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PubMed2000

Antidotes--inappropriate timely availability.

The aim of this study was to determine the availability of antidotes to poisons in Wales and the South West of England. A stocklist of antidotes that are available to accident and emergency departments was requested and was compared with recommendations from the International Programme on Chemical Safety (IPCS). Chief pharmacists were invited to complete a short questionnaire regarding knowledge of existing guidelines. Thirty-four of 43 centres replied (response rate 77%). No department held all 36 antidotes (mean 13, range 7-33). All departments held antidotes that were frequently used. Ninety-one percent of departments held one cyanide antidote. Eighty-eight percent held one heavy metal chelating agent. The remaining antidotes were variably stocked. New agents such as 4-methylpyrazole, hydroxocobalamin and the heavy metal chelating agents DMSA and DMPS were infrequently held. Twenty of 34 chief pharmacists were unfamiliar with existing UK guidelines. A trend exists whereby larger departments stocked more antidotes. Some antidotes to poisons are not available in a timely fashion in Wales and the South West of England. There is a lack of awareness of existing guidelines. New recommendations relevant to clinical need and local practice should ideally be developed.

Antidotes↗

PubMed1999

To what extent are biomonitoring data available in chemical risk assessment?

1. Chemical risk assessment integrates the identification of hazards and the human exposure levels which can be established from external and/or internal exposure data. 2. The availability of biomonitoring and metabolism animal data, the skin penetration ability, and the existence of atmospheric threshold limit values were examined for twelve substances of the European first list of priority existing substances. This investigation was focused on workplace exposures and on urinary biomarkers of exposure. Appropriate biomonitoring data appeared to be available for two substances: styrene and trichloroethylene. Some biomonitoring research has been conducted on acrylonitrile, buta-1,3-diene, cyclohexane, 1,4-dichlorobenzene, hydrogen fluoride, 2-(2-methoxyethoxy)ethanol, however additional studies could be usefully carried out. No biomonitoring data are available for alkanes, C10-13, chloro; benzene, C10-13-alkyl derivatives; bis(pentabromophenyl)ether; diphenylether, octabromo-derivative. 3. It was concluded that in some cases, biomonitoring data are either lacking or scarce. This is rather surprising since the selection of the substances of the priority list was based on high tonnage, widespread use, extent of human exposure, and toxicological concern. The development of biomonitoring information could be helpful in assessing individual or population chemical exposure whatever the source and route, and would result in both more realistic and more accurate risk assessments.

Acrylonitrile↗

PubMed2004

Loss of paramedic availability in an urban emergency medical services system during a severe acute respiratory syndrome outbreak.

OBJECTIVES: To describe the loss of paramedic availability to Toronto Emergency Medical Services during a biphasic (SARS-1 and SARS-2) outbreak of severe acute respiratory syndrome (SARS). METHODS: During the SARS outbreak, a dedicated paramedic surveillance and quarantine program was developed. The authors determined the number of paramedics on quarantine each day, the type of quarantine (either home quarantine [HQ] or work quarantine [WQ]), and the development of SARS-like symptoms. RESULTS: During the SARS outbreak, there were five cases of probable SARS and three cases of suspect SARS. SARS-1 lasted 30 days, during which 234 paramedics were placed on HQ. The total number of HQ days was 1,615. During the five peak days of SARS-1, the total number of HQ days was 664. SARS-2 lasted 18 days, during which 292 paramedics were placed on either HQ or WQ, for a combined number of quarantine days of 1,637. During the five peak days of SARS-2, the combined number of quarantine days was 910. Of these, paramedics were available for duty on 708 days (78%) due to the WQ program. The primary reason for quarantine was unprotected exposure to a health care institution experiencing a SARS outbreak. Under quarantine, SARS-like symptoms developed in 68 paramedics, including cough (53 [78%]), myalgia (33 [48%]), fatigue (30 [44%]), headache (29 [43%]), fever (11 [16%]), and shortness of breath (7 [10%]). CONCLUSIONS: Paramedics were among the health care workers who developed SARS. During SARS-2, WQ optimized the number of days on which paramedics were available for duty. Many paramedics developed SARS-like symptoms without being diagnosed as having SARS. A dedicated paramedic surveillance and quarantine program provided a useful means to manage the paramedic resource during the SARS outbreak.

Absenteeism↗

PubMed2004

Survival of patients with advanced colorectal cancer improves with the availability of fluorouracil-leucovorin, irinotecan, and oxaliplatin in the course of treatment.

PURPOSE: Fluorouracil (FU)-leucovorin (LV), irinotecan, and oxaliplatin administered alone or in combination have proven effective in the treatment of advanced colorectal cancer (CRC). Combination protocols using FU-LV with either irinotecan or oxaliplatin are currently regarded as standard first-line therapies in this disease. However, the importance of the availability of all three active cytotoxic agents, FU-LV, irinotecan, and oxaliplatin, on overall survival (OS) has not yet been evaluated. MATERIALS AND METHODS: We analyzed data from seven recently published phase III trials in advanced CRC to correlate the percentage of patients receiving second-line therapy and the percentage of patients receiving all three agents with the reported median OS, using a weighted analysis. RESULTS: The reported median OS is significantly correlated with the percentage of patients who received all three drugs in the course of their disease (P =.0008) but not with the percentage of patients who received any second-line therapy (P =.19). In addition, the use of combination protocols as first-line therapy was associated with a significant improvement in median survival of 3.5 months (95% CI, 1.27 to 5.73 months; P =.0083). CONCLUSION: Our results support the strategy of making these three active drugs available to all patients with advanced CRC who are candidates for such therapy to maximize OS. In addition, our findings suggest that, with the availability of effective salvage options, OS should no longer be regarded as the most appropriate end point by which to assess the efficacy of a palliative first-line treatment in CRC.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed1984

Erythrocyte 2,3-diphosphoglycerate, PO250%, and available oxygen in young rabbits with and without postnatal fall in hemoglobin.

We determined erythrocyte 2,3-diphosphoglycerate (2,3-DPG), PO250%, whole blood hemoglobin concentration, and available O2 from the 12th to the 30th d after birth in two matched groups of young rabbits. One group received iron parenterally on the 12th, 15th, and 18th d and the other received no iron supplement. In the untreated group there was a marked fall in hemoglobin concentration from the 12th to the 22nd d and thereafter a marked increase to the initial level on the 30th d whereas the iron-treated animals showed a marked rise in hemoglobin concentration from the 12th to the 22nd d, and a subsequent, slight decline from the 22nd to the 30th d. The average values of PO250% and 2,3-DPG, and the changes in PO250% and 2,3-DPG were virtually identical for both groups. During the first period (12-22 d) there was a marked rise in both 2,3-DPG and PO250% whereas in the second period (22-30 d) there was a somewhat smaller rise in 2,3-DPG and only a slight tendency toward a further rise in PO250%. In the untreated animals "available O2," reflecting the O2 delivery capacity of the blood, remained unchanged during the period of fall in hemoglobin concentration and showed a rise during the second period. In the iron-treated animals "available O2" rose markedly during the first period, with iron-treatment, and remained unchanged during the second period. We conclude that the marked postnatal rise in 2,3-DPG and PO250% in the rabbit seems to be independent of the changes in the hemoglobin concentration.

2,3-Diphosphoglycerate↗

PubMed1987

Limited maternal fuel availability due to hyperinsulinemia retards fetal growth and development in the rat.

We rendered pregnant rats chronically hyperinsulinemic to determine the effect of reduced maternal metabolic fuel availability on fetal growth and development. We implanted osmotically driven insulin loaded minipumps on day 14 (term 21.5 days) in pregnant rats. This significantly increased maternal plasma concentrations of insulin and reduced glucose from day 15 until term. From day 17 until birth, fetal growth was significantly less for hyperinsulinemic mothers (term birth weight 4.53 +/- 0.07 versus 5.64 +/- 0.06 g, p less than 0.001). In fetuses of hyperinsulinemic mothers plasma glucose and insulin concentrations were significantly reduced while glucagon concentrations were increased. Total plasma amino acids were significantly reduced in maternal rats and their fetuses from days 17 to 19 while arteriovenous blood gas tensions and pH did not differ between fetuses of hyperinsulinemic and control mothers. Small for gestational age newborn pups of hyperinsulinemic mothers were hypoglycemic for the first 240 min of life as a result of limited hepatic glycogen stores and a delay in the normally expected induction of hepatic cytosolic phosphoenolpyruvate carboxykinase. This occurred despite significant increases in neonatal plasma glucagon concentrations. These data indicate that limitation of maternal glucose and amino acids with normal placental gaseous exchange retards fetal growth, limits hepatic glycogen deposition, and delays neonatal phosphoenolpyruvate carboxykinase induction. Limited fetal insulin secretion resulting from diminished maternal fuel availability may have also been a factor in retarding growth. The delay in phosphoenolpyruvate carboxykinase induction despite enhanced glucagon secretion during fetal and neonatal life suggests a specific "resistance" to this hormone in the rat growth retarded by limited metabolic fuel availability.

Amino Acids↗

PubMed2003

Resources for physical activity participation: does availability and accessibility differ by neighborhood socioeconomic status?

The purpose of this study was to determine whether the availability and accessibility of physical activity resources differed by neighborhood socioeconomic status (SES) in a small U.S. city (population = 133,046). U.S. census tracts (N =32) were used to represent neighborhoods and categorized into high, medium, or low SES on the basis of the percentage of unemployed individuals, per capita income, and percentage of the population below the poverty threshold. We developed a geographic information system to generate a comprehensive list of physical activity resources available within each census tract in the city. We identified 112 parks, 33 sport facilities, 15 fitness clubs, 11 community centers, and 5 walking/biking trails. The total number of physical activity resources varied by neighborhood SES (p <.05); low-SES (M =4.5-/+2.3) and medium-SES (M =4.9-/+2.6) neighborhoods had significantly fewer resources than high-SES (M =8.4-/+3.5) neighborhoods. Low-, medium-, and high-SES neighborhoods did not differ on the number of pay-for-use facilities; however, low-SES (M =3.1-/+1.5) and medium-SES (M =3.8-/+1.6) neighborhoods had significantly fewer free-for-use resources than high- (M =6.1-/+2.4) SES neighborhoods (p <.01). Data suggest that individuals from lower SES neighborhoods may have limited ability to control their physical activity in the face of inaccessible environments. Community research and promotion efforts should include assessment and targeting of available and accessible physical activity resources.

Exercise↗

PubMed1999

Availability of family support as a moderator of exposure to community violence.

Examined the role of availability of family support in moderating the negative effects of exposure to community violence on internalizing symptoms. Participants were 75 low-income African American children between the ages of 10 and 15. Two measures of availability of family support (mother's presence in the home and family size) were evaluated as moderators of the relations between exposure to community violence and depression and posttraumatic stress disorder (PTSD) symptoms. After controlling for age, sex, and concurrent life stress, mother's presence in the home moderated the relation between exposure to community violence and depressive symptoms but not the relation between exposure to community violence and PTSD symptoms. Children living in mother-absent families were at increased risk of depressive symptoms as exposure to community violence increased. In addition, family size approached significance as a moderator of depressive symptoms but not PTSD symptoms, revealing a trend toward children from smaller families being at increased risk of depressive symptoms as exposure to community violence increased. These findings suggest that although availability of family support is an important moderator for depressive symptoms, this is not the case for PTSD symptoms.

Adolescent↗

PubMed1975

Content of nuclear estradiol receptor complex in rat corpora lutea during pregnancy: relationship to estrogen concentrations and cytosol receptor availability.

The content of estradiol receptor in cytosol and nuclear cell fractions of rat corpora lutea changed during pregnancy. The binding of (3-H)) estradiol to luteal cell cytosol was high early in pregnancy between days 3-11, decreased on days 12and15 and was low throughout of the remainder of pregnancy. In contrast, the binding of (3-H) estradiol to nuclear receptor, as measured by nuclear exchange assay, was low early in pregnancy, increased between days 10-15, remained high through day 18 and decreased on days 20 and 22. The administration in vivo of estradiol-17beta (40 mug) 1 hr prior to sacrifice stimulated an increase in nuclear receptor content early in pregnancy (days 3,6,8,10-12) but not later in pregnancy (15,18,20, and 22,). These results suggested that the estradiol binding component(s) present in rat luteal cell cytosol early in pregnancy represented available estradiol receptor capable of being translocated to the nucleus in the presence of sufficient estradiol. However, once available receptor has been saturated by endogenous hormone at midgestation, exogenous hormones hasno further effect on no nuclear receptor content. Importantly,loss of nuclear receptor content late in pregnancy appears to reflect decreased levels of total cellular receptor indicating that corpora lutea at the end of pregnancy have lost the primary mecchanism for responding to estrogens Thus, various stages of luteal cell differentiation are associated with changes in the intra-cellular distribution and total cellular content of estradiol receptor suggesting that luteal cell function may be regulated selectively and separately by hormone concentrations and hormone receptor availability.

Animals↗

PubMed2002

The ubiquitin-proteasome pathway regulates the availability of the GH receptor.

GH promotes not only longitudinal growth in children but is active throughout life in protein, fat, and carbohydrate metabolism. The multiple actions of GH start when GH binds to the cell surface-expressed GH receptor. Effectiveness of the hormone depends both on its presence in the circulation and the availability of receptors at the cell surface of target cells. In this study, we examined the role of the ubiquitin-proteasome pathway in regulating GH receptor availability. We show that receptor turnover is rapid, and almost 3-fold prolonged in the internalization-deficient mutant GH receptor (F327A). Using a monovalent GH antagonist, B2036, we could quantify the internalization of the nonactivated receptor. By comparing internalization of the receptor with shedding of the GH-binding protein, we show that in Chinese hamster lung cell lines, internalization followed by lysosomal degradation is the major pathway for receptor degradation and that the ubiquitin-proteasome pathway controls this process. Inhibition of endocytosis resulted in a 200% increase in receptor availability at the cell surface at steady state.

Animals↗

PubMed2004

Access denied; care impaired: the benefits of having online medical information available at the point-of-care.

The availability of Internet-enabled computers in the operating room (OR) facilitates unparalleled physician access to current peer reviewed research, either in abstract or full text format, a development that provides physicians with an exciting opportunity to incorporate such findings into clinical practice at the point-of-care. In this report I describe how the availability of online peer reviewed medical literature altered, in one case a planned surgical procedure and, in the other, the interpretation by the anesthesiologist of the clinical significance of an intraoperative echocardiographic finding. In case one, a free, rather than an intact, internal mammary (IM) artery graft was placed to the left anterior descending coronary artery of a patient with renal failure and an ipsilateral upper extremity arteriovenous fistula. The change occurred after the full text results of a study indicating that steal could well occur during the initiation of dialysis if an intact IM was used were made available to the surgeon. In case two, the occurrence of mild central mitral regurgitation in a Carpentier-Edwards Perimount prosthetic mitral valve was confirmed to be a benign finding after a study detailing the long term performance characteristics of this valve was accessed online in the OR. The benefits and potential pitfalls of searching and interpreting online medical information are discussed.

Adult↗

PubMed2005

The effect of introducing radiographer reporting on the availability of reports for Accident and Emergency and General Practitioner examinations: a time-series analysis.

This study explores whether the introduction of selectively trained radiographers reporting Accident and Emergency (A&E) X-ray examinations of the appendicular skeleton affected the availability of reports for A&E and General Practitioner (GP) examinations at a typical district general hospital. This was achieved by analysing monthly data on A&E and GP examinations for 1993-1997 using structural time-series models. Parameters to capture stochastic seasonal effects and stochastic time trends were included in the models. The main outcome measures were changes in the number, proportion and timeliness of A&E and GP examinations reported. Radiographer reporting X-ray examinations requested by A&E was associated with a 12% (p=0.050) increase in the number of A&E examinations reported and a 37% (p</=0.001) decrease in the time taken to report on these examinations. Radiographer reporting of A&E X-ray examinations was also associated with a 14% (p=0.067) decrease in the time taken for GP examinations to be reported. That is, radiographer reporting A&E X-ray examinations allowed an increase in the time available to radiologists to report on examinations requested by GPs. An increase in the proportion of GP examinations reported by radiologists was associated with longer reporting times for A&E examinations. In conclusion, selectively trained radiographers reporting on A&E X-ray examinations significantly improved the availability of reports for A&E and GP examinations.

Emergency Service, Hospital↗

PubMed1991

Digestibility and energy availability of Wakame (Undaria pinnatifida) seaweed in Japanese.

The digestibilities of nutrients and energy in Wakame were measured in healthy adult males. A test diet was given for 5 days after 5 days on a basal diet which supplied 40 g/day of protein and 45 kcal/kg/day of energy. The test diet was identical with the basal diet except that Wakame was incorporated. Digestibility was calculated by the difference of fecal output between the test period and the basal period. However the digestibility of its nutrient component was found to be different at each intake level. Therefore the present study simply lists the calculated figures. The results obtained were follows: 1) Composition of Wakame was protein: 20.5%, fat: 1.7%,. Total carbohydrate: 45.1%, gross energy content: 322 kcal/100g. 2) Digestibility of protein was 70.1 +/- 14.0%. 3) Digestibility of fat was 97.5 +/- 59.0%. 4) Digestibility of carbohydrate was 55.8 +/- 14.6%. 5) The ratio of the total available energy to intake energy (Net Energy Availability) was 62.4 +/- 19.4%. Wakame contains proteins and available carbohydrates, and may be consumed as a protein source as well as a good source of vitamins and minerals.

Adult↗

PubMed2003

From phenotype to genotype: issues in navigating the available information resources.

OBJECTIVES: As part of an investigation of connecting health professionals and the lay public to both disease and genomic information, we assessed the availability and nature of the data from the Human Genome Project relating to human genetic diseases. METHODS: We focused on a set of single gene diseases selected from main topics in MEDLINEplus, the NLM's principal resource focused on consumers. We used publicly available websites to investigate specific questions about the genes and gene products associated with the diseases. We also investigated questions of knowledge and data representation for the information resources and navigational issues. RESULTS: Many online resources are available but they are complex and technical. The major challenges encountered when navigating from phenotype to genotype were (1) complexity of the data, (2) dynamic nature of the data, (3) diversity of foci and number of information resources, and (4) lack of use of standard data and knowledge representation methods. CONCLUSIONS: Three major informatics issues arise from the navigational challenges. First, the official gene names are insufficient for navigation of these web resources. Second, navigational inconsistencies arise from difficulties in determining the number and function of alternate forms of the gene or gene product and maintaining currency with this information. Third, synonymy and polysemy cause much confusion. These are severe obstacles to computational navigation from phenotype to genotype, especially for individuals who are novices in the underlying science. Tools and standards to facilitate this navigation are sorely needed.

Databases, Genetic↗

PubMed2002

Drug policy: making effective drugs available without bankrupting the healthcare system.

To the extent possible, drug policy should be based upon good quality evidence. This must extend beyond the traditional focus on efficacy and safety in carefully selected patients, to evidence about real-world effectiveness, cost-effectiveness and safety of drugs. This paper will consider methods of improving the quality of the evidence currently available, and the implications of requiring that evidence. Historically, there has been a direct link between research evidence and policy at the level of licensing - drugs are only made available after they have been shown to be safe and efficacious in well-designed and independently assessed research studies. We propose that this reliance on evidence be logically extended to cover the formulary inclusion and post-marketing surveillance aspects of modern prescription drug policy. More specifically we propose that the decision to initially list a drug on a benefit formulary be based on evidence from relevant head-to-head comparisons and well-designed cost-effectiveness analyses. This evidence would be produced by industry in cooperation with independent peer-reviewed funding agencies. Drugs could only be added to a formulary if they met specific predetermined criteria, and drugs could be removed as superior alternatives became available. The provincial governments are monopsony buyers of medicines, and they wield the power to determine public payer "market access'for medicines. This power (within and across provinces) could be used more effectively to negotiate price in the context of reimbursement. The effect of different methods of influencing prescribing (e.g., 'limited access?) upon drug utilization and patient outcomes should be rigorously assessed, including the randomization of groups of patients or communities to different strategies. We also propose that all drugs on the formulary would be subject to a well-designed post-marketing surveillance program. This program would build on the existing passive reporting of adverse events by adding a proactive system that would systematically describe the use and impact of drugs. The notion of drug safety would be extended to include not only adverse events, but also inappropriate use of drugs that results inpatients receiving drugs that do not benefit them. Inappropriate use wastes resources and can put patients and populations at risk.

Adverse Drug Reaction Reporting Systems↗

PubMed2001

Using available clinical information in practice-based research: mining for silver while dreaming of gold.

Social workers in health and mental health settings routinely collect and record enormous quantities of clinical information about clients, psycho-social interventions and client responses to these interventions. Despite its abundance and non-intrusiveness, social work researchers generally have ignored available clinical information, claiming that it is unreliable and subject to too many threats to validity to warrant serious consideration as a data source. Instead, many researchers have advocated "gold standard" experimental studies, employing standardized instruments and prospective data-collection. As a result, the research potential of retrospective studies based on available clinical information has been relatively unexplored and untested. This paper asserts that available clinical information can be converted into valuable retrospective, data-bases for practice-based research studies. Exemplars of such studies in health and mental health settings are provided as are guidelines for their conduct.

Data Collection↗

PubMed1986

Adolescents' substance use: impact of ethnicity, income, and availability.

This study examines ethnic differences in reported use of cigarettes, alcohol, cannabis, hard drugs, and non-prescription medications among a sample of adolescents and attempts to explain these differences in terms of income, ease of acquisition, and availability from friends. Data were obtained from 847 students three times over a five-year period. Results indicate consistent and significant differences among ethnic groups substance use at all three points in time. It was hypothesized that ethnic groups have differential access to substances and economic resources to purchase various drugs. To test these hypotheses, availability from friends, perceived ease of acquisition, income from earnings and gifts/allowances, and initial substance use were examined across ethnic groups and then used as covariates of the substance differences. A split-plot repeated measures design with covariates was used to compare changes in substance use across time and between ethnic groups. Earned income made a significant impact on explaining the ethnic differences for cigarette, alcohol, and given income on cannabis consumption. Adding community variables such as availability from friends, ease of acquisition, and initial drug use not only eliminates the effects of income variables on drug use, but in most cases, the ethnic differences among adolescents as well.

Adolescent↗

PubMed2006

Effectiveness of commercially-available antibiotic-impregnated implants.

The aim of this study was to determine the effectiveness of antibiotic-impregnated implants in the prevention of bone infection. We used a model of contaminated fracture in goats to evaluate four treatment groups: no treatment, hand-made tobramycin-impregnated polymethylmethacrylate beads, commercially-available tobramycin-impregnated calcium sulphate pellets and commercially-available tobramycin-impregnated polymethylmethacrylate beads. Three weeks after intraosseous inoculation with streptomycin-resistant Staphylococcus aureus tissue cultures showed no evidence of infection in any of the antibiotic-treated groups. All of the cultures were positive in the untreated group. These results show that effective local antibiotic delivery can be obtained with both commercially-available products and with hand-made polymethylmethacrylate beads. The calcium sulphate pellets have the advantage of being bioabsorbable, thereby obviating the need for a second procedure to remove them.

Animals↗