Metabolic consequences of antiepileptic drugs

Purpose of Review: Chemical properties of the widely used older generation antiepileptic drugs (AEDs) suggest that they might be responsible for a number of medical comorbidities. Recent Findings: AEDs which induce the cytochrome P450 system adversely affect bone, lipid, and gonadal steroid metabolism. Specifically, phenytoin causes loss of bone mass in women, and both phenytoin and carbamazepine produce increases in serum lipids and C-reactive protein, as well as decreases in bioactive testosterone in men. Patients treated with inducing AEDs are at increased risk of fracture. Some contradictory data raise the question of whether bone mass is truly related to enzyme induction, and analogously, of whether reductions in testosterone truly account for male sexual dysfunction. Data showing elevations of surrogate cardiovascular and cerebrovascular risk endpoints with epilepsy patients, mostly inducing AED treated, are consistent and concerning, however. Another older AED, valproate, is associated with the occurrence of polycystic ovary syndrome when used in young adulthood or adolescence. Summary: Older generation AEDs are associated with a panoply of metabolic abnormalities. Although more research is needed to see whether individual drugs are directly tied to specific clinical outcomes (e.g. risk of infarction), extant data are sufficiently concerning to suggest that these drugs may produce significant adverse health consequences. Newer generation AEDs may be preferable

Plumbing and wiring: Atherosclerosis in epilepsy.

Over the long term, epilepsy is clearly associated with cognitive impairment. This has been demonstrated functionally, using neuropsychological testing, and reinforced by structural studies showing progressive atrophy in patients with chronic epilepsy 1-3. The prevailing explanation for this, of course, has been the direct and cumulative effects of seizures on the brain. The basic science literature is chock full of studies showing impairment of neuronal function after seizures, both acutely and chronically. And for those of us who see patients, the progressive memory complaints and clear-cut decline in function seen in those with drug-resistant epilepsy — particularly temporal lobe epilepsy — appear to sufficiently attest to the fact that the seizures are the culprit

Intellectual Propriety: Compulsory Licenses Through the TRIPS Agreement and the Doha Declaration on Public Health

The Agreement on Trade Related Aspects of Intellectual Property (TRIPS), part of the Uruguay Round of trade negotiations led to the creation of the World Trade Organization (WTO) in 1995, has led to a variety of interpretations and opinions. Though its application goes beyond matters of public health, it is this area that has come under the most scrutiny in the last fifteen years as the gaps between developed and developing countries have widened and exposed the health disparities between the two groups. Tensions over intellectual property and access to newly developed medicines to treat diseases such as HIV and AIDS grew throughout the late 1990s and culminated in the 2001 Doha Declaration on Public Health. While intellectual property would normally be left to the World Intellectual Property Organization (WIPO), developed and developing countries had difficulty agreeing on compulsory licenses during negotiations in the 1980s and early 1990s, and as a result the matter went to the WTO instead. One of the most controversial aspects of intellectual property has been access to medicines treating HIV and AIDS. The number of those receiving anti-retroviral (ARV) treatment has grown tremendously, which raises the question of the role the TRIPS Agreement and the Doha Declaration on Public Health have played. One cannot attribute success entirely to the TRIPS Agreement but at the same time one cannot deny its impact. This paper will provide an overview of the policies and explain how if nothing else, the power to issue compulsory licenses has aided developing countries in their efforts to provide ARV treatment for HIV/AIDS patients

The impact of a school garden on nutrition knowledge, attitudes and behaviors of urban youth

Hypothesis: A garden-based high school curriculum and school lunch program positively impact the nutrition knowledge, attitudes, behaviors and health outcomes of participating urban youth. Specific aims: 1. To characterize the objectives and implementation of the Common Ground High Schools garden-based curriculum and school lunch program 2. To evaluate the effectiveness of the program in promoting healthy nutrition knowledge, attitudes, behaviors and health outcomes among Common Ground students Methods: Mixed quantitative and qualitative methods were used to conduct the program evaluation. The Common Ground curriculum was characterized through in-depth staff interviews and review of relevant policies and procedures. Surveys on nutrition attitudes, knowledge, and behavior were administered in the Fall and Spring at Common Ground and two comparison schools. Student focus groups were conducted at the three schools. Demographic data and body mass index data were gathered at Common Ground and one of the comparison schools. Direct observations were conducted in the cafeterias of the three schools; students were served vegetables during three different typical lunch periods, and the number of students that tasted and ate the vegetables were counted. Results: Common Ground students learn about health, nutrition and the food system through coursework in the organic garden, the school lunch program, and informal interactions with teachers and staff. Students at comparison schools desire higher quality school food and more control over what is served. Students at Common Ground have more knowledge about the food system than students at comparison schools, but not more knowledge about basic nutrition. Students at Common Ground ate 6.6 and 9.0 servings per week of fruits and vegetables at school at the beginning and end of the school year, respectively, while students at Comparison School #2 ate 7.7 and 6.9 servings per week. In the cafeteria observations, students at comparison schools ate more of the familiar vegetables than students at Common Ground. Students at Common Ground ate more of the unfamiliar vegetables. Average BMI of students at Common Ground from freshmen to seniors is 27.4, 26.1, 23.4, and 26.3 kg/m2. At Comparison School #2, average BMI of freshmen to seniors is 26.5, 24.1, 26.6 and 29.7 kg/m2 (ANOVA shows p = 0.0622). Conclusion: Common Grounds garden-based curriculum and school lunch program positively influences students nutrition knowledge, attitudes, behavior, and health outcomes. Similar interventions should be implemented in other schools and school systems in order to improve population health

Microwave conductivity of slightly ionized gases and electromagnetic scintillations

Two areas of research are briefly summarized. The first is concerned with calculating the conductivity of a slightly ionized gas. A method is proposed which involves an expansion of the Boltzmann collision operator (of the electron distribution function, involving the neutral gas-electron interactions) in powers of the electron-gas mass ratio. The second area of investigation focuses on the problem of a radio wave propagating through the interplanetary medium, taking account of the decreasing plasma density with distance from the sun

A Remote Sensing Technique for Estimating Watershed Runoff

This study was supported in part by the Office of Water Research and Technology, U. S. Department of the Interior under Project A-063-0HI0(print) iii, 53 leaves : ill., map ; 28 cm.Table of Contents -- List of Figures -- List of Tables -- Introduction -- Summary -- Materials and Methods -- Data Analysis -- Results and Discussion -- Conclusions -- Recommendations -- References -- Appendi

Clinical Trans/Aesthetics: the Knowledge Re/production of Transgender Womxn who Exchange Sex

While there is a cornucopia of writing on transgender and sex worker identities vis-à-vis gender and sexuality studies, there is lacuna of transgender worldviews and knowledge re/production beyond these political pigeonholes. When research does include direct quotes from transgender and sex worker informants, more often than not, it is either to bolster the claims of the researcher or to piece together an ethnography. In both cases, the research does not center the informant’s affective and intellectual reasonings, beyond questions of gender and health. This leaves the critical thought of trans womxn sex workers out of the picture. This exclusion is unfortunate because the trans sex workers’ situation gives them a unique vantage point for understanding the world(s) in which we live and beyond. Trans womxn who exchange sex re/produces knowledge that privileged epistemologies do not adequately articulate. But pairing and challenging these hegemonic modes of thinking with trans knowledge re/production, there is a synergy. This dialectic expands the delimited frameworks of hegemonic thought—a critical trans/aesthetic theory. This thesis then develops a clinical trans/aesthetics to critique interviews with trans womxn sex workers in an attempt to make legible the population’s overlooked, elusive and devalued knowledge