Selective COX-2 inhibitors and risk of myocardial infarction

Selective inhibitors of cyclooxygenase- 2 ( COX- 2, ` coxibs') are highly effective anti-inflammatory and analgesic drugs that exert their action by preventing the formation of prostanoids. Recently some coxibs, which were designed to exploit the advantageous effects of non- steroidal anti-inflammatory drugs while evading their side effects, have been reported to increase the risk of myocardial infarction and atherothrombotic events. This has led to the withdrawal of rofecoxib from global markets, and warnings have been issued by drug authorities about similar events during the use of celecoxib or valdecoxib/ parecoxib, bringing about questions of an inherent atherothrombotic risk of all coxibs and consequences that should be drawn by health care professionals. These questions need to be addressed in light of the known effects of selective inhibition of COX- 2 on the cardiovascular system. Although COX- 2, in contrast to the cyclooxygenase-1 ( COX- 1) isoform, is regarded as an inducible enzyme that only has a role in pathophysiological processes like pain and inflammation, experimental and clinical studies have shown that COX- 2 is constitutively expressed in tissues like the kidney or vascular endothelium, where it executes important physiological functions. COX- 2- dependent formation of prostanoids not only results in the mediation of pain or inflammatory signals but also in the maintenance of vascular integrity. Especially prostacyclin ( PGI(2)), which exerts vasodilatory and antiplatelet properties, is formed to a significant extent by COX- 2, and its levels are reduced to less than half of normal when COX- 2 is inhibited. This review outlines the rationale for the development of selective COX- 2 inhibitors and the pathophysiological consequences of selective inhibition of COX- 2 with special regard to vasoactive prostaglandins. It describes coxibs that are currently available, evaluates the current knowledge on the risk of atherothrombotic events associated with their intake and critically discusses the consequences that should be drawn from these insights. Copyright (C) 2005 S. Karger AG, Basel

Japanese encephalitis immunization in South Korea: past, present, and future.

Japanese encephalitis (JE), once a major public health problem in South Korea, has declined since the 1980s, as a result of improved living conditions, a mosquito eradication program, and a national JE vaccination program, which includes annual booster vaccine for all children less than or equal to 15 years of age. Increased immunity has greatly reduced illness and death; however, vaccine adverse effects are increasing, and a National Compensation Program for Vaccine Injury was begun in 1995. This article reviews past successes, current problems, and future direction of the JE vaccination program in South Korea

The Role of the Nurse Practitioner in the Patient-Centered Medical Home

The Patient Centered Medical Home (PCMH) was established to improve patient access to high quality, cost-effective primary care. Critical to this new model of care is the optimal utilization of nurse practitioners (NPs) in performing services traditionally offered by physicians. This study compared the roles of NPs and physicians in providing primary care in two PCMHs in a local health care system. During the calendar year 2011, a total of 50,471 patient visits occurred in the two PCMHs. Each PCMH consisted of a Traditional Clinic that saw patients on a scheduled basis and a Convenient Care Clinic that accepted walk-in visits. Comparisons between NPs and physicians were conducted according to PCMH site and clinic type for the following variables: 1) number of patient visits per provider Full Time Equivalent (FTE); 2) patient age and gender; 3) level of patient health as measured by the Charlson Index; and 4) prevalent International Classification of Diseases, Revision 9 (ICD-9) diagnostic codes assigned to patients. Generally, NPs saw fewer patients per FTE than physicians at the Traditional Clinics but more at Convenient Care. NPs also treated more female and younger patients across PCMHs. The Charlson Index showed patients in both PCMHs to be predominantly healthy but NPs tended to treat less complex problems than physicians. NPs’ ICD-9 diagnostic codes more frequently concerned minor, acute illnesses or well person examinations compared to physicians who assigned codes indicative of chronic conditions. The differences between NPs and physicians across settings appear to be linked to PCMH organizational processes that disparately triage patients in the Traditional versus the Convenient Care Clinics. In conclusion, NPs are underutilized regarding the range of patients and health conditions they could appropriately address in these settings. Suggestions for more strategic and efficient distribution of NP services were offered

Experimental study of boundary layer transition on a heated flat plate

A detailed investigation to the document momentum and thermal development of boundary layers undergoing natural transition on a heated flat plate was performed. Experimental results of both overall and conditionally sampled characteristics of laminar, transitional, and low Reynolds number turbulent boundary layers are presented. Measurements were done in a low-speed, closed-loop wind tunnel with a freestream velocity of 100 ft/s and zero pressure gradient over a range of freestream turbulence intensities from 0.4 to 6 percent. The distributions of skin friction, heat transfer rate, and Reynolds shear stress were all consistent with previously published data. Reynolds analogy factors for momentum thickness Reynolds number, Re(sub theta) less than 2300 were found to be well predicted by laminar and turbulent correlations which accounted for an unheated starting length and uniform heat flux. A small dependence of turbulence results on the freestream turbulence intensity was observed

Turbulent heat flux measurements in a transitional boundary layer

During an experimental investigation of the transitional boundary layer over a heated flat plate, an unexpected result was encountered for the turbulent heat flux (bar-v't'). This quantity, representing the correlation between the fluctuating normal velocity and the temperature, was measured to be negative near the wall under certain conditions. The result was unexpected as it implied a counter-gradient heat transfer by the turbulent fluctuations. Possible reasons for this anomalous result were further investigated. The possible causes considered for this negative bar-v't' were: (1) plausible measurement error and peculiarity of the flow facility, (2) large probe size effect, (3) 'streaky structure' in the near wall boundary layer, and (4) contributions from other terms usually assumed negligible in the energy equation including the Reynolds heat flux in the streamwise direction (bar-u't'). Even though the energy balance has remained inconclusive, none of the items (1) to (3) appear to be contributing directly to the anomaly

Mesoscopic Capacitance Oscillations

We examine oscillations as a function of Fermi energy in the capacitance of a mesoscopic cavity connected via a single quantum channel to a metallic contact and capacitively coupled to a back gate. The oscillations depend on the distribution of single levels in the cavity, the interaction strength and the transmission probability through the quantum channel. We use a Hartree-Fock approach to exclude self-interaction. The sample specific capacitance oscillations are in marked contrast to the charge relaxation resistance, which together with the capacitance defines the RC-time, and which for spin polarized electrons is quantized at half a resistance quantum. Both the capacitance oscillations and the quantized charge relaxation resistance are seen in a strikingly clear manner in a recent experiment.Comment: 9 pages, 2 figure

Application of computer-aided dispatch in law enforcement: An introductory planning guide

A set of planning guidelines for the application of computer-aided dispatching (CAD) to law enforcement is presented. Some essential characteristics and applications of CAD are outlined; the results of a survey of systems in the operational or planning phases are summarized. Requirements analysis, system concept design, implementation planning, and performance and cost modeling are described and demonstrated with numerous examples. Detailed descriptions of typical law enforcement CAD systems, and a list of vendor sources, are given in appendixes