Characteristics of patients making serious inhaler errors with a dry powder inhaler and association with asthma-related events in a primary care setting

Acknowledgements The iHARP database was funded by unrestricted grants from Mundipharma International Ltd and Research in Real-Life Ltd; these analyses were funded by an unrestricted grant from Teva Pharmaceuticals. Mundipharma and Teva played no role in study conduct or analysis and did not modify or approve the manuscript. The authors wish to direct a special appreciation to all the participants of the iHARP group who contributed data to this study and to Mundipharma, sponsors of the iHARP group. In addition, we thank Julie von Ziegenweidt for assistance with data extraction and Anna Gilchrist and Valerie L. Ashton, PhD, for editorial assistance. Elizabeth V. Hillyer, DVM, provided editorial and writing support, funded by Research in Real-Life, Ltd.

Peptide interfacial adsorption is kinetically limited by the thermodynamic stability of self association

We present a study of the adsorption of two peptides at the octane–water interface. The first peptide, Lac21, exists in mixed monomer–tetramer equilibrium in bulk solution with an appreciable monomer concentration. The second peptide, Lac28, exists as a tetramer in solution, with minimal exposed hydrophobic surface. A kinetic limitation to interfacial adsorption exists for Lac28 at moderate to high surface coverage that is not observed for Lac21. We estimate the potential energy barrier for Lac28 adsorption to be 42 kJ/mol and show that this is comparable to the expected free energy barrier for tetramer dissociation. This finding suggests that, at moderate to high surface coverage, adsorption is kinetically limited by the availability of interfacially active monomeric “domains” in the subinterfacial region. We also show how the commonly used empirical equation for protein adsorption dynamics can be used to estimate the potential energy barrier for adsorption. Such an approach is shown to be consistent with a formal description of diffusion–adsorption, provided a large potential energy barrier exists. This work demonstrates that the dynamics of interfacial adsorption depend on protein thermodynamic stability, and hence structure, in a quantifiable way.

Building a retrospective collection in pharmacy: a brief history of the literature with some considerations for U.S. health sciences library professionals

This paper argues that historical works in pharmacy are important tools for the clinician as well as the historian. With this as its operative premise, delineating the tripartite aspects of pharmacy as a business enterprise, a science, and a profession provides a conceptual framework for primary and secondary resource collecting. A brief history and guide to those materials most essential to a historical collection in pharmacy follows. Issues such as availability and cost are discussed and summarized in checklist form. In addition, a glossary of important terms is provided as well as a list of all the major U.S. dispensatories and their various editions. This paper is intended to serve as a resource for those interested in collecting historical materials in pharmacy and pharmaco-therapeutics as well as provide a history that gives context to these classics in the field. This should provide a rationale for selective retrospective collection development in pharmacy.

Web-based distance continuing education: a new way of thinking for students and instructors

As people have more difficulty taking time away from work to attend conferences and workshops, the idea of offering courses via the Web has become more desirable. Addressing a need voiced by Medical Library Association membership, the authors developed a Web-based continuing-education course on the subject of the librarian's role in evidence-based medicine. The aim of the course was to provide medical librarians with a well-constructed, content-rich learning experience available to them at their convenience via the Web. This paper includes a discussion of the considerations that need to be taken into account when developing Web-based courses, the issues that arise when the information delivery changes from face-to-face to online, the changing role of the instructor, and the pros and cons of offering Web-based versus traditional courses. The results of the beta test and future plans for the course are also discussed.

Dimorphism and haploid fruiting in Cryptococcus neoformans: association with the alpha-mating type.

Cryptococcus neoformans is a major opportunistic fungal pathogen in AIDS and other immunosuppressed patients. We have shown that wild-type haploid C. neoformans can develop an extensive hyphal phase under appropriate conditions. Hyphae produced under these conditions are monokaryotic, possess unfused clamp connections, and develop basidia with viable basidiospores. The ability to undergo this transition is determined by the presence of the alpha-mating type locus and is independent of serotype. The association of the hyphal phase with the alpha-mating type may explain the preponderance of this mating type in the environment and the nature of the infectious propagule of C. neoformans.

A general model of invariant chain association with class II major histocompatibility complex proteins.

The binding of invariant chain to major histocompatibility complex (MHC) proteins is an important step in processing of MHC class II proteins and in antigen presentation. The question of how invariant chain can bind to all MHC class II proteins is central to understanding these processes. We have employed molecular modeling to predict the structure of class II-associated invariant chain peptide (CLIP)-MHC protein complexes and to ask whether the predicted mode of association could be general across all MHC class II proteins. CLIP fits identically into the MHC class II alleles HLA-DR3, I-Ak, I-Au, and I-Ad, with a consistent pattern of hydrogen bonds, contacts, and hydrophobic burial and without bad contacts. Our model predicts the burial of CLIP residues Met-91 and Met-99 in the deep P1 and P9 anchor pockets and other detailed interactions, which we have compared with available data. The predicted pattern of I-A allele-specific effects on CLIP binding is very similar to that observed experimentally by alanine-scanning mutations of CLIP. Together, these results indicate that CLIP may bind in a single, general way across products of MHC class II alleles.

Qualidade nutricional de rações para cães: Influência de Zn na absorção de Cu e na prevenção de doença hepática

As rações comerciais devem ser um alimento balanceado que supra todas as exigências nutricionais nas diferentes fases da vida do animal. Sua formulação deve conter ingredientes de qualidade, em proporções adequadas. É de fundamental importância o conhecimento do valor nutricional das rações, para assegurar que o cão esteja ingerindo diariamente quantidades corretas dos nutrientes. O desbalanço de elementos essenciais e a presença de elementos tóxicos podem causar desequilíbrios nutricionais, doenças e, até mesmo, consequências fatais aos cães. O cobre é um dos vários elementos de importância a ser estudado quanto aos defeitos metabólicos nos cães. O acúmulo de cobre no fígado pode ocasionar lesões progressivas nas organelas dos hepatócitos, resultando em hepatite crônica e cirrose. Diante disso, este trabalho teve como objetivos (I) quantificação dos elementos químicos com função nutricional e com potencial tóxico presentes nas rações para cães adultos e filhotes, (II) avaliação da composição centesimal das rações amostradas, (III) avaliação da variação dos elementos químicos entre as amostras de ração de um mesmo lote de produção (IV), estudo da representatividade de pequenas porções-teste, (V) avaliação da bioacessibilidade de cobre em rações, com experimento in vitro. Os elementos químicos Al, As, Br, Ca, Cl, Co, Cr, Cs, Cu, Fe, I, K, La, Mg, Mn, Na, P, Rb, Sb, Sc, Se, Ti, U e Zn foram determinados pela análise por ativação neutrônica instrumental (INAA). A composição centesimal foi avaliada de acordo com os métodos recomendados da AOAC. A homogeneidade de distribuição dos elementos químicos nas rações foi avaliada pela análise de amostras grandes (LS-NAA). A bioacessibilidade de cobre nas rações foi estimada por meio da simulação da digestão gastrointestinal in vitro. Foi possível determinar por INAA todos os nutrientes minerais, isto é, Ca, P, K, Na, Cl, Mg, Fe, Cu, Mn, Zn, I e Se, com limites estabelecidos pela Association of American Feed Control Officials. Foram notadas em algumas rações altas concentrações de Al, Sb e U, elementos com grande potencial tóxico. Cerca de 16 % das amostras de ração apresentaram, pelo menos, um parâmetro não conforme quanto à composição centesimal. Os resultados obtidos por LS-NAA e NAA convencional mostraram variação na composição entre os sacos de ração para Br, Ca, Na e Zn, com boa concordância entre ambos os métodos. O emprego da LS-NAA combinada com NAA convencional permitiu observar que pequenas porções-teste (350 mg) de ração são representativas comparadas com aquelas de 1 kg para Br, Ca, K, Na e Zn. Em todas as rações para cães, 50 % do cobre presente estava sob a forma bioacessível

Evaluation of online tools as didactic resource in the university education

Recently, many efforts have been made in the academic world to adapt the new degrees to the new European Higher Education Area (EHEA). New technologies have been the most important factor to carry out this adaptation. In particular, the tools 2.0 have been spreading quickly, not just the Web 2.0, but even in all the educational levels. Nevertheless, it is now necessary to evaluate whether all these efforts and all the changes, carried out in order to obtain improved academic performance among students, have provided good results. Therefore, the aim of this paper is focused on studying the impact of the implementation of information and communication technologies (ICTs) in a subject belonging to a Master from the University of Alicante in the academic year (2010-2011). In special, it is an elective course called "Advanced Visual Ergonomics" from the Master of Clinical Optometry and Vision. The methodology used to teach this course differs from the traditional one in many respects. For example, one of the resources used for the development of this course is a blog developed specifically to coordinate a series of virtual works, whose purpose is that the student goes into specific aspects of the current topic. Next, the student participates in an active role by writing a personal assessment on the blog. However, in the course planning, there is an attendance to lessons, where the teacher presents certain issues in a more traditional way, that is, with a lecture supported with audiovisual materials, such as materials generated in powerpoint. To evaluate the quality of the results achieved with this methodology, in this work the personal assessment of the students, who have completed this course during this academic year, are collected. In particular, we want to know their opinion about the used resources, as well as the followed methodology. The tool used to collect this information was a questionnaire. This questionnaire evaluates different aspects of the course: a general opinion, quality of the received information, satisfaction about the followed methodology and the student´s critical awareness. The design of this questionnaire is very important to get conclusive information about the methodology followed in the course. The questionnaire has to have an adequate number of questions; whether it has many questions, it might be boring for the student who would pay no enough attention. The questions should be well-written, with a clear structure and message, to avoid confusion and an ambiguity. The questions should be objectives, without any suggestion for a desired answer. In addition, the questionnaire should be interesting to encourage the student´ s interest. In conclusion, this questionnaire developed for this subject provided good information to evaluate whether the methodology was a useful tool to teach "Advanced Visual Ergonomics". Furthermore, the student´s opinion collected by this questionnaire might be very helpful to improve this didactic resource.

Stratigraphic and geochemical study of the organic-rich black shales in the Tarcău Nappe of the Moldavidian Domain (Carpathian Chain, Romania)

An integrated stratigraphic analysis has been made of the Tarcău Nappe (Moldavidian Domain, Eastern Romanian Carpathians), coupled with a geochemical study of organic-rich beds. Two Main Sequence Boundaries (Early Oligocene and near to the Oligocene–Aquitanian boundary, respectively) divide the sedimentary record into three depositional sequences. The sedimentation occurred in the central area of a basin supplied by different and opposite sources. The high amount of siliciclastics at the beginning of the Miocene marks the activation of the “foredeep stage”. The successions studied are younger than previously thought and they more accurately date the deformation of the different Miocene phases affecting the Moldavidian Basin. The intervals with black shales identified are related to two main separate anoxic episodes with an age not older than Late Rupelian and not before Late Chattian. The most important organic-rich beds correspond to the Lower Menilites, Bituminous Marls and Lower Dysodilic Shales Members (Interval 2). These constitute a good potential source rock for petroleum, with homogeneous Type II oil-prone organic matter, highly lipidic and thermally immature. The deposition of black shales has been interpreted as occurring within a deep, periodically isolated and tectonically controlled basin.

A massive association around the obscured open cluster RSGC3

Context. Four clusters of red supergiants have been discovered in a region of the Milky Way close to base of the Scutum-Crux Arm and the tip of the Long Bar. Population synthesis models indicate that they must be very massive to harbour so many supergiants. If the clusters are physically connected, this Scutum Complex would be the largest and most massive star-forming region ever identified in the Milky Way. Aims. The spatial extent of one of these clusters, RSGC3, has not been investigated. In this paper we explore the possibility that a population of red supergiants could be located in its vicinity. Methods. We utilised 2MASS JHKS photometry to identify candidate obscured luminous red stars in the vicinity of RSGC3. We observed a sample of candidates with the TWIN spectrograph on the 3.5-m telescope at Calar Alto, obtaining intermediate-resolution spectroscopy in the 8000−9000 Å range. We re-evaluated a number of classification criteria proposed in the literature for this spectral range and found that we could use our spectra to derive spectral types and luminosity classes. Results. We measured the radial velocity of five members of RSGC3, finding velocities similar to the average for members of Stephenson 2. Among the candidates observed outside the cluster, our spectra revealed eight M-type supergiants at distances <18′ from the centre of RSGC3, distributed in two clumps. The southern clump is most likely another cluster of red supergiants, with reddening and age identical to RSGC3. From 2MASS photometry, we identified four likely supergiant members of the cluster in addition to the five spectroscopically observed. The northern clump may be a small cluster with similar parameters. Photometric analysis of the area around RSGC3 suggests the presence of a large (>30) population of red supergiants with similar colours. Conclusions. Our data suggest that the massive cluster RSGC3 is surrounded by an extended association, which may be very massive ( ≳ 105 M⊙). We also show that supergiants in the Scutum Complex may be characterised via a combination of 2MASS photometry and intermediate-to-high-resolution spectroscopy in the Z band.

Mechanisms that Trigger a Good Health-Care Response to Intimate Partner Violence in Spain. Combining Realist Evaluation and Qualitative Comparative Analysis Approaches

Background. Health care professionals, especially those working in primary health-care services, can play a key role in preventing and responding to intimate partner violence. However, there are huge variations in the way health care professionals and primary health care teams respond to intimate partner violence. In this study we tested a previously developed programme theory on 15 primary health care center teams located in four different Spanish regions: Murcia, C Valenciana, Castilla-León and Cantabria. The aim was to identify the key combinations of contextual factors and mechanisms that trigger a good primary health care center team response to intimate partner violence. Methods. A multiple case-study design was used. Qualitative and quantitative information was collected from each of the 15 centers (cases). In order to handle the large amount of information without losing familiarity with each case, qualitative comparative analysis was undertaken. Conditions (context and mechanisms) and outcomes, were identified and assessed for each of the 15 cases, and solution formulae were calculated using qualitative comparative analysis software. Results. The emerging programme theory highlighted the importance of the combination of each team’s self-efficacy, perceived preparation and women-centredness in generating a good team response to intimate partner violence. The use of the protocol and accumulated experience in primary health care were the most relevant contextual/intervention conditions to trigger a good response. However in order to achieve this, they must be combined with other conditions, such as an enabling team climate, having a champion social worker and having staff with training in intimate partner violence. Conclusions. Interventions to improve primary health care teams’ response to intimate partner violence should focus on strengthening team’s self-efficacy, perceived preparation and the implementation of a woman-centred approach. The use of the protocol combined with a large working experience in primary health care, and other factors such as training, a good team climate, and having a champion social worker on the team, also played a key role. Measures to sustain such interventions and promote these contextual factors should be encouraged.

The Gaia-ESO Survey: radial metallicity gradients and age-metallicity relation of stars in the Milky Way disk

We study the relationship between age, metallicity, and α-enhancement of FGK stars in the Galactic disk. The results are based upon the analysis of high-resolution UVES spectra from the Gaia-ESO large stellar survey. We explore the limitations of the observed dataset, i.e. the accuracy of stellar parameters and the selection effects that are caused by the photometric target preselection. We find that the colour and magnitude cuts in the survey suppress old metal-rich stars and young metal-poor stars. This suppression may be as high as 97% in some regions of the age-metallicity relationship. The dataset consists of 144 stars with a wide range of ages from 0.5 Gyr to 13.5 Gyr, Galactocentric distances from 6 kpcto 9.5 kpc, and vertical distances from the plane 0 < |Z| < 1.5 kpc. On this basis, we find that i) the observed age-metallicity relation is nearly flat in the range of ages between 0 Gyr and 8 Gyr; ii) at ages older than 9 Gyr, we see a decrease in [Fe/H] and a clear absence of metal-rich stars; this cannot be explained by the survey selection functions; iii) there is a significant scatter of [Fe/H] at any age; and iv) [Mg/Fe] increases with age, but the dispersion of [Mg/Fe] at ages >9 Gyr is not as small as advocated by some other studies. In agreement with earlier work, we find that radial abundance gradients change as a function of vertical distance from the plane. The [Mg/Fe] gradient steepens and becomes negative. In addition, we show that the inner disk is not only more α-rich compared to the outer disk, but also older, as traced independently by the ages and Mg abundances of stars.

C.U.C.P. alumni journal.

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Resolution of the committee concerning the way through Rogers's farm, 1762 February 27

One octavo-sized leaf containing a one-page handwritten draft of a resolution by a Harvard Corporation Committee appointed to "lay out an High Way thro' Rogers's Farm & determine about the Cost of the Sd way & the making the fences to enclose it." The resolution permits the town of Waltham to lay a highway on the farm's property as long as it is enclosed by a stone wall.