Massachusetts payers and providers have encouraged clinician usage of e-Prescribing technology to improve patient safety, enhance office practice efficiencies, and reduce medical costs. This report ...describes three early pilot e-Prescribing projects as case studies. These projects identified the e-Prescribing needs of clinicians, illustrated key issues that made implementation difficult, and clarified the impact of various types of functionality. The authors identified ten key barriers: (1) previous negative technology experiences, (2) initial and long-term cost, (3) lost productivity, (4) competing priorities, (5) change management issues, (6) interoperability limitations, (7) information technology (IT) requirements, (8) standards limitations, (9) waiting for an “all-in-one solution,” and (10) confusion about competing product offerings including hospital/Integrated Delivery System (IDN)–sponsored projects. In Massachusetts, regional projects have helped to address these barriers, and e-Prescribing activities are accelerating rapidly within the state.
We followed 235 adults for one year after a self-initiated attempt to stop smoking cigarettes. Relapse rates were much larger than expected in the early days and weeks after the quit attempt. ...Approximately 62% had relapsed by 2 weeks after their quit dates. Those who smoked any cigarettes at all in the post-cessation period (i.e., lapsed) had a 95% probability of resuming their regular pattern of smoking subsequently. Shorter periods of abstinence on prior quit attempts, greater pre-cessation consumption of alcoholic beverages, and lower pre-cessation levels of confidence in quitting were related to relapse. In addition, abstainers who reported decreased confidence after cessation concerning their ability to maintain abstinence were more likely to relapse thereafter. The presence of a greater proportion of smokers in the subjects' environment also increased the likelihood of relapse. Demographic variables such as age, gender, and education level did not predict relapse. Likewise, neither baseline psychosocial stress levels, nor post-cessation increases in stress were related prospectively to relapse. Clinical implications of finding are discussed.
Coffins of the Brave Crisman, Kevin J; Rybka, Walter; Cassavoy, Kenneth ...
2014, 2014-01-30
eBook
<!CDATA In Coffins of the Brave: Lake Shipwrecks of the War of 1812 , archaeologist Kevin J. Crisman and his fellow contributors examine sixteen different examples of 1812-era naval and commercial ...shipbuilding. They range from four small prewar vessels to four 16- or 20-gun brigs, three warships of much greater size, a steamboat hull converted into an armed schooner, two gunboats, and two postwar schooners. Despite their differing degrees of preservation and archaeological study, each vessel reveals something about how its creators sought the best balance of strength, durability, capacity, stability, speed, weatherliness, and seaworthiness for the anticipated naval struggle on the lakes along the US-Canadian border. The underwater archaeology reported here has guided a new approach to understanding the events of 1812–15, one that blends the evidence in contemporary documents and images with a wealth of details derived from objects lost, discarded, and otherwise left behind. This heavily illustrated volume balances scholarly findings with lively writing, interjecting the adventure of working on shipwrecks and archaeological finds into the investigation and interpretation of a war that continues to attract interest two centuries after it was fought. >
Self-quitters make up by far the largest proportion of ex-cigarette smokers, yet this population has not been extensively characterized to date. We compared male self-quitters (N = 191) and ...age-matched recidivists (N = 110) on smoking histories, psychosocial attributes and quitting methods. A number of significant relationships were found, some of which may have clinical implications. those who substituted cigars or pipes for cigarettes were nearly four times more likely to be successful, and those who reported consuming more food/snacks after quitting were 80% more likely to be successful quitters. Subjects who reported using no coping strategies in former smoking settings after cessation because they had no urges to smoke in these settings were also much more likely to be successful quitters. Recidivists were more likely to report using physical activity as a means of coping with temptations to smoke, and were somewhat older at the time of the quit attempt. Withdrawal symptoms and psychosocial stress were reported as reasons for relapse by early relapsers, while late relapsers reported being around other smokers on social occasions, and psychosocial stress.
Erythropoietin (EPO) is a potent regulator of the viability, proliferation and differentiation of erythroid progenitor cells. Its effect is mediated by binding to the erythropoietin receptor (EPO-R), ...a member of a new cytokine receptor family. Alterations of the EPO/EPO-R system have recently been shown to be involved in the pathogenesis of familial erythrocytosis and polycythaemia vera (PV). In order to define whether genetic changes in the EPO-R gene and its ligand play a role in the development of PV, the structure and expression levels of the EPO-R and EPO genes were examined in samples from bone marrow and/or peripheral blood mononuclear cells of 24 patients with PV. As expected, EPO serum levels were low and no detectable level of EPO mRNA was found by reverse polymerase chain reaction (RT-PCR) in the peripheral blood mononuclear cells of our PV patients. To search for structural alterations of the EPO-R, cDNA samples were subjected to PCR and SSCP analysis as well as sequencing. Heterogenous expression of EPO-R mRNA was observed without any structural changes, as revealed by RT-SSCP analysis using overlapping primers spanning the whole coding region of the EPO-R gene. Structural integrity of the EPO-R was further confirmed by sequencing of cloned PCR products. These data suggest that the mechanisms for the development of PV do not involve structural changes of the EPO-R gene.
Recent preclinical and clinical studies that have demonstrated antitumor activity of high-dose recombinant interleukin-2 (rIL-2), and animal models that demonstrated a synergistic effect of low-dose ...cyclophosphamide, led us to study rIL-2 (Cetus Corp., Emeryville, Calif) in a phase II clinical trial in combination with low-dose cyclophosphamide in 32 patients, 18 with malignant melanoma and 14 with renal cell carcinoma. rIL-2 was given once daily at 3 x 10(6) U/m2, as a 30-min infusion for 14 days in cycle I and for 2 x 5 days in cycles II and III respectively; if tolerated, the dose was increased to a maximum of 6 x 10(6) U m-2 day-1; the cycles, separated by 1 week treatment-free intervals, were preceded each by a single i.v. bolus of cyclophosphamide at 350 mg/m2. The most prominent side-effects encountered in this trial consisted of a capillary leak syndrome, myalgia and fever that required dose reduction during the first cycle in one-half of the patients. Given the limit of tolerable toxicities in a standard care unit, the regimen employed achieved minor antitumor activity. No remission was achieved in patients with renal cell carcinoma, and 15% of melanoma patients showed objective responses (partial response + minor response).
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