Narrow pollen diets are associated with declining Midwestern bumble bee species.

Many species of bumble bee (Bombus) have declined in range and abundance across Europe, the Americas, and Asia, whereas other species have persisted and remain common and widespread. One explanation as to why some species have declined, based primarily on studies of the European bumble bee fauna, is that declining species have relatively narrow pollen-foraging niches and are less able to use alternative host plants in the absence of their preferred hosts. Though extensively explored in Europe, this hypothesis has not been investigated in North America, in part due to incomplete information on the foraging niche of many species. We selected 12 bumble bee species found in Michigan and quantified their pollen diets using museum specimens. We also extensively resurveyed the state to understand their contemporary status and distribution. Compared to a pre-2000 baseline, six species remain relatively common and widespread, whereas six species show range contractions of over 50%. There was a significant relationship between dietary breadth and distributional range change, with declined or declining species collecting around one-third fewer pollen types than stable species. Though there were significant compositional differences, we found no differences in the number of pollen types collected by species with differing tongue lengths. Overall, these results support the hypothesis that species with narrower dietary niches are at greater risk of decline. However, it is not clear if narrow dietary niches are a cause of declines, or if both are driven by an underlying factor such as proximity to the edge of climatic niches. Further research is needed to improve our understanding of dietary niche in bumble bees, and how it interacts with other factors to influence population trajectories of stable and at-risk species.

HIV clinicalpharmacists – the USperspective

Clinical pharmacists have been involved in treating people with HIV and AIDS since the epidemic began. Their roles have evolved from inpatient infectious diseases training clinical pharmacists offering treatment regimens for the serious opportunistic infections seen in the hospital, to clinical pharmacists who received specialized training in the treatment of people with HIV in the ambulatory care setting. Their roles and benefits have been documented in the literature, but not to a large extent. Improvements in adherence and cost savings have been seen, but significant improvements in clinical outcomes (changes in viral load and CD4 cell counts) are quite complex and often difficult to identify in the small studies that have been published. This manuscript will review the published data on this topic, and provide examples of clinically trained pharmacists in the US who focus on the treatment of people with HIV infection. The pharmacists discussed here practice in a variety of settings (privately managed free-clinics and government managed clinics), take care of a variety of types of patients (children, adults, military veterans, lower socio-economic groups, etc.), and are employed by a variety of institutions (academic, pharmaceutical company, large healthcare systems and small healthcare systems). These pharmacists were chosen to be representative of the wide variety of individuals, positions and roles of clinical pharmacists involved in the treatment of HIV in the US (AU)

Los farmacéuticos clínicos se han involucrado en el tratamiento de los pacientes con VIH y sida desde el comienzo de la epidemia. Sus papeles han evolucionado desde farmacéuticos con formación en enfermedades infecciosas que requieren hospitalización, aquellos que ofrecen regímenes de tratamiento para las infecciones oportunistas graves que aparecen en el hospital, hasta farmacéuticos con formación especializada para el tratamiento ambulatorio de pacientes con VIH. Sus funciones y beneficios se han documentado en la literatura, pero no de forma exhaustiva. Asimismo, se han demostrado las mejoras en la adherencia al tratamiento y el ahorro en costes, sin embargo las mejoras significativas en los resultados clínicos (cambios en la carga viral y recuentos celulares CD4) son muy complejas y a menudo difíciles de identificar en los escasos estudios publicados. En este documento se revisarán los datos publicados sobre este tema, y se mostrarán ejemplos de farmacéuticos con formación clínica en los Estados Unidos especializados en el tratamiento de personas infectadas con VIH. Además, los farmacéuticos incluidos ejercen en diferentes entornos (clínicas privadas y clínicas públicas), asisten a distintos tipos de pacientes (niños, adultos, veteranos de guerra, grupos de orígenes humildes, etc.), y pertenecen a diferentes instituciones (académicas, farmacéuticas, sistemas sanitarios de gran envergadura y de pequeña envergadura). Estos farmacéuticos se han elegido como representantes de una gran variedad de individuos, puestos y funciones que conforma el grupo de farmacéuticos clínicos involucrados en el tratamiento del VIH en los Estados Unidos (AU)

HIV clinical pharmacists--the US perspective.

Clinical pharmacists have been involved in treating people with HIV and AIDS since the epidemic began. Their roles have evolved from inpatient infectious diseases training clinical pharmacists offering treatment regimens for the serious opportunistic infections seen in the hospital, to clinical pharmacists who received specialized training in the treatment of people with HIV in the ambulatory care setting. Their roles and benefits have been documented in the literature, but not to a large extent. Improvements in adherence and cost savings have been seen, but significant improvements in clinical outcomes (changes in viral load and CD4 cell counts) are quite complex and often difficult to identify in the small studies that have been published. This manuscript will review the published data on this topic, and provide examples of clinically trained pharmacists in the US who focus on the treatment of people with HIV infection. The pharmacists discussed here practice in a variety of settings (privately managed free-clinics and government managed clinics), take care of a variety of types of patients (children, adults, military veterans, lower socio-economic groups, etc.), and are employed by a variety of institutions (academic, pharmaceutical company, large healthcare systems and small healthcare systems). These pharmacists were chosen to be representative of the wide variety of individuals, positions and roles of clinical pharmacists involved in the treatment of HIV in the US.

The CASE adherence index: A novel method for measuring adherence to antiretroviral therapy.

The Center for Adherence Support Evaluation (CASE) Adherence Index, a simple composite measure of self-reported antiretroviral therapy (ART) adherence, was compared to a standard three-day self-reported adherence measure among participants in a longitudinal, prospective cross-site evaluation of 12 adherence programs throughout the United States. The CASE Adherence Index, consisting of three unique adherence questions developed for the cross-site study, along with a three-day adherence self-report were administered by interviews every three months over a one-year period. Data from the three cross-site adherence questions (individually and in combination) were compared to three -day self-report data and HIV RNA and CD4 outcomes in cross-sectional analyses. The CASE Adherence Index correlated strongly with the three-day self-reported adherence data (p < 0.001) and was more strongly associated with HIV outcomes, including a 1-log decline in HIV RNA level (maximum OR = 2.34; p < 0.05), HIV RNA < 400 copies/ml (maximum OR = 2.33; p < 0.05) and performed as well as the three-day self-report when predicting CD4 count status. Participants with a CASE Index score >10 achieved a 98 cell mean increase in CD4 count over 12 months, compared to a 41 cell increase for those with scores < or =10 (p < 0.05). The CASE Adherence Index is an easy to administer instrument that provides an alternative method for assessing ART adherence in clinical settings.

The effect of enzyme treatment of soybean meal on oligosaccharide disappearance and chick growth performance.

Research was conducted to determine the effects of enzymatically hydrolyzing raffinose and stachyose from soybean meal (SBM) on fecal oligosaccharide concentration and growth performance of chicks fed a corn-SBM diet. The alpha-galactosidase treatment was optimized for oligosaccharide degradation. Enzyme treatment degraded raffinose and stachyose in SBM by 69 and 54%, respectively, compared to untreated soybean meal (USBM). Diets containing enzyme-treated soybean meal (ESBM) resulted in excreta raffinose and stachyose concentrations reduced to below measurable levels (<0.1 mg/ g feces). Enzyme treatment increased (P < 0.05) TME from 2,974 to 3,328 kcal/kg. Three chick growth studies were conducted to determine the effect of feeding ESBM on growth performance. There were no statistical differences (P > 0.05) in growth performance among treatments. Chicks fed the ESBM diet had an increased (P < 0.05) fecal neutral detergent fiber (NDF) content in one of two studies. A fourth experiment was conducted to determine if heating, used to enhance enzyme treatment, would decrease lysine availability. Heating significantly (P < 0.05) reduced lysine availability compared to USBM. These experiments demonstrated that feces could be made void of raffinose and stachyose, but chick growth performance was not significantly (P > 0.05) improved by enzyme treatment.

Lopinavir-Ritonavir: a new protease inhibitor.

Lopinavir is a new protease inhibitor that is structurally related to ritonavir. It recently was approved by the Food and Drug Administration as a coformulation with ritonavir under the brand name Kaletra. Ritonavir substantially increases lopinavir drug exposure by inhibiting cytochrome P450 isoenzyme 3A4. Based on limited data, lopinavir-ritonavir demonstrates safety and efficacy in both antiretroviral-naive and protease inhibitor-experienced patients. It has the ability to durably suppress human immunodeficiency virus (HIV) RNA for up to 2 years in antiretroviral-naïve patients. Compared with nelfinavir, it had superior virologic control at 48 weeks in antiretroviral-naïve patients. Its side effects include diarrhea, abnormal stools, abdominal pain, nausea, vomiting, and asthenia. A number of patients experienced grade 3-4 laboratory abnormalities in liver function tests, cholesterol, and triglycerides while receiving this drug combination. The exact resistance patterns of lopinavir-ritonavir are unknown, but the Department of Health and Human Services strongly recommends it for the initial treatment of HIV-infected adults and adolescents.

Schistosomiasis japonica and childhood nutritional status in northeastern Leyte, the Philippines: a randomized trial of praziquantel versus placebo.

The hypothesis that infection with Schistosoma japonicum causes decreased nutritional status was studied in a randomized trial among 170 males and females, mean (SD) age 11.4 (3.5) years, residing in an endemic region of northeastern Leyte, Philippines. The S. japonicum-infected children were randomized to receive praziquantel or placebo and followed-up six months after randomization. Stature, weight, triceps, subscapular, and calf skinfold thicknesses and their sum, and hemoglobin level were measured at baseline and follow-up. Schistosoma japonicum eggs were detected in Kato-Katz stool smears and the intensity of infection was assessed by quantitative egg count. Intensities of hookworm, ascaris, and trichuris infections were also measured. The six-month levels of the anthropometric measures and hemoglobin were adjusted for age and their baseline levels and then compared between the praziquantel and placebo groups. Treatment interactions were also analyzed by sex. Baseline anthropometric and hemoglobin levels and parasite infection intensities were the same in the two groups. At six months, the praziquantel group had significantly higher hemoglobin levels (P < 0.001) and sum of skinfolds (P < 0.001) than the placebo group. Males had a significantly greater increase in hemoglobin levels with treatment than did females. The hemoglobin increase was not due to changes in hookworm intensity. The results show that schistosomiasis japonica caused decreased nutritional status in children and probably is partly responsible for the malnutrition and reduction in growth for age described in prior cross-sectional studies.

Pharmacologic evaluation of megestrol acetate oral suspension in cachectic AIDS patients.

The objective of our study was to define the pharmacokinetics and pharmacodynamics of megestrol acetate in patients with human immunodeficiency virus (HIV) infection. A new suspension formulation of megestrol acetate (40 mg/ml) was administered as a single oral dose of 800 mg per day in an open label pharmacokinetic study for 21 days. On day 21 of therapy, patients were evaluated for changes in body weight and plasma samples were obtained for steady-state pharmacokinetic analysis. Ten HIV-infected men with an involuntary weight loss of > 10% baseline were evaluated. A high degree of interpatient variability in megestrol acetate pharmacokinetics was observed, with an 8- and 5-fold range in the rate and extent of absorption, respectively. All patients reported an increase in appetite, and 8 of 10 patients gained weight by 3 weeks; the median change in weight in all patients at 3 weeks was 1.8-kg gain (range: 2.3-kg loss to 6.4-kg gain). The two patients who did not gain weight had the lowest area under the curve (AUC), Cmax, and Cmin values. A statistically significant correlation between the ratio of body weight at 3 weeks/initial weight (weight index) and the percentage of the 24-h dosing interval that megestrol acetate concentrations exceeded a 300-ng/ml threshold was observed. These data indicate variable levels of systemic exposure to drug following a fixed dose of a suspension formulation of megestrol acetate. Increase in weight during the early stages of megestrol acetate therapy is related to the extent of in vivo drug exposure above a threshold concentration.(ABSTRACT TRUNCATED AT 250 WORDS)

2',3'-didehydro-3'-deoxythymidine (d4T) in patients with AIDS or AIDS-related complex: a phase I trial.

2',3'-didehydro-3'-deoxythymidine (d4T) is a pyrimidine analogue and inhibitor of reverse transcriptase with potent in vitro activity against human immunodeficiency virus (HIV). A phase I trial of d4T was conducted in 41 HIV-infected patients, 12 with AIDS and 29 with AIDS-related complex (ARC). Thirty-six patients were evaluatable. The maximum tolerated dose was 2 mg/kg/day. The dose-limiting toxicity was sensory peripheral neuropathy, which occurred in 20 patients (55%). Four patients (11%) developed hepatotoxicity. Five (14%) developed anemia requiring a transfusion but not discontinuation of drug. The mean +/- SE plasma elimination half-life at all dose levels was 1.2 +/- 0.09 h. Increased or stable absolute CD4 counts were seen in most patients. The majority of patients with detectable serum p24 antigen levels had a persistent decrease by 6 months. d4T is a promising drug for patients with AIDS or ARC. This clinical trial is continuing to determine the minimal effective dose.

Pharmacokinetics of stavudine in patients with AIDS or AIDS-related complex.

The pharmacokinetics of stavudine (d4T; 2',3'-didehydro-3'-deoxythymidine) were studied in patients with AIDS-related complex or AIDS enrolled in a dose-ranging phase I/II study. Twenty-two patients were studied after the first oral dose of 0.67, 1.33, 2.67, or 4 mg/kg of body weight; 17 of them underwent an additional steady-state pharmacokinetic evaluation after thrice-daily dosing of the above doses. Stavudine absorption was rapid, with mean peak concentrations of 1.2-4.2 mg/L over the four dose levels studied. From 34% to 41% of an oral dose was excreted as unchanged drug in the urine. The mean values for plasma elimination half-life ranged from 1 to 1.6 h. The absolute bioavailability of a 4 mg/kg oral dose exceeded 80%. There was no change in pharmacokinetic parameters measured after the first dose and after chronic dosing. Stavudine is a new dideoxynucleoside with more complete and less variable oral absorption than existing nucleosides used for treatment of human immunodeficiency virus infection.

Trends in obstetric-gynecologic academic manpower and research.

Medical school full-time faculties continue to grow, despite unchanged numbers of medical students and residents. The 136 United States schools have 2091 male and 861 female full-time faculty, an increase of 22% over the past 4 years. The mean faculty size is 21.6. While numbers of certified subspecialist faculty also continue to increase, a decreasing percentage of all subspecialists are associated with medical schools. More than 1000 additional faculty are anticipated over the next 5 years. Among all faculty, only 34% of physicians devoted 20% or greater time to research. Although total research funding averages over $1 million per department, there are wide disparities, with 59 departments receiving less than $100,000 in federal funding. Obstetric-gynecologic departments as a group receive 1.5% of all National Institutes of Health research funds.

Pharmacoepidemiology of ciprofloxacin: analysis of use patterns and cost impact.

The pharmacoepidemiology and cost impact of ciprofloxacin use were evaluated after unrestricted availability in a 238-bed community teaching hospital. The medical records on all patients treated with oral ciprofloxacin over 6 months were reviewed. To determine if the availability of ciprofloxacin altered antibiotic usage patterns and outcome variables, a group of control patients from a period prior to ciprofloxacin availability were matched and compared to patients who had received the drug. Ciprofloxacin was used as both initial and replacement for parenteral therapy in a variety of infections. A successful clinical outcome was achieved in approximately 90% of patients treated with ciprofloxacin and resulted in an estimated cost avoidance of approximately $165/course. However, comparisons with the matched-control group revealed no differences in overall antibiotic costs or length of hospital stay. These results suggest that unrestricted availability of oral ciprofloxacin does not ensure changes in outcome variables related to cost. Educational and patient targeting programs may be necessary to promote earlier conversion of appropriate patients to newer oral therapies.