Testing of Candidate Icons to Identify Acetaminophen-Containing Medicines.

Adding icons on labels of acetaminophen-containing medicines could help users identify the active ingredient and avoid concomitant use of multiple medicines containing acetaminophen. We evaluated five icons for communication effectiveness. Adults (n = 300) were randomized to view a prescription container label or over-the-counter labels with either one or two icons. Participants saw two icon candidates, and reported their interpretation; experts judged whether these reflected critical confusions that might cause harm. Participants rated how effectively each icon communicated key messages. Icons based on abbreviations of "acetaminophen" ("Ac", "Ace", "Acm") were rated less confusing and more effective in communicating the active ingredient than icons based on "APAP" or an abstract symbol. Icons did not result in critical confusion when seen on a readable medicine label. Icon implementation on prescription labels was more effective at communicating the warning against concomitant use than implementation on over-the-counter (OTC) labels. Adding an icon to a second location on OTC labels did not consistently enhance this communication, but reduced rated effectiveness of acetaminophen ingredient communication among participants with limited health literacy. The abbreviation-based icons seem most suitable for labeling acetaminophen-containing medications to enable users to identify acetaminophen-containing products.

Pharmacist and Physician Interpretation of Abbreviations for Acetaminophen Intended for Use in a Consumer Icon.

Concomitant use of multiple acetaminophen medications is associated with overdose. To help patients identify acetaminophen medications and thus avoid concomitant use, an icon with an abbreviation for "acetaminophen" has been proposed for all acetaminophen medications. This study assessed pharmacists' and physicians' use and interpretation of abbreviations for "acetaminophen", to identify abbreviations with other meanings that might cause confusion. Physicians (n = 150) reported use and interpretation of candidate abbreviations Ac and Acm. Pharmacists (n = 150) interpretations of prescription orders using the candidate abbreviations APAP, Ac, Ace and Acm in typed, handwritten or spoken form, were judged for critical confusions likely to cause patient harm. Critical confusion was rare, except for omission by pharmacists of the acetaminophen dose for Hydrocodone/APAP prescriptions (10%). Ac was in common use to indicate "before meals", and was interpreted as such, but some physicians (8%) said they use Ac to indicate anticoagulant drugs. Most pharmacists (54%) interpreted Ace as acetaminophen, and none interpreted it as referring to ACE-inhibitors. Acm was rarely used in prescriptions, had no common interfering meanings, and was often (63%) interpreted as acetaminophen, especially when prescribed in combination with an opiate (85%). The data validated concerns about abbreviations in prescribing: all abbreviations resulted in some misinterpretations. However, Acm was rarely misinterpreted, was readily associated with "acetaminophen", and seemed appropriate for use in a graphic icon to help consumers/patients identify acetaminophen medications.

Microbial reductive transformation of phyllosilicate Fe(III) and U(VI) in fluvial subsurface sediments.

The microbial reduction of Fe(III) and U(VI) was investigated in shallow aquifer sediments collected from subsurface flood deposits near the Hanford Reach of the Columbia River in Washington State. Increases in 0.5 N HCl-extractable Fe(II) were observed in incubated sediments and (57)Fe Mössbauer spectroscopy revealed that Fe(III) associated with phyllosilicates and pyroxene was reduced to Fe(II). Aqueous uranium(VI) concentrations decreased in subsurface sediments incubated in sulfate-containing synthetic groundwater with the rate and extent being greater in sediment amended with organic carbon. X-ray absorption spectroscopy of bioreduced sediments indicated that 67-77% of the U signal was U(VI), probably as an adsorbed species associated with a new or modified reactive mineral phase. Phylotypes within the Deltaproteobacteria were more common in Hanford sediments incubated with U(VI) than without, and in U(VI)-free incubations, members of the Clostridiales were dominant with sulfate-reducing phylotypes more common in the sulfate-amended sediments. These results demonstrate the potential for anaerobic reduction of phyllosilicate Fe(III) and sulfate in Hanford unconfined aquifer sediments and biotransformations involving reduction and adsorption leading to decreased aqueous U concentrations.

Pathways of aqueous Cr(VI) attenuation in a slightly alkaline oxic subsurface.

Column experiments combined with geochemical modeling, microscopic inspections, spectroscopic interrogations, and wet chemical extractions were used to study sediment-dependent Cr(VI) desorption, physical location, mineral association, and attenuation mechanism(s) in four freshly or naturally aged contaminated sediments exposed to concentrated Cr(VI) waste fluids. Results showed that majority of Cr(VI) mass was easily removed from the sediments (equilibrium site K(d) varied from 0 to 0.33 mL g(-1) and equilibrium site fraction was greater than 95%). Long tailings of time-dependent Cr(VI) concentrations above maximum contaminant level of 1.9 micromol L(-1) were also observed (kinetically controlled fraction K(d) and desorption reaction half-lives varied from 0 to 45 mL g(-1), and from 76.1 to 126 h, respectively). Microscopic and spectroscopic measurements confirmed that Cr was concentrated within fine-grained coatings in small areas mainly rich in phyllosilicates that contained both Cr(III) and Cr(VI). However, Cr(VI) reduction was neither significant nor complete. Under slightly alkaline and oxic conditions, contaminant Cr in the sediments occurred: (i) In the highly mobile pool (over 95% of total Cr); (ii) In the slow and time-dependent releasing pool, which served as long-term source of contamination; (iii) As reduced Cr(III) which most likely formed during Cr(VI) reaction with aqueous, sorbed, or structural Fe(II).

Does pouch size matter?

BACKGROUND: Mechanical restriction, malabsorption, and hormonal changes appear to play a role in weight loss after Roux-en-Y gastric bypass (RYGBP). This investigation chose to investigate one aspect of the restrictive role of gastric bypass: the pouch size. Our hypothesis was that a small pouch size with no fundus after laparoscopic RYGBP (LRYGBP) would lead to greater loss of excess weight and weight loss success. METHODS: Upper gastrointestinal radiological (UGI) studies were retrospectively reviewed by three blinded experts (2 bariatric surgeons and 1 expert radiologist), to determine pouch size and fundus size. The following grading system was utilized: Size I - smaller than average pouch, Size II - average pouch, Size III larger than average pouch, and Size IV - over 3 times the size of an average pouch. Fundus 0 - no fundus appreciated, Fundus I - slight amount of fundus barely noted, Fundus II - fundus noted, Fundus III - large amount of fundus noted, and Fundus IV - majority of the pouch was fundus. Percentage of excess weight loss (%EWL) and successful weight loss (A. >50% EWL, B. within 50% of ideal body weight, C. loss of >25% of preoperative weight) were calculated. RESULTS: There were 59 patients in this study with 97% follow-up of >1 year. No Size IV or Fundus IV were noted. There were no statistically significant differences between in %EWL or success for either pouch size or fundus size. CONCLUSIONS: While there may be a trend for the mean %EWL to be lower with larger pouches and larger amounts of fundus, no significant differences were found. Larger pouches and the presence of fundus (within reason) still result in a high rate of success after LRYGBP.

Neck injuries caused by automatic two-point seat belts: an analysis of four cases.

Although seat belts significantly reduce the extent and severity of injuries sustained by motor vehicle occupants, seat belts are known to be associated with chest and abdominal trauma. Less commonly understood are severe neck injuries caused by the use of two-point automatic shoulder harnesses without concurrent use of a manual lap belt. Such injuries may include cervical spine fractures, craniocervical dislocations and rarely decapitation. Recognizing patterned injuries caused by seat belts and the ability to correlate autopsy findings with the circumstances surrounding the death will allow for correct interpretation of seat-belt related trauma. The four cases described detail fatal neck injuries as a result of improper seat belt use in which an automatic two-point shoulder harness was used without a manual lap restraint. In two of the cases, the victims were decapitated.

Detection and visualization of compositionally similar cis-regulatory element clusters in orthologous and coordinately controlled genes.

Evolutionarily conserved noncoding genomic sequences represent a potentially rich source for the discovery of gene regulatory regions. However, detecting and visualizing compositionally similar cis-element clusters in the context of conserved sequences is challenging. We have explored potential solutions and developed an algorithm and visualization method that combines the results of conserved sequence analyses (BLASTZ) with those of transcription factor binding site analyses (MatInspector) (http://trafac.chmcc.org). We define hits as the density of co-occurring cis-element transcription factor (TF)-binding sites measured within a 200-bp moving average window through phylogenetically conserved regions. The results are depicted as a Regulogram, in which the hit count is plotted as a function of position within each of the two genomic regions of the aligned orthologs. Within a high-scoring region, the relative arrangement of shared cis-elements within compositionally similar TF-binding site clusters is depicted in a Trafacgram. On the basis of analyses of several training data sets, the approach also allows for the detection of similarities in composition and relative arrangement of cis-element clusters within nonorthologous genes, promoters, and enhancers that exhibit coordinate regulatory properties. Known functional regulatory regions of nonorthologous and less-conserved orthologous genes frequently showed cis-element shuffling, demonstrating that compositional similarity can be more sensitive than sequence similarity. These results show that combining sequence similarity with cis-element compositional similarity provides a powerful aid for the identification of potential control regions.

An analysis of teaching and coaching behaviors of elite strength and conditioning coaches.

The purpose of this study was to analyze the coaching behaviors of 6 elite strength and conditioning coaches from the southern region of the United States. The Arizona State University Coaching Observation Instrument, consisting of 16 behavioral categories, was used for the collection of data. Each coach was observed and filmed on 3 occasions. All observations occurred in the respective team's weight training facility. The data collected in this study consisted of a percentage analysis of the observed coaching behaviors. The most frequently observed behaviors were silent monitoring (21.99%), management (14.62%), and hustle (11.12%). These results indicate that this population of strength and conditioning coaches was predominantly engaged in observation of their athletes (silent monitoring), organization of the weight training activity (management), and verbal statements to intensify effort (hustle). The results are similar to other studies with coaches who were also involved in individual rather than team sports.