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Background: Malignant brain tumours are rare, but are important to study because survival rates are low and few modifiable risk factors have been identified. Existing evidence suggests that outdoor ultrafine particles (UFPs; particulate matter

Background: Concentrations of outdoor ultrafine particles (UFP;

Objective: To evaluate the impact of a Geriatric Pharmacy elective on pharmacy students' knowledge, attitudes, and empathy regarding older adults., Methods: Enrolled students in a 15-week Geriatric Pharmacy elective during 3 consecutive academic years were invited to complete a precourse and postcourse survey. The survey consisted of the revised Palmore facts on aging quiz, the University of California at Los Angeles geriatric attitudes scale, the Kiersma-Chen empathy scale, and demographic questions. The presurvey and postsurvey data were compared and the impact of demographic factors on student knowledge, attitudes, and empathy was assessed in an exploratory analysis., Results: Sixty-six students participated in the study. Scores on the revised Palmore facts on aging quiz and the University of California at Los Angeles geriatric attitudes scale increased significantly postsurvey compared with presurvey. Student scores on the Kiersma-Chen empathy scale increased on the postsurvey compared with the presurvey, but this increase was not statistically significant. Student self-reported experience with older adults, race, and the course year impacted student performance., Conclusion: A geriatric elective positively impacted the students' knowledge and attitudes toward older adults. Future research should include validity and reliability testing of geriatric assessment scales in a diverse student population to ensure effective assessment of student knowledge, attitudes, and empathy in this patient population., Competing Interests: Declaration of Competing Interest None declared., (Copyright © 2024 American Association of Colleges of Pharmacy. Published by Elsevier Inc. All rights reserved.)

Background and Purpose: The objective of this project was to assess the impact of self-care scenario simulations on first year doctor of pharmacy student performance and self-perceived confidence in applying the Pharmacists' Patient Care Process (PPCP) during self-care encounters., Educational Activity and Settings: Self-care scenarios were developed and used during low fidelity simulations in laboratory sessions in a skills-based course. Students met individually with faculty facilitators role-playing patients to apply the PPCP in four simulations. Facilitators graded student performance; a comparison was made between performance on the first and fourth simulation. Students completed a pre- and post-course survey regarding their self-perceived confidence in performance and knowledge in applying the PPCP in self-care encounters., Findings: One hundred and eight (100%) of enrolled students voluntarily agreed to participate in this IRB-approved study. The median percentage of student scores on the fourth simulation, 90.7%, was higher compared to the median percentage of student scores on the first simulation, 82.4%, P < 0.001 with a raw difference of 8.3 percentage points, for participants with scores for both simulations, 106 (98%). For the self-perceived PPCP confidence survey, 100 (92.5%) participants completed both pre- and post-course surveys. Self-perceived confidence on 12 of the 15 survey items where students ranked their confidence in performance and knowledge in self-care encounters increased post- versus pre-course., Summary: Simulations served as a useful tool in improving student performance in applying the PPCP in self-care encounters in a first year doctor of pharmacy course. Student self-perceived confidence in performance and knowledge in self-care encounters also increased., Competing Interests: Declaration of competing interest The authors have no conflicts of interests or disclosures to declare., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Defining the molecular networks orchestrating human brain formation is crucial for understanding neurodevelopment and neurological disorders. Challenges in acquiring early brain tissue have incentivized the use of three-dimensional human pluripotent stem cell (hPSC)-derived neural organoids to recapitulate neurodevelopment. To elucidate the molecular programs that drive this highly dynamic process, here, we generate a comprehensive trans-omic map of the phosphoproteome, proteome, and transcriptome of the exit of pluripotency and neural differentiation toward human cerebral organoids (hCOs). These data reveal key phospho-signaling events and their convergence on transcriptional factors to regulate hCO formation. Comparative analysis with developing human and mouse embryos demonstrates the fidelity of our hCOs in modeling embryonic brain development. Finally, we demonstrate that biochemical modulation of AKT signaling can control hCO differentiation. Together, our data provide a comprehensive resource to study molecular controls in human embryonic brain development and provide a guide for the future development of hCO differentiation protocols., Competing Interests: Declaration of interests The authors declare no competing interests., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Objective To review the pharmacotherapy of prescription drugs approved for treatment of chronic dry eye disease (DED). A brief background on DED management and the pharmacist's role for care is included. Data Sources Articles indexed in PubMed (National Library of Medicine), Iowa Drug Information Service, Cochrane Reviews and Trials, and Google Scholar in the past 10 years using the key words "dry eye," "dry eye and treatment," "cyclosporine," "lifitegrast," and "varenicline." Current guidelines and manufacturers' prescribing information were reviewed. Primary sources were used to locate additional resources. Study Selection/Data Extraction Sixty-five publications were reviewed, and criteria supporting the objectives identified useful resources. Data Synthesis Selected literature included practice guidelines, review articles, research articles, product prescribing information, and drug information databases. Conclusion Patient education, eliminating causative factors, improving the daily environment for eye health, and using ocular lubricants are the first steps in DED management. A therapeutic mainstay is ocular lubricants; preservative-free formulations are recommended for chronic or repeated daily use. The Food and Drug Administration approved prescription medications for chronic use for DED, cyclosporine ophthalmic emulsion and solution, lifitegrast ophthalmic solution, and varenicline nasal spray, all improve signs and symptoms but do not cure DED. The ophthalmic products all cause ocular discomfort upon instillation. As a nasal spray, varenicline does not cause ocular discomfort, but it can cause sneezing, cough, and throat and nose irritation in some patients. Pharmacists have an opportunity to provide patient education regarding lifestyle modifications to mitigate DED and provide counseling on available products. Emerging therapies may provide advances in DED treatment.

Introduction: The American Association of Colleges of Pharmacy has urged pharmacy faculty to commit to actions to reduce the public health threat from opioid use and misuse. Optimizing student pharmacist training necessitates understanding changes in their attitudes and perceptions over time. This study assessed student attitudes, perceptions, and understanding of addiction, opioid use and misuse, and opioid overdose over four sequential years, from 2016 to 2019., Methods: The participants were third-professional year doctor of pharmacy students enrolled in a required course. Participants voluntarily completed a 27-statement survey to determine student attitudes, perceptions, and understanding., Results: A total of 452 participants completed the survey (response rate = 76.5%). Of the 27 survey items, five survey statements showed year on year positive increases in specific student attitudes towards addiction, hopefulness for its treatment, and confidence to use and train opioid overdose reversal agents. These yearly changes did not appear to be related to any changes in the academic aptitude of the students. The 22 remaining statements showed positive and stable attitudes towards self-perceived understanding of opioid use and misuse, hopefulness for its treatment, and the role of pharmacists., Conclusion: To our knowledge, this is the first large multiyear assessment of student pharmacists' attitudes, perceptions, and understanding of opioid use, misuse, and overdose. The data indicate favorable and improving attitudes. Knowledge of student attitudes, perceptions, and understanding regarding opioid use, misuse, and overdose will aid in the development of effective training programs for students in our, and other colleges of pharmacy., Competing Interests: Declaration of Competing Interest None., (Copyright © 2022. Published by Elsevier Inc.)

Background: The gut microbiome and its metabolites can impact brain health and are altered in Parkinson's disease (PD) patients. It has been recently demonstrated that PD patients have reduced fecal levels of the potent epigenetic modulator butyrate and its bacterial producers., Objectives: Here, we investigate whether the changes in the gut microbiome and associated metabolites are related to PD symptoms and epigenetic markers in leucocytes and neurons., Methods: Stool, whole blood samples, and clinical data were collected from 55 PD patients and 55 controls. We performed DNA methylation analysis on whole blood samples and analyzed the results in relation to fecal short-chain fatty acid concentrations and microbiota composition. In another cohort, prefrontal cortex neurons were isolated from control and PD brains. We identified genome-wide DNA methylation by targeted bisulfite sequencing., Results: We show that lower fecal butyrate and reduced counts of genera Roseburia, Romboutsia, and Prevotella are related to depressive symptoms in PD patients. Genes containing butyrate-associated methylation sites include PD risk genes and significantly overlap with sites epigenetically altered in PD blood leucocytes, predominantly neutrophils, and in brain neurons, relative to controls. Moreover, butyrate-associated methylated-DNA regions in PD overlap with those altered in gastrointestinal (GI), autoimmune, and psychiatric diseases., Conclusions: Decreased levels of bacterially produced butyrate are related to epigenetic changes in leucocytes and neurons from PD patients and to the severity of their depressive symptoms. PD shares common butyrate-dependent epigenetic changes with certain GI and psychiatric disorders, which could be relevant for their epidemiological relation. © 2022 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society., (© 2022 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.)

The intracellular misfolding and accumulation of alpha-synuclein into structures collectively called Lewy pathology (LP) is a central phenomenon for the pathogenesis of synucleinopathies, including Parkinson's disease (PD) and dementia with Lewy bodies (DLB). Understanding the molecular architecture of LP is crucial for understanding synucleinopathy disease origins and progression. Here we used a technique called biotinylation by antibody recognition (BAR) to label total (BAR-SYN1) and pathological alpha-synuclein (BAR-PSER129) in situ for subsequent mass spectrometry analysis. Results showed superior immunohistochemical detection of LP following the BAR-PSER129 protocol, particularly for fibers and punctate pathology within the striatum and cortex. Mass spectrometry analysis of BAR-PSER129-labeled LP identified 261 significantly enriched proteins in the synucleinopathy brain when compared to nonsynucleinopathy brains. In contrast, BAR-SYN1 did not differentiate between disease and nonsynucleinopathy brains. Pathway analysis of BAR-PSER129-enriched proteins revealed enrichment for 718 pathways; notably, the most significant KEGG pathway was PD, and Gene Ontology (GO) cellular compartments were the vesicle, extracellular vesicle, extracellular exosome, and extracellular organelle. Pathway clustering revealed several superpathways, including metabolism, mitochondria, lysosome, and intracellular vesicle transport. Validation of the BAR-PSER129-identified protein hemoglobin beta (HBB) by immunohistochemistry confirmed the interaction of HBB with PSER129 Lewy neurites and Lewy bodies. In summary, BAR can be used to enrich for LP from formalin-fixed human primary tissues, which allowed the determination of molecular signatures of LP. This technique has broad potential to help understand the phenomenon of LP in primary human tissue and animal models., Competing Interests: The authors declare no competing interest., (Copyright © 2022 the Author(s). Published by PNAS.)

The gastrointestinal tract may be a site of origin for α-synuclein pathology in idiopathic Parkinson's disease (PD). Disruption of the autophagy-lysosome pathway (ALP) may contribute to α-synuclein aggregation. Here we examined epigenetic alterations in the ALP in the appendix by deep sequencing DNA methylation at 521 ALP genes. We identified aberrant methylation at 928 cytosines affecting 326 ALP genes in the appendix of individuals with PD and widespread hypermethylation that is also seen in the brain of individuals with PD. In mice, we find that DNA methylation changes at ALP genes induced by chronic gut inflammation are greatly exacerbated by α-synuclein pathology. DNA methylation changes at ALP genes induced by synucleinopathy are associated with the ALP abnormalities observed in the appendix of individuals with PD specifically involving lysosomal genes. Our work identifies epigenetic dysregulation of the ALP which may suggest a potential mechanism for accumulation of α-synuclein pathology in idiopathic PD., (© 2021. The Author(s).)

Major depressive disorder (MDD) is a mood disorder common in older individuals. While many clinical guidelines endorse the use of selective serotonin reuptake inhibitors (SSRIs) as first-line therapy in the treatment of MDD, the use of SSRIs in older populations can result in medication-related adverse events. The use of pharmacogenomic (PGx) testing as a personalized tool to determine optimal SSRI therapy could offer a means to decrease morbidity and improve overall quality of life in older people. This manuscript will review the epidemiology and criteria of MDD according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), discuss the prevalence of MDD in older individuals, review the clinical treatment guidelines for the use of SSRIs in MDD, provide a brief overview of PGx testing, and present evidence for SSRI therapy modifications based on PGx testing.

Objective: To review the clinical manifestations and treatment of post-traumatic stress disorder (PTSD) in adults and older people., Data Sources: Articles indexed in PubMed, Embase, psychology databases, and the Cochrane library over the past 10 years using the key words "post-traumatic stress disorder," "stress disorders," and "post-traumatic stress disorder and treatment.", Study Selection and Data Extraction: Sixty-seven publications were reviewed and criteria supporting the primary objective were used to identify useful resources., Data Synthesis: The literature included practice guidelines; review articles; original research articles; and product prescribing information for the clinical manifestations, diagnosis, and treatment of PTSD., Conclusion: Psychotherapy is the first-line therapy for PTSD. Pharmacologic therapy is recommended, as second-line therapy, for adults living with PTSD who do not have access to psychotherapy or refuse psychotherapy. Pharmacologic therapy may also be considered in cases of partial, or no, response to psychotherapy. Current guidelines recommend prescribing one of 3 selective serotonin-reuptake inhibitors, either fluoxetine, paroxetine, or sertraline, or prescribing the serotonin norepinephrine reuptake inhibitor venlafaxine, for adult patients who do not have access to psychotherapy or prefer not to use psychotherapy. Unfortunately, these recommended medications have additional cautions for use in older people so may not be appropriate for many older people living with PTSD. Therapy for older people should be tailored to patient-specific symptoms, with careful consideration of the potential benefits and risks of the therapy and coexisting medical conditions of each patient.

Objective. To evaluate levels of entrustability and practice readiness in advanced pharmacy practice experience (APPE) students using a pilot instrument designed to assess their competency in performing the entrustable professional activities (EPAs) expected of new pharmacy graduates. Methods. A pilot instrument was developed directly from EPAs to measure entrustability levels on a scale of one to five. Five APPE preceptors from several different practice areas participated. Fourth-year students used the instrument to self-evaluate their knowledge and skills at the beginning, midpoint, and end of the APPE. The preceptors evaluated students using the same instrument at APPE midpoint and end. The instrument had assigned weights for each EPA and entrustability level for a score of 100 if all items were marked five. If a rating of non-applicable was chosen, score adjustments were made. All students in the graduating class of 2018 were invited to perform a self-evaluation at the end of the fourth (APPE) year using the same instrument that study participants used. Results. Twenty-eight students and five preceptors completed evaluations during the APPE year. Overall scores from both preceptor evaluations of students and student self-evaluations increased significantly from pre-APPE to midpoint to final. Student self-evaluations were only slightly higher than preceptor evaluations. The mean (SD) preceptor scores for students and student self-assessment scores at the end of each APPE were 85.4% (7.1) and 87.2% (10.3), respectfully. One practice manager EPA and three population health EPAs were considered to not be applicable by preceptors on ≥50% of evaluations. Approximately 94% of all graduating students completed the year-end self-evaluations, with a mean (SD) score of 89% (8.6) and no EPAs marked as not applicable. Conclusion. Pharmacy students' proficiency in EPA improved during individual APPEs. According to preceptors, students' greatest improvement in entrustability was in educating patients and colleagues regarding appropriate use of medications and collecting information to identify medication-related problems., (© 2020 American Association of Colleges of Pharmacy.)

Parkinson's disease (PD) pathogenesis may involve the epigenetic control of enhancers that modify neuronal functions. Here, we comprehensively examine DNA methylation at enhancers, genome-wide, in neurons of patients with PD and of control individuals. We find a widespread increase in cytosine modifications at enhancers in PD neurons, which is partly explained by elevated hydroxymethylation levels. In particular, patients with PD exhibit an epigenetic and transcriptional upregulation of TET2, a master-regulator of cytosine modification status. TET2 depletion in a neuronal cell model results in cytosine modification changes that are reciprocal to those observed in PD neurons. Moreover, Tet2 inactivation in mice fully prevents nigral dopaminergic neuronal loss induced by previous inflammation. Tet2 loss also attenuates transcriptional immune responses to an inflammatory trigger. Thus, widespread epigenetic dysregulation of enhancers in PD neurons may, in part, be mediated by increased TET2 expression. Decreased Tet2 activity is neuroprotective, in vivo, and may be a new therapeutic target for PD.

Introduction: The use of problem-based video podcasts in health sciences education is limited. Principles of Pharmacokinetics is an introductory course that establishes a foundation for understanding pharmacokinetic concepts. The primary objective was to determine the impact of problem-based video podcasts in an introductory pharmacokinetics course on student learning., Methods: Problem-based video podcasts were implemented in an introductory pharmacokinetics course in spring 2015. Student pharmacists in the first professional year enrolled in the course during spring 2015, 2016, and 2017 were included in the study with students enrolled in the course in spring 2014 serving as the control group. The primary outcome was the impact of problem-based video podcasts on student learning as assessed by student performance on the final exam. Other outcomes included student utilization of the video podcasts, overall course grades, and student perceptions of learning using video podcasts., Results: A total of 633 students in four academic years were included for analysis. Final exam scores were significantly higher in spring 2015 and 2016 compared to 2014. The 2017 final exam scores were similar to the final exam scores in 2014. Students perceived the problem-based video podcasts enhanced their ability to apply concepts to a patient case, reinforced concepts from lectures, and improved their understanding of clinical pharmacokinetics., Conclusion: The use of problem-based video podcasts is an innovative method to augment learning outside of the traditional class time and may enhance learning without replacing direct instructor-student contact. Students reported the video podcasts improved their understanding of clinical pharmacokinetics., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Friends and family members' reactions to intimate partner violence (IPV) disclosure play an important role in social support because disclosure often precedes requests for support. Perceptions of social reactions to IPV disclosure are likely to vary by context. Yet, research is limited on the role of ethnicity and severity of physical violence in perceptions of social reactions. We examined perceptions of social reactions to IPV disclosure using data from Wave 6 interviews for Project HOW: Health Outcomes of Women. Participants ( N = 201) were asked proportionately how many friends and family reacted positively and negatively to IPV disclosure. MANOVAs revealed significant differences in perceptions of positive social reactions by ethnicity and severity.

OBJECTIVE : Review the clinical manifestations and treatment of primary Sjögren's syndrome. DATA SOURCES : Articles indexed in PubMed, Scopus, and the Cochrane Library in the past 10 years using the key words "Sjögren," "Sjögren's syndrome," "Sjögren's disease," and "Sjögren's syndrome AND treatment." Primary sources were used to locate additional resources. STUDY SELECTION AND DATA EXTRACTION : Forty-six publications were reviewed and criteria supporting the primary objective were used to identify useful resources. DATA SYNTHESIS : The literature included practice guidelines, review articles, original research articles, and prescribing information for the manifestations, diagnosis, and treatment of primary Sjögren's syndrome. CONCLUSION : Primary Sjögren's syndrome is a chronic autoimmune disease with various clinical manifestations, notably dry eye, dry mouth, fatigue, and inflammatory musculoskeletal pain. Most patients are under the care of a dentist, ophthalmologist, and rheumatologist. There is currently no cure; therapy is tailored for each patient to reduce symptoms, avoid complications, and improve quality of life. Respondents to a recent survey conducted by the Sjögren's Syndrome Foundation reported using more than eight medications and treatments for their symptoms; more than 60% of respondents were older than 60 years of age. Pharmacists familiar with recommended treatment options can provide advice and counseling to Sjögren's syndrome patients on multi-drug regimens prescribed by different health care practitioners.

Objective: Review the clinical manifestations and treatment of primary open-angle glaucoma (POAG)., Data Sources: Articles indexed in PubMed, Scopus, and Cochrane Library in the last 10 years using the key words "glaucoma," "open-angle glaucoma," and "'open-angle glaucoma' AND 'treatment.'" Primary sources were used to locate additional resources. ClinicalTrials. gov was used to locate unpublished studies., Study Selection and Data Extraction: Eighty-one publications were reviewed and criteria supporting the primary objective were used to identify useful resources., Data Synthesis: The literature included practice guidelines, review articles, original research articles, and product prescribing information for POAG., Conclusion: The POAG optic neuropathies result in optic disk damage and visual field loss. Ophthalmic medication therapy retards glaucoma progression, but many older patients require multiple medications to preserve vision and quality of life. An agent from the ophthalmic prostaglandin analog class is used as initial therapy in current practice because of the convenience of once-a-day administration and lower incidence of systemic side effects and slightly increased efficacy compared with other available ophthalmic medication classes. The other ophthalmic medication classes used in clinical practice include the beta-adrenergic blocking agents, the alpha-2 adrenergic agonists, and the carbonic anhydrase inhibitors. Proper ophthalmic eye-drop administration and medication adherence are imperative for preserving vision in POAG. Selective laser trabeculoplasty is a viable alternative to ophthalmic medications either initially or if a patient experiences ocular or systemic side effects from medication therapy. A modified prostaglandin analog was approved by the Food and Drug Administration in November 2017; its role in clinical practice is still evolving.

Introduction: State quitlines provide free telephone-based cessation services and are available in all states. However, quitlines presently reach 1% of US cigarette smokers. We assessed variations in quitline reach by race/ethnicity across 45 US states included in the National Quitline Data Warehouse, a repository on non-identifiable data reported by state quitlines., Methods: During 2011 to 2013, we analyzed 1 220 171 records from the National Quitline Data Warehouse. Annual quitline reach was defined as the proportion of cigarette smokers and smokeless tobacco users who utilized quitline services during each year, and was calculated by dividing the number of state-specific quitline registrants in each year by the number of adult cigarette smokers and smokeless tobacco users in the state., Results: Average annual reach ranged from: 0.08% (Tennessee) to 3.42% (Hawaii) among non-Hispanic whites; 0.17% (Tennessee) to 3.85% (Delaware) among non-Hispanic blacks; 0.27% (Nevada) to 9.98% (Delaware) among non-Hispanic American Indians/Alaska Native; 0.03% (Alabama) to 2.43% (Hawaii) among non-Hispanic Asian/Pacific Islanders; and from 0.08% (Tennessee) to 3.18% (Maine) among Hispanics. Average annual reach was highest among non-Hispanic American Indians/Alaska Native in 27 states, non-Hispanic blacks in 14 states, and non-Hispanic whites in four states., Conclusions: Quitlines appear to be reaching minority populations; however, overall reach remains low and variations in quitline reach exist by race/ethnicity. Opportunities exist to increase the utilization of quitlines and other effective cessation treatments among racial/ethnic minority populations., Implications: Some studies have assessed quitline reach across demographic groups in individual states; however, no studies have provided multistate data about quitline reach across race/ethnic groups. Ongoing monitoring of the use of state quitlines can help guide targeted outreach to particular race/ethnic groups with the goal of increasing the overall proportion and number of tobacco users that use quitlines. These efforts should be complemented by comprehensive tobacco control initiatives that increase cessation including mass media campaigns, smoke-free policies, increased tobacco prices, expansion of health insurance coverage, and health systems change., (Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco 2016. This work is written by (a) US Government employee(s) and is in the public domain in the US.)

Background and Purpose: To describe the use of debates, and to evaluate student performance and perceptions, when student debates are incorporated as an active learning tool in a required pharmacy healthcare delivery course., Educational Activity and Setting: Student live debates replaced 15% of a traditional lecture-based course. Twelve healthcare controversies were debated by student teams each year. Student perception of debate utility and opinion on topics, pre- and post-debate, were measured via a voluntary survey. Both peer and instructor's assessments of team performances, as well as individual student performance on the debate-based questions on course exams, contributed to course grade., Findings: The average survey response rates were 76% (2014) and 86% (2015). Fifteen-54% of student respondents changed their opinion on individual debate topics due to the debates. Although exam performance on debate-based questions was no better than on lecture-based questions, respondents who found the debates useful or very useful in mastering course material increased by 19% post versus pre-debate surveys., Summary: Debates are an effective active learning tool for engaging students in controversial subjects. Assessment of student performance should include student and instructor evaluations, and can be incorporated into the course grade., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Objective: Provide a systematic review of the primary literature on efforts to reduce Clostridium difficile infection (CDI) occurrence and improve outcomes in older adults., Data Sources, Study Selection, Data Extraction: PubMed and CINAHL databases were searched for research studies using search terms CDI, CDI prevention, reduction, control, management, geriatric, elderly, adults 65 years of age and older. The MeSH categories Aged and Aged, 80 and older, were used. A second search of PubMed, CINAHL, National Guideline Clearinghouse, and TRIP databases was conducted for primary, secondary, and tertiary literature for CDI epidemiology, burden, and management in adults of all ages, and prevention and management guidelines. Of the 2,263 articles located, 105 were selected for full review: 55 primary and 50 secondary, tertiary. Primary literature selected for full review included studies of interventions to prevent, reduce occurrence, control, manage, or improve outcomes in adults 65 years of age and older. Patient settings included the community, assisted living, nursing facility, subacute care, or hospital., Data Synthesis: The main outcome measures for research studies were whether the studied intervention prevented, reduced occurrence, controlled, managed, or improved outcomes. Studies were conducted in acute or long-term hospitals, with a few in nursing facilities. Interventions that prevented or reduced CDI included antibiotic policy changes, education, procedure changes, infection control, and multi-intervention approaches. There were few management studies for adults 65 years of age and older or for all adults with results stratified by age. Treatments studied included efficacy of fidaxomicin, metronidazole, vancomycin, and fecal microbiota transplant. Though clinical outcomes were slightly less robust in those 65 years of age and older, age was not an independent predictor of success or failure. The current prevention and management guidelines for adults of all ages, as well as special considerations in skilled nursing facilities, extracted from the secondary/tertiary literature selected, are summarized., Conclusion: There are a limited number of studies designed for older adults. Our findings suggest that guideline recommendations for adults are adequate and appropriate for older adults. Exposure to antibiotics and Clostridium difficile remain the two major risk factors for CDI, reinforcing the importance of antibiotic stewardship and infection control.

Multiunit housing residents are at risk of secondhand smoke exposure from adjoining units and common areas. We developed this case study to document state-level strategies undertaken to address this risk. We explored program documents to identify facilitators, barriers, and outcomes. Three states (Montana, Michigan, and Nebraska) provided detailed information on multiunit housing efforts in the study time frame. We conducted a qualitative analysis using inductive coding to develop themes. Several facilitators relating to existing infrastructure included traditional and nontraditional partnerships, leadership and champions, collecting and using data, efficient use of resources, and strategic plans. We also report external catalysts, barriers, and outcomes. Significant state leadership and effort were required to provide local-level technical assistance to engage traditional and nontraditional partners. Information needs were identified and varied by stakeholder type (i.e., health vs. housing). States recommend starting with public housing authorities, so they can become resources for affordable and subsidized housing. These lessons and resources can be used to inform smoke-free multiunit housing initiatives in other states and localities., (© 2016 Society for Public Health Education.)

Exurban residential land (one housing unit per 0.2-16.2 ha) is growing in importance as a human-dominated land use. Carbon storage in the soils and vegetation of exurban land is poorly known, as are the effects on C storage of choices made by developers and residents. We studied C storage in exurban yards in southeastern Michigan, USA, across a range of parcel sizes and different types of neighborhoods. We divided each residential parcel into ecological zones (EZ) characterized by vegetation, soil, and human behavior such as mowing, irrigation, and raking. We found a heterogeneous mixture of trees and shrubs, turfgrasses, mulched gardens, old-field vegetation, and impervious surfaces. The most extensive zone type was turfgrass with sparse woody vegetation (mean 26% of parcel area), followed by dense woody vegetation (mean 21% of parcel area). Areas of turfgrass with sparse woody vegetation had trees in larger size classes (> 50 cm dbh) than did areas of dense woody vegetation. Using aerial photointerpretation, we scaled up C storage to neighborhoods. Varying C storage by neighborhood type resulted from differences in impervious area (8-26% of parcel area) and area of dense woody vegetation (11-28%). Averaged and multiplied across areas in differing neighborhood types, exurban residential land contained 5240 ± 865 g C/m 2 in vegetation, highly sensitive to large trees, and 13 800 ± 1290 g C/m 2 in soils (based on a combined sampling and modeling approach). These contents are greater than for agricultural land in the region, but lower than for mature forest stands. Compared with mature forests, exurban land contained more shrubs and less downed woody debris and it had similar tree size-class distributions up to 40 cm dbh but far fewer trees in larger size classes. If the trees continue to grow, exurban residential land could sequester additional C for decades. Patterns and processes of C storage in exurban residential land were driven by land management practices that affect soil and vegetation, reflecting the choices of designers, developers, and residents. This study provides an example of human-mediated C storage in a coupled human-natural system., (© 2016 by the Ecological Society of America.)

Unlabelled: Development of substituted 1,8-naphthalimides for photochemical cross-linking of biomolecules is the focus of this research. This study describes limited cross-linking of collagen in the artery wall to control recoil and buckling in arteries following balloon angioplasty. Isolated porcine arteries were overstretched (25%) with balloon angioplasty (BA) +/- light-activated naphthalimide treatment (NVS). Lumen size and recoil were measured as retention of stretch after angioplasty. Cross-sectional compliance and distensibility coefficients were measured as slope of cross-sectional area versus increasing hydrostatic pressure. Buckling was measured, with 30% axial pre-stretch and 200 mmHg, as deviation from the center line. Electron microscopy evaluation of collagen fibers was conducted., Results: Uninjured arteries have low compliance and low levels of buckling, whereas the BA-injured arteries demonstrated much greater compliance and buckling behavior. Treatment of the injured artery with NVS reduced buckling and demonstrated compliance midway between the two groups while retaining the increased luminal diameter imparted by angioplasty compared to untreated vessels. In summary, limited collagen cross-linking with NVS treatment resulted in lumen retention, as well as improved compliance without the accompanying rigidity and stiffness of conventional stent therapy or current cross-linking materials. This treatment shows great promise for dilation, repair and strengthening of arteries damaged by injury or vascular disease., (© 2015 Wiley Periodicals, Inc.)

Objective: Review of the etiology, clinical manifestations, and treatment of dry eye disease (DED)., Data Sources: Articles indexed in PubMed (National Library of Medicine), Iowa Drug Information Service (IDIS), and the Cochrane Reviews and Trials in the last 10 years using the key words "dry eye disease," "dry eye syndrome," "dry eye and treatment." Primary sources were used to locate additional resources., Study Selection and Data Extraction: Sixty-eight publications were reviewed, and criteria supporting the primary objective were used to identify useful resources., Data Synthesis: The literature included practice guidelines, book chapters, review articles, original research articles, and product prescribing information for the etiology, clinical manifestations, diagnosis, and treatment of DED., Conclusion: DED is one of the most common ophthalmic disorders. Signs and symptoms of DED vary by patient, but may include ocular irritation, redness, itching, photosensitivity, visual blurring, mucous discharge, and decreased tear meniscus or break-up time. Symptoms improve with treatment, but the condition is not completely curable. Treatment includes reducing environmental causes, discontinuing medications that cause or worsen dry eye, and managing contributing ocular or systemic conditions. Most patients use nonprescription tear substitutes, and if these are not sufficient, other treatment is prescribed. These treatments include the ophthalmic anti-inflammatory agent cyclosporine, punctal occlusion, eye side shields, systemic cholinergic agents, and autologous serum tears. This article reviews the etiology, symptoms, and current therapy for DED.

We identified and described strategies for promoting smoking cessation and smoke-free environments that were implemented in Oregon and Utah in treatment centers for mental illness and substance abuse. We reviewed final evaluation reports submitted by state tobacco control programs (TCPs) to the Centers for Disease Control and Prevention and transcripts from a call study evaluation. The TCPs described factors that assisted in implementing strategies: being ready for opportunity, having a sound infrastructure, and having a branded initiative. These strategies could be used by other programs serving high-need populations for whom evidence-based interventions are still being developed.

Objective: To compare the impact of 2 different teaching and learning methods on student mastery of learning objectives in a pharmacotherapy module in the large classroom setting., Design: Two teaching and learning methods were implemented and compared in a required pharmacotherapy module for 2 years. The first year, multiple interactive mini-cases with inclass individual assessment and an abbreviated lecture were used to teach osteoarthritis; a traditional lecture with 1 inclass case discussion was used to teach gout. In the second year, the same topics were used but the methods were flipped. Student performance on pre/post individual readiness assessment tests (iRATs), case questions, and subsequent examinations were compared each year by the teaching and learning method and then between years by topic for each method. Students also voluntarily completed a 20-item evaluation of the teaching and learning methods., Assessment: Postpresentation iRATs were significantly higher than prepresentation iRATs for each topic each year with the interactive mini-cases; there was no significant difference in iRATs before and after traditional lecture. For osteoarthritis, postpresentation iRATs after interactive mini-cases in year 1 were significantly higher than postpresentation iRATs after traditional lecture in year 2; the difference in iRATs for gout per learning method was not significant. The difference between examination performance for osteoarthritis and gout was not significant when the teaching and learning methods were compared. On the student evaluations, 2 items were significant both years when answers were compared by teaching and learning method. Each year, students ranked their class participation higher with interactive cases than with traditional lecture, but both years they reported enjoying the traditional lecture format more., Conclusion: Multiple interactive mini-cases with an abbreviated lecture improved immediate mastery of learning objectives compared to a traditional lecture format, regardless of therapeutic topic, but did not improve student performance on subsequent examinations.

Hereditary sensory neuropathy type 1 (HSN-1) is an autosomal dominant neurodegenerative disease caused by missense mutations in the SPTLC1 gene. The SPTLC1 protein is part of the SPT enzyme which is a ubiquitously expressed, critical and thus highly regulated endoplasmic reticulum bound membrane enzyme that maintains sphingolipid concentrations and thus contributes to lipid metabolism, signalling, and membrane structural functions. Lipid droplets are dynamic organelles containing sphingolipids and membrane bound proteins surrounding a core of neutral lipids, and thus mediate the intracellular transport of these specific molecules. Current literature suggests that there are increased numbers of lipid droplets and alterations of lipid metabolism in a variety of other autosomal dominant neurodegenerative diseases, including Alzheimer's and Parkinson's disease. This study establishes for the first time, a significant increase in the presence of lipid droplets in HSN-1 patient-derived lymphoblasts, indicating a potential connection between lipid droplets and the pathomechanism of HSN-1. However, the expression of adipophilin (ADFP), which has been implicated in the regulation of lipid metabolism, was not altered in lipid droplets from the HSN-1 patient-derived lymphoblasts. This appears to be the first report of increased lipid body accumulation in a peripheral neuropathy, suggesting a fundamental molecular linkage between a number of neurodegenerative diseases.

Objective: Review the current recommendations for the prevention and treatment of age-related macular degeneration (AMD)., Data Sources: Articles indexed in PubMed (National Library of Medicine), the Cochrane Reviews and Trials, Dynamed, and Iowa Drug Information Service (IDIS) in the last 10 years using the key words macular degeneration, agerelated macular degeneration (AMD), AMD and treatment, AMD and prevention., Study Selection and Data Extraction: Sixty-nine published papers were reviewed, and criteria supporting the primary objective were used to identify useful resources., Data Synthesis: The literature included practice guidelines, original research articles, review articles, product prescribing information, and supplement product information for the prevention and treatment of AMD., Conclusion: AMD is a leading cause of visual impairment in older adults. At present there is no cure for advanced AMD, but intravitreal vascular endothelial growth factor inhibitors minimize and even reverse vision loss in patients with AMD of the neovascular type. In the Age-Related Eye Disease Study (AREDS), participants with intermediate AMD who received a supplement combination of vitamins C and E, beta-carotene, and zinc had a greater delay in progression to advanced AMD than those participants who received a portion of these supplements. In the second AREDS, AREDS2, the addition of lutein + zeaxanthin, docosahexaenoic acid (DHA) + eicosapentaenoic acid (EPA), or lutein + zeaxanthin and DHA + EPA to the complete AREDS formulation did not further reduce the risk of progression to advanced AMD. Subgroup analyses indicated that additional research with lutein + zeaxanthin supplementation is warranted as it was beneficial in participants with low dietary intake of lutein + zeaxanthin. A formulation without beta-carotene may be best for most patients, especially smokers or former smokers. Health care professionals will want to consider patient-specific information before recommending ocular health supplements.

Due to serious adverse effects and the limited effectiveness of currently available pharmacological therapies for obesity, many research efforts have focused on the development of drugs from natural products. Our previous studies demonstrated that berberine, an alkaloid originally isolated from traditional Chinese herbs, prevented fat accumulation in vitro and in vivo. In this pilot study, obese human subjects (Caucasian) were given 500 mg berberine orally three times a day for twelve weeks. The efficacy and safety of berberine treatment was determined by measurements of body weight, comprehensive metabolic panel, blood lipid and hormone levels, expression levels of inflammatory factors, complete blood count, and electrocardiograph. A Sprague-Dawley rat experiment was also performed to identify the anti-obesity effects of berberine treatment. The results demonstrate that berberine treatment produced a mild weight loss (average 5 lb/subject) in obese human subjects. But more interestingly, the treatment significantly reduced blood lipid levels (23% decrease of triglyceride and 12.2% decrease of cholesterol levels) in human subjects. The lipid-lowering effect of berberine treatment has also been replicated in the rat experiment (34.7% decrease of triglyceride and 9% decrease of cholesterol level). Cortisol, calcitriol, ACTH, TSH, FT4, and SHBG levels were not significantly changed following 12 weeks of berberine treatment. However, there was interestingly, an increase in calcitriol levels seen in all human subjects following berberine treatment (mean 59.5% increase, p=0.11). Blood inflammatory factors (CRP, IL-6, TNFα, COX-2) and erythrocyte sedimentation rate (ESR) were not significantly affected by treatment with berberine. Tests of hematological, cardiovascular, liver, and kidney function following berberine treatment showed no detrimental side effects to this natural compound. Collectively, this study demonstrates that berberine is a potent lipid-lowering compound with a moderate weight loss effect, and may have a possible potential role in osteoporosis treatment/prevention., (Copyright © 2012 Elsevier GmbH. All rights reserved.)

An 88-year-old female, living independently in the community, developed duodenal and gastric ulcers from using overthe-counter naproxen sodium for pain related to a shoulder fracture and arthritis of the knees. She was hospitalized and received packed red blood cells and intravenous proton pump inhibitor therapy. During her hospitalization, she developed atrial fibrillation (AF). Warfarin was not prescribed for stroke prevention because of the gastrointestinal (GI) bleeding. The patient was initially placed on atenolol, and then amiodarone was added. After a two-week hospital stay she was discharged to a nursing facility to gain strength, further correct her anemia, and receive physical therapy for the shoulder and ambulation problems from arthritis of the knees. The amiodarone was continued in the nursing facility. After 15 days of amiodarone therapy (hospital and nursing facility), a laboratory report indicated an elevated thyroid-stimulating hormone level. Levothyroxine was prescribed. The patient was eventually discharged to an assisted living facility once her strength returned and her ambulation improved. GI bleeding with anemia and weakness from nonsteroidal anti-inflammatory drug use and changes in thyroid function with amiodarone therapy for AF will be discussed.

Objective: To develop, implement, and evaluate active-learning exercises requiring the integration and application of pathophysiology, medicinal chemistry, pharmacology, and therapeutics knowledge of osteoarthritis and rheumatoid arthritis to formulate therapeutic recommendations for patients with musculoskeletal disorders., Design: Two team-based case study exercises, one evaluating a patient with osteoarthritis and the second, a patient with rheumatoid arthritis, were developed, incorporating material and questions from pathophysiology, medicinal chemistry, pharmacology, and therapeutics. The learning assignments were implemented in a required pharmacotherapy module., Assessment: Student learning was evaluated using performance on the team-based case study exercises and on 2 examinations. A standard student course evaluation was used to assess students' impressions of the learning activity. The mean student grades for the osteoarthritis and rheumatoid arthritis activities were 9.1 and 8.9, respectively, on a 10-point scale. The majority of students indicated that the learning exercises were more than adequate to excellent in helping students learn., Conclusion: The addition of active-learning activities was successful in teaching pharmacy students the knowledge needed to formulate therapeutic recommendations for patients with musculoskeletal disorders.

Objectives: To examine factors that influenced doctor of pharmacy (PharmD) students to collaborate with faculty members, preceptors, or others on scholarly activities that resulted in publication of an article in a pharmacy journal, and whether this experience influenced their consideration of a career in academic pharmacy., Methods: A 17-question survey instrument was e-mailed to student authors of papers published between 2004 and 2008 in 6 pharmacy journals. Responses were analyzed to determine factors influencing student participation in research and whether the experience led them to consider a career in academic pharmacy., Results: Factors about their participation in the scholarly activity that respondents found valuable included personal fulfillment and making a contribution to the literature. Respondents indicated they were more interested in a career in academic pharmacy after their participation in the scholarly experience (p < 0.001)., Conclusions: Participation in scholarly activities and student authorship of a peer-reviewed journal manuscript during pharmacy school may lead to increased interest in a career in academic pharmacy.

Objective: To design, implement, and assess a women's health elective course for second- and third-year doctor of pharmacy (PharmD) students., Design: A women's health course was developed, focusing on health promotion, disease prevention, and treatment throughout a woman's lifespan. Course format included didactic lectures, in-class activities, peer teaching, case studies, and reading assignments., Assessment: Student performance and learning were assessed based on class participation, (graded 3 times during the semester), activities and assignments, (graded weekly), and 2 formal written assessments. Student survey results indicated perceptions of women's health had changed in 3 ways: a realization that many diseases manifest differently in women than men, an increased awareness of numerous diseases not addressed in the required curriculum that affect women, and a greater appreciation of the physiological and pharmacokinetic differences that increase the potential for adverse drug reactions in women., Conclusion: An elective course in women's health was well received by PharmD students. Excellent student performance in weekly active-learning activities and class participation, however, did not translate into excellent performance on subsequent formal assessments.

Intimate partner violence (IPV) is associated with psychological distress; however, differences in the impact of unidirectional IPV, typically male-dominated, and bidirectional IPV have not been examined. To address this gap in the literature, we compared the effects of various IPV patterns on women's reports of dissociation, post-traumatic stress disorder, and stress in 6 interviews over eight years. We also examined whether differences by IPV pattern existed in women's mental health upon leaving a violent relationship. The 489 low-income women completing all interviews were African American (40%), Euro-American (30%), and Mexican American (30%), over half of whom (58%) were no longer with Wave 1 partners by Wave 6. In general, worse mental health was associated with relationship termination and bidirectional violence.

Objectives: To examine stress and health-related quality of life (HRQOL) among third-year doctor of pharmacy (PharmD) students., Methods: Stress and HRQOL were determined using Perceived Stress and SF-12 HRQOL survey instruments. A questionnaire was administered to determine factors students believed produced and eliminated stress., Results: Eighty percent of third-year students participated (n=109) in this pilot study. Mental HRQOL scores were significantly below US mean score for individuals aged 20-34 years (p<0.0001). As stress increased, mental HRQOL decreased and a significant negative correlation was found between the 2 measures (p<0.001). Family and relationships, examinations and scheduling, outside-of-class assignments, and finances were the most common stress triggers reported by students, while exercising, spending time with friends/family, sleeping, watching TV, and drinking alcohol were the most commonly reported stress-alleviating activities., Conclusion: Third-year PharmD students reported relatively high levels of stress and low mental HRQOL. Students employed mostly positive, but some negative, lifestyle choices to alleviate stress. Further investigation into the effectiveness of students' coping strategies is needed.

Research has consistently demonstrated a strong link between substance misuse and the perpetration of intimate partner violence (IPV). However, studies examining whether substance misuse is associated with IPV victimization have been mixed. Using data collected from 835 low-income ethnically diverse community women, this study extends previous research by utilizing a longitudinal design, considering men's and women's alcohol use, and examining multiple forms of abuse. Despite overall decreases in drinking and abuse, the frequency of male partners' drinking continued to be associated with their perpetration of threats, violence, and sexual aggression. Women's alcohol use frequency was associated with sustaining physical violence, but not threats of violence or sexual aggression.

Objective: To review prevalence, causes, types, and appropriate therapy to treat urinary incontinence (UI) in geriatric patients., Data Sources: Selection and extraction from a PubMed/MEDLINE, English-language literature search from 2000 to the present using the search terms urinary incontinence and geriatrics., Data Synthesis: UI is a prevalent condition in geriatric patients. Unmanaged UI decreases quality of life and increases the risk of perineal skin breakdown, which can lead to painful skin irritation and pressure sores. Identifying the type of UI, and treating or eliminating transient causes as a result of acute conditions or medications, are initial steps in appropriate management. Health professionals can identify medication-related causes by reviewing the patient history, diagnoses, symptoms, and medication regimen. Chronic UI is often caused by physiological changes in the bladder; increasing age also can result in changes in bladder and urethral compliance. Other UI risk factors include impaired function, cognition, mobility, and dexterity as well as neurodegenerative damage that affect the patient's ability to toilet or recognize the need to toilet. Chronic or persistent UI is classified as stress, urge, overflow, functional, or mixed. Treatment options for chronic UI are discussed in detail., Conclusion: Pharmacists can have a positive impact on this condition by recommending appropriate medication changes and pharmacologic and nonpharmacologic treatments.

Objective: To create and implement a web-based written assignment to evaluate student's abilities to select appropriate nonprescription medications and recommend therapy., Design: Each student developed a patient case study from an assigned condition, made treatment recommendations, and provided patient counseling information using at least 2 nonprescription medicines. The active-learning exercise required students to apply information previously presented in a large classroom setting., Assessment: Cases most commonly submitted included therapy for burns, acne, conjunctivitis, lacerations, and poison ivy. One-hundred five students completed a 5-item questionnaire regarding the assignment. The majority of the respondents (51.9%) felt the assignment helped to reinforce course content and 58.1% felt it made them more comfortable with making product recommendations., Conclusion: The Personal Pharmacy assignment was an effective learning activity for enhancing student's understanding and appropriate selection of nonprescription medicines.

Drawing from past research on women's motives for intimate partner violence (IPV) perpetration, correlates of women's perpetration, and correlates of nonviolent conflict, we created a scale containing 125 possible motives, representing 14 broad domains (e.g., self-defense, retaliation). Participants were an ethnically diverse sample of women who had perpetrated no physical IPV against their current partner (n = 243), threats but not physical IPV (n = 70), nonsevere physical IPV (n = 193), and at least one act of severe (e.g., choke) physical IPV (n = 93). An exploratory factor analysis yielded a seven-factor solution, representing Partners' Negative Behaviors, Increase Intimacy, Personal Problems, Retaliation, Childhood Experiences, Situation/Mood, and Partners' Personal Problems. Differences by women's IPV perpetration and race and/or ethnicity were tested with means representing these seven factors and a computed variable representing self-defense. Although motives differed by perpetration type, main effects for Partners' Negative Behavior, Personal Problems, Retaliation, and Childhood Experiences were modified by interactions, suggesting ethnicity should be considered when developing interventions.

This study contrasted the effects of intimate partner and nonpartner sexual assault on women's mental health among a sample (N=835) of low-income, ethnically diverse community women. Compared to sexual assault by a previous partner or by a non-intimate partner, sexual assault by a current partner was the strongest predictor of PTSD, stress, and dissociation. Non-intimate partner sexual assault was only a significant predictor of PTSD and only for African American women. These findings suggest that the victim-offender relationship is important when considering the impact of sexual assault. Specifically, sexual assault perpetrated by an intimate partner may be especially traumatic.

Despite equivocal findings on whether men or women are more violent, the negative impact of violence is greatest for women. To determine how gender asymmetry in perpetration affects women's health status, we conducted a study in two phases with 835 African American, Euro-American, and Mexican American low-income women in Project, How: Health Outcomes of Women. In Phase 1, we used severity and frequency of women's and male partners' violence to create six groups: nonviolent (NV), uni-directional male (UM) perpetrator, uni-directional female (UF) perpetrator and, when both partners were violent, symmetrical (SYM), male primary perpetrator (MPP), and female primary perpetrator (FPP). The MPP group sustained the most threats, violence, sexual aggression, and psychological abuse. They also reported the most fear. Injury was highest in the MPP and FPP groups. In Phase 2, we examined group differences in women's health status over time for 535 participants, who completed five annual interviews. Surprisingly, women's health in the MPP and FPP violence groups was similar and generally worse than if violence was uni-directional.

Objective: To report the probable association of angioedema with aspirin therapy and the selective cyclooxygenase-2 (COX-2) inhibitor rofecoxib., Case Summary: A 44-year-old white woman, previously tolerant to aspirin and other nonsteroidal antiinflammatory drugs (NSAIDs), developed angioedema of the lips after ingesting two 325-mg aspirin tablets during one day. The reaction occurred 3 hours after taking the second aspirin and resolved within 3 hours. Two weeks later, the patient took a 25-mg rofecoxib tablet for a sore throat, and she developed angioedema 5(1/2) hours later. Although the woman took 50 mg of diphenhydramine, the swelling did not subside. She repeated the diphenhydramine dose in the evening and, by noon the next day, 26(1/2) hours after the angioedema began, it was resolved. The patient's internist prescribed an epinephrine auto-injector and advised her to consult an allergist. With skin testing and oral rechallenge with aspirin, but not rofecoxib, the allergist determined the cause of the reactions to be aspirin-induced angioedema and selective COX-2 inhibitor intolerance. The Naranjo probability scale indicated that aspirin was a highly probable cause and rofecoxib was a probable cause of this patient's angioedema., Discussion: Aspirin-induced angioedema and NSAID intolerance have been well documented. There are reports of both tolerance and intolerance to selective COX-2 inhibitors in patients with documented allergy-like reactions to aspirin and NSAIDs., Conclusions: Patients with aspirin and NSAID intolerance may develop intolerance to COX-2 inhibitors, especially with repeated exposure.

Possible mediators of sexual abuse severity were tested on the basis of D. Finkelhor and A. Browne's (1985) traumagenic dynamics model with 178 low-income African American, European American, and Mexican American community women interviewed for Project, How: Health Outcomes of Women. This subsample reported contact sexual abuse before the age of 18 years. Severity was level of force, number of perpetrators, relationship to perpetrator, and age at first assault. As expected, structural equation modeling showed powerlessness, and stigmatization largely mediated the effects of sexual abuse severity on women's psychological distress in adulthood. Powerlessness also mediated the effects of severity on maladaptive social relationships. The expected path from betrayal to relationships was nonsignificant. Overall, the results support extension of D. Finkelhor and A. Browne's model. Possible interventions are addressed., (Copyright 2004 APA.)

Objective: To provide a brief review of the literature discussing treatment of unplanned weight loss in geriatric patients, focusing on megestrol acetate and to report two cases of deep vein thrombosis (DVT) associated with megestrol acetate therapy in geriatric nursing facility residents., Data Sources: Biomedical literature accessed through MEDLINE and PubMed (1990-2003); product manufacturer information., Discussion: Unplanned weight loss, a common problem among frail geriatric nursing facility residents, is associated with increased morbidity and mortality. Once reversible causes of weight loss are identified and addressed, dietary changes, including the addition of nutritional supplements, may be of benefit. In some cases, medications are prescribed. Megestrol acetate oral suspension is approved by the Food and Drug Administration for the treatment of anorexia, cachexia, or unexplained significant weight loss in patients with AIDS. Megestrol acetate tablets are FDA-approved for palliative treatment of advanced breast or endometrial cancer. In recent years, several published prospective and retrospective reports have described the use of megestrol acetate for unplanned weight loss in geriatric patients. While clinical efficacy trials reported diarrhea, impotence, and rash as the most commonly occurring adverse events, post-marketing reports have included deep vein thrombosis and pulmonary embolism. DVP has occurred in geriatric patients., Case Summaries: Case #1: An 86-year-old female with Alzheimer's disease and decreased oral intake was prescribed megestrol acetate suspension 400 mg po bid after a 30-day weight loss of 4.8 kg. Ten days later she developed DVT. Megestrol acetate was discontinued, and she was hospitalized and treated, recovering successfully. Case #2: An 85-year old female with Alzheimer's disease who had stopped eating was prescribed megestrol acetate tablets 40 mg po bid. Four months later she developed DVT. Megestrol acetate was discontinued and she was hospitalized and treated, recovering successfully., Conclusion: Thromboembolic events are potential adverse events associated with megestrol acetate therapy. Caution should be observed in using megestrol acetate in geriatric patients, especially nursing facility residents who often have impaired mobility.

Objective: Psychosocial vulnerabilities were added to a model of healthcare utilization. This extension was tested among low-income women with ethnicity addressed as a moderator., Design: Structured interviews were conducted at 2 points in time, approximately 1 year apart. The constructs of psychosocial vulnerability, demographic predisposing, barriers, and illness were measured by multiple indicators to allow use of Structural Equation Modeling to analyze results. The models were tested separately for each ethnic group., Setting: Community office., Participants: African-American (N = 266), Euro-American (N = 200), and Mexican-American (N = 210) women were recruited from the Dallas Metropolitan area to participate in Project, How: Health Outcomes of Women, a multi-year, multi-wave study. Face-to-face interviews were conducted with this sample. Participants had been in heterosexual relationships for at least 1 year, were between 20 and 49 years of age, and had incomes less than 200% of the national poverty level., Main Outcome Measures: Healthcare utilization, defined as physician visits and general healthcare visits., Results: Illness mediated the effect of psychosocial vulnerability on healthcare utilization for African Americans and Euro-Americans. The model for Mexican Americans was the most complex. Psychosocial vulnerability on illness was partially mediated by barriers, which also directly affected utilization., Conclusions: Psychosocial vulnerabilities were significant utilization predictors for healthcare use for all low-income women in this study. The final models for the 2 minority groups, African Americans and Mexican Americans, were quite different. Hence, women of color should not be considered a homogeneous group in comparison to Euro-Americans.

In the social and behavioural sciences, structural equation modelling has been widely used to test a substantive theory or causal relationship among latent constructs. Cross-validation (CV) is a valuable tool for selecting the best model among competing structural models. Influential cases or outliers are often present in practical data. Therefore, even the correct model for the majority of the data may not cross-validate well. This paper discusses various drawbacks of CV based on sample covariance matrices, and develops a procedure for using robust covariance matrices in the model calibration and validation stages. Examples illustrate that the CV index based on sample covariance matrices is very sensitive to influential cases, and even a single outlier can cause the CV index to support a wrong model. The CV index based on robust covariance matrices is much less sensitive to influential cases and thus leads to a more valid conclusion about the practical value of a model structure.