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Abnormalities in serum biomarkers correlate with lower cardiac index in the Fontan population
- Bradley S. Marino, David J. Goldberg, Adam L. Dorfman, Eileen King, Heidi Kalkwarf, Babette S. Zemel, Margaret Smith, Jesse Pratt, Mark A. Fogel, Amanda J. Shillingford, Barbara J. Deal, Anitha S. John, Caren S. Goldberg, Timothy M. Hoffman, Marshall L. Jacobs, Asher Lisec, Susan Finan, Lazaros K. Kochilas, Thomas W. Pawlowski, Kathleen Campbell, Clinton Joiner, Stuart L. Goldstein, Paul Stephens, Jr, Alvin J. Chin
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- Journal:
- Cardiology in the Young / Volume 27 / Issue 1 / January 2017
- Published online by Cambridge University Press:
- 05 July 2016, pp. 59-68
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Background
Fontan survivors have depressed cardiac index that worsens over time. Serum biomarker measurement is minimally invasive, rapid, widely available, and may be useful for serial monitoring. The purpose of this study was to identify biomarkers that correlate with lower cardiac index in Fontan patients.
Methods and resultsThis study was a multi-centre case series assessing the correlations between biomarkers and cardiac magnetic resonance-derived cardiac index in Fontan patients ⩾6 years of age with biochemical and haematopoietic biomarkers obtained ±12 months from cardiac magnetic resonance. Medical history and biomarker values were obtained by chart review. Spearman’s Rank correlation assessed associations between biomarker z-scores and cardiac index. Biomarkers with significant correlations had receiver operating characteristic curves and area under the curve estimated. In total, 97 cardiac magnetic resonances in 87 patients met inclusion criteria: median age at cardiac magnetic resonance was 15 (6–33) years. Significant correlations were found between cardiac index and total alkaline phosphatase (−0.26, p=0.04), estimated creatinine clearance (0.26, p=0.02), and mean corpuscular volume (−0.32, p<0.01). Area under the curve for the three individual biomarkers was 0.63–0.69. Area under the curve for the three-biomarker panel was 0.75. Comparison of cardiac index above and below the receiver operating characteristic curve-identified cut-off points revealed significant differences for each biomarker (p<0.01) and for the composite panel [median cardiac index for higher-risk group=2.17 L/minute/m2 versus lower-risk group=2.96 L/minute/m2, (p<0.01)].
ConclusionsHigher total alkaline phosphatase and mean corpuscular volume as well as lower estimated creatinine clearance identify Fontan patients with lower cardiac index. Using biomarkers to monitor haemodynamics and organ-specific effects warrants prospective investigation.
From Clinical Research to Clinical Practice: A 4-Year Review of Ziprasidone
- Prakash S. Masand, Charles B. Nemeroff, John W. Newcomer, Jeffrey A. Lieberman, Alan F. Schatzberg, Peter J. Weiden, Clinton D. Kilts, Philip D. Harvey, David G. Daniel
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- Journal:
- CNS Spectrums / Volume 10 / Issue S17 / November 2005
- Published online by Cambridge University Press:
- 07 November 2014, pp. 1-20
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Ziprasidone is a second-generation antipsychotic that received Food and Drug Administration approval in February 2001. It has a unique receptor profile that includes high-affinity antagonist activity at dopamine D2 receptors, inverse agonist activity at serotonin (5-HT)2A receptors, agonist activity at 5-HT1A receptors, and a relatively high affinity for the serotonin and norepinephrine transporters. The 5-HT1A affinity, together with the inhibitory effect on monoamine reuptake, may underlie the hypothesized beneficial effects on comorbid affective and cognitive abnormalities in schizophrenia and schizoaffective disorder. The short-term efficacy of ziprasidone for core positive symptoms of schizophrenia appears to be comparable to other conventional and atypical antipsychotics. The short-term efficacy of ziprasidone in acute mania has been established based on two 3-week, double-blind, placebo-controlled trials. Open-label treatment for up to 52 weeks confirms the sustained efficacy and safety of ziprasidone in bipolar disorder. Maintenance studies in schizophrenia and schizoaffective disorder indicate that long-term ziprasidone therapy is effective in preventing relapse, while maintaining cognitive and psychosocial benefits. The safety database suggests that the overall cardiovascular and cerebrovascular risk associated with ziprasidone is lower than with other atypicals, with notably lower risk of drug-related increases in weight, glucose, or lipids. The data also suggest a modestly increased risk of QTc prolongation that is not dose related or linked to torsades de pointes. Switching to ziprasidone from other atypicals appears to improve both clinical symptoms and metabolic parameters, though more studies are needed to fully characterize these benefits. This monograph summarizes the efficacy, tolerability, and safety of oral ziprasidone in the treatment of schizophrenia, schizoaffective disorder, and bipolar mania.
Notes on contributors
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- By Kimberly VanEsveld Adams, Roger Cardinal's, Edith W. Clowes, Macdonald Daly, Nicholas Dames, Elaine Freedgood, Ray Furness, Willi Goetschel, David Goldie, M. A. R. Habib, Renate Holub, Poul Houe, David Lyle Jeffrey, John D. Kerkering, Wolf Lepenies, Rosemary Lloyd, Clinton Machann, Steven Monte, Gregory Moore, James Najarian, Hilary S. Nias, John Osborne, Allan H. Pasco, Stephen Prickett, Harold Schweizer, Joanne Shattock, Carol J. Singley, Donald Stone, Martin Swales, David Van Leer, Beth S. Wright, Julia M. Wright
- Edited by M. A. R. Habib, Rutgers University, New Jersey
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- Book:
- The Cambridge History of Literary Criticism
- Published online:
- 05 February 2013
- Print publication:
- 07 February 2013, pp ix-xiv
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Evaluation of Potential Environmental Contamination Sources for the Presence of Multidrug-Resistant Bacteria Linked to Wound Infections in Combat Casualties
- Edward F. Keen III, Katrin Mende, Heather C. Yun, Wade K. Aldous, Timothy E. Wallum, Charles H. Guymon, David W. Cole, Helen K. Crouch, Matthew E. Griffith, Bernadette L. Thompson, Joel T. Rose, Clinton K. Murray
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 33 / Issue 9 / September 2012
- Published online by Cambridge University Press:
- 02 January 2015, pp. 905-911
- Print publication:
- September 2012
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Objective.
To determine whether multidrug-resistant (MDR) gram-negative organisms are present in Afghanistan or Iraq soil samples, contaminate standard deployed hospital or modular operating rooms (ORs), or aerosolize during surgical procedures.
Design.Active surveillance.
Setting.US military hospitals in the United States, Afghanistan, and Iraq.
Methods.Soil samples were collected from sites throughout Afghanistan and Iraq and analyzed for presence of MDR bacteria. Environmental sampling of selected newly established modular and deployed OR high-touch surfaces and equipment was performed to determine the presence of bacterial contamination. Gram-negative bacteria aerosolization during OR surgical procedures was determined by microbiological analysis of settle plate growth.
Results.Subsurface soil sample isolates recovered in Afghanistan and Iraq included various pansusceptible members of Enterobacteriaceae, Vibrio species, Pseudomonas species, Acinetobacter Iwojfii, and coagulase-negative Staphylococcus (CNS). OR contamination studies in Afghanistan revealed 1 surface with a Micrococcus luteus. Newly established US-based modular ORs and the colocated fixed-facility ORs revealed no gram-negative bacterial contamination prior to the opening of the modular OR and 5 weeks later. Bacterial aerosolization during surgery in a deployed fixed hospital revealed a mean gram-negative bacteria colony count of 12.8 colony-forming units (CFU)/dm2/h (standard deviation [SD], 17.0) during surgeries and 6.5 CFU/dm2/h (SD, 7.5; P = .14) when the OR was not in use.
Conclusion.This study demonstrates no significant gram-negative bacilli colonization of modular and fixed-facility ORs or dirt and no significant aerosolization of these bacilli during surgical procedures. These results lend additional support to the role of nosocomial transmission of MDR pathogens or the colonization of the patient themselves prior to injury.
Contributors
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- By Shamsuddin Akhtar, Greg Albert, Sidney Allison, Muhammad Anwar, Haruo Arita, Amanda Barker, Mary Hanna Bekhit, Jeanna Blitz, Tyson Bolinske, David Burbulys, Asokumar Buvanendran, Gregory Cain, Keith A. Candiotti, Daniel B. Carr, Derek Chalmers, John Charney, Rex Cheng, Roger Chou, Keun Sam Chung, Anna Clebone, Frederick Conlin, Susan Dabu-Bondoc, Tiffany Denepitiya-Balicki, Jeanette Derdemezi, Anahat Kaur Dhillon, Ho Dzung, Juan Jose Egas, Stephen M. Eskaros, Zhuang T. Fang, Claudia R. Fernandez Robles, Victor A. Filadora, Ellen Flanagan, Dan Froicu, Allison Gandey, Nehal Gatha, Boris Gelman, Christopher Gharibo, Muhammad K. Ghori, Brian Ginsberg, Michael E. Goldberg, Jeff Gudin, Thomas Halaszynski, Martin Hale, Dorothea Hall, Craig T. Hartrick, Justin Hata, Lars E. Helgeson, Joe C. Hong, Richard W. Hong, Balazs Horvath, Eric S. Hsu, Gabriel Jacobs, Jonathan S. Jahr, Rongjie Jaing, Inderjeet Singh Julka, Zeev N. Kain, Clinton Kakazu, Kianusch Kiai, Mary Keyes, Michael M. Kim, Peter G. Lacouture, Ryan Lanier, Vivian K. Lee, Mark J. Lema, Oscar A. de Leon-Casasola, Imanuel Lerman, Philip Levin, Steven Levin, JinLei Li, Eric C. Lin, Sharon Lin, David A. Lindley, Ana M. Lobo, Marisa Lomanto, Mirjana Lovrincevic, Brenda C. McClain, Tariq Malik, Jure Marijic, Joseph Marino, Laura Mechtler, Alan Miller, Carly Miller, Amit Mirchandani, Sukanya Mitra, Fleurise Montecillo, James M. Moore, Debra E. Morrison, Philip F. Morway, Carsten Nadjat-Haiem, Hamid Nourmand, Dana Oprea, Sunil J. Panchal, Edward J. Park, Kathleen Ji Park, Kellie Park, Parisa Partownavid, Akta Patel, Bijal Patel, Komal D. Patel, Neesa Patel, Swati Patel, Paul M. Peloso, Danielle Perret, Anthony DePlato, Marjorie Podraza Stiegler, Despina Psillides, Mamatha Punjala, Johan Raeder, Siamak Rahman, Aziz M. Razzuk, Maggy G. Riad, Kristin L. Richards, R. Todd Rinnier, Ian W. Rodger, Joseph Rosa, Abraham Rosenbaum, Alireza Sadoughi, Veena Salgar, Leslie Schechter, Michael Seneca, Yasser F. Shaheen, James H. Shull, Elizabeth Sinatra, Raymond S. Sinatra, Neil Singla, Neil Sinha, Denis V. Snegovskikh, Dmitri Souzdalnitski, Julie Sramcik, Zoreh Steffens, Alexander Timchenko, Vadim Tokhner, Marc C. Torjman, Co T. Truong, Nalini Vadivelu, Ashley Vaughn, Anjali Vira, Eugene R. Viscusi, Dajie Wang, Shu-ming Wang, J. Michael Watkins-Pitchford, Steven J. Weisman, Ira Whitten, Bryan S. Williams, Jeremy M. Wong, Thomas Wong, Christopher Wray, Yaw Wu, Anthony T. Yarussi, Laurie Yonemoto, Bita H. Zadeh, Jill Zafar, Martha Zegarra, Keren Ziv
- Edited by Raymond S. Sinatra, Jonathan S. Jahr, University of California, Los Angeles, School of Medicine, J. Michael Watkins-Pitchford
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- Book:
- The Essence of Analgesia and Analgesics
- Published online:
- 06 December 2010
- Print publication:
- 14 October 2010, pp xi-xviii
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The National Interest: Normative Foundations
- W. David Clinton
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- Journal:
- The Review of Politics / Volume 48 / Issue 4 / Fall 1986
- Published online by Cambridge University Press:
- 05 August 2009, pp. 495-519
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“The national interest” is frequently criticized in the contemporary study of international relations as an ambiguous term that lends itself to the support of unethical state policies by justifying single-minded national selfishness. This article argues that much of the criticism of the national interest on normative grounds in fact derives from confusion over the meaning of the concept. It separates two meanings — national interest as the common good of the national society, set off from the international environment, and national interests as the concrete objects of value over which states bargain, within that international setting. It surveys six views of the link among the national interest, the international society that legitimates various state interests, and the demands of ethical action, and concludes that statesmanship which relies on both definitions of national interest can provide the best guide to ethical state conduct within the “anarchical society” of international politics.
Contributors
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- By James M. Bjork, Hilary P. Blumberg, Nathalie Boddaert, Susan Bookheimer, Silvia A. Bunge, Beata Buzas, B. J. Casey, Nadia Chabane, Eveline A. Crone, Mirella Dapretto, John A. Detre, Vaibhav A. Diwadkar, Jeffery N. Epstein, Monique Ernst, Guido K. W. Frank, David C. Glahn, David Goldman, Daniel A. Gorman, Ian H. Gotlib, Michael G. Hardin, Clinton D. Hermes, Rebecca M. Jones, Jutta Joormann, Jessica H. Kalmar, Walter H. Kaye, Matcheri S. Keshavan, Dae-Shik Kim, Liat Levita, Lisa H. Lu, Rachel Marsh, Kristin McNealy, Kevin A. Pelphrey, Susan B. Perlman, Bradley S. Peterson, Daniel S. Pine, Steven R. Pliszka, Konasale Prasad, Hengyi Rao, Allan L. Reiss, Perry Renshaw, Susan M. Rivera, Jason Royal, Judith M. Rumsey, Maulik P. Shah, Marisa M. Silveri, Elizabeth R. Sowell, Jeffrey A. Stanley, Henning U. Voss, Jiong-Jiong Wang, Ke Xu, Deborah Yurgelun-Todd, Monica Zilbovicius
- Edited by Judith M. Rumsey, National Institute of Mental Health, Bethesda, Maryland, Monique Ernst, National Institute of Mental Health, Bethesda, Maryland
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- Book:
- Neuroimaging in Developmental Clinical Neuroscience
- Published online:
- 04 August 2010
- Print publication:
- 19 February 2009, pp vii-xii
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2 - A General Equilibrium Analysis of North American Economic Integration
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- By David W. Roland-Hoist, Oecd, Kenneth A. Reinert, Kalamazoo College, Clinton R. Shiells, International Monetary Fund
- Edited by Joseph F. Francois, General Agreement on Tariffs & Trade, Clinton R. Shiells
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- Book:
- Modeling Trade Policy
- Published online:
- 25 March 2010
- Print publication:
- 24 June 1994, pp 47-82
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Summary
Introduction
The North American Free Trade Agreement (NAFTA) is representative of a worldwide trend toward regionalism in trade negotiations. This shift away from multilateralism is a result of both the strengths and weaknesses of the GATT framework. On one hand, GATT has been quite successful at demonstrating once and for all that relatively low tariff protection can greatly expand global trade opportunities. At the same time, however, these norms have lowered the stakes for regionalists, who can now remove residual protection with their neighbors secure in the knowledge that severe retaliation is not individually rational for other trading partners. The success of GATT in reducing average tariff protection has also narrowed the negotiating agenda down to its more stubborn elements, such as trade in agricultural and textile products.
GATT's weaknesses have also become more apparent and problematic over time. In its early days, the multilateral negotiating framework faced a relatively easy task, with a few dominant economies leading the way by leveling tariff barriers on a dominant share of international trade. Now the family of influential traders is much larger, their geographic and economic interests are more diverse, and consensus is much more difficult to achieve or even approximate. Finally, an emphasis on multilateral negotiations on tariff protection has led to proliferation of nontariff trade control measures that in many instances threaten to reverse the long-term trend toward a more liberalized global trading regime.