A clinical audit of the prescribing of celecoxib and rofecoxib in Australian rural general practice

Aims The new cyclooxygenase-2 (COX-2) selective inhibitors, celecoxib (Celebrex®) and rofecoxib (Vioxx®), have been widely prescribed since their launch. No reviews currently appear in the literature of prescribing patterns in Australia. This paper describes a self-audit of the clinical use of selective COX-2 inhibitor therapy undertaken with rural general practitioners (GPs) in Australia. Methods A structured audit form was developed and distributed to interested GPs. The form was self-administered and focused on issues about COX-2 inhibitors and the types of patients who were receiving them, e.g. indications, patient demographics, risk factors and drug interactions. Results A total of 627 patients were recruited (569 celecoxib and 58 rofecoxib). A range of doses was prescribed. Osteoarthritis was the most common indication (68.1%). Risk factors known for the nonselective nonsteroidal anti-inflammatory drugs were identified in 65.1% of patients, with the most common being advanced age, hypertension and previous peptic ulcer disease. Potential drug interactions were common. A variety of reasons for initiation of therapy was identified; these included perceived increased efficacy, safety and failure of other treatment. Conclusions These results show that COX-2 inhibitors are being prescribed for patients with multiple risk factors that may place the patient at increased risk of adverse drug reactions to a COX-2 inhibitor. The perception of improved safety and efficacy was common and is of concern. Limitations of the study include the reliance on self-reporting.

Winter intervention against Aedes aegypti (Diptera : Culicidae) larvae in subterranean habitats slows surface recolonization in summer

At semiarid Charters Towers, north Queensland, Australia, the importance of Aedes aegypti (L.) in wells was assessed in relation to the colonization of surface habitats during the wet season. From April to July 1999, 10 wells (five positive for Ae. aegypti) were monitored to assess their status and larvae population numbers therein. All surface containers located within a 100 m radius of each well were removed, treated with s-methoprene or sealed to prevent the utilization of these containers by mosquitoes. These inner cores were surrounded by outer zones for a further 100 m in which surface containers were left untreated but all subterranean habitats were treated. Ovitraps were monitored monthly in the inner cores for 36 wk from August 1999 to April 2000 and differences in the proportions of ovitraps positive for Ae. aegypti and Ochlerotatus notoscriptus (Skuse) were analyzed by logistic regression. Analysis of the proportions of ovitraps positive for Ae. aegypti near positive wells indicated significantly greater colonization from November to March (the wet season), compared with those situated near Ae. aegypti negative wells. As Oc. notoscriptus were not produced from subterranean sites, comparisons of the proportions of ovitraps positive for Oc. notoscriptus in positive and negative inner cores provided an indication of the relative productivity of the uncontrolled surface containers in the outer zones. Differences in the utililization of ovitraps by Oc. notoscriptus among positive and negative cores were observed during only one month (March), when oviposition was greater in ovitraps in the negative cores, compared with the positive cores. Best subsets linear regression analysis of the proportion of ovitraps positive for Ae. aegypti against meteorological variables (rainfall, mean wind speed, mean relative humidity, mean minimum, and maximum temperature) during the week of ovitrapping indicated that minimum temperature and wind speed accounted for 63.4% of the variability. This study confirms that for semiarid towns such as Charters Towers, the practice of treating a relatively small number of key subterranean habitats during winter will significantly affect Ae. aegypti recolonization of surface container habitats during summer, the period of greatest risk for dengue.

Gene complementation of airway epithelium in the cystic fibrosis mouse is necessary and sufficient to correct the pathogen clearance and inflammatory abnormalities

Increasingly, cystic fibrosis (CF) is regarded as an inflammatory disorder where the response of the lung to Pseudomonas aeruginosa is exaggerated as a consequence of processes mediated by the product of the CF gene, CFTR. Of importance to any gene-replacement strategy for treatment of CF is the identification of the cell type(s) within the lung milieu that need to be corrected and an indication whether this is sufficient to restore a normal inflammatory response and bacterial clearance. We generated G551D CF mice transgenically expressing the human CFTR gene in two tissue compartments previously demonstrated to mediate a CFTR-dependent inflammatory response: lung epithelium and alveolar macrophages. Following chronic pulmonary infection with P. aeruginosa, CF mice with epithelial-expressed but not macrophage-specific CFTR showed an improvement in pathogen clearance and inflammatory markers compared with control CF animals. Additionally, these data indicate the general role for epithelial cell-mediated events in the response of the lung to bacterial pathogens and the importance of CFTR in mediating these processes.

Effects of seawater components on immature Culicoides molestus (Skuse) (Diptera : Ceratopogonidae)

Following analysis of beach sites and an indication that seawater components might influence larval occurrence, we studied the impact of increasing salinity and seawater concentration on survival of fourth-instar larvae of the canal biting midge, Culicoides molestus . While NaCl had little effect on immature survival, increasing the concentration of seawater increased mortality prior to the adult stage. Seawater at three and four times the normal concentration killed all immatures. Artificial elevation of seawater concentration in the sandy substrate preferred by larvae, therefore, has the potential to reduce immature midge survival. Diet also affected survival, with higher mortality of immatures that were fed fish-food flakes compared with those that were fed live nematodes.

Improving the ionic conductivity of yttria-stabilised zirconia electrolyte materials

Low-temperature anneals (1200 degreesC for 40 h) of 8 mol% yttria-stabilised zirconia, prior to the samples being sintered at 1500 degreesC, had the effect of improving the ionic conductivity of the specimens. The presence Of SiO2 in the specimens was shown to be detrimental, however. Irrespective of the SiO2 content, this type of heat treatment also leads to improvements in conductivity. Extensive microstructural analysis provided indication of the mechanism of this phenomenon. This included selective formation of zircon, relief of sintering strain leading to the formation of coherent grain boundaries and segregation effects. (C) 2002 Elsevier Science B.V All rights reserved.

Genetic and Environmental Influences on Migraine: A Twin Study Across Six Countries

Migraine is a common neurovascular brain disorder that is manifested in recurrent episodes of disabling headache. The aim of the present study was to compare the prevalence and heritability of migraine across six of the countries that participate in GenomEutwin project including a total number of 29,717 twin pairs. Migraine was assessed by questionnaires that differed between most countries. It was most prevalent in Danish and Dutch females (32% and 34%, respectively), whereas the lowest prevalence was found in the younger and older Finnish cohorts (13% and 10%, respectively). The estimated genetic variance (heritability) was significant and the same between sexes in all countries. Heritability ranged from 34% to 57%, with lowest estimates in Australia, and highest estimates in the older cohort of Finland, the Netherlands, and Denmark. There was some indication that part of the genetic variance was non-additive, but this was significant in Sweden only. In addition to genetic factors, environmental effects that are non-shared between members of a twin pair contributed to the liability of migraine. After migraine definitions are homogenized among the participating countries, the GenomEUtwin project will provide a powerful resource to identify the genes involved in migraine.

Evidence for a QTL on chromosome 19 influencing LDL cholesterol levels in the general population

The genetic basis of cardiovascular disease (CVD) with its complex etiology is still largely elusive. Plasma levels of lipids and apolipoproteins are among the major quantitative risk factors for CVD and are well-established intermediate traits that may be more accessible to genetic dissection than clinical CVD end points. Chromosome 19 harbors multiple genes that have been suggested to play a role in lipid metabolism and previous studies indicated the presence of a quantitative trait locus (QTL) for cholesterol levels in genetic isolates. To establish the relevance of genetic variation at chromosome 19 for plasma levels of lipids and apolipoproteins in the general, out-bred Caucasian population, we performed a linkage study in four independent samples, including adolescent Dutch twins and adult Dutch, Swedish and Australian twins totaling 493 dizygotic twin pairs. The average spacing of short-tandem-repeat markers was 6 - 8 cM. In the three adult twin samples, we found consistent evidence for linkage of chromosome 19 with LDL cholesterol levels ( maximum LOD scores of 4.5, 1.7 and 2.1 in the Dutch, Swedish and Australian sample, respectively); no indication for linkage was observed in the adolescent Dutch twin sample. The QTL effects in the three adult samples were not significantly different and a simultaneous analysis of the samples increased the maximum LOD score to 5.7 at 60 cM pter. Bivariate analyses indicated that the putative LDL-C QTL also contributed to the variance in ApoB levels, consistent with the high genetic correlation between these phenotypes. Our study provides strong evidence for the presence of a QTL on chromosome 19 with a major effect on LDL-C plasma levels in outbred Caucasian populations.

Evaluation of cyclooxygenase 2 inhibitor use in patients admitted to a large teaching hospital

Background: The heavy usage of coxibs in Australia far outstrips the predicted usage that was based on the treatment of patients with risk factors for upper gastro-intestinal adverse events from conventional anti--inflammatory agents. This raises questions regarding the appropriateness of prescribing. Aims: To determine: (i) the relationship between prescriptions for cyclooxygenase 2 (COX-2) inhibitors and objective evidence of inflammatory arthritis, (ii) prior experience with paracetamol and/or conventional non-steroidal anti-inflammatory drugs (NSAIDs), and (iii) contraindications to the use of NSAIDs. Methods: Drug utilization evaluation and rheumato-logical assessment was conducted on 70 consecutive patients admitted on COX-2 inhibitors to a 480-bed metropolitan hospital. The main outcome measures were: the indication for COX-2 inhibitor; objective -evidence of inflammatory arthritis; previous trial of -paracetamol or conventional NSAIDs; and patient -satisfaction. Results: Only 11 patients (16%) had symptoms or signs of an inflammatory arthropathy, and met Pharmaceut-ical Benefits Schedule criteria for prescribing a COX-2 inhibitor. Fifty-nine patients (84%) had chronic osteo-arthritis, degenerative spinal disease, injury or malignancy, without overt active inflammation. Fourteen patients (20%) had trialled regular paracetamol prior to using any NSAID treatment. Conventional NSAIDs had been previously used by 51 patients (73%). Eleven patients (16%) reported previous adverse gastrointestinal effects from conventional NSAIDs. On the basis of significant renal impairment (creatinine clearance 5/10). Conclusions: Drug utilization data indicate that COX-2 inhibitors are frequently used first line for degenerative osteoarthritis in the absence of overt inflammation, without prior adequate trial of paracetamol and with disregard for the cautions and contraindications of these agents. These findings may explain the unprecedented Pharmaceutical Benefits Schedule expenditure on COX-2 inhibitors in Australia.

Water table waves in an unconfined aquifer: Experiments and modeling

[1] Comprehensive measurements are presented of the piezometric head in an unconfined aquifer during steady, simple harmonic oscillations driven by a hydrostatic clear water reservoir through a vertical interface. The results are analyzed and used to test existing hydrostatic and nonhydrostatic, small-amplitude theories along with capillary fringe effects. As expected, the amplitude of the water table wave decays exponentially. However, the decay rates and phase lags indicate the influence of both vertical flow and capillary effects. The capillary effects are reconciled with observations of water table oscillations in a sand column with the same sand. The effects of vertical flows and the corresponding nonhydrostatic pressure are reasonably well described by small-amplitude theory for water table waves in finite depth aquifers. That includes the oscillation amplitudes being greater at the bottom than at the top and the phase lead of the bottom compared with the top. The main problems with respect to interpreting the measurements through existing theory relate to the complicated boundary condition at the interface between the driving head reservoir and the aquifer. That is, the small-amplitude, finite depth expansion solution, which matches a hydrostatic boundary condition between the bottom and the mean driving head level, is unrealistic with respect to the pressure variation above this level. Hence it cannot describe the finer details of the multiple mode behavior close to the driving head boundary. The mean water table height initially increases with distance from the forcing boundary but then decreases again, and its asymptotic value is considerably smaller than that previously predicted for finite depth aquifers without capillary effects. Just as the mean water table over-height is smaller than predicted by capillarity-free shallow aquifer models, so is the amplitude of the second harmonic. In fact, there is no indication of extra second harmonics ( in addition to that contained in the driving head) being generated at the interface or in the interior.

Biodegradation and ecotoxicity evaluation of a bionolle and starch blend and its degradation products in compost

A polymer based on a blend of starch and Bionolle(TM) has been prepared and tested for biodegradation in compost. The polymer was completely mineralised to carbon dioxide in 45 days. The potential toxicity of the polymer was tested against the earthworm Eisenia fetida using a modification of the American Standard for Testing Materials E1976-97. The earthworms were exposed to 30 g of the polymer for 28 days and changes in weight recorded. In addition, the polymer was firstly degraded by the compost and the worms exposed to the breakdown products for 28 days. Differences in weight were also recorded. In each case the production of juveniles was noted and all earthworms were examined for pathology. The results obtained were processed statistically using a t-test. The number of juveniles, produced from the breakdown products, was highly significant (P < 0.001) when compared to the earthworms added to the intact polymer. There was a definitely significant difference (P < 0.01, t = 3.25) in change in weight between the earthworms that were exposed to the polymer directly and those that were exposed to the breakdown products. There was no indication of any pathology of any earthworms. The polymer is considered safe for this species. (C) 2002 Elsevier Science Ltd. All rights reserved.

Reforma administrativa e marco legal das organiza????es sociais no Brasil: as d??vidas dos juristas sobre o modelo das organiza????es sociais

O modelo brasileiro das organiza????es sociais representa uma das respostas poss??veis ?? crise do aparelho do Estado no ??mbito da presta????o dos servi??os sociais. Essas entidades s??o percebidas como uma forma de parceria do Estado com as institui????es privadas de fins p??blicos (perspectiva ex parte principe) ou, sob outro ??ngulo, uma forma de participa????o popular na gest??o administrativa (perspectiva ex parte populi). No texto s??o tematizadas as diferen??as e semelhan??as entre o marco legal das organiza????es sociais e das entidades de utilidade p??blica no Brasil, as notas distintivas entre a disciplina dos servi??os privados de interesse p??blico e dos servi??os p??blicos, bem como o que distingue juridicamente o modelo das organiza????es sociais de processos de privatiza????o e terceiriza????o. Em todos esses temas os juristas aparecem como protagonistas na determina????o dos limites do modelo das organiza????es sociais, evidenciando que processos de reforma normativa exigem, para serem eficazes, uma concomitante reforma na mentalidade dos agentes p??blicos.

Mid- to Late-Holocene estuarine infilling processes studied by radiocarbon dates, high resolution seismic and biofacies at Vitoria Bay, Espirito Santo, Southeastern Brazil

A Baía de Vitória é um estuário com 20 km de comprimento, morfologicamente estreito, com um regime de micromaré e, como outros estuários modernos, formado durante a última transgressão pós-glacial. A morfologia de fundo do estrato estuarino é caracterizada por um canal natural principal limitado por planícies de maré com manguezais desenvolvidos. Datações de radiocarbono originais foram obtidas para a área. Cinco idades de radiocarbono estendendo-se de 1.010 a 7.240 anos AP foram obtidas através de dois testemunhos de sedimento, representando uma sequência estratigráfica de 5 m de espessura. Os resultados indicam que até aproximadamente 4.000 anos cal. AP, as condições ambientais da Baía de Vitória eram ainda de uma baía aberta, com uma conexão livre e aberta com águas marinhas. Durante os últimos 4.000 anos a baía experimentou uma fase de regressão importante, tornando-se mais restrita em termos de circulação da água do mar e provavelmente aumentando a energia de marés. Três superfícies estratigráficas principais foram reconhecidas, limitando fácies transgressiva, transgressiva/nível de mar alto e regressiva. A morfologia do canal atual representa um diastema de maré, mostrando fácies regressivas truncadas e erodidas. Biofácies de foraminíferos, passando de ambiente marinho para ambiente salobro e de manguezais em planície de maré confirmam a interpretação sismoestratigráfica. A ausência de biofácies de mangue em um dos dois testemunhos é tambémuma indicação de ravinamento de maré atual.

Researchers' information needs in the bibliographic database : a literature review

This article is published online with Open Access and distributed under the terms of the Creative Commons Attribution Non-Commercial License.

Fatores intervenientes na implementação de ações estratégicas para a promoção do selo de indicação geográfica das panelas de barro de goiabeiras

Visando a proteção da propriedade industrial advinda de uma região demarcada, surgiu a Indicação Geográfica (IG). O registro da IG é conferido aos produtos ou serviços característicos de seu local de origem, apresentando qualidades únicas em função dos recursos naturais. Além disso, a IG é responsável por distinguir estes produtos em relação aos disponíveis no mercado. Neste contexto, entidades como Sebrae, MAPA e INPI, têm promovido ações estratégicas com o objetivo de apoiar a proteção do saber fazer e consequentemente, os produtos tradicionais das regiões. Tais entidades são responsáveis por promover a sustentabilidade do processo juntos aos produtores, assim como disseminar o selo para os consumidores. Assim, iniciativas como esta precisam ser apoiadas a fim de entregar resultados significativos para o desenvolvimento das regiões e seus respectivos produtos com o selo de IG. O Plano de Apoio à Gestão da Indicação Geográfica desenvolvido pelo Sebrae/ES tem três pilares: melhoria do processo de produção, promoção do produto e a sustentabilidade do processo. A presente pesquisa, baseando-se nas teorias sobre estratégia e implementação de estratégias, analisa os fatores intervenientes que contribuem para o sucesso da implementação do Plano de Apoio à Gestão da indicação geográfica das Panelas de Barro de Goiabeiras, bairro do município de Vitória, capital do Espírito Santo. A pesquisa é um estudo de caso de natureza qualitativa, exploratória e descritiva ex-post-facto. Os dados foram coletados nos documentos (plano de ação do Sebrae/ES, Livro dos Saberes e relatórios desenvolvidos por consultores especializados) e por meio de entrevistas com seis agentes de políticas públicas e cinco paneleiras, envolvidos na elaboração e implementação do plano de ação. Para a análise dos dados, adotou-se a metodologia de análise de conteúdo com index definido a posteriori. Do Plano de Apoio à Gestão da IG das Paneleiras de Goiabeiras, foram agrupadas três ações estratégicas buscando identificar em que medida os fatores intervenientes afetaram a implementação de cada ação estudada: Ação1: fortalecimento dos aspectos culturais do produto, Ação 2: fortalecimento dos aspectos sociais do produto e Ação 3: fortalecimento dos aspectos econômicos associados à diferenciação por IG. Os resultados mostraram que na Ação 1 o fator interveniente liderança superou as expectativas na implementação das estratégias. Já os aspectos políticos, o acompanhamento de resultados e a estrutura organizacional desenvolveram as ações conforme o planejado, enquanto os fatores intervenientes cultura e clareza nas estratégias apresentaram oportunidades de melhorias. Na Ação 2 somente os fatores intervenientes recursos, cultura e clareza nas estratégias apresentaram-se de acordo com o proposto, enquanto a liderança e a estrutura organizacional mostraram-se como pontos de oportunidades de melhoria. Por fim, na Ação 3 nenhum fator interveniente foi destaque como uma oportunidade de melhoria. A estrutura organizacional e os aspectos políticos apresentaram-se de acordo, enquanto os recursos e a liderança superaram as expectativas.

Options listing and the volatility of the underling asset: a study on the derivative market function

There are basic misunderstandings on derivative markets. Some professionals believe that they are a kind of casinos and have no utility for the investors. This work looks at the effects of options introduction in the Brazilian market, seeking for another benefit for this introduction: changes in the stocks risk leveI. Our results are the same found in the US and other markets: the options introduction reduces the stocks volatility. We also found that there is a slight indication that the volatility becames more stochastic with this alternative.