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Updated 2:00 PM February 11, 2005




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Research Notes

Pharmacists cautiously support drug importation

Community pharmacists are not opposed to importing drugs as a means to help lower patients' costs—as long as those drugs are channeled through U.S. pharmacies to ensure safety and efficacy.

That's according to a recently published study co-authored by David Nau, assistant professor of social and administrative sciences in the College of Pharmacy; Patrick McKercher, former director of the College of Pharmacy's Center for Medication Use, Policy and Economics; and two researchers from the University of Illinois College of Pharmacy.

The study, "Importation of Prescription Medications: The Experiences, Opinions and Intended Behaviors of U.S. Retail Pharmacists," appeared in the November/December edition of the Journal of the American Pharmacists Association.

Findings were based on a survey of 401 practicing pharmacists in Illinois, Michigan, Florida and Minnesota.

While pharmacists overwhelmingly supported drug importation as a compassionate measure, they did not agree on whether importation should be legalized, even for pharmacies. A clear majority of pharmacists opposed legalizing importation for consumers. Nearly 70 percent of pharmacists were willing to procure drugs from Canada, although very few were willing to get drugs from India or China.

Pharmacists were not naive about the financial implications of importation, however. Approximately half of the pharmacists surveyed were concerned about job security as a result of the trend toward importation. This concern was significantly higher among pharmacy owners.

Even in heaven, stars only can get so big

New U-M research shows that there may be an upper limit to the size of a star, somewhere around 120 to 200 times bigger than the sun.
The Hubble Space Telescope's latest image of the star V838 Monocerotis. (Photo by NASA, ESA, And H.E. Bond (STScl)

The sun is the closest star to Earth and therefore looks very big to us, but compared to other stars in the Milky Way, it's considered a low-mass star. Knowing that there may be a limit to a star's mass answers a fundamental question, but raises a raft of other issues about what limits their mass, says Sally Oey, assistant professor of astronomy.

The study is the first to determine the stellar upper mass limit by examining a wide range of star clusters, Oey says. In the paper, "Statistical Confirmation of a Stellar Upper Mass Limit," Oey and colleague C.J. Clarke from the Institute of Astronomy at Cambridge, England, compared historical data on 12 OB associations, large aggregates of hundreds to several thousand young stars.

The paper will appear in the Feb. 10 edition of the Astrophysical Journal Letters.

Other studies have suggested an upper mass limit of about the same size, but had looked at only one cluster.

Oey and Clarke looked at star clusters in the Magellanic Clouds, the Milky Way's brightest satellite galaxies, because they are close enough to see individual stars and make measurements, Oey says.

Based on the size and number of stars, the probability of finding stars above a certain mass dropped significantly at 120-200 solar masses, Oey says.

The question of mass is an important one because it relates to basic star formation, Oey says.

The biggest stars output huge amounts of energy by exploding when they die or by releasing ultraviolet radiation during the star's normal life. That puts tremendous energy into the interstellar medium, which in turn leads to evolutionary activity like renewed star formation and the conversion of gas into stars.

Pain's generation gap also a Black-and-white issue

Adults under the age of 50 who have chronic pain may be less able to cope with their condition and more prone to associated depression than their elders, a new study suggests.

And the same "generation gap" pattern exists among both Blacks and whites, though Blacks of all ages have previously been found to experience more pain and more pain-related negative effects than whites.

The study also finds that, in general, Blacks scored higher than whites on measurements of the intensity of their pain, disability related to their pain and depression symptoms. This finding is consistent with past studies on pain that examined racial differences in chronic pain experience.

The study by researchers at U-M and the University of South Florida (USF), appears in a special issue of the journal Pain Medicine, published by the American Academy of Pain Medicine.

No matter what your color or age, chronic pain has a major impact on your life and your ability to work or function says the study's senior author, pain specialist Dr. Carmen R. Green, an associate professor of anesthesiology at the Medical School and attending physician at the Center for Interventional Pain Medicine. She is co-guest editor of the journal issue.

The study examined detailed data from 5,823 Black and white adults treated at the Multidisciplinary Pain Center over eight years. They were divided into two groups: those under age 50, and those over age 50.

Older whites and Blacks were better able to cope with their pain, had less trouble falling asleep, and had fewer depressive symptoms than younger members of their racial group.

Why the gap? A combination of generational characteristics and attitudes, life experiences and age-related health expectations may be at play, though more research is needed to find out, say Green and colleague Tamara Baker of USF's School of Aging Studies. Baker formerly was a postdoctoral fellow at the U-M School of Public Health Center for Research on Ethnicity, Culture and Health.

Green and Baker note that assessing depression symptoms in people being treated for chronic pain is complicated by a sort of "chicken and egg" problem: depression itself can cause or exacerbate vague pain, but it can also be triggered by a stressful event such as an injury or illness that itself causes pain.

Household wealth results in successful children

Children from households with greater wealth—rather than simply high incomes—are more likely to be on track academically and not engage in problem behaviors, according to a U-M study.

The research shows that children performed better on academic achievement tests and had fewer behavior problems, such as lying to adults and bullying, when household wealth was factored in. In fact, the relative influence of wealth—what families actually own—was greater than income for these outcomes, says the study's author, Trina Williams Shanks, assistant professor in the School of Social Work.

Shanks presented the research "Measuring the Impact of Household Wealth on Child Development Outcomes" at the recent Society of Social Work and Research annual conference.

Some researchers theorize that wealth is distinct from income in that it represents an accumulated stock rather than a passing flow of resources. Wealth is a continuous variable that calculates household net worth. It includes business value, checking or savings, real estate, stocks, IRA accounts and other assets, then subtracting credit card and other debt.

Using data from the Panel Study of Income Dynamics (PSID), Shanks examined the academic achievement and socio-emotional behavior among 2,100 children between the ages of 3 and 12, living in a household with the biological or adopted mother. About 51 percent were white, 41 percent were Black and the remaining were Hispanic.

Even as frequently studied socioeconomic status indicators, such as education and income levels improve for Blacks and, perhaps, Hispanics, continuing differences in wealth may contribute to a persistence of racial disparities in academic outcomes, Shanks says. Whether the correlation primarily is due to wealth being distinct from income, doing a better job of capturing long-term socioeconomic status, being a proxy for important attitudes and perspectives, or leading to distinct social environments, children of color appear to remain at a disadvantage when they grow up in households at wealth levels one-tenth that of their white counterparts, she says.

Endoscopy not the only diagnostic tool

People living with fatigue, abdominal discomfort and bloody diarrhea caused by the chronic inflammation of ulcerative colitis no longer may need to undergo frequent and uncomfortable endoscopies, a new study shows.

Researchers at the U-M Health System (UMHS) found that disease severity in patients with ulcerative colitis can be evaluated accurately in clinical practice and research trials without frequent lower endoscopies. The results from the study are published in the February issue of the American Journal of Gastroenterology.

This new finding will spare patients the discomfort of undergoing regular endoscopies to monitor disease activity, and save researchers the expense of using endoscopy as part of clinical trials, says lead author Dr. Peter D.R. Higgins, lecturer in the Division of Gastroenterology and Hepatology in the Department of Internal Medicine.

Several disease activity measurement scales have been developed—some requiring endoscopy and some not—to monitor the activity of ulcerative colitis, an inflammatory bowel disease that affects more than one million Americans and causes inflammation and bleeding of the colon and rectum. Since none of the scales have been rigorously tested, experts in the field, especially those in clinical research, tend to use multiple disease activity indices, including those requiring endoscopy, to assess patients.

With no gold standard in place to measure disease activity, Higgins and his colleagues set out to determine if endoscopy is truly needed to accurately measure disease activity in ulcerative colitis.

Their findings suggest endoscopy is not a necessary component to determine disease activity and that less expensive, noninvasive indices may be reasonable alternatives for measuring disease activity for ulcerative colitis, Higgins says.

The study's co-author is Dr. Ellen Zimmermann, associate professor of internal medicine at UMHS. In addition to Higgins and Zimmermann, the study was co-authored by Dr. Marc Schwartz, a fellow in gastroenterology at the University of Chicago, and Dr. John Mapili, a house officer in family practice at Wayne State University.

The research investigators for the study were supported by grants from the National Institutes of Health, Medical School and the Department of Internal Medicine.

Study dissects the racial gap in violence

Racial disparities among individuals who commit violence largely can be explained by three factors: the types of neighborhoods where young people live, the marital status of their parents, and whether they are first- or second-generation immigrants, according to a study published in the February 2005 issue of the American Journal of Public Health.

The study, conducted by Robert Sampson of Harvard University, and U-M professors Jeffrey Morenoff and Stephen Raudenbush, shows that the long-standing gap in the racial burden of violence follows a social anatomy and is not immutable.

The odds of committing violence are almost double for Blacks compared to whites. Homicide is consistently ranked as the leading cause of death among young Black men.

Popular explanations for the racial gap in violence—"constitutional" differences in IQ test scores and impulsivity or hyperactivity—accounted for only 6 percent of the racial and ethnic disparities in violent behavior, the researchers found, while family poverty accounted for none of the gap.

In contrast, approximately 60 percent of the difference was explained by neighborhood environment, parents' marital status and immigrant status. Latinos are less likely than whites to engage in violent behavior, and contrary to popular stereotypes, first- and second-generation immigrants and neighborhoods that are immigrant enclaves exhibit lower than average violence.

The researchers found that residential segregation exposes Black youth to neighborhoods with much higher levels of risk for violence and fewer protective factors than the neighborhoods where youth of other racial and ethnic groups tend to live.

According to the authors, efforts to integrate and improve neighborhoods, such as housing vouchers, may reduce violence.

What does stand out is that youth whose parents are married are less likely to commit violence, suggesting the social benefits of marriage and labor-market policies that support stable marriages.

The study is part of the larger Project on Human Development in Chicago Neighborhoods, designed to identify and address the causes of some of the nation's gravest social problems, and to learn more about what goes right as children grow up in urban America.

Positive emotions help people see big picture

Positive emotions like joy and humor help people "get the big picture," virtually eliminating the own-race bias that makes many people think members of other races "all look alike," according to U-M research.

To simulate the experience of getting a quick glance of a stranger, scientists flashed photos of individuals for about a half second, finding subjects recognized members of their own race 75 percent of the time but recognized members of another race only 65 percent of the time, psychology researcher Kareem Johnson says. However, researchers found positive emotions boosted that recognition of about 10 to 20 percent, eliminating the gap.

The findings will appear in an upcoming issue of the journal Psychological Science.

Johnson, who is completing his doctorate work in psychology, and Barbara Fredrickson, a psychology professor and director of the Positive Emotion and Psychophysiology Laboratory, specialize in the power of positive emotions.

Researchers asked a group of 89 students to watch a video either of a comic to induce joy and laughter, a horror video to induce anxiety, or a "neutral" video that would not affect emotions. They then looked at 28 yearbook style photos of college-aged people in random order for 500 milliseconds.

Subjects who watched the comedy tested for having much higher positive emotions, while those who saw the horror video had far more "negative" emotions. In a testing phase, more images flashed by and they were asked to push buttons to indicate whether they'd seen the pictures earlier. Those in a positive mood had a far greater ability to recognize members of another race, while their ability to recognize members of their own race stayed the same.

The researchers conclude that positive emotions bring with them a "broadening effect" that helps people see a bigger, broader picture of the world around them.

U-M scientists develop first micro-machined mechanical cochlea

Scientists at U-M have developed the first micro-machined, life-sized, mechanical cochlea, the tiny organ responsible for converting acoustic vibrations into electrical signals for the brain to "read" and interpret as different sounds.

Most people with hearing loss have lost the ability to translate acoustic sound waves into electrical signals for the brain, so developing a device capable of simulating this function is an important step in the effort to help at least some of the estimated 560 million people who will experience hearing loss by the end of this year.

While the system is not yet ready for use as an implant, the 3-centimeter device potentially could be used as part of a cochlear implant. More immediate applications include a low-power sensor for military or commercial applications, says College of Engineering Associate Professor Karl Grosh.

The three advantages of U-M's mechanical cochlea are its life-sized dimensions, its suitability for mass production, and its use of a unique low-power mechanical method to do acoustic signal processing,
Grosh says.

The mechanical cochlea works in the same way as its biological counterpart. In the biological cochlea, the basilar membrane, which winds along the cochlear spiral, is stiffer at the base and becomes softer as it approaches the center. In the engineered cochlea developed by Grosh and doctoral student Robert White, a fluid-filled duct etched onto a chip acts as the cochlear spiral. When sound waves enter the mechanical cochlea's input membrane, a wave is created, which travels down the duct, interacting with a tapered micro-machined membrane, analogous to the basilar membrane. This process allows the device to separate different frequency tones.

The goal is to use the mechanical cochlea as a sensitive microphone, perhaps in tandem with a cochlear implant, Grosh says, the same way an external microphone, a microprocessor and an antenna work together in present implants.

Grosh and White co-authored a paper "Microengineered Hydromechanical Cochlear Model," which appeared in the Proceedings of the National Academy of Sciences Feb. 1.

The work primarily is funded by the National Science Foundation and the Office of Naval Research.

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