Improved tolerability and efficacy in epilepsy patients with extended-release carbamazepine

The authors conducted a 3-month, prospective, open-label study assessing the effects of switching from immediate-release carbamazepine formulations to an equal total daily dose of carbamazepine extended-release capsules (CBZ-ERC) in adolescents and adults with epilepsy. Using validated, epilepsy-specific measures the authors found that switching to CBZ-ERC significantly improved patients' adverse events and quality-of-life measures. Switching to CBZ-ERC also improved seizure control.

Adjunctive antibiotic treatment of women with preterm rupture of membranes or preterm labor

Subclinical infection is associated with preterm rupture of the membranes (PROM) and preterm labor (PTL) in many cases. It was hypothesized that antibiotic treatment might delay delivery and/or decrease infectious morbidity in those with PROM or PTL. Patients from 19 to 34 weeks with PROM and no labor or PTL with intact membranes (but not both) were separately randomized to receive ampicillin versus placebo in addition to usual therapy. There were 36 women with PTL (21 ampicillin/15 placebo) and 84 with preterm PROM (41 ampicillin/43 placebo). Demographically, the treatment and placebo groups were similar. Outcome variables analyzed included delivery delay after treatment, maternal chorioamnionitis/endometritis, Apgar score, neonatal infection, or respiratory distress, and hospital stay. There were no significant differences between the ampicillin and placebo groups in those with PTL or preterm PROM as it concerned outcome parameters. Adjunctive ampicillin used for treatment of idiopathic PTL or preterm PROM was not beneficial in this study.

Mycorrhizal promotion of host stomatal conductance in relation to irradiance and temperature

Colonization of roots and soil by arbuscular mycorrhizal (AM) fungi sometimes promotes stomatal conductance (gs) of the host plant, but scientists have had difficulty predicting or manipulating the response. Our objective was to test whether the magnitude of AM influence on gs is related to environmental conditions: irradiance, air temperature or leaf temperature. Stomatal conductances of two groups of uncolonized sorghum plants were compared to gs of plants colonized by Glomus intraradices (Gi) or Gigaspora margarita (Gm) in 31 morning and afternoon periods under naturally varying greenhouse conditions. Stomatal conductance of Gi and Gm plants was often markedly higher than gs of similarly sized nonAM plants. AM promotion of gs was minimal at the lowest irradiances and lowest air and leaf temperatures, but was substantial at intermediate irradiance and temperatures. AM promotion was again low or absent at the highest irradiances and temperatures. Magnitude of AM promotion of gs was not a function of absolute gs. Promotion of gs by Gi and Gm was remarkably similar. Differing phosphorus fertilization did not affect gs.

Partitioning mycorrhizal influence on water relations of Phaseolus vulgaris into soil and plant components

There is growing appreciation of arbuscular mycorrhizal effects on soil properties and their potential consequences on plant behavior. We examined the possibility that mycorrhizal soil may directly influence plant water relations. Using wild-type and noncolonizing bean mutants planted into soils previously produced using mycorrhizal or nonmycorrhizal sorghum plants, we partitioned mycorrhizal influence on stomatal conductance and drought resistance into soil and root components, testing whether effects of mycorrhizal fungi occurred mostly via mycorrhization of roots, mycorrhization of soil, or both. The mutation itself had no effect on any water relations parameter. Colonization by Gigaspora margarita Gerdemann & Trappe and Glomus intraradices Schenck & Smith had appreciable effects on leaf water potential at the lethal point and on osmotic adjustment, relative to nonmycorrhizal plants of comparable size. Mycorrhizal effects on drought resistance were attributable to an effect on the plant itself rather than to an effect of mycorrhizal soil. Mycorrhizal effects on stomatal conductance were attributable to mycorrhization of both roots and soil, as well as to mycorrhization of roots alone. Surprisingly, merely growing in a mycorrhizal soil resulted in promotion of stomatal conductance of nonmycorrhizal plants in both amply watered and droughted plants. Mycorrhizal effects on droughted plants did not appear to be related to altered soil water retention properties, as Gigaspora margarita and Glomus intraradices altered the soil's moisture characteristic curve only slightly.Key words: arbuscular mycorrhizal symbiosis, bean, drought, Gigaspora margarita, Glomus intraradices, stomatal conductance.

Relating foliar dehydration tolerance of mycorrhizal Phaseolus vulgaris to soil and root colonization by hyphae

Mycorrhizal symbiosis can modify plant response to drying soil, but little is known about the relative contribution of soil vs. root hyphal colonization to drought resistance of mycorrhizal plants. Foliar dehydration tolerance, characterized as leaf and soil water potential at the end of a lethal drying episode, was measured in bean plants (Phaseolus vulgaris) colonized by Glomus intraradices or by a mix of arbuscular mycorrhizal fungi collected from a semi-arid grassland. Path analysis modeling was used to evaluate how colonization rates and other variables affected these lethal values. Of several plant and soil characteristics tested, variation in dehydration tolerance was best explained by soil hyphal density. Soil hyphal colonization had larger direct and total effects on both lethal leaf water potential and soil water potential than did root hyphal colonization, root density, soil aggregation, soil glomalin concentration, leaf phosphorus concentration or leaf osmotic potential. Plants colonized by the semi-arid mix of mycorrhizal fungi had lower lethal leaf water potential and soil water potential than plants colonized by G. intraradices. Our findings support the assertion that external, soil hyphae may play an important role in mycorrhizal influence on the water relations of host plants.

Occurrence of seizure clusters and status epilepticus during inpatient video-EEG monitoring

OBJECTIVE

To investigate the occurrence of status epilepticus and seizure clusters, and the duration until first seizure at epilepsy monitoring units in the United States.

METHODS

The authors examined the inpatient video-EEG monitoring reports of 514 consecutive patients admitted to five comprehensive epilepsy centers during the year 2000. Time to first seizure, seizure clustering, and seizure duration were ascertained from reports and entered into a database.

RESULTS

In 169 admissions with complex partial seizures (CPSs) or secondarily generalized tonic-clonic (2GTC) seizures, there were 5 (3.0%) patients with status epilepticus, 30 (17.8%) with 4-hour seizure clusters, and 82 (48.5%) with 24-hour seizure clusters. There were no statistically significant differences between centers, except that seizure clusters were observed to be less common at the one center with a formal drug withdrawal protocol. The average time to CPS or 2GTC seizure was 2.1 days; the average number of days to nonepileptic event was 1.2 days (p = 0.001).

CONCLUSIONS

Although status epilepticus is uncommon at epilepsy monitoring units, clusters of seizures are common. Intensive monitoring with drug withdrawal must be performed in a highly supervised, hospitalized setting. Inpatient video-EEG monitoring is efficient, with recording of the first epileptic or nonepileptic events in 2 days or less.

The effects of single-dose fexofenadine, diphenhydramine, and placebo on cognitive performance in flight personnel

BACKGROUND

Sedation and functional impairments are side effects associated with the use of first-generation antihistamines that preclude their use in aviation. Selected second-generation antihistamines do not have such side effects and have been proposed for use in aircrew.

METHODS

Forty-two healthy naval aviation personnel served as subjects in this double-blind, randomized, placebo-controlled crossover study. Subjective drowsiness, cognitive performance, and vigilance were measured under three conditions: 180 mg fexofenadine (F), 50 mg diphenhydramine (D) as a positive control, or placebo (P).

RESULTS

Subjects receiving F vs. D tended to have a faster mean hit reaction time (adjusted mean difference +/- SE, -10.5 +/- 6.8 ms, p = 0.127). Subjects performed faster and better with F vs. D on measures of omission errors and commission errors (p < 0.05). Variable symbol digit coding delayed recall accuracy was better for F vs. D (p = 0.023), and approached significance for shifting attention and divided attention tasks (p = 0.062 and p = 0.057, respectively). Subjects reported significantly more drowsiness (p < 0.005) with D than F.

CONCLUSIONS

Diphenhydramine administration resulted in significant psychomotor decrements compared with fexofenadine, while the effects of fexofenadine were similar to placebo. These results provide additional support for the safe use of fexofenadine by aviation personnel.

Global change and the mulga woodlands of southwest Queensland: greenhouse gas emissions, impacts, and adaptation

The possibility of trading greenhouse gas emission permits as a result of the Kyoto Protocol has spurred interest in developing land-based sinks for greenhouse gases. Extensive grazing lands that have the potential to develop substantial woody biomass are one obvious candidate for such activities. However, such activities need to consider the possible impacts on existing grazing and the possible impacts of continuing CO2 buildup in the atmosphere and resultant climate change. We used simulation models to investigate these issues in the mulga (Acacia aneura) woodlands of southwest Queensland. The simulation results suggest that this system can be managed to act as either a net source or a net sink of greenhouse gases under current climate and CO2 and under a range of global change scenarios. The key component in determining source or sink status is the management of the woody mulga. The most effective means of permanently increasing carbon stores and hence reducing net emissions is to exclude both burning and grazing. There are combinations of management regimes, such as excluding fire with light grazing, which, on average, allows productive grazing but transient carbon storage. The effects of increased CO2 on ecosystem carbon stores were unexpected. Carbon stores increased (7-17%) with doubling of CO2 only in those simulations where burning did not occur, but decreased when burnt. This occurred because the substantial increases in grass growth with doubling of CO2 (34-56%) enabled more fires, killing off the establishing cohorts needed to ensure continued carbon accumulation. On average, the doubling of atmospheric CO2 concentration increased grass growth by 44%, which is identical with mean literature values, suggesting that this result may be applicable in other ecosystems where fire has a similar function. A sensitivity analysis of the CO2 response of mulga showed only minor impacts. We discuss additional uncertainties and shortcomings.

The dynamics of grazed woodlands in southwest Queensland, Australia and their effect on greenhouse gas emissions

This study outlines the development of an approach to evaluate the sources, sinks, and magnitudes of greenhouse gas emissions from a grazed semiarid rangeland dominated by mulga (Acacia aneura) and how these emissions may be altered by changes in management. This paper describes the modification of an existing pasture production model (GRASP) to include a gas emission component and a dynamic tree growth and population model. An exploratory study was completed to investigate the likely impact of changes in burning practices and stock management on emissions. This study indicates that there is a fundamental conflict between maintaining agricultural productivity and reducing greenhouse gas emissions on a given unit of land. Greater agricultural productivity is allied with the system being an emissions source while production declines and the system becomes a net emissions sink as mulga density increases. Effective management for sheep production results in the system acting as a net source (approximately 60-200 kg CO2 equivalents/ha/year). The magnitude of the source depends on the management strategies used to maintain the productivity of the system and is largely determined by starting density and average density of the mulga over the simulation period. Prior to European settlement, it is believed that the mulga lands were burnt almost annually. Simulations indicate that such a management approach results in the system acting as a small net sink with an average net absorption of greenhouse gases of 14 kg CO2 equivalents/ha/year through minimal growth of mulga stands. In contrast, the suppression of fire and the introduction of grazing results in thickening of mulga stands and the system can act as a significant net sink absorbing an average of 1000 kg CO2 equivalents/ha/year. Although dense mulga will render the land largely useless for grazing, land in this region is relatively inexpensive and could possibly be developed as a cost-effective carbon offset for greenhouse gas emissions elsewhere. These results also provide support for the hypothesis that changes in land management, and particularly, suppression of fire is chiefly responsible for the observed increases in mulga density over the past century.

Effects of lovastatin and pravastatin on cognitive function in military aircrew

BACKGROUND

As evidence has accumulated for the role of HMG-CoA reductase inhibitors in the primary prevention of coronary artery disease, younger individuals with no other co-morbid conditions will be increasingly exposed to these agents. Some HMG-CoA reductase inhibitors have been reported to cause impairment of daytime cognitive processes that have the potential to directly impact the ability of pilots and other aircrew to perform. These studies suggested that there might be cognitive effects of these medications that would argue against their routine use in populations whose activities required high, sustained levels of cognitive performance. The objective of this study is to establish the effects of pravastatin and lovastatin on aircrew daytime cognitive function using tests that are correlated with actual cockpit tasks and inflight performance.

METHODS

Military aircrew with hypercholesterolemia were enrolled in the study and assigned to lovastatin, pravastatin or placebo groups. Baseline cognitive and vigilance testing was performed with computerized test instruments. Following a 4-wk treatment period, subjects were retested on both cognitive and vigilance tasks.

RESULTS

Laboratory studies confirmed that both medications were effective in lowering cholesterol. No major treatment-related side effects were encountered. Cognitive performance was not affected by either active treatment, and was not different from that of the placebo group.

CONCLUSIONS

The tested medications did not have significant effects on performance as measured by two computerized performance tests. The data suggest that neither medication has significant effects on flight-related performance.

A Phase II study of topotecan in patients with squamous cell carcinoma of the cervix: a gynecologic oncology group study

OBJECTIVE

The toxicity and activity of intravenous topotecan were assessed in a multicenter Phase II study (GOG 76-U) in patients with advanced, recurrent, or persistent squamous cell carcinoma of the uterine cervix.

METHODS

Intravenous topotecan was administered at 1.5 mg/m2 per day for 5 consecutive days every 4 weeks in patients without prior chemotherapy, aside from chemosensitizing agents used in conjunction with radiotherapy. The study required histologic confirmation of primary diagnosis, adequate performance status, and measurable disease to assess response. A two-stage design for accrual was used to allow for early termination of the study should inadequate response or excessive toxicity be an issue. Modifications of dose were based on hematologic toxicity. Treatment was continued until progression of disease was documented or adverse effects prohibited further therapy.

RESULTS

A total of 49 patients were entered on study: of these 5 were never treated, and 1 was not evaluable for response. More than 88% (38 of 43 patients) had received prior radiotherapy. A median of two courses were administered per patient with a range of 1 to 14 cycles. Grade 4 neutropenia occurred in 68% and grade 4 thrombocytopenia in 18% of patients. Nonhematologic toxic effects were infrequent and not dose-limiting. The overall response rate (complete and partial) was 18.6%. The median progression-free survival was 2.4 months.

CONCLUSIONS

Topotecan administered at this dose and schedule demonstrated moderate activity albeit at a cost of substantial hematologic toxicity in patients with advanced, recurrent, or persistent squamous cell carcinoma of the cervix.

Conservation conflicts across Africa

There is increasing evidence that areas of outstanding conservation importance may coincide with dense human settlement or impact. We tested the generality of these findings using 1 degree-resolution data for sub-Saharan Africa. We find that human population density is positively correlated with species richness of birds, mammals, snakes, and amphibians. This association holds for widespread, narrowly endemic, and threatened species and looks set to persist in the face of foreseeable population growth. Our results contradict earlier expectations of low conflict based on the idea that species richness decreases and human impact increases with primary productivity. We find that across Africa, both variables instead exhibit unimodal relationships with productivity. Modifying priority-setting to take account of human density shows that, at this scale, conflicts between conservation and development are not easily avoided, because many densely inhabited grid cells contain species found nowhere else.

Epidemiology of musculoskeletal and soft tissue injuries aboard a U.S. Navy ship

OBJECTIVE

The objective of this study was to characterize injuries occurring to crew members aboard a U.S. Navy ship.

METHODS

A retrospective review of crew member medical records was conducted covering a 90-day period during which the ship was intermittently at sea. Data on new injuries were collected and sorted. Injuries were classified as soft tissue or musculoskeletal, acute or overuse, and occurring with the ship at sea or in port.

RESULTS

There was a total incidence of 16.5 injuries per 100 man-months. Acute musculoskeletal injuries contributed 2.6 injuries per 100 man-months and resulted in 79 lost and 192.5 modified work days. Overuse musculoskeletal injuries were responsible for 9.3 injuries per 100 man-months and caused 1 lost and 255.5 modified work days. Soft tissue injuries had an incidence of 4.6 injuries per 100 man-months and resulted in no lost and only 106 modified work days. The relative risk of sustaining a soft tissue injury in port compared with at sea was 1.1, but this was not statistically significant. The relative risk of sustaining an acute musculoskeletal injury in port compared with at sea was 3.5 (p = 0.01).

CONCLUSIONS

Overuse musculoskeletal injuries occurred with the greatest incidence, but acute musculoskeletal injuries were responsible for the greatest morbidity. Soft tissue injuries occurred with an intermediate incidence but had the lowest overall morbidity. The safest place for crew members assigned to this Navy ship was aboard that ship at sea. Further studies of this nature could help guide medical efforts at injury treatment and prevention for shipboard personnel.

Characterization and health risk assessment of postmenopausal women with epilepsy

Postmenopausal women with epilepsy represent an understudied patient population. The objectives of this cross-sectional study were to characterize the impact of menopause on seizure activity and to conduct a health risk assessment. We conducted telephone interviews of 40 postmenopausal women with epilepsy concerning the effect of menopause on seizure frequency. We surveyed use of hormone replacement therapy, postmenopausal bone fractures, use of vitamins, and frequency of exercise. The average age and mean seizure duration were 55.8 and 27.6 years, respectively. Twenty-six women had onset of seizure activity before menopause. Of these 26, 3 reported fewer seizures after menopause, 7 reported more seizures, 11 reported no change, and 5 were unsure whether menopause affected their seizures. Only 30% of the 40 women were currently taking hormone replacement therapy. The impact of menopause on seizure activity was variable. Osteoporotic and cardiovascular preventive measures are underutilized. Patient education on these protective measures should be part of the comprehensive treatment approach in this "at-risk" patient population.

Hormone replacement therapy in a postmenopausal woman with epilepsy

OBJECTIVE

To prospectively evaluate the effects of hormone replacement therapy (HRT) on seizure activity in a postmenopausal woman with epilepsy.

BACKGROUND

Postmenopausal women are at an increased risk for cardiovascular disease and osteoporosis secondary to a lack of estrogen's protective effects. As a result, women without known contraindications often take HRT to counteract this risk. Postmenopausal women with epilepsy are at a greater risk for osteoporosis because of the negative effects that certain antiepileptic drugs have on bone density. Clinical studies and experience have shown that hormonal variances across a woman's lifetime play a significant role in seizure activity, but the effects of HRT in postmenopausal women with epilepsy are unknown.

CASE SUMMARY

We report the case of a 51-year-old postmenopausal white woman with epilepsy who presented with frequent vasomotor flushing. To determine individual effects of HRT on seizure activity, therapy was initiated in two three-month phases, with monthly evaluation. A weekly transdermal patch of estradiol 0.1 mg/d was initiated for the first three months. During the second three months, the regimen was expanded to include oral medroxyprogesterone acetate 2.5 mg once daily. Antiepileptic medications and their dosages remained constant. HRT was associated with a decreased incidence of seizures, cessation of vasomotor flushing, improved sleep, and a positive impact on the lipid profile.

CONCLUSIONS

This case report describing the prospective addition of HRT in a postmenopausal woman with epilepsy suggests that HRT can be initiated in certain women to achieve therapeutic benefits without adversely affecting seizure activity.

Centromere-linked microsatellite markers for linkage groups 3, 4, 6, 7, 13, and 20 of zebrafish (Danio rerio)

A large number of interesting mutations affecting development and organogenesis have been identified through genetic screens in zebrafish. Mapping of these mutations to a chromosomal region can be rapidly accomplished using half-tetrad analysis. However, knowledge of centromere-linked markers on every chromosome is essential to this mapping method. Centromeres on all 25 linkage groups have been mapped on the RAPD zebrafish genetic map. However, species specificity and the lack of codominance make RAPD markers less practical for mapping than microsatellite-based markers. On the microsatellite-based genetic map, centromere-linked markers have been identified for 19 linkage groups. No direct evidence has been published linking microsatellite markers to the centromeres of linkage groups 3, 4, 6, 7, 13, and 20. Therefore, we compared the microsatellite-based genetic map with the RAPD map to identify markers most likely linked to the centromeres of these 6 linkage groups. These candidate markers were tested for potential centromere linkage using four panels of half-tetrad embryos derived by early-pressure treatment of eggs from four different female zebrafish. We have identified microsatellite markers for linkage groups 3, 4, 6, 7, 13, and 20 to within 1.7 cM of their centromeres. These markers will greatly facilitate the rapid mapping of mutations in zebrafish by half-tetrad analysis.

An assessment of epilepsy patients' knowledge of their disorder

PURPOSE

Patient education is an effective component of comprehensive care. Studies assessing patient's knowledge of their epilepsy are scarce. We report the first objective study evaluating knowledge of epilepsy patients referred to an American tertiary care center.

METHODS

Two hundred twenty epilepsy patients referred to an epilepsy center completed a knowledge questionnaire. The questionnaire included topics related to safety, compliance, and legal issues of driving and employment. Questionnaire scores were correlated with demographics, number of years with epilepsy, and educational background.

RESULTS

Of 220 patients, 175 were included in study analysis. Thirteen percent (n = 28) were excluded because of the diagnosis of nonepileptic seizures, and 8% (n = 17) were excluded because of having a diagnosis other than epilepsy. The average age and number of years with epilepsy was 34.7 +/- 13 and 14. 4 +/- 13.1, respectively. Neither age (r = 0.20, p </=0.01), number of years with epilepsy (r = 0.09, p = 0.2), nor years of education (r = 0.34, p </=0.01) correlated with questionnaire scores. Thirty percent believed that epilepsy is a mental disorder or contagious. Forty-one percent believed it is appropriate to place an object in a patient's mouth during a seizure to prevent injury. Two of the lowest scores, 13.6% and 47.5%, pertained to the legal issues of driving and employment, respectively.

CONCLUSIONS

Patients with epilepsy are not knowledgeable about their disorder. This is true regardless of age, educational background, or number of years with epilepsy. There is a need for educational intervention in this population, particularly related to injury prevention and the legalities of driving and employment.

Referral characteristics of primary care physicians for seizure patients

PURPOSE

To investigate primary care physicians' behavior with respect to referral patterns, antiepileptic drug (AED) initiation, and level of comfort in managing seizure patients.

METHODS

A cross-sectional descriptive study design was used for collecting and analyzing data. A 20-item survey was developed and mailed to 8,195 primary care physicians including family practitioners, internal medicine physicians, and obstetrics-gynecologists throughout the state of Ohio; 504 primary care physicians that interact regularly with epilepsy patients responded to the survey.

RESULTS

Two patterns of referral emerged. Data showed that the majority (n = 382) of physicians refer >/=50% of their patients, but a minority of physicians (n = 122) refer <50% of their patients. Differences between the two groups existed in three of the four research questions asked: who initiates AED therapy, comfort level, and percentage of patients referred to a neurologist. Influence of managed care on decision making was not different between the two groups.

CONCLUSIONS

A minority of primary care physicians rate themselves very comfortable with seizure patients. These same physicians refer a minority of their patients to a neurologist. As a whole, however, primary care physicians refer a majority of their seizure patients to a neurologist. Neurologists evaluate most seizure patients because most primary care physicians claim not to be extremely comfortable with evaluation and treatment of seizures. We conclude that neurologists play an essential role in the treatment of most seizure patients.

Ethylnitrosourea induces neoplasia in zebrafish (Danio rerio)

The zebrafish (Danio rerio) has been successfully used to discover hundreds of genes involved in development and organogenesis. To address the potential of zebrafish as a cancer model, it is important to determine the susceptibility of zebrafish to tumors. Germ line mutations are most commonly induced for zebrafish mutant screens by exposing adult male zebrafish to the alkylating agent, ethylnitrosourea (ENU). To determine whether ENU induces tumors, we compared the incidence of tumors in ENU-treated fish with untreated controls. Interestingly, 18 of 18 (100%) fish mutagenized with either 2.5 or 3.0 mM ENU developed epidermal papillomas, which numbered 1 to 22 per fish, within 1 year of treatment. The induced epidermal lesions included epidermal hyperplasia, flat papillomas (0.2 to 1.2 mm), and pedunculated papillomas (1.2 to 8 mm in greatest dimension), but no skin cancers. Angiogenesis was evident in papillomas larger than approximately 1 mm. All but two papillomas contained the three cell types (keratinocytes, club, and mucous cells) of normal zebrafish epidermis; histologic variants lacked either club cells or mucous cells. Two cavernous hemangiomas and a single malignant peripheral nerve sheath tumor were also found in the treated fish. None of five untreated controls developed tumors. These studies establish the feasibility of the zebrafish as an experimental model for the study of skin tumors.

Alternative medicine use by patients with epilepsy

Purpose. The objectives of this study were, first, to determine the prevalence, characteristics, and demographic patterns of alternative medicine (AM) use in patients with epilepsy, and second, to ascertain the extent to which these patients inform the neurologist of AM use. Methods. Surveys were distributed randomly to patients attending a tertiary care epilepsy clinic. The survey assessed use of specific herbal medicine/dietary supplements, along with other forms of AM. Results. Of 150 surveys distributed, 92 were used for analysis. Twenty-two patients with epilepsy (24%) used AM, and only 31% of AM users reported such to their neurologists. Massage and herbs/supplements were used the most, and only two patients used AM specifically for treatment related to epilepsy. Conclusions. A sizable minority of patients with epilepsy who visit our tertiary care clinic use AM. Health professionals should actively monitor therapies to ensure safety and effectiveness with combined traditional medicine and AM use.

Investigations of crashes involving pregnant occupants

Case reports of 16 crashes involving pregnant occupants are presented that illustrate the main conclusions of a crash-investigation program that includes 42 crashes investigated to date. Some unusual cases that are exceptions to the overall trends are also described. The study indicates a strong association between adverse fetal outcome and both crash severity and maternal injury. Proper restraint use, with and without airbag deployment, generally leads to acceptable fetal outcomes in lower severity crashes, while it does not affect fetal outcome in high-severity crashes. Compared to properly restrained pregnant occupants, improperly restrained occupants have a higher risk of adverse fetal outcome in lower severity crashes, which comprise the majority of all motor-vehicle collisions.

Hearing loss and automobile airbag deployments

In an on-going research program, on the causation of injuries in motor vehicle accidents, at the University of Michigan Transportation Research Institute, crashes with airbags have been, and are continuing to be, investigated. In order to determine the occurrence, if any, of 'hearing problems' associated with airbag deployments, drivers and passengers who had been involved in 'airbag' automobile crashes were interviewed by telephone. From the crashes investigated, 225 attempts were made to contact drivers who were exposed to airbag deployments. From these telephone interviews, contacts were made with 177 car occupants. Only three reported that they had experienced any type of hearing-related problems subsequent to their crash. One other case is reported of a driver who had pre-crash hearing loss. It appears that permanent hearing deficit due to airbag deployment, both in cars with the steering wheel airbag alone, and in those with a passenger side airbag, is an infrequent event (1.7%) from the data of this study.

Assessing the needs of pharmacists and physicians in caring for patients with epilepsy

OBJECTIVE

To obtain primary care physicians' and community pharmacists' opinions of the Pharmacist Note, a model epilepsy patient profile maintained by the pharmacist and transmitted to the physician as needed, and the information it contains.

DESIGN

A cross-sectional descriptive study design was used for collecting and analyzing data. Separate surveys were developed and mailed to physicians and pharmacists.

PARTICIPANTS

554 primary care physicians and 114 community pharmacists in Ohio who interact regularly with epilepsy patients.

MAIN OUTCOME MEASURES

Pharmacist and physician opinions on the Pharmacist Note program.

RESULTS

Physicians ranked seizure frequency as their most useful piece of information, followed by medication compliance and drug interaction screening. For medication profile and drug interaction screening, most physicians currently use themselves as their primary source of information, although a significant number would prefer to use pharmacists as information sources in these areas (p < .05). A majority (62%) would like to have pharmacists more involved in the care of their patients. Pharmacists identified lack of time and lack of appointments with patients, inadequate pharmacy staff, and insufficient reimbursement as barriers to implementing the Pharmacist Note program.

CONCLUSION

Physicians desire pharmacist involvement in specific areas of care for patients with epilepsy, and the feasibility of implementing the Pharmacist Note and similar programs appears promising. However, pharmacists identified barriers to implementation, and these barriers need to be addressed if this type of program is to be successful.

A descriptive analysis of "not aeronautically adaptable" dispositions in the U.S. Navy

BACKGROUND

All aviation personnel in the U.S. Navy are evaluated for aeronautical adaptability (AA) in both initial and periodic examinations and for daily aeromedical disposition. By definition, all aviation personnel with a diagnosed personality disorder or those with maladaptive personality traits that have had a documented effect on safety of flight, crew coordination, or mission completion, are determined to be Not Aeronautically Adapted (NAA).

METHODS

NAA dispositions were examined for demographic data, basis for disposition, and frequency of personality features.

RESULTS

NAA dispositions were made on the basis of personality disorders and maladaptive personality traits in 29% and 35% of the cases, respectively. The officer and enlisted NAA dispositions were distinctly different in terms of frequency of personality features. Obsessive-compulsive features were present in 58% of officer and 10% of enlisted NAA dispositions. Dependent and avoidant features were present in excess in comparison to psychologically healthy aviators, suggesting the incompatibility of these features with aviation.