Medication therapy discontinuation after MI is common and occurs early after discharge. Patients who discontinue taking evidence-based medications are at increased mortality risk. These findings suggest the need to improve the transition of care from the hospital to outpatient setting to ensure that patients continue to take medications that have mortality benefit.

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In a large population of matched pharmacologic stress patients, myocardial perfusion PET was superior to SPECT in image quality, interpretive certainty, and diagnostic accuracy.

ObjectiveTo determine the cost-effectiveness of nurse practitioners delivering primary and specialised ambulatory care.DesignA systematic review of randomised controlled trials reported since 1980.Data sources10 electronic bibliographic databases, handsearches, contact with authors, bibliographies and websites.Included studiesRandomised controlled trials that evaluated nurse practitioners in alternative and complementary ambulatory care roles and reported health system outcomes.Results11 trials were included. In four trials of alternative provider ambulatory primary care roles, nurse practitioners were equivalent to physicians in all but seven patient outcomes favouring nurse practitioner care and in all but four health system outcomes, one favouring nurse practitioner care and three favouring physician care. In a meta-analysis of two studies (2689 patients) with minimal heterogeneity and high-quality evidence, nurse practitioner care resulted in lower mean health services costs per consultation (mean difference: −€6.41; 95% CI −€9.28 to −€3.55; p<0.0001) (2006 euros). In two trials of alternative provider specialised ambulatory care roles, nurse practitioners were equivalent to physicians in all but three patient outcomes and one health system outcome favouring nurse practitioner care. In five trials of complementary provider specialised ambulatory care roles, 16 patient/provider outcomes favouring nurse practitioner plus usual care, and 16 were equivalent. Two health system outcomes favoured nurse practitioner plus usual care, four favoured usual care and 14 were equivalent. Four studies of complementary specialised ambulatory care compared costs, but only one assessed costs and outcomes jointly.ConclusionsNurse practitioners in alternative provider ambulatory primary care roles have equivalent or better patient outcomes than comparators and are potentially cost-saving. Evidence for their cost-effectiveness in alternative provider specialised ambulatory care roles is promising, but limited by the few studies. While some evidence indicates nurse practitioners in complementary specialised ambulatory care roles improve patient outcomes, their cost-effectiveness requires further study.

We provide evidence that the androgen receptor (AR) can promote nuclear translocation of ␤-catenin in LNCaP and PC3 prostate cancer cells. Using AR-expressing cells (LNCaP) and non-AR-expressing cells (PC3) we showed by time course cell fractionation that the AR can shuttle ␤-catenin into the nucleus when exposed to exogenous androgen. Cells exposed to the synthetic androgen, R1881, show distinct, punctate, nuclear co-localization of the AR and ␤-catenin. We further showed that the AR does not interact with adenomatous polyposis coli or glycogen synthase kinase-3␤ and, therefore, conclude that androgenmediated transport of ␤-catenin occurs through a distinct pathway. The minimal necessary components of the AR and ␤-catenin required for binding nuclear accumulation of ␤-catenin nuclear import appears to be the DNA/ligand binding regions and the Armadillo repeats of ␤-catenin. We also employed a novel DNA binding assay to illustrate that ␤-catenin has the capacity to bind to the probasin promoter in an AR-dependent manner. The physiological relevance of AR-mediated transport of ␤-catenin and binding to an AR promoter appeared to be a substantial increase in AR transcriptional reporter activity. ARmediated import represents a novel mode of nuclear accumulation of ␤-catenin. The androgen receptor (AR)1 has a fundamental role in development and differentiation of androgen-sensitive tissue but also has an important role in prostate cancer (1). Proliferation of prostatic epithelium is dependent on the uptake of androgens from the serum through the cell membrane, binding to the cognate steroid receptors, and translocation to the nucleus leading to activation of transcription (2, 3) of downstream genes (4). Structurally, the AR belongs to a superfamily of ligand-activated transcription factors composed of a highly conserved DNA binding domain (AR DBD ) and a moderately conserved ligand binding domain (AR LBD ), while containing an N-terminal domain (AR Nt ), which is least conserved (5-7). The AR Nt contains a ligand-independent transcriptional activating function whereas the AR Ct contains one that is ligand-dependent (8). The ligand binding domain of nuclear receptors interact with a variety of other proteins following ligand binding (9), which has the potential to augment or modulate transcriptional response. The transcriptional activity of the AR is largely determined by the presence or absence of other co-factors, including co-activators, which enhance AR activity, and corepressors, which repress AR activity. Examples of previously identified co-activating molecules of the AR include CBP, SRC1, and TIF-2 (10 -12).There is strong documentation to suggest steroid receptor shuttling upon exposure to the cognate ligand. Such studies have pertained to the AR (13-16), glucocorticoid receptor (GR) (17), estrogen receptor (ER) (19), mineralocorticoid receptor (20), and thyroid receptor (TR) (21). These receptors show a certain degree of trafficking either to or from the nucleus but also in a subnuclear fashion. Those that s...