Over-the-Counter Medications in Pregnancy.

High-quality research on the safety and effectiveness of over-the-counter medications in pregnancy is limited. Physicians should explore nonpharmacologic treatments before recommending medication. For nausea and vomiting in pregnancy, vitamin B6 (pyridoxine), H1 antihistamines, and ginger are safe and effective. Physicians can recommend calcium carbonate, H2 antihistamines, and proton pump inhibitors for gastroesophageal reflux disease. Osmotic laxatives, fiber preparations, and probiotics are safe and effective treatments for constipation. Many over-the-counter topical medications are safe in pregnancy due to low systemic absorption, but topical retinoids, such as adapalene, should be avoided. Hypertonic saline nasal rinse and antihistamines are safe, beneficial options for treating pregnancy-induced rhinitis, and intranasal corticosteroids have demonstrated benefit for chronic allergic rhinitis. The safety of acetaminophen for the treatment of headaches and low back pain during pregnancy has come into question with recent studies; therefore, judicious use is advised. Physicians should screen all pregnant patients for their risk of developing preeclampsia and initiate low-dose aspirin from 12 weeks' gestation until delivery for those at increased risk. Data are limited on the safety and effectiveness of herbal supplements during pregnancy.

APC Loss Prevents Doxorubicin-Induced Cell Death by Increasing Drug Efflux and a Chemoresistant Cell Population in Breast Cancer.

Chemoresistance is a major health concern affecting cancer patients. Resistance is multifactorial, with one mechanism being the increased expression of ABC transporters (such as MDR1 and MRP1), which are drug efflux transporters capable of preventing intracellular accumulation of drugs and cell death. Our lab showed that the loss of Adenomatous Polyposis Coli (APC) caused an intrinsic resistance to doxorubicin (DOX), potentially through an enhanced tumor-initiating cell (TIC) population and the increased activation of STAT3 mediating the expression of MDR1 in the absence of WNT being activated. Here, in primary mouse mammary tumor cells, the loss of APC decreased the accumulation of DOX while increasing the protein levels of MDR1 and MRP1. We demonstrated decreased APC mRNA and protein levels in breast cancer patients compared with normal tissue. Using patient samples and a panel of human breast cancer cell lines, we found no significant trend between APC and either MDR1 or MRP1. Since the protein expression patterns did not show a correlation between the ABC transporters and the expression of APC, we evaluated the drug transporter activity. In mouse mammary tumor cells, the pharmacological inhibition or genetic silencing of MDR1 or MRP1, respectively, decreased the TIC population and increased DOX-induced apoptosis, supporting the use of ABC transporter inhibitors as therapeutic targets in APC-deficient tumors.

The eldercare landscape: Evidence from California.

Although the literature suggests that nursing home location is instrumental to the efficient functioning of the long-term care industry, there has been little research directly focused on the spatial distribution of nursing homes. We discuss factors that may influence nursing home location choice, emphasizing agglomeration economies around hospitals. We estimate econometric models of location using information on all freestanding, MediCal-licensed long-term care facilities in the state of California. We find that nursing homes are more likely to locate in the same Census tract as a hospital and are more likely to locate in tracts nearer to those containing a hospital.

Plateau in Core Temperature during Shorter but Not Longer Work/Rest Cycles in Heat.

This study compared physiological responses to two work/rest cycles of a 2:1 work-to-rest ratio in a hot environment. In a randomized crossover design, fourteen participants completed 120 min of walking and rest in the heat (36.3 ± 0.6 °C, 30.2 ± 4.0% relative humidity). Work/rest cycles were (1) 40 min work/20 min rest [40/20], or (2) 20 min work/10 min rest [20/10], both completing identical work. Core temperature (Tc), skin temperature (Tsk), heart rate (HR), nude body mass, and perception of work were collected. Comparisons were made between trials at equal durations of work using three-way mixed model ANOVA. Tc plateaued in [20/10] during the second hour of work (p = 0.93), while Tc increased in [40/20] (p < 0.01). There was no difference in maximum Tc ([40/20]: 38.08 ± 0.35 °C, [20/10]: 37.99 ± 0.27 °C, p = 0.22) or end-of-work Tsk ([40/20]: 36.1 ± 0.8 °C, [20/10]: 36.0 ± 0.7 °C, p = 0.45). End-of-work HR was greater in [40/20] (145 ± 25 b·min-1) compared to [20/10] (141 ± 27 b·min-1, p = 0.04). Shorter work/rest cycles caused a plateau in Tc while longer work/rest cycles resulted in a continued increase in Tc throughout the work, indicating that either work structure could be used during shorter work tasks, while work greater than 2 h in duration may benefit from shorter work/rest cycles to mitigate hyperthermia.

Pulse labeling of dissolved (13) C-carbonate into tree xylem: developing a new method to determine the fate of recently fixed photosynthate.

Stable carbon isotopes are often employed as tracers in plant and soil systems to study the fate and transformations of carbon as is it assimilated by the forest canopies and then translocated into the soil matrix and soil microorganisms. This experiment tested a new method of (13) C-labeling. We dissolved (13) C-carbonate into 12 mL of water and injected it into the xylem of a 6-cm diameter tree. The isotopic composition of foliage, stem CO(2) , and phloem contents were measured before the experiment and up to two weeks after the pulse label. Isotopic enrichments of 6.1‰ and 7.7‰ were observed in stem CO(2) and phloem contents, respectively. No enrichment in bulk foliage was observed. The pulse came through the phloem five days after the label was injected, consistent with expectations based on transport rates through the tree. The application of this xylem pulse-labeling method may provide new insights into labile carbon sequestration in trees, perhaps even in much larger trees. Furthermore, the method could be applied under experimental treatments that would elucidate the mechanisms controlling the fate and transformation of recently fixed photosynthate in forests.

Systematic review: Automated vehicles and services for people with disabilities.

People with disabilities face many travel barriers. Autonomous vehicles and services may be one solution. The purpose of this project was to conduct a systematic review of the grey and scientific literature on autonomous vehicles for people with disabilities. Scientific evidence (n = 35) was limited to four observational studies with a very low level of evidence, qualitative studies, reviews, design and model reports, and policy proposals. Literature on older adults was most prevalent. Grey literature (n = 37) spanned a variety of media and sources and focuses on a variety of disability and impairment types. Results highlight opportunities and barriers to accessible and usable AVs and services, outline research gaps to set a future research agenda, and identify implications for policy and knowledge translation. People with disabilities are a diverse group, and accessible and usable design solutions will therefore need to be tailored to each group's needs, circumstances, and preferences. Future research in diverse disability groups should include more participatory action design and engineering studies and higher quality, prospective experimental studies to evaluate outcomes of accessible and usable AV technology. Studies will need to address not only all vehicle features but also the entire travel journey.

The secrets to successful strategy execution.

When a company finds itself unable to execute strategy, all too often the first reaction is to redraw the organization chart or tinker with incentives. Far more effective would be to clarify decision rights and improve the flow of information both up the line of command and across the organization. Then, the right structures and motivators tend to fall into place. That conclusion is borne out by the authors' decades of experience as Booz & Company consultants and by the survey data that they have been collecting for almost five years from more than 125,000 employees of some 1,000 organizations in more than 50 countries. From this data they have distilled--and ranked in order of importance--the top 17 traits exhibited by the organizations that are most effective at executing strategy. The single most common attribute of such companies is that their employees are clear about which decisions and actions they are responsible for. As a result, decisions are rarely second-guessed, and accurate competitive information quickly finds its way up the hierarchy and across organizational boundaries. Managers communicate the key drivers of success, so frontline employees have the information they need to understand the impact of their day-to-day actions. Motivators--like performance appraisals that distinguish high, adequate, and low performers and rewards for fulfilling particular commitments--are also important but are most effective when applied after decision rights and information flows have been addressed. That holds true for structural moves as well. Surprisingly, the most effective structural moves turn out to be promoting people laterally--and more slowly. How can you make the most educated and cost-efficient decisions about which change initiatives to implement? The authors have developed a powerful online diagnostic and simulation tool that can help you test the effectiveness of various approaches virtually, without risking significant amounts of time and money.

Prescription of Panoramic Radiographs in Children: A Health Services Assessment of Current Guidelines.

PURPOSE: To (1) determine adherence to guidelines when prescribing panoramic radiographs (PR) for patients 18 y.o. and younger; and 2) compare PR prescriptions between general dentists (GPs) and pediatric dentists (PDs). METHODS: A retrospective analysis of insurance claims included codes for PRs and associated codes for two cities between 2008 and 2015. Chi-square tests ascertained the likelihood of a PR being associated within three days of routine exams. RESULTS: A total of 81,699 pediatric patients were seen by 2,077 GPs and 103 PDs. There were 11,993 PRs, 119,068 routine exams (7,343 associated with a PR), 13,819 orthodontic procedures (378 associated with a PR), 798 third molar procedures (172 associated with a PR), and 16,636 procedures for acute problems (1,670 associated with a PR). Patients aged eight years old and younger had the largest discrepancy between GPs and PDs. GPs prescribed proportionally more films in patients five years old and younger, but PDs prescribed more in seven and eight year olds. Nine- to 18 year olds. had more similar patterns between GPs and PDs, except for 14- to 15 year olds, when GPs prescribed more. CONCLUSIONS: GPs prescribed PR in patients younger than five years old more often and were somewhat less likely to follow guidelines.