Examining Miliary Disease Etiology in a Coccidioides-Endemic Center: A Retrospective Cohort Study.

Background: A miliary pattern on chest imaging is often attributed to tuberculosis (TB) infection. However, a myriad of conditions can cause a miliary pattern, many of which are imminently life-threatening. Research Question: The primary aim of our study is to elucidate the potential causes of miliary chest imaging patterns to improve workup and empiric therapy selection. The secondary aims are to discern the predictors of miliary disease etiology and to determine whether appropriate empiric antimicrobial therapies were given. Study Design and Methods: In this retrospective cohort study, we searched a radiology database for patients with chest imaging studies described by the word "miliary". Subjects were excluded if they were under 18 years of age and if there were insufficient objective data to support a miliary disease etiology. A radiologist independently reviewed all imaging studies, and studies that did not appear to have a true miliary pattern were excluded. The collected data include patient demographics, immunocompromising risk factors, conditions associated with miliary disease, ß-D-glucan levels, serum eosinophil count, and empiric therapies received. Results: From our 41-patient cohort, 22 patients (53.7%) were clinically diagnosed with coccidioidomycosis, 8 (19.5%) with TB, 7 (17.1%) with metastatic solid cancer, 1 (2.4%) with lymphoma, 1 (2.4%) with other (Mycobacterium simiae), and 3 (7.3%) with unknown diseases (the sum equals 42 patients because one individual was diagnosed with both coccidioidomycosis and TB). All six patients with greater than 500 eosinophils/µL were diagnosed with coccidioidomycosis. Of the 22 patients diagnosed with coccidioidomycosis, 20 (90.91%) were empirically treated with an antifungal regimen. Of the eight patients with TB, six were empirically treated for TB. Interpretation: Based on our data from a Coccidioides-endemic region with close proximity to tuberculosis-endemic areas, the leading cause of miliary disease is coccidioidomycosis, although TB and cancer are also common etiologies. Serum eosinophilia and elevated ß-D-glucan levels were strongly predictive of coccidioidomycosis in our patient cohort with a miliary chest imaging pattern.

Predatory Publishing in Orthopaedic Research.

BACKGROUND: The open-access model has changed the landscape of academic publishing over the last 20 years. An unfortunate consequence has been the advent of predatory publishing, which exploits the open-access model for monetary gain by collecting publishing fees from authors under the pretense of being a legitimate publication while providing little-to-no peer review. This study aims to investigate the predatory publishing phenomenon in orthopaedic literature. METHODS: We searched Beall's List of Predatory Journals and Publishers and another list of predatory journals for journal titles that are possibly related to orthopaedics. We then searched their web sites for the following information: total number of articles published, journal country of origin, author country of origin, article processing charge (APC), quoted review time, and location of the listed headquarters. We also reported the article quality of a random sample of these journals. We consulted InCites Journal Citation Reports to determine the number of nonpredatory orthopaedic publications that are indexed, and we manually searched a random sample of these legitimate journals for Beall's criteria. Additionally, we searched the Directory of Open Access Journals (DOAJ) and PubMed databases for any possible predatory journal titles. RESULTS: We found 104 suspected predatory publishers, representing 225 possible predatory journals. One journal was indexed in the DOAJ, and 20 were indexed in PubMed. Review time was not identified for 56.2% of the journals, and 36.5% quoted a review time of <1 month. Nearly half of the listed addresses of the publishers were either unsearchable or led to residential or empty lots. Eighty-two legitimate journals were identified. The median APC was $420 for predatory journals and $2,900 for legitimate journals. We found that a random sample of the legitimate journals published studies with higher reporting standards, but a few also contained 1 criterion that is found on Beall's list. CONCLUSIONS: This study highlights the scope of orthopaedic predatory publishing. Possibly predatory journals outnumber legitimate orthopaedic journals. Orthopaedic surgeons should be aware of the suspected predatory journals and consult available online tools to identify them because distinguishing them from legitimate journals can be a challenge.

Incineration: why this may be the most environmentally sound method of renal healthcare waste disposal.

The environment and 'green' issues are currently being promoted in the healthcare sector through recently launched initiatives. This paper considers aspects of healthcare waste management, with particular reference to waste generated in dialysis units. With dialysis being dependent upon large amounts of disposables, it generates considerable volumes of waste. This paper focuses upon a typical haemodialysis unit, evaluating and quantifying the volumes and categories of waste generated. Each haemodialysis patient on thrice weekly dialysis generates some 323 kg per year of waste, of which 271 kg is classified as clinical. This equates to 1626 kg of (solid) clinical waste per dialysis bed, which is around three times the volume of clinical waste generated per general hospital bed. Waste disposal routes are considered and this suggests that present healthcare waste paradigms are outmoded. They do not allow for flexible approaches to solving what is a dynamic problem, and there is a need for new thinking models in terms of managing the unsustainable situation of disposal in constantly growing landfills. Healthcare waste management must be considered not only in terms of the environmental impact and potential long-term health effects, but also in terms of society's future energy requirements.

Novel pyrrolidine heterocycles as CCR1 antagonists.

A novel series of pyrrolidine heterocycles was prepared and found to show potent inhibitory activity of CCR1 binding and CCL3 mediated chemotaxis of a CCR1-expressing cell line. A potent, optimized triazole lead from this series was found to have acceptable pharmacokinetics and microsomal stability in rat and is suitable for further optimization and development.

Discovery of Dinaciclib (SCH 727965): A Potent and Selective Inhibitor of Cyclin-Dependent Kinases.

Inhibition of cyclin-dependent kinases (CDKs) has emerged as an attractive strategy for the development of novel oncology therapeutics. Herein is described the utilization of an in vivo screening approach with integrated efficacy and tolerability parameters to identify candidate CDK inhibitors with a suitable balance of activity and tolerability. This approach has resulted in the identification of SCH 727965, a potent and selective CDK inhibitor that is currently undergoing clinical evaluation.

Dechlorination by ultraviolet radiation: a suitable alternative to activated carbon in dialysis water systems?

Chlorine-based products are widely used in the water supply industry, and the potential for adverse effects in the haemodialysis setting is well documented. To date, the most commonly used method of chlorine removal has been granular activated carbon filters. An increasingly popular method of dechlorination is the use of high intensity, broad-spectrum UV systems to reduce both free chlorine and combined chlorine compounds (chloramines) into easily removed by-products. UV radiation has been successfully used in the pharmaceutical and food industries to destroy free chlorine and/or chloramines present in water, and kill all known spoilage microorganisms including bacteria, viruses, yeasts and moulds (and their spores). This nonchemical method can offer significant advantages and benefits compared to conventional dechlorination technologies currently employed in dialysis water systems. Whilst UV treatment at 254 nm wavelength has been routinely used for disinfection purposes in dialysis water systems, this paper considers whether UV radiation can be used as an alternative to more traditional methods of chlorine removal.

2-Benzimidazolyl-9-(chroman-4-yl)-purinone derivatives as JAK3 inhibitors.

A novel class of Janus tyrosine kinase 3 (JAK3) inhibitors based on a 2-benzimidazoylpurinone core structure is described. Through substitution of the benzimidazoyl moiety and optimization of the N-9 substituent of the purinone, compound 24 was identified incorporating a chroman-based functional group. Compound 24 shows excellent kinase activity, good oral bioavailability and demonstrates efficacy in an acute mechanistic mouse model through inhibition of interleukin-2 (IL-2) induced interferon-gamma (INF-gamma) production.

Potential uses of health promotion competencies.

Projects in Australia and internationally over the past two decades have sought to define and clarify competencies required to work in health promotion. It is now apparent that such competencies are very useful to health promotion practice. However, to date little attempt has been made to describe those uses. More than 200 health promotion practitioners throughout Australia were engaged in workshops to explore and define potential uses of health promotion competencies. The suggestions from these 10 workshops are summarised in eight categories of uses. Agreed health promotion competencies have potential to impact on recruitment, training, employment policy and health promotion practice.

Health promotion competencies for Australia 2001-5: trends and their implications.

This important research builds on past projects in Australia and internationally that have sought to define and clarify competencies required to work in health promotion. The paper briefly explains the process undertaken in 2005 to update the Australian health promotion competencies as a collaboration of several leading health promotion agencies. The article reports findings from research undertaken in 2001 and 2005 and compares trends in perceptions of health promotion competencies across time. This dialogue among researchers, health promotion academics and practitioners can help to further the impact of competencies research on professional practice in health promotion globally. This project placed a priority on methodology that engaged the health promotion workforce in Australia. A two-stage process was employed including expert consultation with 39 senior health promotion professionals, followed by a modified Delphi process to engage 400 practitioners. Space was allowed for comment on the competencies including suggested word changes, and respondents were also invited to add additional competencies. The research involved a modified Delphi study where participants were invited to rate each competency as "essential", "desirable" or "not relevant", and to suggest changes to wording, as well as additions to the list. Responses were received from 400 practitioners and the results were presented and compared with the 2001 survey results. Results indicate a substantial shift in perceptions about health promotion practice in Australia during the initial years of the 21(st) century.The overall significant changes in perceptions indicate that by 2005 the Australian health promotion workforce had substantially moved away from an individual behaviour-dominated perception of health promotion practice. Increasing recognition was given to competencies that reflect environmental, economic and policy influences on health, and increased recognition that these processes are legitimate and essential components of the health promotion process.

Should renal nurses be aware of water quality?

Although traditionally considered the domain of the renal technologist, many units do not have technicians or may only have part-time access to one. In these cases, it often falls to nursing staff to ensure that patients are dialysed safely. However, water quality is an area in which some nurses do not feel confident. This paper is aimed at providing information about the importance of appropriate water treatment, water testing and monitoring and the implications to the patient if the water is not checked appropriately in accordance with the guidelines.

Noise and acoustics in renal units and hospitals [corrected].

The quality of the patient's life while in the hospital setting is important and hence the quality of the hospital environment is equally important. The effect of noise on health varies depending upon the susceptibility of the individual, but can include higher blood pressure, stress and annoyance in staff, and can erode quality of care. This paper ascertains what the noise levels are in a typical renal unit and considers the potential effects on staff and patients. The quality of the hospital environment plays an important part in treating patients effectively and efficiently. The use of acoustic design principles can reduce the level and impact of noise and, in doing so, improve the quality of care and the patient experience.

Health promotion competencies for Australia 2001-5: trends and their implications

This important research builds on past projects in Australia and internationally that have sought to define and clarify competencies required to work in health promotion. The paper briefly explains the process undertaken in 2005 to update the Australian health promotion competencies as a collaboration of several leading health promotion agencies. The article reports findings from research undertaken in 2001 and 2005 and compares trends in perceptions of health promotion competencies across time. This dialogue among researchers, health promotion academics and practitioners can help to further the impact of competencies research on professional practice in health promotion globally. This project placed a priority on methodology that engaged the health promotion workforce in Australia. A two-stage process was employed including expert consultation with 39 senior health promotion professionals, followed by a modified Delphi process to engage 400 practitioners. Space was allowed for comment on the competencies including suggested word changes, and respondents were also invited to add additional competencies. The research involved a modified Delphi study where participants were invited to rate each competency as essential, desirable or not relevant, and to suggest changes to wording, as well as additions to the list. Responses were received from 400 practitioners and the results were presented and compared with the 2001 survey results. Results indicate a substantial shift in perceptions about health promotion practice in Australia during the initial years of the 21(st) century. The overall significant changes in perceptions indicate that by 2005 the Australian health promotion workforce had substantially moved away from an individual behaviour dominated perception of health promotion practice. Increasing recognition was given to competencies that reflect environmental, economic and policy influences on health, and increased recognition that these processes are legitimate and essential components of the health promotion process. (AU)

Pyrazolo[1,5-a]pyrimidines as orally available inhibitors of cyclin-dependent kinase 2.

Properly substituted pyrazolo[1,5-a]pyrimidines are potent and selective CDK2 inhibitors. Compound 15j is orally available and showed efficacy in a mouse A2780 xenograft model.

Process evaluation of the Act-Belong-Commit Mentally Healthy WA campaign: first 12 months data.

OBJECTIVE: To assess the extent of partnerships established by the Act-Belong-Commit campaign in the six intervention towns in the first 12 months, from October 2005 to September 2006, and the exposure achieved. METHODS: In each town, data were collated on media exposure, partnerships established and co-branding of community-based events and activities under the Act-Belong-Commit banner. RESULTS: In the first 12 months, four press advertisements were developed and placed twice a month in a local newspaper in each town. The total coverage area was 45,350 cm2, with a media buy of $63,000. The campaign generated a total of 124 campaign-related press articles in these local newspapers (27,529 cm2), equating to approximately $38,000 worth of paid media in terms of coverage area (cm2). In total, 59 major partnerships were established, holding 115 co-branded community events and activities. The campaign attracted 21 sponsorships for partners, totalling approximately $250,000. CONCLUSIONS: The partnerships with community organisations facilitated the co-branding of events and activities, which provided opportunities for individuals to act-belong-commit. The campaign officers were successful in forming ongoing partnerships in each of the towns, as partners believed the campaign offered them significant benefits for their co-operation. The campaign officers were instrumental in securing sponsorships of community events and activities. A substantial amount of unpaid media was generated.

The relationship between organised physical recreation and mental health.

ISSUE ADDRESSED: The mental health benefit of participation in organised physical recreation is investigated as strategies aimed at enhancing mental health and well-being in the community have the potential to decrease social and economic costs. METHODS: A literature review was undertaken to explore evidence relating to the mental health benefits of participation in organised physical recreation. RESULTS: Regular physical activity is widely recognised as protective against the overall burden of disease. Evaluations by government departments in Australia and the United States (US) found that people who participate in sports clubs and organised recreational activity enjoy better mental health, are more alert, and more resilient against the stresses of modern living. Participation in recreational groups and socially supported physical activity is shown to reduce stress, anxiety and depression, and reduce symptoms of Alzheimer's disease, yet more than one-third of adult Australians report no participation in sports and physical recreation. Evaluations of some programs found that physical activity is increased when the social environment is supportive and that the mental and physical benefits of participating in organised recreational activity can be experienced by people other than those directly involved with the sport or activity. CONCLUSION: This review supports the development and maintenance of organised sport and recreational activities that are socially and culturally appropriate. An increase in valid and reliable evaluations of sport and physical recreation programs would contribute to the international body of evidence of the mental health benefits of organised physical recreation.

Is the term 'lifestyle' appropriate to use in health promotion today?

ISSUE ADDRESSED: The term 'lifestyle' has become popularised and is used across a variety of fields. This has diminished its currency in the health field somewhat. The term is also used to describe behaviour change and does not include social and environmental influences on health status. Many health professionals now question whether this term is appropriate to use in health promotion today. METHODS: A Google search on the world wide web produced 855,000 hits. A search for 'health lifestyle' in Australia alone yielded 23,000 hits. RESULTS: The Google search led to a variety of national and international reports related to lifestyle and healthy lifestyle as well as marketing reports such as the Australian Lifestyle Survey. The search helped to clarify the history of the term and its current use in health and other fields. CONCLUSIONS: There is no doubt the term 'lifestyle' has become popularised and is used to market everything from pets to health to pay TV. If the health field is to continue to use this term it needs to be prefixed with the word 'healthy'. However, it may be even more important for health professionals to be clear and consistent about what a 'healthy lifestyle' involves.