Search

Background: Recent evidence from case reports, observational studies, and randomized trials suggests that long-term use of antidepressants increases the risk of developing diabetes. However, the nature of the relationship between antidepressants and diabetes remains unclear., Objective: To determine whether there is an association between antidepressant use and the risk of developing type 2 diabetes mellitus., Methods: A nested case-control study using the Texas Medicaid prescription claims database was conducted. Data were extracted for new users of either antidepressant agents (exposed) or benzodiazepines (unexposed) from January 1, 2002 through December 31, 2009. Patients aged 18-64 years without a history of diabetes were included in the cohort. The adjusted odds ratio (OR) and 95% confidence interval (CI) for the risk of diabetes associated with antidepressant exposure was computed using conditional logistic regression, controlling for demographic and clinical covariates., Main Outcome Measure: Development of type 2 diabetes mellitus., Results: Among the total sample (N = 44,715), the majority were in the exposed (N = 35,552) vs. the unexposed (N = 9,163) group. A total of 2,943 cases of type 2 diabetes mellitus and 11,748 matched controls (1:4) were identified using risk-set sampling. Cases and controls were matched using age and gender. Antidepressant use was associated with an increase in the risk of (type-2) diabetes when compared to benzodiazepine use [Adjusted Odds Ratio (OR) = 1.512; 95% CI 1.345-1.700]. The association was observed with serotonin-norepinephrine reuptake inhibitors (OR = 1.742; 95% CI 1.472-2.060), tricyclic antidepressants (OR = 1.533; 95% CI 1.295-1.814), selective serotonin reuptake inhibitors (OR = 1.457; 95% CI 1.279-1.659), "Other" antidepressants (OR = 1.318; 95% CI 1.129-1.540)., Conclusions: Antidepressant use was associated with an increased risk of (type-2) diabetes. This association was observed for tricyclic antidepressants, serotonin-reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, and other antidepressants.

Breast cancer treatment has changed substantially with increased specialization. Overall, the number of cases performed by residents upon completion of residency has decreased and the introduction of sentinel lymph node biopsy has reduced the number of axillary lymph node dissections being performed. Our objective was to evaluate the breast surgery education being provided by general surgery residency programs. A survey was administered to applicants to the Roswell Park Cancer Institute surgical oncology fellowship program in the fall of 2009. This survey examined the type of training program, the breast surgery exposure, and applicant comfort with the medical and surgical aspects of breast cancer. The survey was completed by 29 of 35 applicants. Of the respondents, 83 per cent were chief residents. Overall, participants had comfort levels above 8 (of 10) with breast related cases. For modified radical mastectomies and axillary lymph node dissections the comfort level dropped below 8. Participants were least comfortable discussing the medical management of breast cancer. General surgery residents completing training were less comfortable operating in the axilla compared with the breast. The study suggests careful attention should be paid to assuring adequate breast education in surgical residency.

Background: Total body volume (TBV), with the exclusion of internal air voids, is necessary to quantify body composition in Lohman's 4-compartment (4C) model., Objective: This investigation sought to derive a novel, TBV measure with the use of only dual-energy X-ray absorptiometry (DXA) attenuation values for use in Lohman's 4C body composition model., Design: Pixel-specific masses and volumes were calculated from low- and high-energy attenuation values with the use of first principle conversions of mass attenuation coefficients. Pixel masses and volumes were summed to derive body mass and total body volume. As proof of concept, 11 participants were recruited to have 4C measures taken: DXA, air-displacement plethysmography (ADP), and total body water (TBW). TBV measures with the use of only DXA (DXA-volume) and ADP-volume measures were compared for each participant. To see how body composition estimates were affected by these 2 methods, we used Lohman's 4C model to quantify percentage fat measures for each participant and compared them with conventional DXA measures., Results: DXA-volume and ADP-volume measures were highly correlated (R(2) = 0.99) and showed no statistically significant bias. Percentage fat by DXA volume was highly correlated with ADP-volume percentage fat measures and DXA software-reported percentage fat measures (R(2) = 0.96 and R(2) = 0.98, respectively) but were slightly biased., Conclusions: A novel method to calculate TBV with the use of a clinical DXA system was developed, compared against ADP as proof of principle, and used in Lohman's 4C body composition model. The DXA-volume approach eliminates many of the inherent inaccuracies associated with displacement measures for volume and, if validated in larger groups of participants, would simplify the acquisition of 4C body composition to a single DXA scan and TBW measure.

Background: Patients newly diagnosed with type 2 diabetes mellitus generally initiate therapy with either metformin [Met] or a sulfonylurea [SU] drug, followed by the addition of a second agent (Met, an SU drug, or a thiazolidinedione [TZD] drug) if the diabetes is not well controlled. If necessary, the usual third line of treatment is the addition of insulin., Objective: The purpose of our study was to compare the progression to insulin among 3 cohorts receiving the oral antidiabetic (OAD) drug combinations Met/SU, Met/TZD, or SU/TZD., Methods: This study used data from the Texas Medicaid database. The date of addition of a second OAD was considered a patient's index date and patients were followed for up to 5 years. Cox proportional hazards regression compared the progression to first insulin use among cohorts, using the Met/SU cohort as the reference group, while adjusting for demographics, comorbidities, and propensity scores., Results: A total of 4083 patients were included in the study (Met/SU = 2872, Met/TZD = 438, and SU/TZD = 773). Insulin was added to the medication regimen of patients by the end of follow-up in 19.7% of the Met/SU cohort, 17.6% of the Met/TZD cohort, and 26.3% of the SU/TZD cohort. The adjusted Cox proportional model estimated that patients in the SU/TZD cohort had a 40% higher probability of progression to insulin than patients in the Met/SU cohort (odds ratio [OR] = 1.40; 95% CI, 1.19-1.64), whereas there was no significant difference between the Met/TZD and Met/SU cohorts (OR = 0.85; 95% CI, 0.67-1.08)., Conclusions: It appears that mechanism of action may play a role in progression to insulin for concomitant OAD agents. A slower progression to insulin was seen for patients receiving a paired sensitizer regimen (ie, Met/TZD) compared with those receiving a secretagogue sensitizer regimen (ie, SU/TZD)., (Copyright © 2011 Elsevier HS Journals, Inc. All rights reserved.)

Protein lipidation and lipid trafficking control many key biological functions in all kingdoms of life. The discovery of diverse lipid species and their covalent attachment to many proteins has revealed a complex and regulated network of membranes and lipidated proteins that are central to fundamental aspects of physiology and human disease. Given the complexity of lipid trafficking and the protein targeting mechanisms involved with membrane lipids, precise and sensitive methods are needed to monitor and identify these hydrophobic molecules in bacteria, yeast, and higher eukaryotes. Although many analytical methods have been developed for characterizing membrane lipids and covalently modified proteins, traditional reagents and approaches have limited sensitivity, do not faithfully report on the lipids of interest, or are not readily accessible. The invention of bioorthogonal ligation reactions, such as the Staudinger ligation and azide-alkyne cycloadditions, has provided new tools to address these limitations, and their use has begun to yield fresh insight into the biology of protein lipidation and lipid trafficking. In this Account, we discuss how these new bioorthogonal ligation reactions and lipid chemical reporters afford new opportunities for exploring the biology of lipid-modified proteins and lipid trafficking. Lipid chemical reporters from our laboratory and several other research groups have enabled improved detection and large-scale proteomic analysis of fatty-acylated and prenylated proteins. For example, fatty acid and isoprenoid chemical reporters in conjunction with bioorthogonal ligation methods have circumvented the limited sensitivity and hazards of radioactive analogues, allowing rapid and robust fluorescent detection of lipidated proteins in all organisms tested. These chemical tools have revealed alterations in protein lipidation in different cellular states and are beginning to provide unique insights in mechanisms of regulation. Notably, the purification of proteins labeled with lipid chemical reporters has allowed both the large-scale analysis of lipidated proteins as well as the discovery of new lipidated proteins involved in metabolism, gene expression, and innate immunity. Specific lipid reporters have also been developed to monitor the trafficking of soluble lipids; these species are enabling bioorthogonal imaging of membranes in cells and tissues. Future advances in bioorthogonal chemistry, specific lipid reporters, and spectroscopy should provide important new insight into the functional roles of lipidated proteins and membranes in biology., (© 2011 American Chemical Society)

Aim: To investigate the influence of pharmacists' attitudes on intention to report serious adverse drug events (ADEs) to the Food and Drug Administration (FDA)., Methods: This cross-sectional study used a mail survey to collect data from hospital and community pharmacists practicing in Texas, United States. Three and 16 items were used to measure intention and attitudes, respectively, using a seven-point bipolar scale. Pharmacists' demographic and practice characteristics, and past reporting were also measured., Results: The response rate was 26.4% (n= 377/1500 pharmacists). Most pharmacists intended (n= 297, 78.8%) to report serious ADEs that they will encounter to the FDA through MedWatch. Overall, pharmacists held favourable attitudes towards reporting serious ADEs (mean = 24.5, SD = 6.7, possible range 1-49, neutral = 16). Pharmacists intending to report serious ADEs had more favourable attitudes than those who did not (P < 0.001). About 90% of the pharmacists believed that reporting serious ADEs would improve patient safety. However, 72.6% indicated that reporting serious ADEs was time consuming and over half (55.5%) of the respondents believed that reporting serious ADEs disrupted the normal workflow. Non-intenders held stronger beliefs that ADE reporting would disrupt the normal workflow and was time consuming compared with intenders. Years of experience, number of hours worked and practice setting were associated with pharmacists' attitudes towards reporting (P < 0.05)., Conclusions: Most pharmacists held moderately favourable attitudes and high intentions toward reporting serious ADEs to the FDA. This study's findings contribute to an increased understanding of individual factors that influence pharmacists' attitude and intention towards reporting serious ADEs to the FDA., (© 2011 The Authors. British Journal of Clinical Pharmacology © 2011 The British Pharmacological Society.)

Key impediments to increased corn yield and quality in the southeastern US coastal plain region are damage by ear-feeding insects and aflatoxin contamination caused by infection of Aspergillus flavus. Key ear-feeding insects are corn earworm, Helicoverpa zea, fall armyworm, Spodoptera frugiperda, maize weevil, Sitophilus zeamais, and brown stink bug, Euschistus servus. In 2006 and 2007, aflatoxin contamination and insect damage were sampled before harvest in three 0.4-hectare corn fields using a grid sampling method. The feeding damage by each of ear/kernel-feeding insects (i.e., corn earworm/fall armyworm damage on the silk/cob, and discoloration of corn kernels by stink bugs), and maize weevil population were assessed at each grid point with five ears. The spatial distribution pattern of aflatoxin contamination was also assessed using the corn samples collected at each sampling point. Aflatoxin level was correlated to the number of maize weevils and stink bug-discolored kernels, but not closely correlated to either husk coverage or corn earworm damage. Contour maps of the maize weevil populations, stink bug-damaged kernels, and aflatoxin levels exhibited an aggregated distribution pattern with a strong edge effect on all three parameters. The separation of silk- and cob-feeding insects from kernel-feeding insects, as well as chewing (i.e., the corn earworm and maize weevil) and piercing-sucking insects (i.e., the stink bugs) and their damage in relation to aflatoxin accumulation is economically important. Both theoretic and applied ramifications of this study were discussed by proposing a hypothesis on the underlying mechanisms of the aggregated distribution patterns and strong edge effect of insect damage and aflatoxin contamination, and by discussing possible management tactics for aflatoxin reduction by proper management of kernel-feeding insects. Future directions on basic and applied research related to aflatoxin contamination are also discussed.

Objectives: To assess Texas pharmacists' knowledge of adverse drug event (ADE) reporting to the Food and Drug Administration (FDA) and to determine demographic and practice characteristics associated with this knowledge., Design: Cross-sectional descriptive study., Setting: Austin, TX, in June and July 2009., Participants: 377 pharmacists practicing in hospital and community settings., Intervention: Survey instrument mailed to participants., Main Outcome Measures: Scores on an eight-item test were used to assess pharmacists' knowledge about ADE reporting to FDA. Pharmacists' demographic and practice characteristics, as well as past reporting, were also measured., Results: 1,500 surveys were mailed and 377 usable responses were obtained (26.4% response rate). Most (67.9%) pharmacists had never reported ADEs to FDA. A majority of pharmacists (65.7%) reported having inadequate knowledge about ADE reporting. Pharmacists had low knowledge scores on ADE reporting, and the pass rate for all items ranged from 56.7% to 96.0%. Pharmacists' age (r = -0.106, P = 0.042) and years of experience (-0.134, P = 0.010) were negatively correlated with knowledge levels, whereas hours worked by pharmacists was positively correlated with knowledge levels (0.130, P = 0.012). Mean knowledge levels differed by practice setting, job title, and area/setting of primary place of employment (P < 0.001)., Conclusion: Texas pharmacists have knowledge gaps concerning ADE reporting to FDA. Pharmacists need more education, awareness, and training on ADE reporting, especially regarding reportable ADEs, how to report, and what constitutes a good report.

Bioorthogonal chemical reporters are useful tools for visualizing and identifying post-translational modifications on proteins. Here we report the proteomic analysis of mammalian proteins targeted by a series of fatty acid chemical reporters ranging from myristic to stearic acid. The large-scale analysis of total cell lysates from fully solubilized Jurkat T cells identified known fatty-acylated proteins and many new candidates, including nuclear proteins and in particular histone H3 variants. We demonstrate that histones H3.1, H3.2, and H3.3 are modified with fatty acid chemical reporters and identify the conserved cysteine 110 as a new site of S-acylation on histone H3.2. This newly discovered modification of histone H3 could have implications for nuclear organization and chromatin regulation. The unbiased proteomic analysis of fatty-acylated proteins using chemical reporters has revealed a greater diversity of lipid-modified proteins in mammalian cells and identified a novel post-translational modification of histones.

The core of plant physiology is a set of functional solutions to a tradeoff between CO(2) acquisition and water loss. To provide an important evolutionary perspective on how the earliest land plants met this tradeoff, we constructed a mathematical model (constrained geometrically with measurements of fossils) of the hydraulic resistance of Asteroxylon, an Early Devonian plant. The model results illuminate the water transport physiology of one of the earliest vascular plants. Results show that Asteroxylon's vascular system contains cells with low hydraulic resistances; these resistances are low because cells were covered by scalariform pits, elliptical structures that permit individual cells to have large areas for water to pass from one cell to another. Asteroxylon could move a large amount of water quickly given its large pit areas; however, this would have left these plants particularly vulnerable to damage from excessive evapotranspiration. These results highlight a repeated pattern in plant evolution, wherein the evolution of highly conductive vascular tissue precedes the appearance of adaptations to increase water transport safety. Quantitative insight into the vascular transport of Asteroxylon also allows us to reflect on the quality of CO(2) proxy estimates based on early land plant fossils. Because Asteroxylon's vascular tissue lacked any safety features to prevent permanent damage, it probably used stomatal abundance and behavior to prevent desiccation. If correct, low stomatal frequencies in Asteroxylon reflect the need to limit evapotranspiration, rather than adaptation to high CO(2) concentrations in the atmosphere. More broadly, methods to reveal and understand water transport in extinct plants have a clear use in testing and bolstering fossil plant-based paleoclimate proxies., (© 2011 Blackwell Publishing Ltd.)

The involvement of axillary nodes remains a significant prognostic factor in breast cancer. However, management has changed from complete surgical staging to sentinel lymph node biopsies. Although little controversy exists regarding patients with negative sentinel lymph node biopsies, some remains regarding what to do with patients with small volume of axillary disease. This article focuses on the examination of recent evidence in management of the axilla. It focuses on both the prognostic and therapeutic information gleaned from isolated tumor cells and micrometastatic disease and on the use of completion axillary lymph node dissections or axillary radiation in preventing regional recurrence.

Brown stink bug, Euschistus servus (Say) (Heteroptera: Pentatomidae), damage on developing corn, Zea mays L., ears was examined in 2005 and 2006 by using eight parameters related to its yield and kernel quality. Stink bug infestations were initiated when the corn plants were at tasseling (VT), mid-silking (R1), and blister (R2) stages by using zero, three, and six in 2005 or zero, one, two, and four bugs per ear in 2006, and maintained for 9 d. The percentage of discolored kernels was affected by stink bug number in both years, but not always affected by plant growth stage. The growth stage effect on the percentage of discolored kernels was significant in 2006, but not in 2005. The percentage of aborted kernels was affected by both stink bug number and plant growth stage in 2005 but not in 2006. Kernel weight was significantly reduced when three E. sercus adults were confined on a corn ear at stage VT or R1 for 9 d in 2005, whereas one or two adults per ear resulted in no kernel weight loss, but four E. servus adults did cause significant kernel weight loss at stage VT in 2006. Stink bug feeding injury at stage R2 did not affect kernel damage, ear weight or grain weight in either year. The infestation duration (9 or 18 d) was positively correlated to the percentage of discolored kernels but did not affect kernel or ear weight. Based on the regression equations between the kernel weight and stink bug number, the gain threshold or economic injury level should be 0.5 bugs per ear for 9 d at stage VT and less for stage R1. This information will be useful in developing management guidelines for stink bugs in field corn during ear formation and early grain filling stages.

Far-infrared outdoor imagery has a lower contrast in the morning/afternoon relative to the highest contrast, which is observed at 14:00. Millimeter-wave (mmW) imagery can also follow this pattern. However, in this paper, we show that the opposite can occur for mmW imagery, wherein a higher contrast can occur in the morning/afternoon and lower contrast at 14:00. To this end, we show that a wood and rubber sample are observed to have a difference in mmW radiometric temperature of 17 degrees C at 9:00 and a difference of only 7 degrees C at 14:00. Details of our observations are presented.

Background: Local recurrence remains the major cause of death in patients with retroperitoneal sarcoma (RPS). There is no consensus regarding management of patients with recurrent RPS., Study Design: We performed a retrospective review of patients with recurrent RPS managed at 2 tertiary care centers between 1983 and 2008. Presentation, treatments, and outcomes were analyzed., Results: Seventy-eight patients were identified and analyzed. Sixteen patients (22%) presented with concurrent metastatic disease; survival in this subset of patients was poor (median 12 months). Forty-eight patients underwent resection of the first local recurrence of RPS. Palliation of tumor-related symptoms was achieved in 79% with operation. Survival was significantly better in patients having complete (p = 0.001) and incomplete resection (p = 0.02) compared with patients having biopsy only. Among patients with first local recurrence, high grade tumor (p = 0.0001) and no resection (p = 0.007) were significantly associated with reduced survival. On multivariate analysis, radiation therapy, multifocality, histologic subtype, and time to local recurrence did not significantly correlate with survival. Second and third local recurrences occurred at shorter intervals compared with first local recurrence and were less likely to be completely resectable. Patients undergoing resection of second and third local recurrences had survival similar to that in patients undergoing resection of first local recurrence., Conclusions: Tumor biology (high grade) is a significant prognostic factor for patients with recurrent RPS. Resection should be considered in patients with first and subsequent local recurrences (even if multifocal) of RPS because it is associated with improved survival. Operation should also be considered for palliation of symptoms in patients in whom resection is not possible., (Copyright 2010 American College of Surgeons. Published by Elsevier Inc. All rights reserved.)

Chinch bug, Blissus leucopterus leucopterus (Say) (Heteroptera: Blissidae), is one of the most important insect pests on forage pearl millet, Pennisetum glaucum L. R. Br., production in the southeastern United States. Twenty-nine forage pearl millet genotypes were assessed for chinch bug resistance by using stunt and necrosis ratings in combination with quantitative measurements of chlorophyll content and leaf photosynthetic rate. Plant stunt and leaf sheath necrosis ratings, and chlorophyll content in flag leaves differed among the 29 genotypes. Photosynthetic rate differed both among the noninfested control and among the chinch bug-infested plants. The chinch bug-infested plants had lower photosynthetic rate than the noninfested control plants. Inbreds with resistance superior to that of Tift 23DB were identified for hybrid development. When the 29 pearl millet genotypes were assessed by the six parameters by using cluster analysis, genotypes 07F-1226, 07F-1229, 07F-1231, 07F-1235, 07F-1238, 07F-1239, and 07F-1240 were the most resistant, whereas the genotypes 07F-1220, 07F-1221, 07F-1225, 07F-1227, 07F-1232, 07F-1246, and Tift 23DB were the most susceptible to chinch bug feeding. The rest of the genotypes expressed intermediate responses to the six parameters. To differentiate the physiological impact of chinch bug feeding on light and dark reactions of plant photosynthesis, photosynthesis capacity was assessed using light and CO2 (A/Ci) response curves on noninfested and chinch bug-infested plants of genotypes 07F-1246, 07F-1223, and 07F-1245, which expressed low, intermediate, and high chlorophyll content, respectively. Based on the A/Ci curves, photosynthesis capacity of injured leaves was suppressed in 07F-1223 and 07F-1246, whereas the chinch bug-injured 07F-1245 leaves showed an increase of photosynthetic rate compared with the noninfested plants. In contrast, light response curves were suppressed in the chinch bug-injured plants compared with the noninfested plants of all three genotypes, irrespective of their variations in insect injury ratings. This research demonstrated that visual stunt and necrosis rating methods in combination with chlorophyll and photosynthesis measurements could be used in screening forage pearl millet for chinch bug resistance and deciphering the underlying resistance mechanisms.

We have recently noted an increase in patients injured by an unusual mechanism and source: leaping sturgeon. We present our experience with eight cases of sturgeon related injuries. Between January 2006 and June 2007, there were eight patients evaluated at our Level I trauma center for sturgeon related injuries. Injuries included isolated fractures, liver lacerations, severe facial trauma, and a closed head injury. The overall length of stay was 6 days (range 0-20) and 50 per cent of patients required an intensive care unit stay. For comparative purposes, injuries were classified as primary sturgeon injuries (injuries where the sturgeon directly impacted the patient) and secondary sturgeon injuries (injuries related to the sturgeon but not resultant from direct impact). There were five primary injuries and three secondary injuries in our series. Patients with secondary injuries had a longer length of stay (12 days vs 3 days) and a higher intensive care unit utilization (100 % vs 20%) when compared with patients having primary injuries. This is the first report of sturgeon-related injuries in the medical literature. These peculiar insults seem to have increased in recent years. Public awareness and proper boat safety are vital in reducing the number and severity of these incidents.

Background: The process of geocoding produces output coordinates of varying degrees of quality. Previous studies have revealed that simply excluding records with low-quality geocodes from analysis can introduce significant bias, but depending on the number and severity of the inaccuracies, their inclusion may also lead to bias. Little quantitative research has been presented on the cost and/or effectiveness of correcting geocodes through manual interactive processes, so the most cost effective methods for improving geocoded data are unclear. The present work investigates the time and effort required to correct geocodes contained in five health-related datasets that represent examples of data commonly used in Health GIS., Results: Geocode correction was attempted on five health-related datasets containing a total of 22,317 records. The complete processing of these data took 11.4 weeks (427 hours), averaging 69 seconds of processing time per record. Overall, the geocodes associated with 12,280 (55%) of records were successfully improved, taking 95 seconds of processing time per corrected record on average across all five datasets. Geocode correction improved the overall match rate (the number of successful matches out of the total attempted) from 79.3 to 95%. The spatial shift between the location of original successfully matched geocodes and their corrected improved counterparts averaged 9.9 km per corrected record. After geocode correction the number of city and USPS ZIP code accuracy geocodes were reduced from 10,959 and 1,031 to 6,284 and 200, respectively, while the number of building centroid accuracy geocodes increased from 0 to 2,261., Conclusion: The results indicate that manual geocode correction using a web-based interactive approach is a feasible and cost effective method for improving the quality of geocoded data. The level of effort required varies depending on the type of data geocoded. These results can be used to choose between data improvement options (e.g., manual intervention, pseudocoding/geo-imputation, field GPS readings).

Objectives: Most patients with hypertension need combination therapy to reach adequate blood pressure control. The objective of this study was to assess type, duration of, and adherence to antihypertensive therapies among veterans, focusing on the use of combination therapies., Research Design and Methods: The design of the study was a retrospective cohort analysis of electronic medical and pharmacy records from the Central Texas Veterans Health Care System (CTVHCS). Data were extracted for adults newly identified with hypertension between 1995 and 2003. Drug utilization was measured as a time-dependent variable; thus, the use of combination therapies was captured for any given day for each patient in the sample. Medication adherence was assessed using medication possession ratios (MPR), calculated by the number of days of therapy dispensed to a patient divided by the number of days between subsequent prescriptions., Results: The average age of the participants (n = 11 187) was 60.7 (standard deviation (SD): 12.7). Half (50.1%) of the patients could be categorized as having controlled blood pressure. Veterans were followed for an average of 3.6 years (total of 51 549 person-years). Overall, 29 561 treatment episodes were identified, an average of about 2.6 per patient. Over 40% (41.6%) of these episodes involved one medication only, but patients frequently used dual (26.9%) and three or more (15.9%) therapies in combination. The frequency of prescribed antihypertensive therapies, as well as the length of, and adherence to, these therapies were described. Descriptively, medication adherence appeared to be lower among patients who received therapy for longer duration, indicating higher probability of missed doses and more frequent therapy changes., Conclusions: New information can be gained on the utilization of antihypertensive medications by using time-dependent variables. Understanding the type of combination therapies, the length of and adherence to these therapies, along with the observed blood pressure control rates will provide important new insights into the management of hypertensive patients. Limitations of the study arise primarily from the use of electronic medical records and the information that is contained within the datasource, and generalizability of the findings beyond the study sample.

Wastewater from small communities often has a greater environmental impact than conventional on-site treatment systems can mitigate, yet the flow rate is too low to achieve economies of scale with municipal treatment processes. As a result, the cost of wastewater treatment is often beyond the financial means of the community, in terms of capital costs and annual operational costs. The recirculating gravel filter (RGF) is an attached-growth treatment process for wastewater from small communities. In the RGF process, pre-settled wastewater is recirculated through a gravel filter bed, while a biofilm on the filter media oxidizes the organic matter and ammonia. Effluent from the RGF process has equivalent or lower concentrations of BOD5, TSS and ammonia nitrogen as effluent from other wastewater treatment processes typically employed in small communities. Two small communities in Washington State, USA, have selected the RGF process for wastewater treatment, due to low operational costs, simplicity of equipment, and high effluent quality. For the two communities, the RGF wastewater treatment facilities were estimated to have somewhat lower construction costs and significantly lower annual operational costs than the alternatives evaluated. Low annual operational expenses are important for wastewater system sustainability in small communities., (IWA Publishing 2008.)

Magnetorheological finishing (MRF) is a deterministic subaperture polishing process. The process uses a magnetorheological (MR) fluid that consists of micrometer-sized, spherical, magnetic carbonyl iron (CI) particles, nonmagnetic polishing abrasives, water, and stabilizers. Material removal occurs when the CI and nonmagnetic polishing abrasives shear material off the surface being polished. We introduce a new MRF material removal rate model for glass. This model contains terms for the near surface mechanical properties of glass, drag force, polishing abrasive size and concentration, chemical durability of the glass, MR fluid pH, and the glass composition. We introduce quantitative chemical predictors for the first time, to the best of our knowledge, into an MRF removal rate model. We validate individual terms in our model separately and then combine all of the terms to show the whole MRF material removal model compared with experimental data. All of our experimental data were obtained using nanodiamond MR fluids and a set of six optical glasses.

Pearl millet is increasingly being grown as a premium-value grain for the recreational wildlife and poultry industries in the southern US. We conducted three experiments to assess grain mold development in storage conditions typically encountered in the region of production. Variables included production year, temperature, relative humidity, atmosphere, and grain moisture content. In the first experiment, grain was stored for 9 weeks at 20 or 25 degrees C and maintained at 86% or 91% relative humidity (r.h.). In the second experiment, grain was stored for 9 weeks at 20 or 25 degrees C in either air (aerobic) or N2 (anaerobic), and maintained at 100% r.h. In the third experiment, high-moisture grain was stored for 3 weeks at 20 or 25 degrees C and maintained at 100% r.h. Grain was sampled at weekly intervals and plated to determine changes in fungal frequency. Fungi isolated included Fusarium chlamydosporum (19% of grain), Curvularia spp. (14%), F. semitectum (16%), Alternaria spp. (9%), Aspergillus flavus (8%), "Helminthosporium"-type spp. (6%), and F. moniliforme sensu lato (3%). Year of grain production significantly affected isolation frequency of fungi. Isolation frequencies from low-moisture grain were rarely affected by temperature, relative humidity, or atmosphere treatments, but was affected by storage duration for some fungi. Changes in isolation of toxigenic fungi occurred in high-moisture grain. Isolation frequency of F. chlamydosporum increased in grain stored at 86% and 91% r.h. Incidence of A. flavus increased in high-moisture grain treatments, particularly at 25 degrees C. Incidence of deoxynivalenol was not affected by storage treatment. Low concentrations of nivalenol were detected in most grain incubated at 100% r.h. Zearalenone was detected only when grain moisture content was 20-22%. Aflatoxin contamination averaged 174 ng g(-1) over all treatments, and increased up to 798 ng g(-1) in high-moisture grain at stored at 25 degrees C.

Spatial variation in childhood asthma and a recent increase in prevalence indicate that environmental factors play a significant role in the etiology of this important disease. Socioeconomic position (SEP) has been associated inversely and positively with childhood asthma. These contradictory results indicate a need for systematic research about SEP and asthma. Pathways have been suggested for effects of SEP on asthma at both the individual and community level. We examined the relationship of prevalent asthma to community-level indicators of SEP among 5762 children in 12 Southern California communities, using a multilevel random effects model. Estimates of community-level SEP were derived by summarizing census block group-level data using a novel method of weighting by the proportion of the block groups included in a community-specific bounding rectangle that contained 95% of local study subjects. Community characteristics included measures of male unemployment, household income, low education (i.e., no high school diploma) and poverty. There was a consistent inverse association between male unemployment and asthma across the inter-quartile range of community unemployment rates, indicating that asthma rates increase as community SEP increases. The results were robust to individual-level confounding, methods for summarizing census block group data to the community level, scale of analysis (i.e., community-level vs. neighborhood-level) and the modeling algorithm. The positive association between SEP and prevalent childhood asthma might be explained by differential access to medical care that remains unmeasured, by the hygiene hypothesis (e.g., lower SES may associate with higher protective exposures to endotoxin in early life), or by SEP acting as a proxy for unmeasured neighborhood characteristics.

Objective: To examine the type and extent of pharmacoepidemiology education offered by US colleges and schools of pharmacy., Methods: An electronic Web-survey was sent to all 89 US colleges and schools of pharmacy between October 2005 and January 2006 to examine the type and extent of pharmacoepidemiology education offered to professional (PharmD) and graduate (MS/PhD) students., Results: The response rate was 100%. Of the 89 schools surveyed, 69 (78%) provided pharmacoepidemiology education to their professional students. A mean of 119 (+/-60) PharmD students per college/school per year received some pharmacoepidemiology education (range 1-60 classroom hours; median 10 hours). Thirty-five schools (39%) provided education to a mean of 6 (+/-5) graduate students (range 2-135 classroom hours; median 15 hours)., Conclusions: A majority of US colleges and schools of pharmacy offer some pharmacoepidemiology education in their curriculum. However, the topics offered by each school and number of classroom hours varied at both the professional and graduate level.

Idiopathic granulomatous mastitis, also known as idiopathic granulomatous lobular mastitis, is a benign breast lesion that represents both a diagnostic and therapeutic dilemma. We report two cases of granulomatous mastitis recently evaluated and managed at our institution. To better understand this rare disease, we analyzed treatment outcomes in reported cases of granulomatous mastitis. One hundred sixteen cases were subsequently analyzed. Primary management strategies included observation (n = 9), steroids (n = 29), partial mastectomy (n = 75), and mastectomy (n = 3). Success rates with each treatment were observation, 56 per cent; steroids, 42 per cent; partial mastectomy, 79 per cent; and mastectomy, 100 per cent. Based on this analysis, we propose a clinically useful algorithm for both workup and management of these challenging cases.

Background: Current guidelines/algorithms recommend atypical antipsychotics as first-line agents for the treatment of schizophrenia. Because there are extensive healthcare costs associated with the treatment of schizophrenia, many institutions and health systems are faced with making restrictive formulary decisions regarding the use of atypical antipsychotics. Often, medication acquisition costs are the driving force behind formulary decisions, while other treatment factors are not considered., Objective: To apply a multi-attribute utility theory (MAUT) analysis to aid in the selection of a preferred agent among the atypical antipsychotics for the treatment of schizophrenia., Methods: Five atypical antipsychotics (risperidone, olanzapine, quetiapine, ziprasidone, aripiprazole) were selected as the alternative agents to be included in the MAUT analysis. The attributes identified for inclusion in the analysis were efficacy, adverse effects, cost, and adherence, with relative weights of 35%, 35%, 20%, and 10%, respectively. For each agent, attribute scores were calculated, weighted, and then summed to generate a total utility score. The agent with the highest total utility score was considered the preferred agent., Results: Aripiprazole, with a total utility score of 75.8, was the alternative agent with the highest total utility score in this model. This was followed by ziprasidone, risperidone, and quetiapine, with total utility scores of 71.8, 69.0, and 65.9, respectively. Olanzapine received the lowest total utility score. A sensitivity analysis was performed and failed to displace aripiprazole as the agent with the highest total utility score., Conclusions: This model suggests that aripiprazole should be considered a preferred agent for the treatment of schizophrenia unless found to be otherwise inappropriate.

Background: The growing interest in the effects of contextual environments on health outcomes has focused attention on the strengths and weaknesses of alternate contextual unit definitions for use in multilevel analysis. The present research examined three methods to define contextual units for a sample of children already enrolled in a respiratory health study. The Inclusive Equal Weights Method (M1) and Inclusive Sample Weighted Method (M2) defined communities using the boundaries of the census blocks that incorporated the residences of the CHS participants, except that the former estimated socio-demographic variables by averaging the census block data within each community, while the latter used weighted proportion of CHS participants per block. The Minimum Bounding Rectangle Method (M3) generated minimum bounding rectangles that included 95% of the CHS participants and produced estimates of census variables using the weighted proportion of each block within these rectangles. GIS was used to map the locations of study participants, define the boundaries of the communities where study participants reside, and compute estimates of socio-demographic variables. The sensitivity of census variable estimates to the choice of community boundaries and weights was assessed using standard tests of significance., Results: The estimates of contextual variables vary significantly depending on the choice of neighborhood boundaries and weights. The choice of boundaries therefore shapes the community profile and the relationships between its components (variables)., Conclusion: Multilevel analysis concerned with the effects of contextual environments on health requires careful consideration of what constitutes a contextual unit for a given study sample, because the alternate definitions may have differential impact on the results. The three alternative methods used in this research all carry some subjectivity, which is embedded in the decision as to what constitutes the boundaries of the communities. The Minimum Bounding Rectangle was preferred because it focused attention on the most frequently used spaces and it controlled potential aggregation problems. There is a need to further examine the validity of different methods proposed here. Given that no method is likely to capture the full complexity of human-environment interactions, we would need baseline data describing people's daily activity patterns along with expert knowledge of the area to evaluate our neighborhood units.

Exposure to ultraviolet radiation has commonly been recognized as the most important environmental risk factor for melanoma. The measurement of UV exposure in humans, however, has proved challenging. Despite the general appreciation that an objective metric for individual UV exposure is needed to properly assess melanoma risk, little attention has been given to the issue of accuracy of UV exposure measurement. The present research utilized a GIS based historical UV exposure model (for which the accuracy of exposure estimates is known) and examined, in the case-control setting, the relative importance of UV exposure compared to self-reported time spent outdoors, in melanoma risk. UV estimates were coupled with residential histories of 820 representative melanoma cases among non-Hispanic white residents under 65 years of age from Los Angeles County and for 877 controls matched to cases by age, sex, race, and neighborhood of residence, to calculate the cumulative lifetime UV exposure and average annual UV exposure. For historical measures, when the participants resided outside the US, we also calculated UV estimates. While there was no increased risk of melanoma associated with self-reported time spent outdoors, the association between annual average UV exposure based on residential history and melanoma risk was substantial, as was the association between cumulative UV exposure based on residential history and melanoma. The time spent in outdoor activities appeared to have no significant effect on melanoma risk in any age strata, however, when adjusted for UV exposure based on residential history, time spent outdoors during young age significantly increased risk for melanoma. While there was some attenuation of risk when we excluded data from people resident overseas (as all other studies we are aware of have done), this did not significantly impact subsequent risk estimates of UV exposure on melanoma.

Objectives: To determine learning-style scores of second-year pharmacy students before and after a problem-based learning (PBL) teaching experience and to evaluate the relationships between scores and demographic variables., Methods: The Grasha-Reichmann Student Learning Style Scale (GRSLSS) was given to pharmacotherapy laboratory students before and after a semester-long problem-based learning class., Results: Only one of the GRSLSS score variables was reported as "high" ("collaborative") and none were reported as "low." Students' "avoidant" mean score increased and "participant" mean score decreased after completing the PBL experience (p < or = 0.05)., Conclusion: While PBL appears to be a teaching style that is conducive to the learning preferences of this cohort of pharmacy students, significant changes in learning styles were noted after completing the PBL experience. These changes may reflect difficulties that occurred in adapting from a didactic teaching style to PBL, and specifically, difficulties in adjusting to participating in a group learning experience. A major limitation was that the teaching style of the facilitator was not measured.

Resistance to Meloidogyne incognita is important to provide stability to pearl millet production and to reduce nematode populations that can damage crops grown in rotation with pearl millet. The objectives of this study were to determine whether resistance to M. incognita exists in pearl millet from West and East Africa, and to determine if heterogeneity for resistance exists within selected cultivars. Resistance was assessed as nematode egg production per gram of root in greenhouse trials. Seventeen pearl millet cultivars of diverse origin were evaluated as bulk (S 0 ) populations. All African cultivars expressed some level of resistance. P3Kollo was among the least resistant of the African cultivars, Zongo and Gwagwa were intermediate, and SoSat-C88 was among the most resistant. Thirty selfed (S 1 ) progeny selections from SoSat-C88, Gwagwa, Zongo, and P3Kollo were evaluated for heterogeneity of resistance within cultivar. Reactions were verified in 13 S 2 progeny of each of the four cultivars. In S 1 evaluations, each of these cultivars was heterogeneous for resistance. Progeny reaction varied from highly resistant to highly susceptible. Patterns of apparent segregation of resistance varied among the four cultivars. Discreet resistant and susceptible phenotypes were identified in Zongo progeny, and it was estimated that two dominant genes for resistance segregated in this cultivar. Averaged across progenies, egg production on the four cultivars was less (P ≤ 0.001) than on the susceptible hybrid HGM-100, but was not different from resistant hybrid TifGrain 102. Reproduction of M. incognita on the S 2 progeny tended to confirm the results from inoculations of S 1 progeny. Heritability of nematode reproduction (standardized as the ratio of the value to HGM-100) determined by parent-offspring regression was 0.54. Realized heritability determined by divergent selection was 0.87.

Pearl millet is widely consumed in regions of Africa and Asia, and is increasingly being grown as an alternative grain in drought-prone regions of the United States. Pearl millet and corn were grown in dryland conditions at Tifton, Georgia, USA and grains were compared for pre-harvest infection by potentially toxigenic fungi and contamination by mycotoxins. Corn hybrids Agripro 9909 and Pioneer 3146, and pearl millet Tifgrain 102 were grown in 2000 and 2001; pearl millet HGM 100 was included in the test in 2001. Hybrids were sown on multiple planting dates in each year to induce variation in flowering time. Host species differed in the frequency of isolation of potentially toxigenic fungal species in both years. Across years, corn hybrids were more prone to infection by Aspergillus flavus Link (maximum isolation frequency = 8.8%) and Fusarium moniliforme Sheldon sensu lato (maximum isolation frequency = 72.8%), with corresponding greater concentrations of aflatoxins (maximum concentration = 204.9 microg kg(-1)) and fumonisins (maximum concentration = 34,039 microg kg(-1)). Pearl millet was more prone to infection by F. semitectum Berk. & Ravenel (maximum isolation = 74.2%) and F. chlamydosporum Wollenweb & Reinking (maximum isolation = 33.0%), and contamination by moniliformin (maximum contamination = 92.1 microg kg(-1)). Beauvericin (maximum concentration = 414.6 microg kg(-1)) was present in both hosts. Planting date of corn affected aflatoxin and beauvericin contamination in 2000, and fumonisin concentration in 2001. The observed differences in mycotoxin contamination of the grains, which are likely due to host-specific differences in susceptibility to pre-harvest mycoflora, may affect food safety when the crops are grown under stress conditions.

Background and Objective: The search for NSAIDs with less gastrointestinal toxicity led to the introduction of the selective cyclo-oxygenase-2 (COX-2) inhibitors. However, following their introduction into the market, concerns have developed regarding their safety, particularly their cardiovascular safety. The purpose of this study was to assess the cardiovascular risk (events included were myocardial infarction, stroke and myocardial infarction-related deaths) associated with long-term (>180 days of exposure) and short-term (or=35 years of age who received celecoxib, rofecoxib, ibuprofen, etodolac and naproxen from 1 January 1999 through 31 December 2001, were included. Multivariate Cox proportional hazard models were used to analyse the relationship between cardiovascular risk and NSAID use, including selective COX-2 inhibitor use, while adjusting for various risk factors., Results: We identified 12 188 exposure periods (11 930 persons) and 146 cardiovascular events over the entire study period. Compared with long-term ibuprofen use, long-term use of celecoxib (adjusted hazard ratio [HR] 3.64; 95% CI 1.36, 9.70) and rofecoxib (adjusted HR 6.64; 95% CI 2.17, 20.28) was associated with a significant increase in cardiovascular risk. When restricted to patients >or=65 years of age, the cardiovascular risks associated with long-term celecoxib (adjusted HR 7.36; 95% CI 1.62, 33.48) and rofecoxib (adjusted HR 13.24; 95% CI 2.59, 67.68) use increased. Short-term use of celecoxib (adjusted HR 0.75; 95% CI 0.42, 1.35) and rofecoxib (adjusted HR 0.85; 95% CI 0.39, 1.86) was not associated with any significant change in cardiovascular risk when compared with short-term ibuprofen use. Neither long- nor short-term exposure to naproxen and etodolac was associated with cardionegative or cardioprotective effects when compared with ibuprofen use., Conclusions: The findings of this observational study, along with recent clinical trial results, suggest that prolonged exposure to selective COX-2 inhibitors may be associated with an increased risk of adverse cardiovascular outcomes.

Study Objective: To examine adherence measures with different stimulants in children and adolescents., Design: Retrospective analysis., Data Source: Texas Medicaid prescription claims database., Patients: A total of 9549 patients aged 5-18 years with attention-deficit-hyperactivity disorder., Measurements and Main Results: Paid prescription claims for newly started stimulants during the 2001-2002 school year were extracted from a database; 28,344 prescriptions (9549 patients) were available for analysis. Adherence was evaluated based on the drug therapy prescribed (i.e., mixed amphetamine salts, immediate-release methylphenidate, and extended-release methylphenidate-OROS [oral-osmotic formulation]) and the age and sex of the patient. Adherence measures were persistence and medication possession ratio (MPR). Persistence was higher for extended-release methylphenidate-OROS (0.50 +/- 0.33) than for mixed amphetamine salts (0.42 +/- 0.29) or immediate-release methylphenidate (0.37 +/- 0.26; p < 0.001). The MPR was also higher for extended-release methylphenidate-OROS (0.76 +/- 0.37) than for mixed amphetamine salts (0.73 +/- 0.37) or immediate-release methylphenidate (0.69 +/- 0.37; p < 0.001). Patients aged 5-9 years had equal or better persistence and MPR than those aged 10-14 and 15-18 years (p < 0.001). No sex-related differences in adherence were observed., Conclusion: Adherence measures in our study were low. Although they were significantly better for extended-release methylphenidate-OROS than the other stimulants, the clinical significance of these differences are unclear. Further research should be conducted regarding pharmaceutical products, administration methods, and clinical interventions that may enhance adherence.

Based on the available literature, this review article investigates the issue of resilience in relation to trauma and posttraumatic stress disorder. Resilient coping to extreme stress and trauma is a multifaceted phenomena characterized as a complex repertoire of behavioral tendencies. An integrative Person x Situation model is developed based on the literature that specifies the nature of interactions among five classes of variables: (a) personality, (b) affect regulation, (c) coping, (d) ego defenses, and (e) the utilization and mobilization of protective factors and resources to aid coping.

Objective: To estimate prevalence rates of antipsychotic use in children and adolescents from 1996 to 2001 in three state Medicaid programs (midwestern [MM], southern [SM], and western [WM]) and one private managed care organization (MCO)., Method: Prescription claims were used to evaluate antipsychotic prevalence, defined as the number of children and adolescents up to the age of 19 years with at least one prescription claim for an antipsychotic per 1,000 enrolled youths., Results: From 1996 to 2001, the prevalence of total antipsychotic use increased in each program (MM: 4.7 to 14.3 per 1,000; SM: 6.3 to 15.5; WM: 4.5 to 6.9; and MCO: 1.5 to 3.4). Typical antipsychotic use decreased (MM: 3.7 to 2.0 per 1,000; SM: 4.6 to 1.5; WM: 4.4 to 1.3; and MCO: 1.2 to 0.9), while atypical antipsychotic use dramatically increased (MM: 1.4 to 13.1 per 1,000; SM: 2.5 to 14.9; WM: 0.3 to 6.2; and MCO: 0.4 to 2.7)., Conclusions: The increased prevalence of antipsychotic use in children and adolescents from 1996 to 2001 was attributed to increased use of atypical antipsychotics. Given the limited data with atypical antipsychotics in youths, this emphasizes the need for additional studies of these agents and other treatment modalities in this population.

This study was designed to identify and compare the Fusarium species of the Gibberella fujikuroi complex on pearl millet (Pennisetum glaucum (L.) R. Br) and corn (Zea mays L.) crops grown in southern Georgia, and to determine their influence on potential fumonisin production. Pearl millet and corn samples were collected in Georgia in 1996, 1997 and 1998. Three percent of the pearl millet seeds had fungi similar to the Fusarium species of the G. fujikuroi species complex. One hundred and nineteen representative isolates visually similar to the G. fujikuroi species complex from pearl millet were paired with mating population A (Fusarium verticillioides (Sacc.) Nirenberg), mating population D (F. proliferatum (Matsushima) Nirenberg) and mating population F (F. thapsinum (Klittich, Leslie, Nelson and Marasas) tester strains. Successful crosses were obtained with 50.4%, 10.1% and 0.0% of these isolates with the A, D and F tester strains, while 39.5 of the isolates did not form perithecia with any tester strains. Two of the typical infertile isolates were characterized by DNA sequence comparisons and were identified as Fusarium pseudonygamai (Nirenberg and O'Donnell), which is the first known isolation of this species in the United States. Based on the pattern of cross-compatibility, conidiogenesis, colony characteristics and media pigmentation, a majority of the infertile isolates belong to this species. Fumonisins FB(1) and FB(2) were not detected in any of the 81 pearl millet samples analyzed. The species of the G. fujikuroi species complex were dominant in corn and were isolated from 84%, 74% and 65% of the seed in 1996, 1997 and 1998, respectively. Representative species of the G. fujikuroi species complex were isolated from 1996 to 1998 Georgia corn survey (162, 104 and 111 isolates, respectively) and tested for mating compatibility. The incidence of isolates belonging to mating population A (F. verticillioides) ranged from 70.2% to 89.5%. Corn survey samples were assayed for fumonisins, and 63% to 91% of the 1996, 1997 and 1998 samples were contaminated. The total amount of fumonisins in the corn samples ranged from 0.6 to 33.3 microg/g.

Study Objective: To validate or refute a widely accepted epidemiologic phenomenon known as the Weber effect by replicating Weber's original observation by using drugs that were marketed in the United States and using reports from a U.S. database., Design: Retrospective analysis of adverse event databases., Setting: University research center., Drugs: The original nonsteroidal antiinflammatory drugs studied by Weber that were approved by the U.S. Food and Drug Administration (FDA) and marketed in the United States: diclofenac sodium, diclofenac potassium, diflunisal, sulindac, flurbiprofen, and piroxicam., Intervention: Reports of adverse events submitted to the FDAs Spontaneous Reporting System and the Adverse Event Reporting System from January 1969-December 2000 for these drugs were analyzed according to the number of adverse events reported for each drug per year from the time the drug was approved until December 2000., Measurements and Main Results: Reporting patterns were considered to demonstrate the Weber effect if the highest peak in reports during the first 5 years after product approval occurred during year 2. All five drugs analyzed in this study demonstrated the Weber effect., Conclusion: The Weber effect was replicable by using drugs marketed in the United States and using reports that were submitted to a U.S. database. Various other factors affected spontaneous reporting of adverse events, as peaks in the number of reports were seen numerous times for each drug after the initial 5-year marketing period.

Understanding the effects of prolonged contact, in a professional role, with trauma victims has led to conceptualizations of helper stress. Various terms such as compassion fatigue, vicarious traumatization, secondary traumatic stress reactions, empathic strains, burn out, and Type land Type II countertransference have been proposed These terms required conceptual classification to make a proper diagnosis and classification of their impact on the helping process. It is proposed that Traumatoid States is a more inclusive and accurate term to define sub-types of occupationally-related stress response syndromes (OSRS).

This research investigated the prevalence of Posttraumatic Stress Disorder (PTSD), Major Depressive Disorder (MDD) and substance abuse in a midwestern university population following the terrorist attacks on September 11, 2001, in New York City and Washington, DC. Three-hundred five subjects volunteered to complete a questionnaire which measured nine areas of psychosocial functioning which included demographics, personality, PTSD, MDD, prior traumatic experiences, alcohol and drug use, psychiatric history and treatment, and current attitudes towards government, religion, the economy, and how children were affected by the events. The participants lived in a large urban city over which United Flight 93 circled before crashing in Pennsylvania due to terrorist attacks. The subjects were forced to evacuate their university and city due to attacks on New York and errant United Flight 93. The study also replicated the first two national studies on PTSD prevalence (Schuster, et al., 2002; Galea, et al., 2002). The results found a prevalence rate of 5.9% for probable PTSD, matching identically previous national surveys. There were higher levels of PTSD and MDD for females, those with less education and who were single or unmarried, and those who had a prior history of mental health problems or psychological trauma. PTSD and MDD were associated with higher levels of alcohol and drug use since September 11. Relations to active duty military personnel appear to moderate the perception of threat, suggesting the importance of affiliative kinship patterns to coping with stress. Finally, the concept of geographic and psychological proximity to the 'zone of danger' is discussed.

Objective: To expose pharmacy educators and practitioners to concepts of medical geography and medical surveillance. Severe acute respiratory syndrome (SARS) is used as a case example because it is an emerging infection and a prime example of the type of disease that pharmacists may encounter in daily practice (e.g., easily transmitted, resembles the common cold)., Data Sources: We retrieved data from publications related to medical geography, medical surveillance, and SARS. Data on current SARS cases in Hong Kong were obtained from the Hong Kong Department of Health Web site., Study Selection and Data Extraction: Variables regarding new cases and deaths due to SARS were evaluated., Data Synthesis: Background information on medical geography and medical surveillance was reviewed. Descriptive statistics were calculated for incidence, prevalence, and the number of deaths due to SARS in Hong Kong from March 14 to May 31, 2003., Conclusions: Emerging infections are a serious concern for both the public and healthcare practitioners. The recent global diffusion of SARS highlights the ease in which diseases can diffuse from place to place. Understanding concepts related to medical geography and medical surveillance can help pharmacists be better prepared to anticipate disease diffusion and to evaluate signs of emerging infections. In turn, this can help pharmacists be better prepared to provide information and care to their patients. The long-term benefit of understanding how diseases spread and the specific activities related to disease detection is an opportunity for expanding the scope of pharmacy practice.

Objective: The Weber effect is a phenomenon which states that the number of reported adverse reactions for a drug increases until the middle to end of the second year of marketing. The purpose of this study was to examine the number of adverse event reports associated with specific selective serotonin-reuptake inhibitor (SSRI) use., Methods: Data used in this study included voluntary adverse event reports submitted to the US federal government through the Spontaneous Reporting System and Adverse Event Reporting System. Adverse event reports were analyzed for the following SSRIs: citalopram, fluoxetine, fluvoxamine, paroxetine, and sertraline., Results: Adverse event reporting associated with fluvoxamine demonstrates the Weber effect. Adverse events related to fluoxetine, paroxetine, and sertraline do not exhibit the Weber effect. Fluoxetine-related adverse events peaked at year 3, with peaks also occurring during the 10th and 12th years after market entry. Adverse event reports associated with paroxetine and sertraline use increased 5-8 years after market entry., Conclusions: Within 1 class of medications, it is possible for a few agents to exhibit the Weber effect, while there is no definite pattern with others. A new observation in adverse event reporting is introduced and suggests that a peak in adverse event reporting occurs 1-2 years after a medication receives approval for a new indication. Future research is necessary to validate this effect and examine the generalizability to other medications.

Host-plant resistance is an efficient, economical and environmentally benign approach used to manage many pests and diseases of agricultural crops. After nearly a century of research, the resources and tools have become more refined, but the basic tasks in breeding for resistance have not changed. Resistance must be identified, incorporated into elite germplasm, and deployed in a form useful to growers. In some instances, biotechnology has expedited this process through incorporating a foreign gene(s) for resistance into elite germplasm. The USDA Agricultural Research Service (ARS) has made significant contributions in the development of germplasm with resistance to insects, nematodes and plant diseases. Because resistant plant varieties are an essential component of sustainable production systems, ARS is committed to developing techniques and germplasm to help meet this goal.

This paper discusses the phenomenon of secondary victimization or revictimization of Croatian war veterans with post-traumatic stress disorder (PTSD). This revictimization is mainly characterized by a disappointing institutional response from the helping professions, together with a lack of social recognition and support after the war. Also, we describe the "blaming the victim" process in which the veterans with PTSD were accused for bringing their maladies on themselves due to their premorbid psychological characteristics. This paper traces the origins of these phenomena in Croatia and compares them to other traumatized populations throughout the world, adding to the established body of knowledge which confirms that denial of PTSD in war veterans is a widespread social occurrence which spans over history, crossing national and cultural boundaries.

Pearl millet, Pennisetum glaucum, has potential as a grain crop in the southeastern United States. Our objectives were to (i) determine the resistance and/or tolerance of pearl millet hybrids to Meloidogyne incognita race 3 and M. arenaria race 1; (ii) compare reproduction of Meloidogyne spp. on pearl millet and corn; and (iii) determine the disease severity of leaf blight caused primarily by Pyricularia grisea. In a field naturally infested with M. incognita, experimental pearl millet hybrids with inbreds 114 and 117 as the pollinators had fewer numbers of second-stage juveniles and more severe leaf blight than did HGM-100, a nematode-susceptible hybrid; hybrids with inbred 115 as the pollinator were similar to HGM-100 in both nematode numbers and foliar disease severity. Grain yields in pearl millet were greater in plots treated with 1,3-dichloropropene than in control plots and were negatively correlated with leaf blight severity. In a greenhouse experiment, both M. incognita and M. arenaria produced fewer eggs on pearl millet hybrids with pollinators 114, 117, 101, 102, and 103 than on hybrid HGM-100. Reproduction of M. incognita was less on the resistant pearl millet hybrids than on corn. Because both M. incognita and P. grisea can reduce grain yield of pearl millet, hybrids developed for the southeastern United States should be resistant to both pathogens.

Stalk rot is frequently observed in maturing, rust-infected pearl millet (Pennisetum glaucum). Fungi were isolated from internal stalk tissue, and their association with node discoloration and rust infection at different stages of plant maturity was determined to gain a greater understanding of stalk rot etiology. In 1995, stalk rot was observed in a breeding population of pearl millet. Stalks of 10 rust-infected plants were collected on each of three dates during grain fill. Frequency of symptomatic, discolored nodes was higher in the later sampling dates. Stalk sections from 119 discolored nodes were surface sterilized and plated onto agar media. Fungi most frequently isolated from symptomatic nodes were Bipolaris setariae (isolated from 47% of discolored nodes), Fusarium semitectum (28.6%), and F. moniliforme sensu lato (23.5%). Isolation frequency of these fungi differed (P < 0.05) with sampling date. In 1996 and 1997, the hybrid HGM 100 was evaluated at two dates of planting in each year. Ten stalks were sampled at each of four growth stages: panicle emergence, stigma emergence, milk, and hard dough. A total of 140 stalks was assessed for rust severity and for internal stalk discoloration at the nodes. The frequency of discolored nodes increased with plant maturation and was correlated (P < 0.01) with severity of rust infection. All nodes were plated on an agar medium, and a total of 1,512 isolates from 30 fungal genera or species were isolated from the 1,540 nodes of the sampled stalks. F. moniliforme was isolated most frequently (isolated from 23.5% of all nodes). Frequency of isolation of F. moniliforme from nodes within stalks increased with advancing maturity in the earlier dates of planting, but was not correlated with rust infection. B. setariae (isolated from 9.2% of all nodes) was more frequently isolated from plants at the dough stage in three plantings, and was correlated (P < 0.01) with rust severity. Trends in the frequency of isolation of other fungi were inconsistent between planting dates or among growth stages. Frequency of isolation of F. semitectum (isolated from 11.0% of all nodes) and Alternaria spp. (6.9% of all nodes) was correlated (P < 0.05) with rust severity. Frequency of isolation of Curvularia spp. (isolated from 7.0% of all nodes) was negatively correlated (P < 0.05) with rust severity. Isolation of Alternaria spp. and B. setariae was more frequently associated with node discoloration than was isolation of the other fungi. Stalk rot of pearl millet is the result of a complex of several fungi whose incidence was influenced by rust infection, plant maturation, and environmental factors associated with differences among years and dates of planting.

Assessing help-seeking patterns following disaster provides useful information about who needs professional help the most, who is willing to seek help, and who is reluctant to seek help. 231 Japanese evacuees from the Miyake Island volcanic eruption (2000) participated in this study (ages 20-93, average age 59.52). Ten months after the evacuation, participants were mailed questionnaires which elicited demographic data, disaster experiences, help-seeking patterns, and psychological symptoms (Post-traumatic stress disorder and depression). Help-seeking patterns were categorized as: professionals (physicians, nurses, psychotherapists/counselors, telephone consultation, social workers, priests and monks, and others); or informal (family, relatives, friends, neighbors, and others) and, (information, advice, tangible, and emotional). The findings indicate that younger and/or female victims frequently sought help from informal sources while male and/or older victims frequently sought help from professionals. Severity of PTSD and depression symptoms were positively correlated with help-seeking from physicians, but not psychologists or mental health professionals. Very high rates of utilizing medical assistance rather than mental health treatment were also identified among these disaster victims, and appeared related to cultural norms regarding shame and self disclosure of emotional distress.

Objective: To determine the number of cases of statin-associated rhabdomyolysis reported to the Food and Drug Administration for 6 statins and to profile the cases., Methods: A retrospective analysis of all domestic and foreign reports of statin-associated rhabdomyolysis between November 1997 and March 2000 was conducted. Outcome measures included the total number of reports (initial plus follow-up), the number of unique cases, age, gender, percentages of report codes and role codes, and frequencies of concomitant interacting drugs that may have precipitated rhabdomyolysis, outcomes codes, and report source codes., Results: There were 871 reports of statin-associated rhabdomyolysis in the 29-month time frame examined, representing 601 cases. The following number of cases were associated with each of the individual statins: simvastatin, 215 (35.8%); cerivastatin, 192 (31.9%); atorvastatin, 73 (12.2%); pravastatin, 71 (11.8%); lovastatin, 40 (6.7%); and fluvastatin, 10 (1.7%). Drugs that may have interacted with the statins were present in the following number of cases: mibefradil (n = 99), fibrates (n = 80), cyclosporine (n = 51), macrolide antibiotics (n = 42), warfarin (n = 33), digoxin (n = 26), and azole antifungals (n = 12). The reports of 62.1% of cases were classified as expedited. Statins were designated as the primary suspect in 72.0% of the cases. Death was listed as the outcome in 38 cases. The majority of reports (n = 556) were from health professionals., Conclusions: Compared with the other statins, simvastatin and cerivastatin were implicated in a relatively higher number of reports. Because of the various limitations of a spontaneous reporting-system database, caution is urged when interpreting the relative number of cases reported.