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Purpose: Therapeutic drug monitoring (TDM) is widely recognised as a key attribute of clinical pharmacologists; yet, the extent to which physicians undertaking postgraduate training in clinical pharmacology (hereafter trainees) are involved in TDM is poorly characterised. Our own experience suggests wide variation in trainee exposure to TDM. Method: We performed a Europe-wide cross-sectional internet-based survey of trainees to determine the nature and extent of trainee involvement in TDM. Results: There were 43 responses from eight countries analysed. Of the 21 respondents from the UK, all were also training in general internal medicine (GIM), while all of the respondents who were solely training in clinical pharmacology were from outside the UK. Overall, 86.0% of respondents reported access to drug monitoring for clinical care at their affiliated institution, of which 81.0% were personally involved in TDM in some capacity. On average, trainees reported that drug monitoring was available for 16 of the 33 (48%) of the drug/drug classes surveyed. UK-based respondents were involved in requesting drug-level investigations and interpreting the results for patients under their care in 76.2% and 85.7% of cases, respectively, while non-UK respondents supported other healthcare professionals to interpret results in 45.4% of cases. Trainees felt TDM training was generally either insufficient or very inadequate. Conclusion: While access to TDM is relatively available at institutions where trainees are based, the role of trainees is variable and affected by a variety of factors including country and training programme. Universally, trainees feel they need more education in TDM. [ABSTRACT FROM AUTHOR]

Many archaeological sites along coastlines and rivers contain large quantities of marine and riverine bivalve shell. Often shell is the only datable organic material available to determine radiocarbon age estimates of features and to build regional chronologies. Shell is difficult to date accurately because of reservoir effects, and archaeologists have avoided it despite its abundance. If reservoir effects are understood, shell can provide accurate radiocarbon age estimates. This report provides an example using regression relations computed from radiocarbon assays of paired shell/charcoal samples from archaeological sites along the middle and lower Snake River, Northwestern North America. [ABSTRACT FROM AUTHOR]

The article focuses on circular letter Congregation for the Doctrine of the Faith (CDF) reminded episcopal conferences in which Pope Benedict XVI had promulgated a revised version of the motu proprio Sacramentorum sanctitatis tutela (SST). It mentions that the guidelines on delicta graviora including clergy sexual abuse of minors. It also mentions the degrees of collaboration between ecclesiastical and civil authorities in dealing abuse which impact the credibility of the Church's leadership.

In this article, the author discusses the responsibilities of a bishop for managing or administering diocesan personnel and financial resources. He states that the bishop manages resources to achieve celebration of divine worship, the ministry of charity the care of the Church's ministers. He mentions that Church goods are basically designed to serve church purposes including apostolic works of the church.

The article presents information on the legislative renewal of ecclesiastical laws. It emphasized on a point that such laws must provide legal certainty regarding the basic rights and duties of officeholders and also discusses the significance of historical change in laws if it is to serve the Church's mission well. It also discusses several aspects that necessitate a change in law including nature and purpose of plenary council, provincial council, and membership terms.

The article reflects on some of the canonical implications of a May 2010 papal document containing substantive and procedural norms on grave delicts reserved to the Congregation for the Doctrine of the Faith. The norms included in the document deal with the delict of clerical sexual abuse of minors and other delicts that impair the mission of the Church. It is noted that the revised norms released by the Church do not represent notable new canonical developments.

Context. Rising aminotransferases (ATs) [either aspartate aminotransferase (AST) or alanine aminotransferase (ALT) are one of the first signs of hepatotoxicity following acetaminophen (APAP)] overdose (OD). However, the timing and speed of such rises are not well characterized, hampering early risk prediction. Objective. To describe the kinetics of AT release in acute APAP OD patients who develop hepatotoxicity despite treatment. Methods. A descriptive study of acute APAP OD patients with peak AT > 1,000 IU/L taken from the derivation subset of the Canadian Acetaminophen Overdose Study (CAOS), a large, multicenter retrospective cohort of patients hospitalized for APAP poisoning. Results. Of 2,488 hospital admissions for acute APAP OD, 94 met inclusion criteria. Treatment with acetylcysteine, mostly intravenously, was begun in all cases within 24 h of ingestion. The initial AT concentration was already elevated in most patients at presentation [median 211 (IQR 77-511) IU/L obtained at 15.3 (12.1-19.2) h postingestion], and exceeded 100 IU/L in almost all patients within 24 h of ingestion. Serum AT concentrations rose rapidly [doubling time 9.5 h (95% CI: 8.7-10.4 h)], especially in patients who developed AT > 1,000 IU/L within 48 h of ingestion. Coagulopathy was worse in these patients and in those with an AT > 250 IU/L during the first 12 h of treatment with acetylcysteine. Discussion and conclusions. An abnormal and rapidly doubling AT at presentation is more typical in severely poisoned patients, as judged by the effects on clotting. These data suggest that risk prediction instruments may be improved by incorporating both the serum AT concentration at initiation of antidotal therapy and its rate of change. Further studies using such an approach are warranted. [ABSTRACT FROM AUTHOR]

Context. The first available predictors of hepatic injury following acetaminophen (APAP) overdose are the serum APAP and aminotransferases [AT, i.e ., aspartate (AST) aminotransferase or alanine (ALT) aminotransferase]. Objective. We describe the initial value, rate of change, and interrelationship between these biomarkers in patients who develop hepatotoxicity despite treatment following acute overdose. A new parameter, the APAP × AT multiplication product, is proposed for early risk stratification. Methods. We conducted a descriptive study of individuals selected from a multicenter retrospective cohort of patients hospitalized for APAP poisoning. We selected those acute APAP overdose patients who subsequently developed AT > 1,000 IU/L. Rising serum AT values were compared to simultaneously measured (or estimated) falling serum APAP. The APAP × AT was expressed relative to initiation of acetylcysteine therapy and grouped by time to meeting hepatotoxicity criteria. Results. In the 94 cases studied, serum APAP concentrations were still appreciable [median 570 (interquartile range (IQR) 314-983) μmol/L] at the time of the first measured AT [211 (77-511) IU/L at 15.3 (12.1-19.2) h post-ingestion], yielding an initial APAP × AT of 99,000 (52,000-240,000) μmol × IU/L2. Because serum AT rose rapidly (doubling time 9.5 h ) and APAP fell slowly (half-life 4.8 h), the multiplication product remained elevated during the first 12-24 h of antidotal therapy, especially among patients who developed earlier hepatotoxicity (AT > 1,000 IU/L). Discussion and conclusions. The APAP × AT multiplication product, calculated at the time of presentation and after several h of antidotal therapy, holds promise as a new risk predictor following APAP overdose. It requires neither graphical interpretation nor accurate time of ingestion, two limitations to current risk stratification. [ABSTRACT FROM AUTHOR]

The workup of the emergency patient with a raised anion gap metabolic acidosis includes assessment of the components of "MUDPILES" (methanol; uremia; diabetic ketoacidosis; paraldehyde; isoniazid, iron or inborn errors of metabolism; lactic acid; ethylene glycol; salicylates). This approach is usually sufficient for the majority of cases in the emergency department; however, there are many other etiologies not addressed in this mnemonic. Organic acids including 5-oxoproline (pyroglutamic acid) are rare but important causes of anion gap metabolic acidosis. We present the case of a patient with profound metabolic acidosis with raised anion gap, due to pyroglutamic acid in the setting of malnutrition and chronic ingestion of acetaminophen. [ABSTRACT FROM AUTHOR]

Several animal models have been used to investigate the mechanisms of atherogenesis. Each animal species has advantages and disadvantages with regard to similarity with human lipoprotein metabolism. In humans, fractional esterification rate in apolipoprotein B-depleted plasma (FERHDL) has been shown to correlate with the quality of high density lipoprotein particles. Increased values of FERHDL indicate an atherogenic lipoprotein profile. Such an association has not been defined in animal models. Thus, we have characterized plasma lipoprotein profile and FERHDL values in four animal species namely, cats, pigs, guinea pigs and rabbits. These animal species have been used in experimental dyslipidemia and atherosclerosis. Our data indicate a wide rage of variations among various animal species. High-density lipoprotein (HDL) particles contain approximately 40% of total plasma cholesterol concentrations in rabbits, pigs and cats <10% in guinea pigs. A negative association between FERHDL values and plasma HDL-cholesterol levels was observed in pigs, rabbits and guinea pigs. On the other hand, FERHDL values showed a positive association with plasma triglyceride levels in all animal species tested. These findings are in agreement with data reported in humans. More research is needed to identify the better animal models which closely resemble human lipoprotein metabolism. [Copyright &y& Elsevier]

The 1990 Native American Graves Protection and Repatriation Act requires universities, museums, and federal agencies to inventory their archeological collections to prepare for the repatriation of skeletons to their Native American descendants. The loss of these collections will be a detriment to the study of North American osteology, but the inventory and repatriation process has increased the number of skeletons studied from about 30% to nearly 100%. The availability of funds stimulated by this law produced osteological data collection and systematization unprecedented in the history of osteology. The possibility of forming partnerships between Native Americans and osteologists has the potential of producing a vibrant future for North American osteology and the new bioarcheology. [ABSTRACT FROM AUTHOR]

Explores theologically significant issues in the revised Code of Canon Law of 1983 in light of certain principles of institutional reforms. Organizational differences between the revised law and its 1917 predecessor; Fate of the Lex fundamentalism and the integration of its canons into the present law; Implications of each principles for the revised Code.

Presents information on the discovery of human skeletal remains in a gravel quarry in south-central Idaho near the town of Buhl in January 1989, which revealed the remains of a young Paleoindian woman. Estimated age of the Paleoindian woman; Description of her burial site; Suggestions from the isotopic analysis; What the radiographs revealed.

Presents a geochemical and microwear analysis of an obsidian artifact from the Brown Bluff Site in Arkansas. Description of the obsidian flake; Observations of microscopic damages in the artifact; Determination of the prehistoric uses of the artifact.