Amelioration of Acute Sequelae of Blast Induced Mild Traumatic Brain Injury by N-Acetyl Cysteine: A Double-Blind, Placebo Controlled Study

Background: Mild traumatic brain injury (mTBI) secondary to blast exposure is the most common battlefield injury in Southwest Asia. There has been little prospective work in the combat setting to test the efficacy of new countermeasures. The goal of this study was to compare the efficacy of N-acetyl cysteine (NAC) versus placebo on the symptoms associated with blast exposure mTBI in a combat setting. Methods: This study was a randomized double blind, placebo-controlled study that was conducted on active duty service members at a forward deployed field hospital in Iraq. All symptomatic U.S. service members who were exposed to significant ordnance blast and who met the criteria for mTBI were offered participation in the study and 81 individuals agreed to participate. Individuals underwent a baseline evaluation and then were randomly assigned to receive either N-acetyl cysteine (NAC) or placebo for seven days. Each subject was re-evaluated at 3 and 7 days. Outcome measures were the presence of the following sequelae of mTBI: dizziness, hearing loss, headache, memory loss, sleep disturbances, and neurocognitive dysfunction. The resolution of these symptoms seven days after the blast exposure was the main outcome measure in this study. Logistic regression on the outcome of 'no day 7 symptoms' indicated that NAC treatment was significantly better than placebo (OR = 3.6, p = 0.006). Secondary analysis revealed subjects receiving NAC within 24 hours of blast had an 86% chance of symptom resolution with no reported side effects versus 42% for those seen early who received placebo. Conclusion: This study, conducted in an active theatre of war, demonstrates that NAC, a safe pharmaceutical countermeasure, has beneficial effects on the severity and resolution of sequelae of blast induced mTBI. This is the first demonstration of an effective short term countermeasure for mTBI. Further work on long term outcomes and the potential use of NAC in civilian mTBI is warranted. Trial Registration: ClinicalTrials.gov NCT00822263

Use of Bone Scanning and Skeletal Radiography in the Diagnosis of Bone Metastasis

The radionuclide bone scan is becoming increasingly useful for evaluating a wide variety of bone and joint disorders. However, the commonest application is still the detection of skeletal metastases in the patient with known or suspected neoplastic disease. The role of this examination relative to other well established methods of evaluating these patients, especially the radiographic skeletal survey, is not clear to all physicians. We hope in this communication to define the role of the radionuclide bone scan and to place in perspective the integral relationship between the scan and the survey, the two radiologic modalities which today are the principal methods of evaluating the skeletal system for metastatic disease

Religious Healing Methods among Muslims in the Netherlands

In search for Islamic healers, inquiries made at mosques and Islamic organizations revealed a striking contradiction. In these places, it is generally said that the activities of these healers have nothing to do with Islam. Direct contact with Islamic healers through healthcare workers, however, revealed that they themselves are of the opinion that what they do fits fully in the Islamic tradition. In actual practice, the formal taboo on Islamic healing methods is often ignored at the informal level

Current-induced two-level fluctuations in pseudo spin-valves (Co/Cu/Co) nanostructures

Two-level fluctuations of the magnetization state of pseudo spin-valve pillars Co(10 nm)/Cu(10 nm)/Co(30 nm) embedded in electrodeposited nanowires (~40 nm in diameter, 6000 nm in length) are triggered by spin-polarized currents of 10^7 A/cm^2 at room temperature. The statistical properties of the residence times in the parallel and antiparallel magnetization states reveal two effects with qualitatively different dependences on current intensity. The current appears to have the effect of a field determined as the bias field required to equalize these times. The bias field changes sign when the current polarity is reversed. At this field, the effect of a current density of 10^7 A/cm^2 is to lower the mean time for switching down to the microsecond range. This effect is independent of the sign of the current and is interpreted in terms of an effective temperature for the magnetization.Comment: 4 pages, 5 figures, revised version, to be published in Phys. Rev. Let

Utilizing RxNorm to Support Practical Computing Applications: Capturing Medication History in Live Electronic Health Records

RxNorm was utilized as the basis for direct-capture of medication history data in a live EHR system deployed in a large, multi-state outpatient behavioral healthcare provider in the United States serving over 75,000 distinct patients each year across 130 clinical locations. This tool incorporated auto-complete search functionality for medications and proper dosage identification assistance. The overarching goal was to understand if and how standardized terminologies like RxNorm can be used to support practical computing applications in live EHR systems. We describe the stages of implementation, approaches used to adapt RxNorm's data structure for the intended EHR application, and the challenges faced. We evaluate the implementation using a four-factor framework addressing flexibility, speed, data integrity, and medication coverage. RxNorm proved to be functional for the intended application, given appropriate adaptations to address high-speed input/output (I/O) requirements of a live EHR and the flexibility required for data entry in multiple potential clinical scenarios. Future research around search optimization for medication entry, user profiling, and linking RxNorm to drug classification schemes holds great potential for improving the user experience and utility of medication data in EHRs.Comment: Appendix (including SQL/DDL Code) available by author request. Keywords: RxNorm; Electronic Health Record; Medication History; Interoperability; Unified Medical Language System; Search Optimizatio

Rashba spin-orbit coupling and spin precession in carbon nanotubes

The Rashba spin-orbit coupling in carbon nanotubes and its effect on spin-dependent transport properties are analyzed theoretically. We focus on clean non-interacting nanotubes with tunable number of subbands $N$. The peculiar band structure is shown to allow in principle for Datta-Das oscillatory behavior in the tunneling magnetoresistance as a function of gate voltage, despite the presence of multiple bands. We discuss the conditions for observing Datta-Das oscillations in carbon nanotubes.Comment: 12 pages, published versio

Sustained high-level expression of human factor IX (hFIX) after liver-targeted delivery of recombinant adeno-associated virus encoding the hFIX gene in rhesus macaques

The feasibility, safety, and efficacy of liver-directed gene transfer was evaluated in 5 male macaques (aged 2.5 to 6.5 years) by using a recombinant adeno-associated viral (rAAV) vector (rAAV-2 CAGG-hFIX) that had previously mediated persistent therapeutic expression of human factor IX (hFIX; 6%-10% of physiologic levels) in murine models. A dose of 4 × 1012 vector genomes (vgs)/kg of body weight was administered through the hepatic artery or portal vein. Persistence of the rAAV vgs as circular monomers and dimers and high-molecular-weight concatamers was documented in liver tissue by Southern blot analysis for periods of up to 1 year. Vector particles were present in plasma, urine, or saliva for several days after infusion (as shown by polymerase chain reaction analysis), and the vgs were detected in spleen tissue at low copy numbers. An enzyme-linked immunosorption assay capable of detecting between 1% and 25% of normal levels of hFIX in rhesus plasma was developed by using hyperimmune serum from a rhesus monkey that had received an adenoviral vector encoding hFIX. Two macaques having 3 and 40 rAAV genome equivalents/cell, respectively, in liver tissue had 4% and 8% of normal physiologic plasma levels of hFIX, respectively. A level of hFIX that was 3% of normal levels was transiently detected in one other macaque, which had a genome copy number of 25 before abrogation by a neutralizing antibody (inhibitor) to hFIX. This nonhuman-primate model will be useful in further evaluation and development of rAAV vectors for gene therapy of hemophilia B. © 2002 by The American Society of Hematology

The social aspects of rural life and farm tenantry, Cedar County, Iowa

This survey is a detailed study of 400 farms and farm families located in the northwest corner of Cedar county, Iowa. The area comprises Pioneer, Fremont, Red Oak, Linn, and the northeast part of Cass townships, exclusive of the incorporated towns of Stanwood and Mechanicsville. Only a record of the organizations and institutions in these towns is included in this study. The study is a detailed analysis of the population, economic, educational, religious and social conditions as found on the 400 farms and among the farm people on these farms. The area covers 128 square miles, or a little over one-fifth of the entire county