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Objective: This case series is a retrospective chart analysis conducted to evaluate the efficacy of duloxetine as a migraine preventive medication and to suggest possible predictors of response., Background: Duloxetine, a relatively new selective serotonin and norepinephrine reuptake inhibitor, is FDA-approved for treatment of depression and diabetic peripheral neuropathic pain. The efficacy of duloxetine as a headache preventive medication is currently unknown., Method: A retrospective chart review was performed using the electronic medical records of Headache Wellness Center, a headache specialty practice in Greensboro, North Carolina. From January 2004 to December 2006, 65 patients were identified who were prescribed duloxetine for migraine prevention for at least 2 months. Doses ranged from 30 mg qd to 90 mg qd. Frequency, severity, and impact of migraine disability were measured at baseline and compared to values obtained after 2 months of treatment., Results: The total patient sample demonstrated a reduction in mean monthly headache frequency from 19.40 (SD=7.1) to 15.70 (SD=8.2) (P= .01). The 50% responder rate was 22%. In subset analysis, individuals with abnormal baseline Zung anxiety scores demonstrated a greater reduction in mean monthly headache frequency (4.28, P= .03) and a greater responder rate (25%) than those in the total patient sample. Non-statistically significant trends were observed in those patients with abnormal baseline Zung Depression scores exhibiting a less robust mean monthly migraine reduction (2.75, P= .18) than those with normal baseline depression scores (3.42, P= .07)., Conclusions: Duloxetine demonstrates minimal effectiveness as a headache preventive medication. An interesting trend suggests that the presence of anxiety may be a positive predictor in treatment with duloxetine.

Despite repeated calls for gender-based recovery models for women, there has been a lack of empirical research on this topic. We thus sought to evaluate a women's manual-based substance use disorder recovery model in a pilot study. Participants were opioid-dependent women in a methadone maintenance treatment program who received 12 sessions of the gender-based model in group format over two months. Assessment was conducted before and after the intervention, with results indicating significant improvements in drug use (verified by urinalysis), impulsive-addictive behavior, global improvement, and knowledge of the treatment concepts. Patients' high attendance rate (87% of available sessions) and strong treatment satisfaction additionally support the potential use of this treatment model. Future research would benefit from larger samples and enhanced scientific methodology.

Understanding effects of flow alteration on stream biota is essential to developing ecologically sustainable water supply strategies. We evaluated effects of altering flows via surface water withdrawals and instream reservoirs on stream fish assemblages, and compared effects with other hypothesized drivers of species richness and assemblage composition. We sampled fishes during three years in 28 streams used for municipal water supply in the Piedmont region of Georgia, U.S.A. Study sites had permitted average withdrawal rates that ranged from < 0.05 to > 13 times the stream's seven-day, ten-year recurrence low flow (7Q10), and were located directly downstream either from a water supply reservoir or from a withdrawal taken from an unimpounded stream. Ordination analysis of catch data showed a shift in assemblage composition at reservoir sites corresponding to dominance by habitat generalist species. Richness of fluvial specialists averaged about 3 fewer species downstream from reservoirs, and also declined as permitted withdrawal rate increased above about 0.5 to one 7Q10-equivalent of water. Reservoir presence and withdrawal rate, along with drainage area, accounted for 70% of the among-site variance in fluvial specialist richness and were better predictor variables than percent of the catchment in urban land use or average streambed sediment size. Increasing withdrawal rate also increased the odds that a site's Index of Biotic Integrity score fell below a regulatory threshold indicating biological impairment. Estimates of reservoir and withdrawal effects on stream biota could be used in predictive landscape models to support adaptive water supply planning intended to meet societal needs while conserving biological resources.

Forested riparian corridors are thought to minimize impacts of landscape disturbance on stream ecosystems; yet, the effectiveness of streamside forests in mitigating disturbance in urbanizing catchments is unknown. We expected that riparian forests would provide minimal benefits for fish assemblages in streams that are highly impaired by sediment or hydrologic alteration. We tested this hypothesis in 30 small streams along a gradient of urban disturbance (1-65% urban land cover). Species expected to be sensitive to disturbance (i.e., fluvial specialists and "sensitive" species that respond negatively to urbanization) were best predicted by models including percent forest cover in the riparian corridor and a principal components axis describing sediment disturbance. Only sites with coarse bed sediment and low bed mobility (vs. sites with high amounts of fine sediment) had increased richness and abundances of sensitive species with higher percent riparian forests, supporting our hypothesis that response to riparian forests is contingent on the sediment regime. Abundances of Etheostoma scotti, the federally threatened Cherokee darter, were best predicted by models with single variables representing stormflow (r(2) = 0.34) and sediment (r(2) = 0.23) conditions. Lentic-tolerant species richness and abundance responded only to a variable representing prolonged duration of low-flow conditions. For these species, hydrologic alteration overwhelmed any influence of riparian forests on stream biota. These results suggest that, at a minimum, catchment management strategies must simultaneously address hydrologic, sediment, and riparian disturbance in order to protect all aspects of fish assemblage integrity.

Over 1 billion people lack access to improved water sources and 2.6 billion lack access to appropriate sanitation, greatly contributing to the global burden of disease. The international community has committed to reducing by half the proportion of the world's population lacking access to water and sanitation as a part of the Millennium Development Goals (MDGs). However, the disease burden due to poor access, is borne primarily by the poorest countries and the poorest people within them. Simply reducing the proportion of people without adequate access will not automatically result in proportional reductions in the related disease burden. The public health challenge inherent in meeting the MDG targets is ensuring that improvements result in access to water and sanitation for the critical at-risk populations. Innovative approaches are required to ensure the availability of low-cost, simple, and locally acceptable water and sanitation interventions and integrating these approaches into existing social institutions, such as schools, markets, and health facilities.

Background: The plant peroxisomal multifunctional protein (MFP) possesses up to four enzymatic activities that are involved in catalyzing different reactions of fatty acid beta-oxidation in the peroxisome matrix. In addition to these peroxisomal activities, in vitro assays revealed that rice MFP possesses microtubule- and RNA-binding activities suggesting that this protein also has important functions in the cytosol., Results: We demonstrate that MFP is an authentic microtubule-binding protein, as it localized to the cortical microtubule array in vivo, in addition to its expected targeting to the peroxisome matrix. MFP does not, however, interact with the three mitotic microtubule arrays. Microtubule co-sedimentation assays of truncated versions of MFP revealed that multiple microtubule-binding domains are present on the MFP polypeptide. This indicates that these regions function together to achieve high-affinity binding of the full-length protein. Real-time imaging of a transiently expressed green fluorescent protein-MFP chimera in living plant cells illustrated that a dynamic, spatial interaction exits between peroxisomes and cortical microtubules as peroxisomes move along actin filaments or oscillate at fixed locations., Conclusion: Plant MFP is associated with the cortical microtubule array, in addition to its expected localization in the peroxisome. This observation, coupled with apparent interactions that frequently occur between microtubules and peroxisomes in the cell cortex, supports the hypothesis that MFP is concentrated on microtubules in order to facilitate the regulated import of MFP into peroxisomes.

Migraine preventive medications considered effective reduce headache frequency by 50 percent in approximately 50 percent of treated patients. In spite of similar effectiveness, these medications vary tremendonsly in their prices. Knowledge of medication prices and employing cost-effective strategies may greatly reduce treatment costs.

Microtubules play an essential role in the growth and development of plants and are known to be involved in regulating many cellular processes ranging from translation to signaling. In this article, we describe the proteomic characterization of Arabidopsis tubulin-binding proteins that were purified using tubulin affinity chromatography. Microtubule co-sedimentation assays indicated that most, if not all, of the proteins in the tubulin-binding protein fraction possessed microtubule-binding activity. Two-dimensional gel electrophoresis of the tubulin-binding protein fraction was performed, and 86 protein spots were excised and analyzed for protein identification. A total of 122 proteins were identified with high confidence using LC-MS/MS. These proteins were grouped into six categories based on their predicted functions: microtubule-associated proteins, translation factors, RNA-binding proteins, signaling proteins, metabolic enzymes, and proteins with other functions. Almost one-half of the proteins identified in this fraction were related to proteins that have previously been reported to interact with microtubules. This study represents the first large-scale proteomic identification of eukaryotic cytoskeleton-binding proteins, and provides insight on subcellular trafficking, metabolic channeling, and signaling in plant cells.

Objective: To provide medication price data and cost-reducing strategies for the acute treatment of migraine., Methods: Retail prices for common acute care medications were found at http://www.drugstore.com. Cost-reduction tactics were obtained from literature searches and clinical experience., Results: Several strategies can reduce cost without sacrificing treatment outcome. In mild to moderate migraine, low-priced nonsteroidal anti-inflammatory drugs can be used as first-line medications due to their proven efficacy and favorable tolerability. For patients with more severe migraine, implementing a stratified care approach-using migraine-specific medications early in acute treatment-is cost-effective for most patients. Stratified care not only improves outcome and decreases disability, but also reduces cost. Pill splitting and early administration of triptans within an attack enhance their value. Supplying rescue medications, such as opioids, sedatives, and phenothiazines, can prevent emergency department visits. Minimizing multiple dosing of triptans and reducing utilization of expensive health care resources are key factors in reducing the cost of effective migraine treatment. An important affordability factor for patients with co-payments is the number of triptan pills per package. Sumatriptan, naratriptan, and frovatriptan each contain 9 tablets per package, while most other triptan packages contain 6. Current triptan retail prices (per unit) include: Amerge 1 and 2.5 mg, 17.78 dollars; Axert 6.25 and 12.5 mg, 16.31 dollars; Frova 2.5 mg, 13.89 dollars; Imitrex 50 mg, 14.96 dollars; Imitrex 100 mg, 14.41 dollars; Imitrex Nasal Spray 20 mg, 21.61 dollars; Imitrex SQ 6 mg, 50.26 dollars; Maxalt 5 and 10 mg, 15 dollars; Maxalt-MLT 5 and 10 mg, 15 dollars; Relpax 40 mg, 13.58 dollars; Zomig 2.5 mg, 13.67 dollars; Zomig 5 mg, 15.89 dollars; Zomig-ZMT 2.5 mg, 13.67 dollars; and Zomig-ZMT 5 mg, 15.89 dollars., Conclusions: Practitioners can optimize the use of health care dollars without compromising quality of care through awareness of cost-saving treatment strategies, as well as price variations among medications.

Over a 22 month period Barbus graellsii, Chondrostoma toxostoma, Cyprinus carpio, Esox lucius, Gobio gobio, and Leuciscus cephalus displayed non-random microhabitat use in the Rio Mattarraña, Spain and generally were overrepresented in deep microhabitats with low or undetectable flow velocities. Substrate composition did not strongly affect microhabitat use outside of its covariation with depth and velocity. Most seasonal differences in microhabitat use were attributable to seasonal changes in microhabitat availability, although all species selectively occupied deeper microhabitats during Spring 1984, 1985, and Early Summer 1984. Smaller specimens of B. graellsii, Ch. toxostoma, G. gobio, and L. cephalus all occurred closer to the substrate than larger specimens. Smaller specimens also tended to occupy shallower areas with greater amounts of erosional substrates (except for Ch. toxostoma). Assemblage members occupied statistically distinct microhabitats and could be classified as: 1) upper water column (L. cephalus), 2) mid-water column (Ch. toxostoma, C. carpio), 3) lower water column (B. graellsii), or 4) benthic (G. gobio, E. lucius). We hypothesize that the observed pattern of vertical segregation was produced by a combination of predator avoidance and differential evolutionary adaptation rather than by interspecific competition for space.

We examined microhabitat use in Barbus graellsii, Barbus haasi, Chondrostoma toxostoma, Rutilus arcasii, and Salmo gairdneri over a 19 month period in the upper Rio Matarraña, Spain. B. graellsii and Ch. toxostoma exhibited non-random microhabitat use during all seasons and preferentially occupied deep microhabitats with heterogeneous substrates. During the majority of seasons in which they were present, B. haasi and R. arcasii occurred in microhabitats similar to those occupied by B. graellsii and Ch. toxostoma. S. gairdneri was over-represented in high velocity microhabitats with erosional substrates. We did not observe any evidence of interspecific interference competition or avoidance. Substrate composition did not appear to affect microhabitat use outside of its covariation with depth and velocity. Seaonal variation in microhabitat use by B. graellsii, B. haasi and Ch. toxostoma was strongly correlated with seasonal changes in microhabitat availability. S. gairdneri, however, occurred closer to the substrate when average velocities were high. Larger B. graellsii and B. haasi sometimes occupied deeper, higher velocity microhabitats than did smaller specimens. Larger B. graellsii also occasionally occurred farther from shelter than did smaller specimens; the reverse was true for B. haasi. Larger Ch. toxostoma sometimes were found farther from both the substrate and shelter than smaller individuals, whereas smaller specimens occasionally inhabited deeper areas with more depositional substrates than did larger Ch. toxostoma. During Late Summer 1985, smaller Ch. toxostoma also occupied microhabitats with higher velocities than did larger specimens. A comparison of microhabitat use for two species present in both upper and lower portions of the Matarraña indicated that most differences in microhabitat use could be attributed to inter-site differences in microhabitat availability. The data suggest, hovever, that both species shifted to more protected microhabitats in the higher velocity site. Assemblage members generally occupied statistically distinguishable microhabitats and could be classified as: 1) high-velocity upper water column (S. gairdneri), 2) low velocity lower water column (B. graellsii, Ch. toxostoma and R. arcasii), and 3) shelter-oriented benthic (B. haasi). The introduction of S. gairdneri during Winter 1984 did not produce microhabitat shifts in any of the native species. Whether or not the native species affected microhabitat use in S. gairdneri is unknown. Interspecific competition for space, however, did not appear to strongly influence microhabitat use among the native species.

The heightened secretion of estrogen on diestrus-2 is required for the release of an ovulatory amount of LH on the following day, proestrus. Though these surges occur once every 4-5 days in cycling rats, the treatment of ovariectomized rats with a single injection of estrogen results in daily proestrus-like surges of LH. The present study was designed to test the possibility that progesterone, secreted on proestrus, prevents the daily expression of LH surges in cycling animals. The administration of estradiol benzoate (EB, 50 mug) to ovariectomized rats resulted in daily surges of LH secretion for 3 consecutive days. These surges were similar in the timing of onset and duration to the preovulatory surge of LH on proestrus. Serum LH concentrations were not increased on either the second or the third day when 5 mg of progesterone was given at 1600 h on the day of the first surge. These data suggest that progesterone blocks the expression of daily LH surges induced by estrogen. To determine whether this relationship obtains during the estrous cycle, groups of rats were treated with sodium pentobarbital (PB) at 1345 h during proestrus. This treatment postponed the proestrous surges of LH and progesterone for 24 h. When the surge of progesterone was simulated in PB-treated rats by the administration of 5 mg of the steroid at 1400 h during proestrus, a preovulatory surge of LH was not detected during either proestrous, estrus,, or diestrus-1. These data, taken together, suggest that estrogen turns on a "memory center" for the expression of daily LH surges and that one function of the increased secretion of progesterone on proestrus is to limit the expression of the "memory center" to this day.

This is the report on a study of patients admitted to a Level I trauma center. For a description of a trauma unit and a detailed analysis of the perioperative nurse's role in caring for the trauma patient in the OR, please see the accompanying article, "Perioperative nursing care of the multiple trauma patient: When seconds count."