anthropology, 2009 trends, anthropological impacts] [source] Significant impact of cutaneous T-cell lymphoma on patients' quality of lifeCANCER, Issue 10 2006Results of a 2005 National Cutaneous Lymphoma Foundation Survey Abstract BACKGROUND. Cutaneous T-cell lymphoma (CTCL) can have a profound impact on a patient's health-related quality of life; however, little is known about its actual impact. The authors evaluated patients' perspectives on the impact of CTCL on physical functioning, lifestyle, emotional well being, and satisfaction with treatment. METHODS. A 4-page, self-administered questionnaire was mailed and made available online in March 2005 to the entire United States membership of the Mycosis Fungoides Foundation (n = 930 members). Outcome measures were patients' perspectives on the psychosocial impact of CTCL and the management of their disease. RESULTS. The response rate was 68%, and 93.6% of respondents were white. The majority of respondents had mycosis fungoides (89%). Respondents were bothered by skin redness (94%) and by the extent of symptoms that affected their choice of clothing (63%). For most patients, the disease had a functional impact, rendering them tired or affecting their sleep. Health distress was reported by almost all respondents, with 94% reporting that they worried about the seriousness of their disease and 80% worrying about dying from the disease. Sixty-two percent of respondents reported that their disease made them feel unattractive, 85% reported that their treatment made their disease seem more manageable, but 61% reported that they felt burdened financially by their disease. CONCLUSIONS. The high response rate and patients' responses to the survey provided compelling evidence that patients believed CTCL had a profound and severe impact on their functioning, emotional, and social well being. A striking health distress was prevalent in almost all respondents. Although the majority of patients reported that treatments made their disease more manageable, a significant proportion reported that they felt burdened financially by their disease. Cancer 2006. © 2006 American Cancer Society. [source] Competence Models and the Maintenance ProblemCOMPUTATIONAL INTELLIGENCE, Issue 2 2001Barry Smyth Case-based reasoning (CBR) systems solve problems by retrieving and adapting the solutions to similar problems that have been stored previously as a case base of individual problem solving episodes or cases. The maintenance problem refers to the problem of how to optimize the performance of a CBR system during its operational lifetime. It can have a significant impact on all the knowledge sources associated with a system (the case base, the similarity knowledge, the adaptation knowledge, etc.), and over time, any one, or more, of these knowledge sources may need to be adapted to better fit the current problem-solving environment. For example, many maintenance solutions focus on the maintenance of case knowledge by adding, deleting, or editing cases. This has lead to a renewed interest in the issue of case competence, since many maintenance solutions must ensure that system competence is not adversely affected by the maintenance process. In fact, we argue that ultimately any generic maintenance solution must explicitly incorporate competence factors into its maintenance policies. For this reason, in our work we have focused on developing explanatory and predictive models of case competence that can provide a sound foundation for future maintenance solutions. In this article we provide a comprehensive survey of this research, and we show how these models have been used to develop a number of innovative and successful maintenance solutions to a variety of different maintenance problems. [source] Significance of Modeling Error in Structural Parameter EstimationCOMPUTER-AIDED CIVIL AND INFRASTRUCTURE ENGINEERING, Issue 1 2001Masoud Sanayei Structural health monitoring systems rely on algorithms to detect potential changes in structural parameters that may be indicative of damage. Parameter-estimation algorithms seek to identify changes in structural parameters by adjusting parameters of an a priori finite-element model of a structure to reconcile its response with a set of measured test data. Modeling error, represented as uncertainty in the parameters of a finite-element model of the structure, curtail capability of parameter estimation to capture the physical behavior of the structure. The performance of four error functions, two stiffness-based and two flexibility-based, is compared in the presence of modeling error in terms of the propagation rate of the modeling error and the quality of the final parameter estimates. Three different types of parameters are used in the parameter estimation procedure: (1) unknown parameters that are to be estimated, (2) known parameters assumed to be accurate, and (3) uncertain parameters that manifest the modeling error and are assumed known and not to be estimated. The significance of modeling error is investigated with respect to excitation and measurement type and locations, the type of error function, location of the uncertain parameter, and the selection of unknown parameters to be estimated. It is illustrated in two examples that the stiffness-based error functions perform significantly better than the corresponding flexibility-based error functions in the presence of modeling error. Additionally, the topology of the structure, excitation and measurement type and locations, and location of the uncertain parameters with respect to the unknown parameters can have a significant impact on the quality of the parameter estimates. Insight into the significance of modeling error and its potential impact on the resulting parameter estimates is presented through analytical and numerical examples using static and modal data. [source] THE IMPACT OF PRICES AND CONTROL POLICIES ON CIGARETTE SMOKING AMONG COLLEGE STUDENTSCONTEMPORARY ECONOMIC POLICY, Issue 2 2001C Czart Smoking among youths and young adults rose throughout the 1990s. Numerous policies were enacted to try to reverse this trend. However, little is known about the impact these policies have on the smoking behavior of young adults. This article uses a dichotomous indicator of daily smoking participation in the past 30 days, an ordered measure representing the frequency of cigarette consumption, and a quasi-continuous measure of the number of cigarettes smoked per day on average to examine the impact of cigarette prices, clean indoor air laws, and campus-level smoking policies on the smoking behaviors of a 1997 cross section of college students. The results of the analysis indicate that higher cigarette prices are associated with lower smoking participation and lower levels of use among college student smokers. Local- and state-level clean indoor air restrictions have a cumulative impact on the level of smoking by current smokers. Complete smoking bans on college campuses are associated with lower levels of smoking among current smokers but have no significant impact on smoking participation. Bans on cigarette advertising on campus as well as bans on the sale of cigarettes on campus have no significant effect on the smoking behavior of college students. [source] Effect of Oscillating Sheath on Near-Wall Electron Current Profile in Hall ThrustersCONTRIBUTIONS TO PLASMA PHYSICS, Issue 9-10 2008D. R. Yu Abstract The radial profile of the axial electron current in Hall thrusters was measured; however, the significant decay of the current density peak in the near-wall region can't be explained effectively by the steady sheath theory. As the sheath exhibits an oscillating character when the thruster is in operation, its effect on the near-wall current profile has been studied in this paper. To obtain a comprehensive knowledge, we have considered a wide sheath oscillation frequency span which includes two asymptotic frequency cases at high and low ends. Based on the case studied, either an analytical treatment or a numerical simulation is applied. The results show that the current density peak has a fastest damping speed away from the wall at the asymptotic low frequency. With the increase of the frequency, both the decay and the spatial "wavelength" of the current profile decrease. The decay finally disappears at the asymptotic high frequency with a constant spatial "wavelength". Moreover, the sheath oscillation amplitude can enhance the decay and enlarge the spatial "wavelength". Taking into account of the realistic situation in Hall thrusters, the significant impact of the oscillating sheath on the near-wall electron current profiles can be anticipant. (© 2008 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim) [source] Development of the Detachment under the Influence of the Supersonic Flow in the Divertor RegionCONTRIBUTIONS TO PLASMA PHYSICS, Issue 1-3 2008O. Marchuk Abstract It is demonstrated in the framework of a one-dimensional model for the scrape-off layer that with increasing upstream plasma density and decreasing temperature near divertor target plates a supersonic flow develops in the front of the target. This flow is an important mechanism for the transition from high-recycling regime to a weak detached state and has a significant impact on the plasma parameters, in particular, the pressure and particle flux to the plates, after detachment. (© 2008 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim) [source] Harmonization of light scatter and fluorescence flow cytometry profiles obtained after staining peripheral blood leucocytes for cell surface-only versus intracellular antigens with the Fix & PermÔ reagent,,§CYTOMETRY, Issue 1 2010Elaine Sobral da Costa Abstract Staining for intracellular markers with the Fix & PermÔ reagent is associated with variations in the scatter properties of leucocytes, limiting automated analysis of flow cytometry (FCM) data. Here, we investigated those variables significantly contributing to changes in the light scatter, autofluorescence, and bcl2 staining characteristics of peripheral blood (PB) leucocytes, after fixation with Fix & PermTM. Our major aim was to evaluate a new mathematical approach for automated harmonization of FCM data from datafiles corresponding to aliquots of a sample treated with cell-surface-only versus Fix & Perm intracellular staining techniques. Overall, neither the anticoagulant used nor sample storage for <24 h showed significant impact on the light scatter and fluorescence properties of PB leucocytes; similarly, the duration of the fixation period (once >15 min were used) had a minimum impact on the FCM properties of PB leucocytes. Conversely, changes in cell/protein concentrations and the fixative/sample (vol/vol) ratio had a clear impact on the light scatter features of some populations of leucocytes. Accordingly, lower cell/protein concentrations were associated with lower scatter values, particularly for the neutrophils. Such changes could be partially corrected through the use of higher fixative to sample volume ratios. Despite the variable changes detected between aliquots of the same sample treated with cell surface-only versus intracellular staining procedures, the new mathematical approach here proposed and evaluated for automated harmonization of common parameters in both datafiles, could correct the FCM profiles of leucocytes derived from cells undergoing conventional fixation/permeabilization procedures, and made them indistinguishable from those corresponding to aliquots of the same sample treated with cell-surface-only staining techniques. © 2009 Clinical Cytometry Society [source] Increased immature hematopoietic progenitor cells CD34+/CD38dim in myelodysplasiaCYTOMETRY, Issue 2 2006Mariela B. Monreal Abstract Background Myelodysplastic syndromes (MDS) are clonal disorders affecting hematopoietic progenitor cells (HPC). Despite the relevance of clonal CD34+ cells in developing MDS, only few studies analyze the phenotype of this cell population. The aim of this study was to evaluate phenotypic changes on HPC in MDS that could reflect abnormalities in the differentiation process of stem cells. Methods We analyzed the expression of CD38 and HLA-DR on CD34+ cells by flow cytometry in 36 patients with MDS, as well as in healthy donors (n = 12) and patients with other hematological disorders: non-Hodgkin lymphomas and multiple myeloma, both in complete remission (CR) (n = 32); acute lymphoblastic leukemia in CR (n = 17); de novo acute myeloblastic leukemia (AML) at diagnosis (n = 22) and in CR (n = 37); and AML secondary to MDS at diagnosis (n = 19). Cases with available karyotype were grouped according to the International Prognostic Scoring System (IPSS). Results Compared to normal BM, the fraction of immature HPC, characterized as CD34+bright, intermediate FSC/SSC, and CD38dim, was significantly increased in high risk MDS and secondary AML, but not in low risk MDS, (P , 0.001, P = 0.03, and P = 0.7). De novo AML showed decreased immature HPC. High numbers of immature HPC correlated with higher IPSS risk groups (P = 0.05) and showed significant impact on disease progression (P = 0.03). Conclusion Our study confirms that evaluation of CD38 expression pattern on HPC is an easy and reproducible test that allows evaluating the immature subset of progenitor cells. Increased immature HPC in high risk MDS and secondary AML may reflect blocked differentiation of CD34+ cells in these diseases. © 2006 International Society for Analytical Cytology [source] T-cell subset counting and the fight against AIDS: Reflections over a 20-year struggleCYTOMETRY, Issue 2 2002Francis Mandy Abstract The story of T-lymphocyte subset immunophenotyping technology is reviewed on the occasion of the 20th anniversary of CD4 T-cell enumeration. Over time, immunophenotyping has evolved into precise, reliable, but complicated and expensive technology requiring fresh blood samples. The gating technologies that were universally adapted for clinical flow cytometry for the past decade relied on rapidly deteriorating morphological scatter characteristics of leukocytes. This special issue dedicated to CD4 T-cell enumeration features most of the available new options that will have a significant impact on how this technology will be implemented within the first decade of the 21st century. In a series of original publications, including the new NIH guideline for T-cell subset enumeration, contemporary gating protocols that use immunologically logical parameters are presented as part of the more reliable and affordable immunophenotyping alternative. Some of the improvements addressed here include the costs of the assays and the capacity to monitor interlaboratory and intralaboratory performances. It is clear that an effective attack on the human immunodeficiency virus (HIV) epidemic has to embrace resource-poor regions. Reducing the cost of the assay while improving reliability and durability is a move in the right direction. Cytometry (Clin. Cytometry) 50:39,45, 2002. © 2002 Wiley-Liss, Inc. [source] Molecular diagnostics of non-small cell lung cancer using mediastinal lymph nodes sampled by endoscopic ultrasound-guided needle aspirationCYTOPATHOLOGY, Issue 1 2006M. Al-Haddad Non-small cell lung cancer is a common cancer with significant mortality. Accurate and early staging of this cancer has a significant impact on outcome. Endoscopic ultrasound-guided fine needle aspiration of involved mediastinal lymph nodes is critical for staging. Several molecular markers have been identified recently in association with non-small cell carcinoma of the lung that are promising to make early detection of metastatic disease more reliable. [source] Service Personnel, Technology, and Their Interaction in Influencing Customer Satisfaction,DECISION SCIENCES, Issue 1 2006Craig M. Froehle ABSTRACT Managing both the technologies and the personnel needed for providing high-quality, multichannel customer support creates a complex and persistent operational challenge. Adding to this difficulty, it is still unclear how service personnel and these new communication technologies interact to influence the customer's perceptions of the service being provided. Motivated by both practical importance and inconsistent findings in the academic literature, this exploratory research examines the interaction of media richness, represented by three different technology contexts (telephone, e-mail, and online chat), with six customer service representative (CSR) characteristics and their influences on customer satisfaction. Using a large-sample customer survey data set, the article develops a multigroup structural equation model to analyze these interactions. Results suggest that CSR characteristics influence customer service satisfaction similarly across all three technology-mediated contexts. Of the characteristics studied, service representatives contribute to customer satisfaction more when they exhibit the characteristics of thoroughness, knowledgeableness, and preparedness, regardless of the richness of the medium used. Surprisingly, while three other CSR characteristics studied (courtesy, professionalism, and attentiveness) are traditionally believed to be important in face-to-face encounters, they had no significant impact on customer satisfaction in the technology-mediated contexts studied. Implications for both practitioners and researchers are drawn from the results and future research opportunities are discussed. [source] Examining Drivers of Course Performance: An Exploratory Examination of an Introductory CIS Applications CourseDECISION SCIENCES JOURNAL OF INNOVATIVE EDUCATION, Issue 1 2006Rhonda A. Syler ABSTRACT The accelerating diffusion of broadband Internet access provides many opportunities for the development of pedagogically robust Web-based instruction (WBI). While the supporting technology infrastructure of broadband disseminates, the attention of academic researchers focuses upon issues such as the drivers of student usage of WBI. Specifically, the research presented herein examined the impact of WBI on a student's aggregate course performance. We hypothesized that learning independence (LI) is a determinate factor in a student's use of WBI. In this study, we employed structural equation modeling techniques to examine the data and assess the direct and indirect effects of LI on WBI usage. The subjects, students in an introductory Computer Information Systems applications course, used a Web-based tutorial program for skills instruction. The findings of this study suggest that WBI usage has a significant impact on a student's course performance. Despite its plausibility, the effect of LI on WBI usage was not significant. However, we did conclude that two of the second order factors of the LI construct have a direct effect on a student's performance in the course. [source] Structuring the Classroom for Performance: Cooperative Learning with Instructor-Assigned Teams*DECISION SCIENCES JOURNAL OF INNOVATIVE EDUCATION, Issue 1 2003Gary D. Koppenhaver ABSTRACT The main concern is a longstanding one in classroom instruction,the determinants of effective team performance. The paper explicitly examines the effect of teacher-controlled factors on the use and functioning of student teams. From a sample of 500 undergraduate students, data are obtained on aptitude, diversity, instability, motivation, personality style, size, and performance. The regression results suggest that team motivation and instability, which are both partly controlled by the instructor, are particularly important in determining a team's performance. An implication is that instructor decisions about team make-up and incentives can have a significant impact on student achievement. [source] Achieving remission with venlafaxine and fluoxetine in major depression: its relationship to anxiety symptomsDEPRESSION AND ANXIETY, Issue 1 2002Jonathan R.T. Davidson M.D., M.B.A. Abstract Venlafaxine, a serotonin and norepinephrine reuptake inhibitor (SNRI), produces significantly higher remission rates in depressed patients than do the selective serotonin reuptake inhibitors (SSRIs). In this analysis of pooled data, we explored the relationship between differences in treatment efficacy, early improvement of symptoms, and severity of baseline anxiety in depressed patients treated with either venlafaxine or fluoxetine. A pooled analysis was performed on data from 1,454 outpatients with major depression from five double-blind, randomized studies comparing the 6-week efficacy of venlafaxine (542 patients) with fluoxetine (555 patients). The Hamilton rating scale for depression (HAM-D) total and item scores were analyzed at different treatment times up to 6 weeks. Venlafaxine and fluoxetine both produced statistically significant higher response and remission rates compared with placebo starting from week 2 for response and weeks 3 to 4 for remission. Venlafaxine was statistically significantly superior to fluoxetine from week 3 until week 6 in respect of response rate, and from week 2 until week 6 for remission rate. After 1 week of treatment, greater improvement in individual symptoms was observed in the depressed mood, suicide, and psychic anxiety items of the HAM-D scale for both venlafaxine- and fluoxetine-treated patients compared with placebo. Improvement in psychic anxiety was statistically significantly greater with venlafaxine than with fluoxetine. The presence of baseline psychic anxiety correlated significantly to treatment outcome when analyzing the remission rates. In depressed patients with moderate anxiety (HAM-D psychic anxiety score ,2), venlafaxine statistically significantly increased remission rates compared with placebo from week 4 until week 6, while a significant effect of fluoxetine on remission rates was observed starting at week 6. Remission rates in the severely anxious depressed patients (score >2) were statistically significantly higher with venlafaxine than placebo starting from week 3 until the end of the study period, but no difference could be observed between fluoxetine and placebo. Baseline severity of psychic anxiety had a significant impact on remission rates after treatment of patients diagnosed with depression. Venlafaxine's superior remission rates in the more severely anxious patients and its ability to improve psychic anxiety as early as week 1 compared with fluoxetine suggest that venlafaxine's early efficacy on anxiety symptoms may be the basis for its superior efficacy in depression. Depression and Anxiety 16:4,13, 2002. © 2002 Wiley-Liss, Inc. [source] Simple Transfers, Complex Outcomes: The Impacts of Pensions on Poor Households in BrazilDEVELOPMENT AND CHANGE, Issue 5 2006Peter Lloyd-Sherlock ABSTRACT Drawing on quantitative survey data and in-depth interviews, this article seeks to map out the potential direct and indirect effects of simple cash transfers on households in impoverished rural and urban settings. Brazil is shown to have an extensive system of old age pensions, which affords almost universal coverage to households containing older people. These benefits have a significant impact on levels of poverty and vulnerability in recipient households. They also facilitate access to essential healthcare items, such as drugs, which are seldom freely available through the state health system. The in-depth interviews reveal that pensions can have important effects on intra-household relations, but these effects were not generalizable nor easily captured by quantitative survey tools. There was clear evidence that pensions reduced the propensity of older people to remain economically active, but this must be understood in a context of limited employment opportunities for all age groups and a high prevalence of disability. Overall, the article demonstrates the complex effects of a relatively simple cash transfer, which policy makers need to take into account. [source] Weight gain in bipolar disorder: pharmacological treatment as a contributing factorACTA PSYCHIATRICA SCANDINAVICA, Issue 1 2008C. Torrent Objective:, The aim of this paper was to review the association of most commonly used psychopharmacological drugs with weight gain in bipolar disorder. Method:, Information was retrieved from a PubMed/Medline literature search reviewing weight gain in pharmacological studies in bipolar disorder. Results:, Obesity and overweight in bipolar disorder are partly related to prescribed drugs with a strong effect of clozapine and olanzapine. Lesser but still relevant weight gain is caused by quetiapine, risperidone, lithium, valproate, gabapentin and by some antidepressants. Ziprasidone, aripiprazole, carbamazepine and lamotrigine do not seem to cause significant overweight. Conclusion:, Careful monitoring of weight changes in patients before and after drug prescription should be implemented in the clinical routine and drugs which potentially cause weight gain should be avoided in overweight patients with bipolar disorder. Furthermore, eating habits and daily activities should be targeted as they may also have a significant impact on overall health and weight-related issues. [source] A randomized controlled trial of the impact of therapeutic horse riding on the quality of life, health, and function of children with cerebral palsyDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 2 2009E DAVIS PHD This randomized controlled trial examined whether therapeutic horse riding has a clinically significant impact on the physical function, health and quality of life (QoL) of children with cerebral palsy (CP). Ninety-nine children aged 4 to 12 years with no prior horse riding experience and various levels of impairment (Gross Motor Function Classification System Levels I,III) were randomized to intervention (10wks therapeutic programme; 26 males, 24 females; mean age 7y 8mo [SD 2y 5mo] or control (usual activities, 27 males, 22 females; mean age 8y 2mo [SD 2y 6mo]). Pre- and post-measures were completed by 72 families (35 intervention and 37 control). Children's gross motor function (Gross Motor Function Measure [GMFM]), health status (Child Health Questionnaire [CHQ]), and QoL (CP QoL-Child, KIDSCREEN) were assessed by parents and QoL was assessed by children before and after the 10-week study period. On analysis of covariance, there was no statistically significant difference in GMFM, CP QoL-Child (parent report and child self-report), and CHQ scores (except family cohesion) between the intervention and control group after the 10-week study period, but there was weak evidence of a difference for KIDSCREEN (parent report). This study suggests that therapeutic horse riding does not have a clinically significant impact on children with CP. However, a smaller effect cannot be ruled out and the absence of evidence might be explained by a lack of sensitivity of the instruments since the QoL and health measures have not yet been demonstrated to be sensitive to change for children with CP. [source] The metabolic syndrome in type 2 diabetes: When does it matter?DIABETES OBESITY & METABOLISM, Issue 6 2006J. Wong Aims:, Young adults with type 2 diabetes (T2Dm) present the clinician with the problem of when to start therapies for the primary prevention of vascular disease and how to identify those at most vascular risk. We examine whether the metabolic syndrome (MetS) can be a useful clinical tool to stratify vascular risk in this context. Methods:, Data were collected from 5928 subjects with T2Dm, and subjects were categorized as having MetS by World Health Organization criteria (body mass index criteria modified for Asians using >23 kg/m2). The prevalence of macrovascular disease was examined by MetS status and age. Results:, The overall MetS prevalence was 72.3%. MetS was associated with an increased prevalence of ischaemic heart disease (IHD) (17.2% MetS vs. 11.6% no MetS, p < 0.0001), coronary artery bypass graft (7.6 vs. 4.7%, p < 0.0003), peripheral vascular disease (PVD) (4.7 vs. 3.7%, p = 0.08) and stroke (6 vs. 3.9%, p = 0.002) across all age groups. MetS subjects had an IHD prevalence equivalent to that seen in subjects who were one decade older without MetS. The most significant impact of MetS was for the age group of 40,49 years with much lesser impact seen with progressively increasing age [odds ratio (OR) = 2.1 for IHD in MetS compared with no MetS at age 40,50 years, p < 0.05; falling progressively to OR = 1.5 at age >70 years, p > 0.05]. Similar trends were seen for coronary artery by-pass graft (CABG) and PVD. There was a strong relationship between the number of MetS risk factors and IHD prevalence (r = 0.99, p = 0.0001). Conclusions:, These data suggest that MetS is particularly useful in stratifying vascular risk in younger T2Dm patients and in those with a high number of MetS components. For patients with MetS, especially those with a full house of MetS risk factors, commencing risk-lowering interventions 10 years earlier than their MetS-free counterparts could be considered. [source] Differentiating members of the thiazolidinedione class: a focus on efficacy,DIABETES/METABOLISM: RESEARCH AND REVIEWS, Issue S2 2002Barry J. Goldstein Abstract The thiazolidinediones (TZDs) or ,glitazones' are a new class of drug used for the treatment of type 2 diabetes. Although their precise mechanism of action is not known, TZDs target insulin resistance directly and thus tackle an underlying cause of the disease. Two TZDs are indicated for use in type 2 diabetes in the USA, pioglitazone and rosiglitazone. A third, troglitazone, has been associated with significant hepatotoxicity and has been withdrawn from use. In clinical trials, all three TZDs effectively lower blood glucose levels as monotherapy and in combination therapy with sulfonylureas, metformin and insulin. To date, head-to-head comparative studies with these agents have not been performed. It is difficult, therefore, to make direct comparisons of their efficacy since other variables, including baseline glucose levels and study design, can have a significant impact on treatment outcome. Despite this and in light of unique safety issues characterized with certain TZDs, it is useful to look closely at the efficacy data for these agents. It is not sufficient to assume that ,all glitazones are the same' because the studies have not yet been done to support this statement. This article will review what is known about the relative efficacy of the TZDs. Copyright © 2002 John Wiley & Sons, Ltd. [source] RD Lawrence Lecture 2009 Old genes, new tricks: learning about blood glucose regulation from naturally occurring genetic variation in humansDIABETIC MEDICINE, Issue 11 2009A. L. Gloyn Abstract The study of rare monogenic forms of diabetes and pancreatic B-cell dysfunction provides an unrivalled opportunity to link a specific change in gene function with precise cellular consequences and clinical phenotype in humans. Over the past 20 years there has been considerable success in determining the genetic aetiology of a number of rare monogenic forms of diabetes, which has had a significant impact on both our understanding of normal physiology and on translational medicine. The impact of these discoveries has been substantial, with insights into both developmental biology and normal physiology. There are clear examples where determining the genetic aetiology for individuals with rare monogenic subtypes of diabetes has led to improved treatment. Although formerly in the shadow of the monogenic diabetes field, over the past 3 years there has been staggering progress in our understanding of the genetic basis of Type 2 diabetes. This has been largely as a result of genome-wide association studies and has seen the list of ,diabetes susceptibility genes' increase from three to close to 20. There is now encouraging evidence to support a potential role for genetics in determining the response of individuals with Type 2 diabetes to different therapeutic options. One of the challenges that lies ahead is determining how the non-coding genetic variants exert their pathogenicity. It is possible that parallels can be drawn from functional work on rare regulatory mutations causing monogenic forms of diabetes. However, it is more likely that comprehensive approaches will be necessary. [source] Healthcare charges and utilization associated with diabetic neuropathy: impact of Type 1 diabetes and presence of other diabetes-related complications and comorbiditiesDIABETIC MEDICINE, Issue 1 2009Y. Zhao Abstract Aims The aim was to examine the impact of Type 1 diabetes and having any other diabetes-related complication or comorbidity on healthcare charges and utilization in patients with diabetic neuropathy (DN). Methods We selected individuals aged < 65 years who continuously enrolled in a large US commercial plan from July 2004 to June 2006 and who received at least one diagnosis of DN at any time from July 2004 to June 2005. We compared the prevalence of other diabetes-related complications or comorbidities between patients with Type 1 and with Type 2 diabetes. In patients with DN with or without any other diabetes-related complication or comorbidity, we used multivariate regression to assess the marginal contribution of Type 1 diabetes on healthcare charges and utilization from July 2005 until June 2006. Results The majority of DN patients had at least one other diabetes-related complication or comorbidity. Most of the DN patients had Type 2 diabetes. DN patients with Type 1 diabetes had more comorbid medical conditions than those with Type 2 diabetes. Compared with Type 2, Type 1 patients had a higher prevalence of each individual non-DN diabetes-related complication or comorbidity, except heart disease. Controlling for comorbidities, Type 1 and Type 2 patients with DN but no other diabetes-related complication or comorbidity had similar healthcare utilization. However, Type 1 patients had significantly higher charges than those with any other diabetes-related complication or comorbidity. Conclusions Many patients with DN have Type 1 diabetes and other common diabetes-related complications or comorbidities, which can have a significant impact on healthcare charges and utilization. [source] Clinical significance of cultures collected from fine-needle aspiration biopsyDIAGNOSTIC CYTOPATHOLOGY, Issue 2 2008Laura A. Granville M.D. Abstract The rate of positive cultures in fine-needle aspiration biopsy (FNAB) specimens is evaluated, and the value of submitting FNAB culture is assessed. Review of 3,300 FNAB specimens from 2,416 patients were tabulated for culture results, when obtained from the FNAB material. For positive culture results, clinical impact was assessed. Of 3,300 FNAB specimens and 2,416 patients, 185 had cultures performed (6% of specimens, 8% of patients). Of the 185 cultured specimens, 63 (34%) were positive and 122 (66%) were negative. Of the 63 positive cultures, 23 (12% of all FNAB cultures) had a significant impact on patient care. In our institution the FNA culture rate is 6%. When cases with clinical or microscopic suspicion of infection are cultured, 34% are positive for aerobic or anaerobic bacteria, mycobacteria or fungus. Culture in FNA specimens is a useful adjunct to diagnosis and impacts care in 12% of patients cultured at FNAB. This method can be used to triage patients with suspected infectious diseases and can aid in managing patients who may have recurrent infections. Diagn. Cytopathol. 2008;36:85,88. © 2008 Wiley-Liss, Inc. [source] Fine-needle aspiration of the testis in azoospermic men: The value of measuring serum follicle stimulating hormone and testicular sizeDIAGNOSTIC CYTOPATHOLOGY, Issue 4 2005W.A. Mourad M.D. Abstract Testicular fine-needle aspiration biopsy (FNAB) is used as a primary tool in assessing azoospermic infertile men in our institution. If the FNA is negative for sperm, a subsequent testicular biopsy specimen and wet preparation are obtained with possible immediate fertilization. To our knowledge, the value of these techniques in the context of testicular size and serum levels of follicle stimulating hormone (FSH) has not been explored. We reviewed 453 FNA biopsies of the testis performed for the identification of sperm in infertile azoospermic males between 1999 and 2000. We identified cases that had all three procedures (FNA, wet preparation and biopsy) performed. These were the patients that were compared for testicular size using Seager orchiometry and serum levels of FSH. Of the 453 FNAs reviewed, 128 (21%) had all three procedures performed. Seventy-two cases (56%) were negative in all three tests, 26 (20%) cases were positive in all tests, and 30 cases (23%) had different results. These 30 cases were excluded. The testicular size in the negative group ranged from 4 to 16 ml (median, 10 ml) and the positive group had testicular sizes ranging from 10 to 25 ml (median, 15 ml; P = 0.0001). The negative group had serum FSH levels ranging from 3 to 52 IU/l (median, 19 IU/l) whereas the positive group had serum levels ranging from 3 to 26 IU/l (median, 10 IU/l; P = 0.0001). Our findings suggest that in infertile azoospermic men, a testicular size of <10 ml combined with a serum FSH level of >19 IU/l, the chances of retrieving sperm are minimal using all three diagnostic modalities. The use of this cutoff point would lead to a 30,50% reduction in the number of procedures performed. This reduction would have a significant impact on the management of these patients with a significant decrease in cost, logistics, and patient anxiety. Diagn. Cytopathol. 2005;32:185,188. © 2005 Wiley-Liss, Inc. [source] Smaller and more numerous harvesting gaps emulate natural forest disturbances: a biodiversity test case using rove beetles (Coleoptera, Staphylinidae)DIVERSITY AND DISTRIBUTIONS, Issue 6 2008Jan Klimaszewski ABSTRACT Aim To evaluate changes in the abundance, species richness and community composition of rove beetles (Coleoptera, Staphylinidae) in response to three configurations of experimental gap cuts and to the effects of ground scarification in early succession yellow birch-dominated boreal forest. In each experimental treatment, total forest removed was held constant (35% removal by partial cutting with a concomitant decrease in gap size) but the total number of gaps was increased (two, four and eight gaps, respectively), resulting in an experimental increase in the total amount of ,edge' within each stand. Location Early succession yellow birch-dominated forests, Quebec, Canada. Methods Pitfall traps, ANOVA, MIXED procedure in sas®, post hoc Tukey's adjustment, rarefaction estimates, sum-of-squares and distance-based multivariate regression trees (ssMRT, dbMRT). Results Estimates of species richness using rarefaction were highest in clearcut and two-gap treatments, decreased in smaller and more numerous gaps and were significantly higher in scarified areas than in unscarified areas. ANOVA indicated a significant impact of harvesting on the overall standardized catch. Post hoc Tukey's tests indicated that the total catch of all rove beetles was significantly higher in uncut forests than in the treated areas. Both sum-of-squares and distance-based multivariate regression trees indicated that community structure of rove beetles differed among treatments. Assemblages were grouped into (a) control plots, (b) four- and eight-gap treatments and (c) two-gap and clearcut treatments. Main conclusions Rove beetle composition responded significantly to increasing gap size. Composition among intermediate and small-sized gap treatments (four- and eight-gap treatments) was more similar to uncut control forests than were larger gap treatments (two-gap) and clearcuts. Effects of scarification were nested within the harvested treatments. When the total area of forest removed is held constant, smaller, more numerous gaps are more similar to uncut control stands than to larger gaps and falls more closely within the natural forest heterogeneity. [source] The association of alcohol dependence with general practice attendanceDRUG AND ALCOHOL REVIEW, Issue 2 2009HEATHER PROUDFOOT Abstract Introduction and Aims. This study was designed to examine the relationship between alcohol dependence and general practitioner (GP) service attendance in Australia. Design and Methods. Data were analysed from the 1997 Australian National Survey of Mental Health and Wellbeing. In this survey, a representative sample of the Australian population was interviewed to ascertain past 12 month psychiatric diagnoses for all major mental disorders as well as the use of primary and other health services (n = 10 641, 79% response rate). Results. People with alcohol dependence comorbid with other psychiatric disorders have higher rates of service usage than those without such disorders. Discussion and Conclusions. Alcohol dependence comorbid with mental disorders has a significant impact on GP service in Australia. High rates of service use by individuals with such comorbidities were a considerable burden for GP services.[Proudfoot H, Teesson M. The association of alcohol dependence with general practice attendance. Drug Alcohol Rev 2009] [source] The prevalence of methamphetamine and amphetamine abuse in North America: a review of the indicators, 1992,2007DRUG AND ALCOHOL REVIEW, Issue 3 2008JANE CARLISLE MAXWELL PhD Senior Research Scientist Abstract Introduction. This paper reviews epidemiological information about methamphetamine production and use in North America. Methods. Information is drawn from a range of sources, including, but not limited to, historical accounts, peer-reviewed papers, population surveys and large national databases. Results. Methamphetamine and amphetamine use in North America is characterised by geographic variations, with different types of the drug, different routes of administration and different types of users at various times. Unlike some other drug use patterns in North America, the nature of methamphetamine use in Canada, Mexico and the United States has been linked closely in terms of production and supply of the drug. According to their national household surveys, the annual prevalence for ,speed' use in Canada was 0.8% in 2004, 0.3% for ,anfetaminas' and 0.1% for ,metanfetaminas' in Mexico in 2002, and 1.4% for ,stimulants' in the United States in 2006. Discussion. Although the data sources in the three North American countries are not consistent in methodology, terminology or frequency of reporting, all show similar trends. The type of stimulant most used has shifted from non-medical use of pharmaceutical amphetamine to use of powder methamphetamine and then to use of ,ice'. The indicators show the problem is greatest in the western parts of the countries and is moving eastward, but the decreased availability of pseudoephedrine may have a significant impact on the nature of the epidemic in the future. Nevertheless, use of methamphetamine poses a number of risks for users and specialised treatment resources for these various populations are needed. [source] Neuronal plasticity: implications in epilepsy progression and managementDRUG DEVELOPMENT RESEARCH, Issue 8 2007Sherifa A. HamedArticle first published online: 12 FEB 200 Abstract Epilepsy is a common neurological disease. A growing number of research studies provide evidence regarding the progressive neuronal damage induced by prolonged seizures or status epilepticus (SE), as well as recurrent brief seizures. Importantly, seizure is only one aspect of epilepsy. However, cognitive and behavioral deficits induced by progressive seizures or antiepileptic treatment can be detrimental to individual function. The neurobiology of epilepsy is poorly understood involving complex cellular and molecular mechanisms. The brain undergoes changes in its basic structure and function, e.g., neural plasticity with an increased susceptibility in neuronal synchronization and network circuit alterations. Some of these changes are transient, while others are permanent with an involvement of both glutamatergic and ,-aminobutyric acid (GABA)ergic systems. Recent data suggest that impaired neuronal plasticity may underlie the cognitive impairment and behavioral changes associated with epilepsy. Many neurologists recognize that the prevention or suppression of seizures by the use of antiepileptic drugs (AEDs) alone is insufficient without clear predictions of disease outcome. Hence, it is important to understand the molecular mechanisms underlying epileptogenesis because this may allow the development of innovative strategies to prevent or cure this condition. In addition, this realization would have significant impact in reducing the long-term adverse consequences of the disease, including neurocognitive and behavioral adverse effects. Drug Dev Res 68:498,511, 2007. © 2008 Wiley-Liss, Inc. [source] Antiepileptic drugs in the preventive treatment of migraine in children and adolescentsDRUG DEVELOPMENT RESEARCH, Issue 6 2007Catello Vollono Abstract Migraine prevalence in childhood ranges from 2.7 to 10% causing a significant impact on quality of life. No drugs are currently approved for use in the prevention of pediatric migraine. Antiepileptic drugs such as valproate and topiramate have been approved for the preventive treatment of migraine in adults. The present study aimed at reviewing evidence on the efficacy and safety of antiepileptic drugs in the preventive treatment of migraine in children and adolescents. We searched PubMed from 1988 to May 2007 and reviewed, abstracted, and classified relevant literature. Thirteen studies were reviewed. Data from randomized controlled trials are available only for valproate and topiramate. They show that both topiramate and valproate are effective in reducing headache frequency, intensity, and duration. As for safety and tolerability, topiramate is well tolerated, while there are insufficient data regarding the tolerability of valproate. Open-label or retrospective studies suggest that levetiracetam, zonisamide, and gabapentin are effective, but further evidence is warranted to confirm these data. Drug Dev Res 68:355,359, 2007. © 2007 Wiley-Liss, Inc. 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