Synthesis, biological activity, and preliminary pharmacokinetic evaluation of analogues of a phosphosulfomannan angiogenesis inhibitor (PI-88)

The phosphosulfomannan 1 (PI-88) is a mixture of highly sulfated oligosaccharides that is currently undergoing clinical evaluation in cancer patients. As well as it's anticancer properties, 1 displays a number of other interesting biological activities. A series of analogues of 1 were synthesized with a single carbon (pentasaccharide) backbone to facilitate structural characterization and interpretation of biological results. In a fashion similar to 1, all compounds were able to inhibit heparanase and to bind tightly to the proangiogenic growth factors FGF-1, FGF-2, and VEGF. The compounds also inhibited the infection of cells and cell-to-cell spread of herpes simplex virus (HSV-1). Preliminary pharmacokinetic data indicated that the compounds displayed different pharmacokinetic behavior compared with 1. Of particular note was the n-octyl derivative, which was cleared 3 times less rapidly than 1 and may provide increased systemic exposure.

Fixing the system? The experience of service users of the quasi-market in disability services in Australia

A qualitative study involving semi-structured interviews with 31 people with disabilities and 32 carers in the state of Queensland, Australia, found that their experience of supportive service delivery had not improved despite reforms of the service delivery system driven by a version of the quasi-market model. Instead of delivering increased consumer choice and improved efficiency in service delivery, service users experienced inadequate service supply, service cutbacks, and an increased emphasis on cost subsidisation and assessment processes. Additionally, few consumers felt that individualised funding arrangements had personally delivered the benefits which the quasi-market model and associated policy paradigm had indicated that they should receive. For many consumers, the notion of consumer 'choice' around service provision was fictitious and they felt that any efficiency gains were at the agency level, largely at the consumers' cost. It is concluded that there appears to be no particular benefit to service users of quasi-market reforms, particularly in policy contexts where service delivery systems are historically under-funded.

Heparin-induced thrombocytopenia: recent experience in a large teaching hospital

Background: Heparin-induced thrombocytopenia (HIT) is a potentially serious adverse reaction caused by platelet-activating antibodies. Aim: To describe experience with HIT. Methods: Twenty-two patients identified by laboratory records of heparin-associated antibodies with a 50% or greater decrease in platelet count were reviewed in our 600-bed metropolitan teaching hospital from 1999 to April 2005. Results: There was an increase in the frequency of HIT diagnosed during the review period, which was associated with a rise in the number of requests for HIT antibodies. Thrombotic complications were identified in 14 of 22 patients with HIT. Mean age was 65 years, and 11 patients were men. Seven patients died and HIT was considered contributory in four. One patient required mid-forearm amputation. Unfractionated heparin was used in all cases and five patients also received enoxaparin. Mean time to HIT screen, reflecting when the diagnosis was first suspected, was 14 days. Platelet nadir ranged from 6 x 10(9)/L to 88 x 10(9)/L, with a percentage drop in platelet count of 67-96%. Alternative anticoagulation (danaparoid) was not used in three patients, two of whom died. Conclusions: HIT is a potentially life-threatening complication of heparin therapy, associated with a fall in platelet count and a high incidence of thromboembolic complications. It is most frequently seen using unfractionated heparin therapy. The increase in frequency of HIT diagnosed in our hospital appears to be associated with a greater awareness of the entity, although detection is often delayed. Platelet count should be monitored in patients on heparin and the presence of antiplatelet antibodies determined if HIT is suspected. Treatment involves both discontinuation of heparin and the use of an alternative anticoagulant such as danaparoid because of the persisting risk of thrombosis.

A systematic review of successes and failures in home telehealth: preliminary results

We conducted a systematic review of the literature to identify studies in home telehealth that compared a home telehealth intervention with a non-telehealth standard/usual care alternative in terms of administrative changes, patient management decisions, patient outcomes, caregiver outcomes, economic impact or social impact on patients. A search of various databases produced 6643 references. Of these 769 papers were selected for more detailed investigation. These papers, combined with hand searching of relevant telehealth journals and cross-referencing of citations in identified publications, resulted in 138 papers referring to 130 projects for review. In this preliminary analysis we used a quality appraisal approach that took into account the study design. An additional analysis of patient numbers was then used to calculate a net evidence score. A large proportion of studies (80%) were randomised controlled trials. Only 22 projects (17%) reported economic data deemed to be sufficient for appraisal. Evidence exists for the clinical effectiveness of home telehealth in diabetes, the general area of mental health, high risk pregnancy monitoring, heart failure and cardiac disease.

Relationships between quality of experience and participation in diverse performance settingshttp://espace.library.uq.edu.au/workflow/edit_metadata.php?id=382160&wfs_id=778

The flow concept describes a model of enjoyment that has relevance for understanding participation and experience across a wide range of activities (Csikszentmihalyi, 1997). The basic premise of the flow concept is that when challenges and skills are simultaneously balanced and extending the individual, a state of total absorption can occur. Research by Jackson and colleagues has examined the utility of the flow concept to understanding participation and performance in sport settings. Recently, Jackson and Eklund have examined flow in a range of performance settings: sport, exercise, dance, creative and performing arts, and music. In this paper, we present descriptive and construct validity data on how participants in these activities experienced flow, as assessed by the recently revised flow scales: The Dispositional Flow Scale-2 (DFS-2) and Flow State Scale-2 (FSS-2) (Jackson & Eklund, 2002). The fmdings will be discussed in relation to the utility of the flow concept to understanding participation across performance settings.

Walking towards health in a university community: Preliminary analyses of baseline data

Research has shown that accumulating 10 000 steps/day provides a range of significant clinical health benefits. However, opportunities for daily walking are constrained by a number of barriers, including employment in sedentary occupations.

The relationship between extra-role behaviours and job burnout for primary school teachers: A preliminary model and development of an organisational citizenship behaviour scale

Recent research on teacher stress in primary schools (e.g. Leonard, Bourke & Schofield, 1999) has shown that higher levels of teacher exhaustion are associated with higher levels of student satisfaction. This paper seeks to explain this surprising finding by considering a construct discussed widely in the organisational literature known as extra-role or organisational citizenship behaviour (OCB). Teacher OCB may include extra efforts to make lessons enjoyable and interesting, organising extra-curricular activities and spending personal time talking with students. The proposed model of analysis also draws on literature relating to job burnout (Maslach, 1982), which generally suggests that the three components of chronic occupational stress - exhaustion, depersonalisation and reduced accomplishment - occur together. However, this paper proposes that although teachers who engage in more OCB experience more exhaustion, they may simultaneously increase their feelings of personal accomplishment and work identification, which may in turn help to avert burnout. It is argued that only with this particular set of job attitudes are the effects of exhaustion caused by high levels of OCB sufficiently buffered to avoid job burnout, and thus positively affect students' quality of school life. The development and piloting of an instrument to measure teachers' OCB will be discussed. The preliminary findings reported herein are part of a larger ongoing study investigating the consequences of stress and OCB in primary school teachers.