Complexes of fluconazole with sodium p-sulfonatocalix[n]arenes: characterization, solubility and antifungal activity

Aiming at providing new formulations capable of improving the biopharmaceutical properties of fluconazole, we studied the formation of host–guest complexes of this antifungal agent with water-soluble sodium p-sulfonatocalix[n]arenes.

Optimization of the magnetoelectric response of poly(vinylidene fluoride)/epoxy/Vitrovac laminates

The effect of the bonding layer type and piezoelectric layer thickness on the magnetoelectric (ME) response of layered poly(vinylidene fluoride) (PVDF)/epoxy/Vitrovac composites is reported. Three distinct epoxy types were tested, commercially known as M-Bond, Devcon, and Stycast. The main differences among them are their different mechanical characteristics, in particular the value of the Young modulus, and the coupling with the polymer and Vitrovac (Fe39Ni39Mo4Si6B12) layers of the laminate. The laminated composites prepared with M-Bond epoxy exhibit the highest ME coupling. Experimental results also show that the ME response increases with increasing PVDF thickness, the highest ME response of 53 V·cm(-1)·Oe(-1) being obtained for a 110 μm thick PVDF/M-Bond epoxy/Vitrovac laminate. The behavior of the ME laminates with increasing temperatures up to 90 °C shows a decrease of more than 80% in the ME response of the laminate, explained by the deteriorated coupling between the different layers. A two-dimensional numerical model of the ME laminate composite based on the finite element method was used to evaluate the experimental results. A comparison between numerical and experimental data allows us to select the appropriate epoxy and to optimize the piezoelectric PVDF layer width to maximize the induced magnetoelectric voltage. The obtained results show the critical role of the bonding layer and piezoelectric layer thickness in the ME performance of laminate composites.

Integrating health and environmental impact analysis

Scientific investigations have progressively refined our understanding of the influence of the environment on human health, and the many adverse impacts that human activities exert on the environment, from the local to the planetary level. Nonetheless, throughout the modern public health era, health has been pursued as though our lives and lifestyles are disconnected from ecosystems and their component organisms. The inadequacy of the societal and public health response to obesity, health inequities, and especially global environmental and climate change now calls for an ecological approach which addresses human activity in all its social, economic and cultural complexity. The new approach must be integral to, and interactive, with the natural environment. We see the continuing failure to truly integrate human health and environmental impact analysis as deeply damaging, and we propose a new conceptual model, the ecosystems-enriched Drivers, Pressures, State, Exposure, Effects, Actions or 'eDPSEEA' model, to address this shortcoming. The model recognizes convergence between the concept of ecosystems services which provides a human health and well-being slant to the value of ecosystems while equally emphasizing the health of the environment, and the growing calls for 'ecological public health' as a response to global environmental concerns now suffusing the discourse in public health. More revolution than evolution, ecological public health will demand new perspectives regarding the interconnections among society, the economy, the environment and our health and well-being. Success must be built on collaborations between the disparate scientific communities of the environmental sciences and public health as well as interactions with social scientists, economists and the legal profession. It will require outreach to political and other stakeholders including a currently largely disengaged general public. The need for an effective and robust science-policy interface has never been more pressing. Conceptual models can facilitate this by providing theoretical frameworks and supporting stakeholder engagement process simplifications for inherently complex situations involving environment and human health and well-being. They can be tools to think with, to engage, to communicate and to help navigate in a sea of complexity. We believe models such as eDPSEEA can help frame many of the issues which have become the challenges of the new public health era and can provide the essential platforms necessary for progress.

Functional brain connectivity and deactivation in new onset schizophrenia: A pilot study

There has been previous evidence of aberrant functional connectivity in the so-called “default-mode” network (DMN) in patients with schizophrenia.

Objective

The purpose of this study was to test whether such aberrant connectivity, if existent, can be modulated by a task involving the challenge of attention, working memory and executive functioning.

Methods

A functional magnetic resonance imaging (fMRI) experiment alternating between periods of “rest” and periods of visual stimulation with successive series of pictures extracted from the Wechsler Adult Intelligence Scale-III was carried out in seven patients with new onset schizophrenia according to the DSM-IV criteria and in six healthy control subjects matched for sex, age, and education. The DMN was extracted by using independent component analysis (ICA). The degree of deactivation during periods of stimulation was tested by means of a correlation analysis. To determine the existence of differences in deactivation between patients and controls, we used a non-parametric statistical test.

Results

An overall increased activation of the DMN in patients with schizophrenia relative to control subjects seems to occur. There was also an almost significant difference in the degree of deactivation between the two groups (controls>patients, p = 0.05).

Conclusions

Aberrant connectivity of the DMN is indeed a consistent feature in schizophrenia. An altered deactivation of the DMN during a highly demanding task in patients with schizophrenia confirms previous results suggesting an abnormal behaviour of networks in the transition from “rest” to goal-directed activity.

Effects of land-use changes on landslides in a landslide-prone area (Ardesen, Rize, NE Turkey)

Various natural hazards such as landslides, avalanches, floods and debris flows can result in enormous property damages and human casualties in Eastern Black Sea region of Turkey. Mountainous topographic character and high frequency of heavy rain are the main factors for landslide occurrence in Ardesen, Rize. For this reason, the main target of the present study is to evaluate the landslide hazards using a sequence of historical aerial photographs in Ardesen (Rize), Turkey, by Photogrammetry and Geographical Information System (GIS). Landslide locations in the study area were identified by interpretation of aerial photographs dated in 1973 and 2002, and by field surveys. In the study, the selected factors conditioning landslides are lithology, slope gradient, slope aspect, vegetation cover, land class, climate, rainfall and proximity to roads. These factors were considered as effective on the occurrence of landslides. The areas under landslide threat were analyzed and mapped considering the landslide conditioning factors. Some of the conditioning factors were investigated and estimated by employing visual interpretation of aerial photos and topographic data. The results showed that the slope, lithology, terrain roughness, proximity to roads, and the cover type played important roles on landslide occurrence. The results also showed that degree of landslides was affected by the number of houses constructed in the region. As a consequence, the method employed in the study provides important benefits for landslide hazard mitigation efforts, because a combination of both photogrammetric techniques and GIS is presented.

Oncology patients' experience at the interface between hospital and community care: a mixed method investigation

Introduction

Oncology patients often experience breakdowns in care when transitioning between care settings.

Aims and objectives

To examine the experience of oncology patients at the transition between hospital and community care and identify factors which affect fragmentation.

Methods

We used a complementary mixed method approach. Qualitative phase: semi-structured interviews and focus groups were conducted with patients and their caregivers, nurses, social workers, physicians and medical administrators. Quantitative phase: a survey was administered to 400 oncology patients of a large tertiary medical center in Northern Israel. Patients who were discharged from the hospital completed a validated questionnaire on their transition from the hospital to the community and on their perceptions of the quality of their primary care. The surveys were administered in Hebrew, Arabic, and Russian.

Results

From the preliminary analysis of the qualitative data four broad themes emerged: (1) responsibility for care, (2) administrative and bureaucratic burden, (3) informal routes of communication, and (4) cultural barriers. The regression analyses examined the effect of patient characteristics (gender, age, education, income, health status, and language group) and showed that patients' language accounted for most of the variance in quality scores. Russian speaking patients reported poorer quality of care and Arabic speaking patients reported better quality of care, than Hebrew speakers, in all primary care domains. Both Arabic and Russian speakers scored significantly higher on the Care Transition Measure than Hebrew speakers.

Conclusions

The differences between sub-groups found here suggest that avoidable variations in care exist. To enable a more streamlined process, cultural issues need to be addressed at the interface between care settings. Further research should examine the causes for such differences.

Challenges in quantifying biosphere-atmosphere exchange of nitrogen species

Recent research in nitrogen exchange with the atmosphere has separated research communities according to N form. The integrated perspective needed to quantify the net effect of N on greenhouse-gas balance is being addressed by the NitroEurope Integrated Project (NEU). Recent advances have depended on improved methodologies, while ongoing challenges include gas-aerosol interactions, organic nitrogen and N(2) fluxes. The NEU strategy applies a 3-tier Flux Network together with a Manipulation Network of global-change experiments, linked by common protocols to facilitate model application. Substantial progress has been made in modelling N fluxes, especially for N(2)O, NO and bi-directional NH(3) exchange. Landscape analysis represents an emerging challenge to address the spatial interactions between farms, fields, ecosystems, catchments and air dispersion/deposition. European up-scaling of N fluxes is highly uncertain and a key priority is for better data on agricultural practices. Finally, attention is needed to develop N flux verification procedures to assess compliance with international protocols.

Degradation of keratinous materials by the plant pathogenic fungus Myrothecium verrucaria

In this paper it is described for the first time the capability of Myrothecium verrucaria to grow in submerged and solid state cultures using poultry feathers as the only substrate. The fungus produced a protease with an unusual keratinolytic activity among plant pathogenic fungi. Its crude protease hydrolyzed keratinous substrates at pH 9.0 and 40 degrees C in the following order: poultry feather keratin > sheep wool keratin > human nail keratin > human hair keratin. Protease activity was highly sensitive to phenylmethyl sulphonyl fluoride (PMSF) indicating that the enzyme belonged to the serine protease family.

An electronic pressure-meter nociception paw test for mice

The aim of the present investigation was to describe and validate an electronic mechanical test for quantification of the intensity of inflammatory nociception in mice. The electronic pressure-meter test consists of inducing the animal hindpaw flexion reflex by poking the plantar region with a polypropylene pipette tip adapted to a hand-held force transducer. This method was compared to the classical von Frey filaments test in which pressure intensity is automatically recorded after the nociceptive hindpaw flexion reflex. The electronic pressure-meter and the von Frey filaments were used to detect time versus treatment interactions of carrageenin-induced hypernociception. In two separate experiments, the electronic pressure-meter was more sensitive than the von Frey filaments for the detection of the increase in nociception (hypernociception) induced by small doses of carrageenin (30 microg). The electronic pressure-meter detected the antinociceptive effect of non-steroidal drugs in a dose-dependent manner. Indomethacin administered intraperitoneally (1.8-15 mg/kg) or intraplantarly (30-300 microg/paw) prevented the hypersensitive effect of carrageenin (100 microg/paw). The electronic pressure-meter also detected the hypernociceptive effect of prostaglandin E2 (PGE2; 10-100 ng) in a dose-dependent manner. The hypernociceptive effect of PGE2 (100 ng) was blocked by dipyrone (160 and 320 microg/paw) but not by intraplantar administration of indomethacin (300 microg/paw). The present results validate the use of the electronic pressure-meter as more sensitive than the von Frey filaments in mice. Furthermore, it is an objective and quantitative nociceptive test for the evaluation of the peripheral antinociceptive effect of anti-inflammatory analgesic drugs, which inhibit prostaglandin synthesis (indomethacin) or directly block the ongoing hypernociception (dipyrone).

The pattern and timing of breathing during incremental exercise: a normative study

Clinical evaluation of the pattern and timing of breathing during submaximal exercise can be valuable for the identification of the mechanical ventilatory consequences of different disease processes and for assessing the efficacy of certain interventions. Sedentary individuals (60 male/60 female, aged 20-80 yrs) were randomly selected from >8,000 subjects and submitted to ramp incremental cycle ergometry. Tidal volume (VT)/resting inspiratory capacity, respiratory frequency, total respiratory time (Ttot), inspiratory time (TI), expiratory time (TE), duty cycle (TI/Ttot) and mean inspiratory flow (VT/TI) were analysed at selected submaximal ventilatory intensities. Senescence and female sex were associated with a more tachypnoeic breathing pattern during isoventilation. The decline in Ttot was proportional to the TI and TE reductions, i.e. TI/Ttot was remarkably constant across age strata, independent of sex. The pattern, but not timing, of breathing was also influenced by weight and height; a set of demographically and anthropometrically based prediction equations are therefore presented. These data provide a frame of reference for assessing the normality of some clinically useful indices of the pattern and timing of breathing during incremental cycle ergometry in sedentary males and females aged 20-80 yrs.

The interaction of the Bcr-Abl tyrosine kinase with the Src kinase Hck is mediated by multiple binding domains

Bcr-Abl is found in more than 95% of cases with CML. The mechanism of Bcr-Abl-induced transformation is not fully understood. Bcr-Abl is a constitutively active tyrosine kinase with transforming capacity for hematopoietic cells. We demonstrated recently that the Src kinase Hck interacts directly with Bcr-Abl by a kinase-independent mechanism. Moreover, the inhibition of the Hck kinase seems to block some of the transforming effects of Bcr-Abl. To identify the binding domains mediating this interaction of Hck with Bcr-Abl, we co-expressed different plasmid and baculovirus vectors containing mutants or single domains of Bcr-Abl and/or Hck in COS7 and Sf9 cells. At least four independent binding regions for Hck were identified in Bcr-Abl, one in Bcr, one in the region comprising the SH3 and SH2 domain of Abl, one in the SH1 domain of Abl, and one in the C-terminal domain of Abl. In the Hck kinase, deletion of the SH2 and/or the SH3 region abolished binding to Bcr-Abl. In contrast, deletion of the Hck SH1 domain enhanced binding of Hck to Abl and Bcr-Abl. In conclusion, the results indicate that the interaction of Bcr-Abl with Hck is mediated by a novel, complex mechanism that involves multiple domains of Bcr-Abl and the SH2 and SH3 domains of Hck.

Derivative spectrophotometry as a tool for the determination of drug partition coefficients in water/dimyristoyl-L-alpha-phosphatidylglycerol (DMPG) liposomes

The partition coefficients (K(p)) between lipid bilayers of dimyristoyl-L-alpha-phosphatidylglycerol (DMPG) unilamellar liposomes and water were determined using derivative spectrophotometry for chlordiazepoxide (benzodiazepine), isoniazid and rifampicin (tuberculostatic drugs) and dibucaine (local anaesthetic). A comparison of the K(p) values in water/DMPG with those in water/DMPC (dimyristoyl-L-alpha-phosphatidylcholine) revealed that for chlordiazepoxide and isoniazid, neutral drugs at physiological pH, the partition coefficients are similar in anionic (DMPG) and zwitterionic (DMPC) liposomes. However, for ionised drugs at physiological pH, the electrostatic interactions are different with DMPG and DMPC, with the cationic dibucaine having a stronger interaction with DMPG, and the anionic rifampicin having a much larger K(p) in zwitterionic DMPC. These results show that liposomes are a better model membrane than an isotropic two-phase solvent system, such as water-octanol, to predict drug-membrane partition coefficients, as they mimic better the hydrophobic part and the outer polar charged surface of the phospholipids of natural membranes.

Determining teaching objectives for the family medicine clerkship in medical school--an Israeli national Delphi survey

BACKGROUND

Most of the published documents proposing teaching objectives for undergraduate clerkships were prepared by expert bodies. Seldom have the clinical teachers, who are critical to the learning process and to the implementation of the teaching objectives, been the actual proponents of its core content.

OBJECTIVE

To develop a national-scale proposal of teaching objectives for the family medicine clerkship in medical school, using a consensus method and the actual, community-based teachers as the expert body.

METHODS

The Delphi method was chosen for that purpose. In the first round all 189 family medicine teachers in Israeli medical schools were asked to propose five teaching objectives. In the second round the objectives, which were generated in the first round, were characterized by key words and were sent to the participants as a second round for ranking according to their importance.

RESULTS

A total of 116 family medicine teachers (61.38%) responded in the first round and 91 of the 116 (78.5%) in the second round. They formulated 51 teaching objectives listed in order of importance, covering a wide array of themes and including knowledge, attitude and skills objectives. The most important objectives were common problems in primary care, recognition of the biopsychosocial model, and understanding the importance of the doctor-patient relationship. The structure of the list provides a unique insight into the relative importance of each objective in the context of the whole core content of the clerkship.

CONCLUSIONS

Constructing a proposal for teaching objectives is feasible using the Delphi method and the field instructors as the selecting body. The process and its results can provide faculty with relevant and important suggestions on the content and structure of the family medicine clerkship.

Trends in medical specialty choice among Israeli medical graduates, 1980-1995

BACKGROUND

Which medical specialties do Israeli medical graduates choose? Answers to this question can serve as an essential means of evaluating both Israeli medical education and the healthcare system.

OBJECTIVES

To determine the distribution of medical specialty choice, its change over time and the possible influence of the medical school on the choice; to study the graduates' gender, gender variability in specialty choice and time trends in both; and to assess the choice of family medicine as a career among the graduates as a group, by medical school, gender, and time trends.

METHODS

The study population comprised all graduates of the four medical schools in Israel during 16 years: 1980-1995 inclusive. Data were obtained from the four medical schools, the Israel Medical Association's Scientific Council, and the Ministry of Health. Data allowed for correct identification of two-thirds of the graduates.

RESULTS

A total of 4,578 physicians graduated during this period. There was a significant growth trend in the proportion of women graduates from 22.6% in 1980 (lowest: 20.0% in 1981) to 35.3 in 1995 (highest: 41.5% in 1991). Overall, 3,063 physicians (66.8%) started residency and 1,714 (37.4%) became specialists. The four most popular residencies were internal medicine, pediatrics, obstetrics and gynecology, and family medicine. Ten percent of Israeli graduates choose family medicine.

CONCLUSIONS

The overall class size in Israel was stable at a time of considerable population change. Women's place in Israeli medicine is undergoing significant change. Family medicine is one of the four most popular residencies. A monitoring system for MSC in Israel is imperative.

Doctor-patient discussions of alternative medicine for back pain

OBJECTIVE

To document the frequency of conversations about alternative medicine during primary care consultations for back pain in diverse settings.

DESIGN

"Exit interview" type patient survey.

SETTINGS

General practices in Seattle, Washington; rural Israel; and Birmingham, England.

PATIENTS

A convenience sample of 218 adults completing a doctor visit for back pain.

MAIN OUTCOME MEASURES

Frequencies of doctor-patient discussions of alternative medicine.

RESULTS

Alternative medicine was discussed in a minority of visits (US site 40%, Israel site 37%, UK site 14%, p < 0.05). At each site, patients initiated at least half of the discussions. Users were five to six times more likely to discuss alternative medicine with their doctor than non-users (p < 0.05 for comparison at each site). The percentage of patients who used alternative medicine but left the consultation without discussing it was similar at all sites (US site 17%, Israel site 23%, UK site 15%).

CONCLUSIONS

Discussions of alternative medicine occurred in a minority of consultations for back pain although the rate varied considerably by site. Discussions were initiated primarily by patients who use it.

Assessment of a rapid HIV test strategy during labor: a pilot study from Rio de Janeiro, Brazil

OBJECTIVES

To use two rapid human immunodeficiency virus (HIV) tests at labor, measure test acceptance and performance, and measure HIV prevalence in these women.

METHODS

Between February and October 2000, two rapid tests (Determine; Abbott, Chicago, IL, U.S.A. and Double Check; Orgenics, Yavne, Israel) were used in three public maternities in Rio de Janeiro, Brazil. Enzyme-linked immunosorbent assay (ELISA) and Western blot (WB) analysis confirmed positive and discordant results.

RESULTS

Of the 858 patients who were enrolled, the mean gestational age was 36 weeks (median = 39, mode = 40) and 17 (2%) refused testing. Of the 841 patients tested, 13 were positive by both tests, which represents a 1.5% prevalence (95% confidence interval: 0.7%-2.3%); all were confirmed by ELISA and WB analysis. Seven samples gave discordant results by the rapid tests; of these, six were ELISA-negative/WB-negative and one was ELISA-negative/WB-indeterminate. The positive predictive value for samples that were positive by both rapid tests simultaneously was 100%.

CONCLUSIONS

Two rapid HIV tests used at labor were well accepted (98%). When the combined results of the two rapid tests (but not a single rapid test) were analyzed, this strategy was as efficient as the standard ELISA and WB HIV strategy for correctly classifying individuals.