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PubMed2004

A tale of two cities: financing two voucher programs for substance abusers through community donations.

Voucher-based reinforcement therapy (VBRT) is an effective drug abuse treatment, but the cost of VBRT rewards has limited its dissemination. Obtaining VBRT incentives through donations may be one way to overcome this barrier. Two direct mail campaigns solicited donations for use in VBRT for pregnant, postpartum, and parenting drug users in Toronto, Ontario, Canada, and in Los Angeles, California. In Toronto, 19% of those contacted over 2 months donated 8,000 dollars (4,000 dollars/month) of goods and services. In Los Angeles, nearly 26% of those contacted over 34 months donated 161,000 dollars (4,472dollars/month) of goods and services. Maintaining voucher programs by soliciting donations is feasible and sustainable. The methods in this article can serve as a guide for successful donation solicitation campaigns. Donations offer an alternative for obtaining VBRT rewards for substance abuse treatment and may increase its dissemination.

Female↗
PubMed1993

Training opinion leaders to promote safer sex.

Training opinion leaders in a men's residence hall in a brief program focused on communication and life skills is an effective way to stimulate peer discussions on HIV prevention and risk reduction and appears likely to have positive influences on behavioral change or intention. The program at the University of Wisconsin-Madison was extremely cost-effective and generated more than 350 conversations in a single residence hall in 1 month. This limited intervention revealed several key indicators of risk reduction. We believe that larger, more refined programs over a longer period will produce sustained prevention benefits and changes in the peer norms that so strongly influence behavior.

Curriculum↗
PubMed1997

Programmatic role of the infectious diseases physician in controlling antimicrobial costs in the hospital.

Controlling antimicrobial costs has preoccupied infectious diseases physicians (IDPs). IDPs have controlled antimicrobial costs by the use of eight strategies: education, formulary restriction, pharmacy justification, formulary substitution, computer surveillance, laboratory item cost listing, purchase plans, and multidisciplinary approaches. Most strategies had input from IDPs and resulted in cost savings (up to $500,000 annually), particularly during the initiation periods. Educational efforts were successful in reducing costs but needed continual intervention. Formulary restriction was the most straightforward cost-control mechanism. Restriction of "target antimicrobials" has given way to "switch" therapy between expensive and less costly agents or between parenteral and oral regimens. Switch therapy is facilitated through the use of innovative order forms and on-line computer interaction. Computer surveillance has a capacity for interactive controls. Purchase plans may give way to centralized pharmacy monitoring, a strategy that is attractive to managed care organizations. Multidisciplinary antimicrobial management programs (AMPs) offer the best potential for sustaining savings in antimicrobial costs. Ten recommendations lay a groundwork for IDPs to translate their expertise into leadership of AMPs.

Anti-Bacterial Agents↗
PubMed1993

Effects of prenylamine and AQ-A 39 on reentrant ventricular arrhythmias induced during the late myocardial infarction period in conscious dogs.

The effects of prenylamine (PNL) and AQ-A 39 on sustained ventricular tachycardia (SVT) were studied by programmed stimulation in conscious dogs 4-10 days after ligation of the left anterior descending (LAD) coronary artery. In 8 of 16 dogs developing SVT in the control, PNL (3 mg/kg intravenously, i.v.) suppressed inducibility of SVT and slowed the rate of tachycardia in 6 other animals. In a separate group of 10 dogs with inducible SVT, AQ-A 39 (4 mg/kg i.v.) abolished elicitation of tachycardia in 3 dogs and decreased its rate in 6 other dogs. Neither drug affected normal conduction significantly, but PNL impaired slow conduction in the infarct zone, as indicated by prolongation of late potential. Both agents increased the effective refractory period (ERP) of infarcted and normal ventricular myocardium and prolonged the corrected QT interval. PNL and AQ-A 39 exert notable efficacy in preventing infarcted heart from severe ventricular arrhythmias. Prolongation of ventricular refractoriness and repolarization, as well as decreased slow conduction in ischemically damaged myocardium, are major mechanisms accounting for the effectiveness of these drugs against ventricular arrhythmias.

Animals↗
PubMed1998

Autonomic effects of nicotine patch administration in habitual cigarette smokers: a double-blind, placebo-controlled study using spectral analysis of RR interval and systolic arterial pressure variabilities.

Nicotine patch administration is often used to sustain tobacco abstinence in smoking-cessation programs. There is some concern regarding safety issues, as a consequence of the sympathomimetic action of nicotine. We used spectral analysis of RR interval and (noninvasive) systolic arterial pressure (SAP) beat-by-beat variabilities in a crossover double-blind design to assess the autonomic effects of cigarette smoking, of transdermal nicotine, and of placebo. The study group consisted of 27 heavy smokers (age 43 +/- 2 years). The RR interval and its variability were significantly reduced in the smoking group, as compared with nicotine or placebo groups. The LF component of RR interval variability (in normalized units, nu), and the LF/HF ratio showed greatest values during smoking, as compared with placebo. Values of LF(RR) and LF/HF during nicotine patch treatment were slightly, but not significantly, greater than observed with placebo. No differences were observed in SAP and its variability components. The index alpha (a frequency domain measure of baroreflex gain) was minimal in the smoking period. Habitual cigarette smoking is associated with signs of sympathetic predominance in the autonomic control of the sinoatrial (SA) node. Nicotine patches produce only minor disturbances of autonomic regulation. This corroborates their safe use in smoking-cessation strategies.

Administration, Cutaneous↗
PubMed1991

Entrainment of ventricular tachycardia in arrhythmogenic right ventricular tachycardia.

In two patients with arrhythmogenic right ventricular dysplasia (ARVD), sustained ventricular tachycardia (VT) was induced by programmed stimulations during serial drug testings. One patient had five and the other had two VT morphologies, and the sites of origin were determined by endocardial catheter mappings. When overdrive pacing was performed, constant fusion in the QRS complex was observed in the two patients. Constant fusion of a different degree was also observed at different paced cycle lengths. Both patients had dilated right ventricles and wall-motion abnormality, and the diagnosis of ARVD was further confirmed by the specimen resected at the site of origin of VT. Therefore, VT in ARVD can be entrained and reentry is the most likely mechanism of such VT.

Adult↗
PubMed1992

Ablation of ventricular tachycardia using multiple sequential transcatheter application of radiofrequency energy.

Multiple sequential radiofrequency energy was applied in the left and right ventricles of 24 dogs to produce large ablated areas limited to endocardial and subendocardial regions. Endocardial ablation was performed in nine dogs with normal ventricles and 15 that had survived remote myocardial infarcts, three with inducible sustained monomorphic ventricular tachycardia. A quadripolar catheter was positioned either at the site of earliest ventricular activation during induced monomorphic ventricular tachycardia or at circumscribed areas of the left ventricle. Radiofrequency energy was delivered between two adjacent poles of the catheter, successively applying radiofrequency energy to the distal, middle, and proximal electrode pairs; this was repeated 9 to 11 times with the catheter in a slightly different position. A cumulative energy of 9,688 +/- 4,191 joules resulted in an ablated endocardial/subendocardial surface area of 4.7 +/- 2.2 cm2 (range 2.4-10 cm2, maximum depth 4 mm). Sustained tachycardia was not inducible by aggressive programmed ventricular stimulation in the dogs with previously inducible tachycardia, indicating successful ablation of the tachycardia foci. Only seven normal dogs were available for electrophysiological studies; three were used in acute and four in chronic studies. Ventricular tachycardia was not induced in the remaining dogs either before or after radiofrequency ablation, indicating the lack of an arrhythmogenic effect of this method. Histologic examination was performed in all nine normal dogs (five were sacrificed for acute pathological examination) as well as in the 15 with myocardial infarction. The late pathological examination of the radiofrequency lesion in these 19 animals showed homogeneous areas of coagulation necrosis and endocardial proliferation. Thus, this modified technique of radiofrequency ablation produced large homogeneous endocardial/subendocardial scars suitable for treating ventricular tachycardia and showed no evidence of an arrhythmogenic influence.

Animals↗
PubMed1992

Role of ventricular tachycardia surgery and catheter ablation as complements or alternatives to the implantable cardioverter defibrillator in the 1990s.

Although the implantable cardioverter defibrillator is used increasingly, other nonpharmacological approaches have their indications and merits. Furthermore, as the natural history of ventricular tachyarrhythmias or their underlying structural cardiac abnormality, i.e., coronary artery disease, dilated cardiomyopathy, arrhythmogenic right ventricular disease, etc. change, the mode of therapy may be modified accordingly. Because of the disappointing results of the CAST study in previously asymptomatic patients after myocardial infarction and the evidence that failure of one or two antiarrhythmic drugs tested by programmed ventricular stimulation in patients with documented sustained ventricular tachycardia or fibrillation predicts further drug failure, there will be a significant increase in the use of implantable cardioverters defibrillators in the 1990s. However, care should be taken to avoid inappropriate use of these devices.

Adult↗
PubMed1994

Knowledge and practice of sexual safety in Melbourne gay men in the nineties.

Despite the impact of education programs, the ability of gay men to sustain sexual safety still comes under public scrutiny. A self-administered questionnaire was distributed in 1990 to a convenience sample of 284 gay-identified Melbourne men recruited from gay groups, health clinics, gay pubs and nightclubs, sex-on-premises venues, and the social networks of these men. The questionnaire measured the perceived safety of various sexual practices and the practice of unprotected anal intercourse over the previous three months. These results were compared with results from other Australian studies. Whereas nearly all the men were sexually active, only a small proportion considered activities such as oral sex without ejaculation and anal sex with condoms to be 'totally safe'. The majority considered these activities to be 'more safe than unsafe', suggesting a risk-reduction rather than a 'no-risk' approach to sex. Comparisons with other Australian studies suggest that gay men are becoming more confident in the safety of sexual activities labelled as 'safe' by the AIDS Council. There was no elevated practice of unprotected anal sex at 'sex-on-premises' venues. Most men who had anal sex used condoms all of the time, whether sexual partnerships were 'once only' or were 'ongoing', suggesting that 'condoms always' is still a viable option in various partnerships. There was some evidence that a minority of men abandoned condoms in ongoing partnerships. If specific education campaigns are developed to promote 'negotiated safety' in partnerships, then such campaigns should not contradict the 'condoms always' strategy.

Adult↗
PubMed2005

Long-term monitoring of bacteria undergoing programmed population control in a microchemostat.

Using an active approach to preventing biofilm formation, we implemented a microfluidic bioreactor that enables long-term culture and monitoring of extremely small populations of bacteria with single-cell resolution. We used this device to observe the dynamics of Escherichia coli carrying a synthetic "population control" circuit that regulates cell density through a feedback mechanism based on quorum sensing. The microfluidic bioreactor enabled long-term monitoring of unnatural behavior programmed by the synthetic circuit, which included sustained oscillations in cell density and associated morphological changes, over hundreds of hours.

4-Butyrolactone↗
PubMed1981

Initiation of sustained ventricular tachyarrhythmias in a canine model of chronic myocardial infarction: importance of the site of stimulation.

The importance of the site of stimulation to the initiation of sustained ventricular tachyarrhythmias was determined in 24 adult mongrel dogs. Studies were performed 3-30 days after two-stage occlusion of the mid- or distal left anterior descending coronary artery, modified by a reperfusion stage. Unipolar cathodal stimuli of twice-threshold intensity and 2 msec duration were introduced at five to 24 sites in each dog in the distribution of occluded and nonoccluded vessels. Strength-interval curves were constructed from 232 measurements at these sites and local properties of excitability and refractoriness were correlated with the ability to initiate arrhythmias. All dogs had sustained ventricular tachyarrhythmias inducible from at least one site. Intramyocardial sites with normal excitability and refractoriness within 2 cm of an area of infarction were most often successful (27 of 44, 61%) in the initiation of sustained arrhythmias. Less successful sites included normal left ventricular plunge electrode sites less than 2 cm from an area of infarction (eight of 32, 25%) (p = 0.002), left ventricular plunge electrode sites within an area of infarction (20 of 103, 19%) (p less than 0.001), normal right ventricular sites (five of 24, 21%) (p less than 0.001), and endocardial catheter sites (six of 29, 21%), (p less than 0.001). These findings suggest that local properties of excitability and refractoriness at the site of stimulation, as well as anatomic and geometric factors, may be critical in the initiation of sustained ventricular tachyarrhythmias using the technique of programmed electrical stimulation.

Animals↗
PubMed1991

Hemodynamic and electrophysiological actions of cocaine. Effects of sodium bicarbonate as an antidote in dogs.

BACKGROUND: Cocaine abuse has been implicated as a cause of death due to sudden cardiac arrest. METHODS AND RESULTS: We examined the hemodynamic and electrophysiological effects of cocaine administered as a series of 5-mg/kg i.v. boluses coupled with a continuous infusion in anesthetized dogs. Sodium bicarbonate (50 meq i.v.) was administered as a potential antidote in 11 of 15 dogs, and intravenous 5% dextrose was given in the remaining four. In a dose-dependent fashion, cocaine significantly decreased blood pressure, coronary blood flow, and cardiac output; increased PR, QRS, QT, and QTc intervals and sinus cycle length; and increased ventricular effective refractory period and dispersion of ventricular refractoriness. No afterdepolarizations were noted in the monophasic action potential recording. Nonsustained monomorphic ventricular tachycardia occurred spontaneously in two dogs, and sustained ventricular tachycardia could be induced by programmed stimulation at the end of the dosing protocol in five of 11 animals. Sodium bicarbonate promptly decreased cocaine-induced QRS prolongation to nearly that measured at baseline but had no effect on the other electrocardiographic or hemodynamic variables. In one dog, sodium bicarbonate administration was associated with reversion of ventricular tachycardia to sinus rhythm. CONCLUSIONS: We conclude that high-dose cocaine possesses negative inotropic and potent type I electrophysiological effects. Sodium bicarbonate selectively reversed cocaine-induced QRS prolongation and may be a useful treatment of ventricular arrhythmias associated with slowed ventricular conduction in the setting of cocaine overdose.

Animals↗
PubMed2006

Mesodermal expression of Tbx1 is necessary and sufficient for pharyngeal arch and cardiac outflow tract development.

The development of the segmented pharyngeal apparatus involves complex interaction of tissues derived from all three germ layers. The role of mesoderm is the least studied, perhaps because of its apparent lack of anatomical boundaries and positionally restricted gene expression. Here, we report that the mesoderm-specific deletion of Tbx1, a T-box transcription factor, caused severe pharyngeal patterning and cardiovascular defects, while mesoderm-specific restoration of Tbx1 expression in a mutant background corrected most of those defects in the mouse. We show that some organs, e.g. the thymus, require Tbx1 expression in the mesoderm and in the epithelia. In addition, these experiments revealed that different pharyngeal arches require Tbx1 in different tissues. Finally, we show that Tbx1 in the mesoderm is required to sustain cell proliferation. Thus, the mesodermal transcription program is not only crucial for cardiovascular development, but is also key in the development and patterning of pharyngeal endoderm.

Animals↗
PubMed1990

Perceived barriers to exercise and weight control practices in community women.

A sample of community women was surveyed to determine exercise habits, weight control methods, and perceived barriers to sustaining and initiating exercise and weight management programs. Lack of time was reported to be the most significant factor limiting exercise, while lack of willpower and time constraints were the most frequently reported obstacles to weight management. Suggestions to aid adherence to exercise and weight control programs among women are outlined.

Adolescent↗
PubMed2003

Impact of overexploitation of shellfish: northeastern coast of India.

India has a very extensive coastline of about 7515 km, rich in diverse living resources. These resources continue to deteriorate with rampant harvesting or are altered for other uses such as aquaculture and fisheries. The present paper deals with degrading coastal habitats in northeastern India, and projects the intensity of the stress arising from the collection of tiger prawn seeds (Penaeus monodon) for aquacultural farms and molluskan shells for poultry feed and edible lime. Indiscriminate exploitation of these resources leads to a heavy reduction of the species concerned and other associated marine communities. The magnitude of such destruction has been quantified. The impacts of biodiversity loss and their after-effects on the ecobalance of this coastal system have become a matter of great concern to ecologists to maintain security and sustainability. The authors propose a public awareness program on themes relating to the importance of biodiversity for human livelihoods.

Animals↗
PubMed1993

The effect of federal grants on medical schools' production of primary care physicians.

OBJECTIVES: Title VII of the Health Professions Educational Assistance Act of 1976 was created to encourage the production of primary care physicians. This study explored recent trends in the proportion of US medical school graduates entering primary care in relationship to Title VII funding. METHODS: The American Medical Association Physician Masterfile was used to determine the specialty choice of all students graduating from American medical schools between 1960 and 1985. RESULTS: The proportion of graduates entering primary care rose from 19.7% in 1967 to 31.1% in 1976 and remained stable for the subsequent decade. The increase occurred before implementation of Title VII. Rural, state-owned medical schools with departments of family medicine tend to produce a greater proportion of primary care physicians than urban private schools without family medicine departments. CONCLUSIONS: The values of American medical schools and the reward structure of American medical practice favor the production of specialists over primary care physicians. Although Title VII helped to encourage and sustain the development of primary care educational programs at both the medical student and graduate levels, an increase in the proportion of primary care physicians will require fundamental changes.

Career Choice↗
PubMed1996

Generic drugs. Therapeutic equivalence.

For economic reasons, the use of generic substitution is increasingly being supported by health authorities. Potentially, this may be problematic for drugs with a narrow therapeutic window if quality control and/or bioequivalence is not optimal. Many developing countries do not have the resources or expertise to carry out appropriate quality control resulting in widespread distribution of substandard or even counterfeit drugs. Even in countries where procedures are well regulated, substandard drugs reach the market from time to time. Interchangeability of drugs is determined by bioequivalence studies comparing the serum concentration versus time curves for the products following single dose administration to fasting volunteers in a randomised crossover design. A number of reports, largely anecdotal, of treatment failure or increased adverse events after switching brands has cast some doubts upon whether bioequivalence testing is sufficient in all cases. These reports have covered cardiovascular, respiratory, hormonal, psychotropic, anticonvulsant, anti-infective and anti-inflammatory drugs. Equivalence is particularly difficult to obtain with many sustained-release formulations. The WHO has initiated programs to prevent the distribution of substandard preparations and has drafted guidelines for testing bioequivalence based on internationally accepted reference products. Until such time as means can be provided-first, to enforce internationally accepted production standards, and second, to permit uniform testing of therapeutic agents-the safest clinical choice, particularly in countries where registration requirements and quality control are minimal, must remain the branded product.

Biological Availability↗
PubMedDate not supplied

Surgical treatment of the unstable ankle.

Symptomatic ankle instability will develop in as many as 20% of patients after inversion sprain of the lateral ankle ligaments. Although most patients may be successfully treated with a rehabilitative exercise program and bracing, some will continue to sustain recurrent ankle sprains with activities of daily living, work on uneven terrain, or sports. The anterior talofibular ligament and the calcaneofibular ligament are the primary stabilizers of the lateral ankle, and surgical procedures should be aimed at restoring the normal function of these ligaments. Preoperative stress radiographs should be obtained to determine the degree of laxity and to differentiate between subtalar joint and ankle joint instability. Numerous surgical techniques have been described to correct ankle instability, most with an 80% to 90% success rate. Reconstructions using tendon grafts may restrict normal ankle and subtalar joint motion, depending on the placement of the graft. Direct repair of the anterior talofibular and calcaneofibular ligaments with shortening and reattachment to the fibula has a success rate similar to that for augmented reconstruction and avoids the increased morbidity associated with tendon graft procedures. Patients with severe laxity or with weak or deficient tissue for direct repair may require an augmented reconstruction. Osteotomy may be required in addition to ligament reconstruction in patients with severe ankle or hindfoot varus alignment, in order to prevent failure of the repair. Patients with paralysis or weakness of the peroneal musculature may require a nonanatomic procedure that limits subtalar motion.

Ankle Joint↗