Pharmacists' role in a smoking-cessation program at a managed health care organization

A smoking-cessation program at a managed health care organization and the involvement of pharmacists are described. Kaiser Permanente Northwest Region is a prepaid group-practice managed health care organization serving more than 380,000 members in Oregon and southwest Washington. A multidepartmental team at Northwest Region designed and implemented a stepped-care approach to smoking cessation in March 1992. The program progresses from advising and helping patients to quit on their own to enrolling patients in a behavioral-modification course to referring them to nicotine-replacement therapy to be given concurrently with the behavioral modification. The program was established with the help of pharmacists, and pharmacists are deeply involved in its operation. They work closely with each patient, the health educator instructing the patient, and the prescribing physician. Pharmacists attend 5 of the 10 behavioral modification/nicotine-replacement course sessions and take responsibility for enrollees throughout the program. Pharmacists prescribe and monitor nicotine-replacement therapy by protocol. They also monitor each patient for the dose-response effect, adverse drug reactions, drug interactions, concurrent medical conditions, and progress and outcome. The physician is informed about any important changes in the patient's status. In 1992, more than 80 courses were held with nearly 1000 participants, and rates of long-term abstinence achieved compare favorably with literature rates for community-based group smoking-cessation programs. Satisfaction of patients, pharmacists, and physicians with the program has been high. Pharmacists at a managed health care organization participate in a smoking-cessation program by helping with behavioral modification, educating patients about nicotine-replacement therapy, and prescribing and monitoring therapy by protocol.     

Strength of secondary-cured resin composite inlay repairs

A study was designed to simulate the repair of an indirect resin composite restoration with conventionally cured resin composite. Two-part specimens were prepared to test the diametral tensile strength of the repair interface between the base material of an indirectly cured resin composite (Herculite XRV) and repairs carried out with three directly cured materials (Herculite XRV, TPH, and Charisma). The repairs were carried out with and without use of the bonding resin for the repair material. The diametral tensile strengths of all repaired specimens were significantly less than those of bulk unrepaired specimens. There were no significant differences between the diametral tensile strengths of repaired blocks when the repair materials were used without bonding resin. The use of an intermediate layer of bonding resin significantly increased the bond strengths obtained when Herculite XRV and TPH were used for repair. There was no significant difference between the strength values of Herculite XRV and TPH, but Charisma exhibited the lowest strengths of repaired specimens.     

Bronchogenic carcinoma: utility of CT in the evaluation of patients with suspected lesions

PURPOSE: To assess the utility of computed tomography (CT) in the evaluation of suspected bronchogenic carcinoma. MATERIALS AND METHODS: CT scans were reviewed of 362 patients who had undergone CT for suspected bronchogenic carcinoma. RESULTS: CT findings of 275 patients were consistent with bronchogenic carcinoma. Sixty-five tumors were deemed unresectable on the basis of CT findings, 21 were deemed unresectable on the basis of CT findings and poor surgical risk, 26 proved to be benign, six were metastatic disease from an extrathoracic primary tumor, and 157 were potentially resectable bronchogenic carcinoma. Surgical mediastinal nodal sampling enabled documentation of metastases in 60 of 159 patients. According to nodal station, the sensitivity of CT for metastases was 67% for nodes measured in the long axis and 58% for nodes measured in the short axis; specificity was 56% and 86%, respectively. CONCLUSION: CT can be used to confirm or exclude the presence of bronchogenic carcinoma and to obviate thoracotomy. The specificity of CT is limited, and a histologic diagnosis or follow-up evaluation is necessary. CT has limited value in staging mediastinal lymph nodes.     

Differential effects of peripheral manipulations on vibrissae-related patterns in the trigeminal brainstem

The derivation of the conclusion "Anna is bigger than Mary" from the premises "Anna is bigger than Paul" and "Mary is smaller than Paul" is considered an instance of transitive deduction. For a non-verbal presentation, the premise statements were here transformed into a multiple operant discrimination task. Adult subjects were trained with overlapping pairs of a six-member stimulus series A+B-, A+C-, C+D-, D+E-, E+F-; +: choice rewarded, -: choice penalized). A computer game-type presentation that hid the actual problem structure from the subjects was employed. The effects of varying the presentation style of the task on the objective performance and the structure awareness of subjects were investigated. A first experiment used random polygons as stimuli and the relations between them were only signalled by the above reinforcement allocations. In a second experiment the stimuli were cartoon figures additionally involved in a dominance hierarchy that was suggested graphically. A third experiment used named items that were related through visible size differences in addition to the reinforcement allocations but was otherwise like an experiment using an abstract format reported by Werner et al. (1992). In all experiments a similar proportion of subjects responded transitively when subsequently tested with the pairs BD, BE and CE by preferentially choosing stimulus B or C. Each subject subsequently filled in a questionnaire, completed a stimulus ordering exercise, and was interviewed to find out whether they were explicitly aware of the stimulus hierarchy underlying each of the tasks. Although the proportion of subjects revealing an explicit transitive responding increased together with the concreteness of the stimuli and their relations across the experiments, the objective performance in terms of choice accuracy did not vary. The accuracy performance on tests could be accurately simulated with a modification of a simple conditioning model. It is concluded that an implicit mode of processing may underlie many instances of transitive responding in humans even when explicit task understanding is reported.     

A Vitruvius Inspired Criterion for the Construction of Polygons

A geometric analysis carried out on three homonymous works, known as the Vitruvian man, by Leonardo da Vinci, Giacomo Andrea da Ferrara and Gulielmo Philandro has identified the equilateral triangle as a common feature, differing only with respect to the central position of the apex. Considerations regarding the intended purpose of the tangential outer arc in the Ferrara’s sketch and the possible implications of the two secants, drawn from the mid-point at the base to its intersections with the sides of the square, have provided the basis for a general construction of polygons. The underlying criterion relies on the parameters that define the geometric components of the arc to establish the position of the vertices of the polygon. The fundamental nature of the construction was confirmed through a comparison with an existing procedure by Fletcher, named “squaring the circle”.     

Frontal sinus disease. IV. Cellular response to experimentally-induced infection

The pathogenesis of chronic frontal sinusitis is poorly understood. The canine frontal sinus model was developed to isolate experimentally the variables involved. We have recently determined that blockage of the naso-frontal duct does not, by itself, produce sinusitis or mucocele experimentally. The purpose of the present investigation is to examine the histological and ultrastructural responses of the sinus mucosa to artificially-induced infection. Bone wax was implanted in the canine frontal sinus via an osteoplastic flap, and subsequently removed three months later. Radiological, histological and ultrastructural analysis of the resultant infected mucosa was performed at periods up to one year. The sinus mucosa did not return to normal up to nine months following removal of the infection-inciting foreign body. Persistent changes included epithelial and submucosal thickening, polypoid degeneration, matting of the ciliary carpet, and "bursting" of the ciliary cell bodies. In the light of this and previous experiments, an insidious cycle of events leading to irreversible frontal sinus disease is postulated, requiring the interplay of at least three variables: the infectious insults, the response of the sinus mucosa, and the variable patency of the nasofrontal duct.     

Angiographic documentation of systemic-portal venous shunting as a cause of a liver scan "hot spot' in superior vena caval obstruction

Four patients with superior vena caval obstruction were evaluated with contrast venography and radiocolloid liver scans to investigate systemic-portal venous shunting as a cause of a liver scan "hot spot". In two of the cases a hot spot due to systemic-portal venous shunting was documented by angiography. The venous anatomy and pathophysiology related to hot spot formation on the liver scan is discussed. To develop a liver scan hot spot it appears necessary to have considerable systemic-portal venous flow through anterior parietal and periumbilical venous channels.     

On the identification of rheological properties of cement suspensions: Rheometry,Computational Fluid Dynamics modeling and field test measurements

Cementitious composites with customized rheologies are becoming increasingly popular throughout a wide variety of civil engineering applications. Assessing their fundamental rheological properties is crucial for the success of a particular application. Their measurement is not a trivial task and typically requires dedicated and expensive equipment. These equipment may not be compatible with field applications and not even available in every laboratory. Correlations between fundamental rheological properties and field test measurements have been assessed, as for the yield stress versus the slump flow diameter. As for the plastic viscosity, different attempts have been made, with flow time parameters measured from different tests. This work provides further evidence to the aforementioned correlations, with reference to a broad range of cement pastes and mortars formulated from SCCs, as well as employing a tool for Computational Fluid Dynamics (CFD) modeling developed by the authors.     

Maternal virus load and perinatal human immunodeficiency virus type 1 subtype E transmission, Thailand. Bangkok Collaborative Perinatal HIV Transmission Study Group

To determine the rate and risk factors for human immunodeficiency virus (HIV)-1 subtype E perinatal transmission, with focus on virus load, pregnant HIV-infected women and their formula-fed infants were followed prospectively in Bangkok. Of 281 infants with known outcome, 68 were infected (transmission rate, 24.2%; 95% confidence interval, 19.3%-29.6%). Transmitting mothers had a 4.3-fold higher median plasma HIV RNA level at delivery than did nontransmitters (P<.001). No transmission occurred at <2000 copies/mL. On multivariate analysis, prematurity (adjusted odds ratio [AOR], 4.5), vaginal delivery (AOR, 2.9), low NK cell percentage (AOR, 2.4), and maternal virus load were associated with transmission. As RNA quintiles increased, the AOR for transmission increased linearly from 4.5 to 24.8. Two-thirds of transmission was attributed to virus load>10,000 copies/mL. Although risk is multifactorial, high maternal virus load at delivery strongly predicts transmission. This may have important implications for interventions designed to reduce perinatal transmission.