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Comprehensive Assessment (comprehensive + assessment)
Selected AbstractsEvidence for a familial correlation between increased reactivity to stress and positive psychotic symptomsACTA PSYCHIATRICA SCANDINAVICA, Issue 5 2010T. Lataster Lataster T, Collip D, Lardinois M, van Os J, Myin-Germeys I. Evidence for a familial correlation between increased reactivity to stress and positive psychotic symptoms. Objective:, This study tested the hypothesis that stress-reactivity may represent an intermediary phenotype underlying positive psychotic symptoms. It was examined whether: (i) stress-reactivity clusters within families of psychotic patients and (ii) stress-reactivity in relatives cosegregates with positive symptoms in patients. Method:, The sample consisted of 40 patients and 47 siblings of these patients. The Experience Sampling Method (ESM , a structured diary technique) was used to measure stress-reactivity. Positive symptoms in patients were measured with the Comprehensive Assessment of Symptoms and History. Results:, Within-trait, cross-sib associations showed a significant association between stress-reactivity in the patient and stress-reactivity in their siblings. Significant cross-trait, cross-sib associations were established showing a significant association between positive psychotic symptoms in the patient and stress-reactivity in the sibling. Conclusion:, The findings show familial clustering of increased stress-reactivity, suggesting common aetiological influences, probably both genetic and environmental, underlying stress-reactivity in the siblings and patients. In addition, the results underscore the hypothesis that increased stress-reactivity is an unconfounded mechanism of risk underlying the positive symptoms of psychotic disorders. [source] Holocaust Survivors in Old Age: The Jerusalem Longitudinal StudyJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 3 2008Jochanan Stesssman MD OBJECTIVES: To examine the hypothesis that Holocaust exposure during young adulthood negatively affects physical aging, causing greater morbidity, faster deterioration in health parameters, and shorter survival. DESIGN: A longitudinal cohort study of the natural history of an age-homogenous representative sample born in 1920/21 and living in Jerusalem. SETTING: Community-based home assessments. PARTICIPANTS: Four hundred fifty-eight subjects of European origin aged 70 at baseline and 77 at follow-up. MEASUREMENTS: Comprehensive assessment of physical, functional, and psychosocial domains; biographical history of concentration camp internment (Camp), exposure to Nazi occupation during World War II (Exposure), or lack thereof (Controls); and 7-year mortality data from the National Death Registry. RESULTS: Holocaust survivors of the Camp (n=93) and Exposure (n=129) groups were more likely than Controls (n=236) to be male and less educated and have less social support (P=.01), less physical activity (P=.03), greater difficulty in basic activities of daily living (P=.009), poorer self-rated health (P=.04), and greater usage of psychiatric medication (P=.008). No other differences in health parameters or physical illnesses were found. Holocaust survivors had similar rates of deterioration in health and illness parameters over the follow-up period, and 7-year mortality rates were identical. Proportional hazard models showed that being an elderly Holocaust survivor was not predictive of greter 7-year mortality. CONCLUSION: Fifty years after their Holocaust trauma, survivors still displayed significant psychosocial and functional impairment, although no evidence was found to support the hypothesis that the delayed effects of the trauma of the Holocaust negatively influence physical health, health trajectories, or mortality. [source] Aortic and mitral regurgitation: Quantification using moving slice velocity mappingJOURNAL OF MAGNETIC RESONANCE IMAGING, Issue 2 2001Sebastian Kozerke PhD Abstract Comprehensive assessment of the severity of valvular insufficiency includes quantification of regurgitant volumes. Previous methods lack reliable slice positioning with respect to the valve and are prone to velocity offsets due to through-plane motion of the valvular plane of the heart. Recently, the moving slice velocity mapping technique was proposed. In this study, the technique was applied for quantification of mitral and aortic regurgitation. Time-efficient navigator-based respiratory artifact suppression was achieved by implementing a prospective k-space reordering scheme in conjunction with slice position correction. Twelve patients with aortic insufficiency and three patients with mitral insufficiency were studied. Aortic regurgitant volumes were calculated from diastolic velocities mapped with a moving slice 5 mm distal to the aortic valve annulus. Mitral regurgitant flow was indirectly assessed by measuring mitral inflow at the level of the mitral annulus and net aortic outflow. Regurgitant fractions, derived from velocity data corrected for through-plane motion, were compared to data without correction for through-plane motion. In patients with mild and moderate aortic regurgitation, regurgitant fractions differed by 60% and 15%, on average, when comparing corrected and uncorrected data, respectively. Differences in severe aortic regurgitation were less (7%). Due to the large orifice area of the mitral valve, differences were still substantial in moderate-to-severe mitral regurgitation (19%). The moving slice velocity mapping technique was successfully applied in patients with aortic and mitral regurgitation. The importance of correction for valvular through-plane motion is demonstrated. J. Magn. Reson. Imaging 2001;14:106,112. © 2001 Wiley-Liss, Inc. [source] Practitioner Review: Adolescent alcohol use disorders: assessment and treatment issuesTHE JOURNAL OF CHILD PSYCHOLOGY AND PSYCHIATRY AND ALLIED DISCIPLINES, Issue 11 2008Francheska Perepletchikova Background:, Alcohol use disorders in adolescents are associated with significant morbidity and mortality. Over the past decade, there has been a burgeoning of research on adolescent alcohol use disorders. Methods:, A summary of the alcohol assessment tools is provided, and randomized studies reviewed and synthesized to provide an overview of state of the art knowledge of treatment of adolescent alcohol use disorders. Animal models of addiction are also briefly reviewed, and the value of translational research approaches, using findings from basic studies to guide the design of clinical investigations, is also highlighted. Results:, Comorbidity is the rule, not the exception in adolescent alcohol use disorders. Comprehensive assessment of psychiatric and other substance use disorders, trauma experiences, and suicidality is indicated in this population to optimize selection of appropriate clinical interventions. In terms of available investigated treatments for adolescents with alcohol use disorders, Multidimensional Family Therapy and group administered Cognitive Behavioral Therapies have received the most empirical support to date. There is a paucity of research on pharmacological interventions in this patient population, and no firm treatment recommendations can be made in this area. Conclusions:, Given the high rate of relapse after treatment, evaluation of combined psychosocial and pharmacological interventions, and the development of novel intervention strategies are indicated. [source] Life Cycle Cost Disclosure, Consumer Behavior, and Business ImplicationsJOURNAL OF INDUSTRIAL ECOLOGY, Issue 1 2010Evidence From an Online Field Experiment Summary Comprehensive assessments of final consumption have identified "housing" as a major contributor to total environmental impacts. Within this category, electrical-energy-using products are important. Do consumers opt for more energy-efficient household appliances if they are provided with life cycle cost (LCC),that is, the sum of purchase price and operating cost estimated over the life span of the appliance? And what consequences does LCC disclosure have for business? Physical energy figures shown on appliance labels may be cognitively demanding for consumers, whereas monetary information promises to simplify the decision problem. Despite the rising interest in monetary cost disclosure, its effectiveness relative to physical cost disclosure has not been rigorously evaluated. This research approached the question of effectiveness with an online field experiment for washing machines. Customers of a commercially operating online shop were randomly assigned to two groups. The control group was provided with regular product price information; the treatment group received additional LCC information. A total of 2,065 clicks were recorded and analyzed with multiple regression that controlled for several product characteristics. The evidence suggests that LCC disclosure decreases the mean specific energy use of chosen washing machines by 0.8% (p < 0.01) and their mean specific water use by 0.7% (p < 0.05). As to business implications, LCC disclosure had no effect on the indicator of retail volume, which makes it unattractive for retailers to provide LCC on their own initiative. [source] Psychotic phenomena in 257 young children and adolescents with bipolar I disorder: delusions and hallucinations (benign and pathological)BIPOLAR DISORDERS, Issue 1 2008Rebecca Tillman Objectives:, In contrast to studies of adult bipolar I disorder (BP-I), there is a paucity of data on psychotic phenomena in child BP-I. Therefore, the aim of this work was to describe delusions and hallucinations in pediatric BP-I. Methods:, Subjects were 257 participants, aged 6,16, in either of two large, ongoing, NIMH-funded studies, ,Phenomenology and Course of Pediatric Bipolar Disorders' or ,Treatment of Early Age Mania (TEAM)'. All subjects had current DSM-IV BP-I (manic or mixed phase) with a Children's Global Assessment Scale score ,60 (definite clinical impairment), and all had cardinal mania symptoms (i.e., elation and/or grandiosity). Comprehensive assessments included the Washington University in St. Louis Kiddie Schedule for Affective Disorders and Schizophrenia (WASH-U-KSADS), which was administered to parents about their children and separately to children about themselves by experienced research clinicians. The WASH-U-KSADS contains modules for developmentally child-age-specific manifestations of numerous categories of psychotic phenomena. Results:, Psychosis was present in 76.3% (n = 196) of subjects, which included 38.9% (n = 100) with delusions, 5.1% (n = 13) with pathological hallucinations, and 32.3% (n = 83) with both. The most common delusion was grandiose (67.7%, n = 174), and the most common pathological hallucination was visual (16.0%, n = 41). Benign hallucinations occurred in 43.6% (n = 112). A median split by age yielded 6,9 year-olds (n = 139) and 10,16 year-olds (n = 118). Analyses of these two groups, and of 6, 7, 8, and 9 year-olds separately, found no significant differences in psychotic phenomena. Conclusions:, Counterintuitively, psychosis was equally prevalent in 6,9 compared to 10,16 year-olds. High prevalence of psychosis in child BP-I warrants focus in intervention strategies and is consistent with increasing evidence of the severity of child-versus adult-onset BP-I. [source] Making Collaboration Work: Lessons from a comprehensive assessment of over 200 wideranging cases of collaboration in environmental managementCONSERVATION, Issue 1 2000Steven L. Yaffee First page of article [source] A Nationwide Assessment of the Biodiversity Value of Uganda's Important Bird Areas NetworkCONSERVATION BIOLOGY, Issue 1 2006HERBERT TUSHABE AIAs; complementariedad; congruencia trans-taxón; selección de sitios de conservación Abstract:,BirdLife International's Important Bird Areas (IBA) program is the most developed global system for identifying sites of conservation priority. There have been few assessments, however, of the conservation value of IBAs for nonavian taxa. We combined past data with extensive new survey results for Uganda's IBAs in the most comprehensive assessment to date of the wider biodiversity value of a tropical country's IBA network. The combined data set included more than 35,000 site × species records for birds, butterflies, and woody plants at 86 Ugandan sites (23,400 km2), including 29 of the country's 30 IBAs, with data on additional taxa for many sites. Uganda's IBAs contained at least 70% of the country's butterfly and woody plant species, 86% of its dragonflies and 97% of its birds. They also included 21 of Uganda's 22 major vegetation types. For butterflies, dragonflies, and some families of plants assessed, species of high conservation concern were well represented (less so for the latter). The IBAs successfully represented wider biodiversity largely because many have distinctive avifaunas and, as shown by high cross-taxon congruence in complementarity, such sites tended to be distinctive for other groups too. Cross-taxon congruence in overall species richness was weaker and mainly associated with differences in site size. When compared with alternative sets of sites selected using complementarity-based, area-based, or random site-selection algorithms, the IBA network was efficient in terms of the number of sites required to represent species but inefficient in terms of total area. This was mainly because IBA selection considers factors other than area, however, which probably improves both the cost-effectiveness of the network and the persistence of represented species. Resumen:,El programa de Áreas de Importancia para las Aves (AIAs) de Birdlife International es el sistema global más desarrollado para la identificación de sitios de prioridad para la conservación. Sin embargo, ha habido pocas evaluaciones del valor de conservación de las AIAs para taxa no aviares. En la evaluación más integral, hasta la fecha, del valor de la biodiversidad en general de la red de AIAs de un país tropical, combinamos datos antiguos con los resultados de muestreos extensivos recientes de las AIAs de Uganda. El conjunto de datos combinados incluyó más de 35000 registros de sitios x especies de aves, mariposas y plantas leñosas en 86 sitios en Uganda (23400 km2), incluyendo 29 de las 30 AIAs del país, con datos sobre taxa adicionales en muchos sitios. Las AIAs de Uganda contenían por lo menos un 70% de las especies de mariposas y plantas leñosas del país, 86% de sus libélulas y 97% de sus aves. También incluyeron 21 de los 22 principales tipos de vegetación. En las mariposas, libélulas y algunas de las familias de plantas evaluadas, la representación de especies de alto interés para la conservación fue buena (menor en las plantas). Las Áreas de Importancia para las Aves representaron exitosamente a la biodiversidad en general principalmente porque muchas tienen avifaunas distintivas y, como muestra la alta congruencia trans-taxón en complementariedad, tales sitios tendieron a ser distintivos para otros grupos también. La congruencia trans-taxón en la riqueza de especies total fue más débil y se asoció principalmente con diferencias en el tamaño del sitio. Cuando se compara con conjuntos alternativos de sitios seleccionados mediante algoritmos basados en complementariedad, área o selección aleatoria de sitios, la red de AIAs fue eficiente en términos del número de sitios requeridos para representar especies, pero ineficiente en términos del área total. Sin embargo, esto se debió principalmente a que la selección de AIA considera factores distintos al área que probablemente mejoran tanto la efectividad de la red como la persistencia de las especies representadas. [source] The mental health of female sex workersACTA PSYCHIATRICA SCANDINAVICA, Issue 2 2010W. Rössler Rössler W, Koch U, Lauber C, Hass A-K, Altwegg M, Ajdacic-Gross V, Landolt K. The mental health of female sex workers. Objective:, There is limited information available about the mental health of female sex workers. Therefore, we aimed to make a comprehensive assessment of the mental status of female sex workers over different outdoors and indoors work settings and nationalities. Method:, As the prerequisites of a probability sampling were not given, a quota-sampling strategy was the best possible alternative. Sex workers were contacted at different locations in the city of Zurich. They were interviewed with a computerized version of the World Health Organization Composite International Diagnostic Interview. Additional information was assessed in a structured face-to-face interview. Results:, The 193 interviewed female sex workers displayed high rates of mental disorders. These mental disorders were related to violence and the subjectively perceived burden of sex work. Conclusion:, Sex work is a major public health problem. It has many faces, but ill mental health of sex workers is primarily related to different forms of violence. [source] Clues to an accurate diagnosis of contact dermatitisDERMATOLOGIC THERAPY, Issue 3 2004Robert L. Rietschel ABSTRACT:, An accurate diagnosis of allergic contact dermatitis can be achieved by a combination of historical, morphologic, and diagnostic steps. Clues in the history and physical examination can point to an irritant as the source of contact dermatitis. While irritants and allergens share many common features both immunologically and clinically, there are grounds for the distinction. Knowledge of occupational factors is necessary to assess the source of contact dermatitis. A common pitfall is the failure to appreciate the role of endogenous factors in the clinical presentation and overall care of the dermatitis patient. A comprehensive assessment of the patient's environment will lead to appropriate patch tests being applied and a correct diagnosis being reached. [source] General measures of cognition for the preschool childDEVELOPMENTAL DISABILITIES RESEARCH REVIEW, Issue 3 2005Elizabeth O. LichtenbergerArticle first published online: 13 SEP 200 Abstract Preschool-age children who are experiencing delays in physical, cognitive, communication, social, emotional, or adaptive development are often referred for a comprehensive assessment to make diagnostic determinations and to help develop appropriate interventions. Typically cognitive assessment has a key role in a comprehensive evaluation of a young child. In this article, five individually administered tests of cognitive ability, normed for the preschool-age child, are reviewed. These specific tests include the Bayley Scales of Infant Development, 2nd edition, the Kaufman Assessment Battery for Children, 2nd edition, the Wechsler Preschool and Primary Scale of Intelligence, 3rd edition, the Stanford-Binet Intelligence Scale, 5th edition, and the Differential Abilities Scales. The following is provided for these cognitive instruments: a description of the test procedures, information on scoring systems, highlights of the technical qualities, and a summary of the general meaning of test results. The article concludes with strengths and limitations of the instruments. © 2005 Wiley-Liss, Inc. MRDD Research Reviews 2005;11:197,208. [source] Live/Real Time Three-Dimensional Transthoracic Echocardiographic Assessment of Pericardial DiseaseECHOCARDIOGRAPHY, Issue 10 2009Carlos Martinez Hernandez M.D. We studied 19 patients with pericardial disease using two-dimensional and three-dimensional transthorathic echocardiography (2DTTE and 3DTTE, respectively) in order to determine whether 3DTTE provides incremental value on top of 2DTTE in the evaluation of these patients. With 3DTTE a more comprehensive assessment of pericardial effusion can be made and both the parietal and visceral layers of the pericardium can be visualized en face and examined for pathologies and fibrin deposits. In our series of patients, 3DTTE was superior to 2DTTE in uncovering mass lesions involving the pericardium such as tuberculous granulomas and metastatic disease. Furthermore, it provided a better assessment of the nature of pericardial lesions, such as pericardial and mediastinal hematomas, pericardial cysts, and metastatic disease to the pericardium by sequential cropping of the 3D data sets and visualizing the interior of the lesions in a manner not possible with 2DTTE. It was also valuable in determining the extent of pericardial calcification in pericardial constriction and in measuring the size of pericardial masses. These preliminary results suggest the superiority of 3DTTE over 2DTTE in the evaluation of pericardial diseases and that it provides incremental knowledge to the echocardiographer. [source] Incremental Value of Live/Real Time Three-Dimensional Transthoracic Echocardiography in the Assessment of Right Ventricular MassesECHOCARDIOGRAPHY, Issue 5 2009Venkataramana K. Reddy M.D. This case series demonstrates the incremental value of three-dimensional transthoracic echocardiography (3D TTE) over two-dimensional transthoracic echocardiography (2D TTE) in the assessment of 11 patients with right ventricular (RV) masses or mass-like lesions (three cases of RV thrombus, one myxoma, one fibroma, one lipoma, one chordoma, and one sarcoma and three cases of RV noncompaction, which are considered to be mass-like in nature). 3D TTE was of incremental value in the assessment of these masses in that 3D TTE has the capacity to section the mass and view it from multiple angles, giving the examiner a more comprehensive assessment of the mass. This was particularly helpful in the cases of thrombi, as the presence of echolucencies indicated clot lysis. In addition, certainty in the number of thrombi present was an advantage of 3D TTE. Also, sectioning of cardiac tumors allowed more confidence in narrowing the differential diagnosis of the etiology of the mass. In addition, 3D TTE allowed us to identify precise location of the attachments of the masses as well as to determine whether there were mobile components to the mass. Another noteworthy advantage of 3D TTE was that the volumes of the masses could be calculated. Additionally, the findings by 3D TTE correlated well with pathologic examination of RV tumors, and some of the masses measured larger by 3D TTE than by 2D TTE, which was also validated in one case by surgery. As in the case of RV fibroma, another advantage was that 3D TTE actually identified more masses than 2D TTE. RV noncompaction was also well studied, and the assessment with 3D TTE helped to give a more definitive diagnosis in these patients. [source] Assessing ecosystem threats from global and regional change: hierarchical modeling of risk to sagebrush ecosystems from climate change, land use and invasive species in Nevada, USAECOGRAPHY, Issue 1 2010Bethany A. Bradley Global change poses significant challenges for ecosystem conservation. At regional scales, climate change may lead to extensive shifts in species distributions and widespread extirpations or extinctions. At landscape scales, land use and invasive species disrupt ecosystem function and reduce species richness. However, a lack of spatially explicit models of risk to ecosystems makes it difficult for science to inform conservation planning and land management. Here, I model risk to sagebrush (Artemisia spp.) ecosystems in the state of Nevada, USA from climate change, land use/land cover change, and species invasion. Risk from climate change is based on an ensemble of 10 atmosphere-ocean general circulation model (AOGCM) projections applied to two bioclimatic envelope models (Mahalanobis distance and Maxent). Risk from land use is based on the distribution of roads, agriculture, and powerlines, and on the spatial relationships between land use and probability of cheatgrass Bromus tectorum invasion in Nevada. Risk from land cover change is based on probability and extent of pinyon-juniper (Pinus monophylla; Juniperus spp.) woodland expansion. Climate change is most likely to negatively impact sagebrush ecosystems at the edges of its current range, particularly in southern Nevada, southern Utah, and eastern Washington. Risk from land use and woodland expansion is pervasive throughout Nevada, while cheatgrass invasion is most problematic in the northern part of the state. Cumulatively, these changes pose major challenges for conservation of sagebrush and sagebrush obligate species. This type of comprehensive assessment of ecosystem risk provides managers with spatially explicit tools important for conservation planning. [source] Binding of ciprofloxacin by humic substances: A molecular dynamics studyENVIRONMENTAL TOXICOLOGY & CHEMISTRY, Issue 1 2010Ludmilla Aristilde Abstract A comprehensive assessment of the potential impacts of antimicrobials released into the environment requires an understanding of their sequestration by natural particles. Of particular interest are the strong interactions of antimicrobials with natural organic matter (NOM), which are believed to reduce their bioavailability, retard their abiotic and biotic degradation, and facilitate their persistence in soils and aquatic sediments. Molecular dynamics (MD) relaxation studies of a widely used fluoroquinolone antibiotic, ciprofloxacin (Cipro), interacting with a model humic substance (HS) in a hydrated environment, were performed to elucidate the mechanisms of these interactions. Specifically, a zwitterionic Cipro molecule, the predominant species at circumneutral pH, was reacted either with protonated HS or deprotonated HS bearing Ca, Mg, or Fe(II) cations. The HS underwent conformational changes through rearrangements of its hydrophobic and hydrophilic regions and disruption of its intramolecular H-bonds to facilitate favorable intermolecular H-bonding interactions with Cipro. Complexation of the metal cations with HS carboxylates appeared to impede binding of the positively charged amino group of Cipro with these negatively charged HS complexation sites. On the other hand, an outer-sphere complex between Cipro and the HS-bound cation led to ternary Cipro,metal,HS complexes in the case of Mg,HS and Fe(II),HS, but no such bridging interaction occurred with Ca,HS. The results suggested that the ionic potential (valence/ionic radius) of the divalent cation may be a determining factor in the formation of the ternary complex, with high ionic potential favoring the bridging interaction. Environ. Toxicol. Chem. 2010;29:90,98. © 2009 SETAC [source] Immune thrombocytopenic purpura: epidemiology and implications for patientsEUROPEAN JOURNAL OF HAEMATOLOGY, Issue 2009Marc Michel Abstract The age-adjusted prevalence of immune thrombocytopenic purpura (ITP) is estimated to be 9.5 per 100 000 persons in the USA while its annual incidence is estimated to be 2.68 per 100 000 in Northern Europe (at a cut-off platelet count of <100 × 109/L). The mean age of adults at diagnosis in Europe is 50 yrs and the incidence of ITP increases with age. Both the treatments used to treat patients with ITP and the disease itself can impact on patient health-related quality of life (HRQoL). As the incidence of ITP in Europe rises, especially in the elderly, the number of patients with a decreased HRQoL is increasing. Literature searches and focus groups have aided the development of a conceptual model to assess HRQoL. In this model, low platelet counts and the associated symptoms of ITP in addition to the side effects of treatment are proposed as the main determinants of a negatively impacted HRQoL. Primary conceptual domains of HRQoL, affected in patients with ITP, include emotional health, functional health, work, social and leisure activities and reproductive health. As treatment benefits are likely to improve these domains, the conceptual model could be used for better management of patients, taking into account HRQoL. The short-form 36-item questionnaire (SF-36) and the ITP Patient Assessment Questionnaire (ITP-PAQ) are validated measures of HRQoL which can provide a comprehensive assessment of numerous factors to help evaluate decisions about patient management. Future clinical trials investigating treatment options for ITP should assess HRQoL using these validated questionnaires. [source] Complex regulation of CCR9 at multiple discrete stages of T,cell developmentEUROPEAN JOURNAL OF IMMUNOLOGY, Issue 1 2006Marc-André Wurbel Dr. Abstract We have conducted a comprehensive assessment of CCR9 expression and function at the important milestone stages of murine thymocyte development. We reveal an unusually complex regulatory pattern, in which CCR9 influences T,cell development at several widely dispersed stages. We find that CCR9 is not expressed within the thymus until the double-negative (DN)3 stage, although it appears to contribute to T,cell precursor development prior to residence in the thymus. CCR9 expression is influenced by pre-T,cell receptor signals, and is dramatically up-regulated in a population that appears to be transitional between the DN4 and double-positive stages. In the periphery, functional CCR9 is expressed by all naive CD8 T,cells, but not by naive CD4 T,cells. To our knowledge, this latter finding is the first difference observed in homing receptor expression between naive lymphocyte populations. This suggests that naive CD8 T,cells might have access to lymphoid microenvironments from which naive CD4 T,cells are excluded. [source] Quantitation of non-motor symptoms in Parkinson's diseaseEUROPEAN JOURNAL OF NEUROLOGY, Issue 2008K. Ray Chaudhuri Background:, Disabling non-motor symptoms (NMS) associated with Parkinson's disease (PD), such as dementia and loss of balance, do not respond well to levodopa therapy and can lead to eventual death in patients with the disease. In 2006, a multidisciplinary group of experts and patient representatives developed an NMS screening questionnaire (NMSQuest) and a unified Non-Motor Symptoms Scale (NMSS) to address the need for simple identification and comprehensive assessment of NMS in patients with PD. Methods and Results:, An international pilot study of 96 healthy controls and 123 patients with various stages of treated and untreated PD was conducted to demonstrate that the NMSQuest is a feasible, valid, and accepted tool. Conclusion:, The majority of patients and caregivers felt that the questionnaire was clear and relevant to their daily lives. Data from 242 PD patients with no dementia were analysed in a pilot study on the clinimetric validation of NMSS. Similar to the NMSQuest study, the NMSS study revealed a significant correlation between progression of PD and increasing NMS burden. These studies suggest that the NMSQuest accurately detects the NMS, and that the NMSS closely correlates with quality of life for PD patients. [source] Long-term prognosis and satisfaction after percutaneous endoscopic gastrostomy in a general hospital,GERIATRICS & GERONTOLOGY INTERNATIONAL, Issue 3 2004Joji Onishi Background: Percutaneous endoscopic gastrostomy (PEG) has been widely acknowledged as a safer method for enteral feeding; however, its long-term impact on prognosis and quality of life in elderly patients is not sufficiently understood. There are issues still to be studied regarding the indications for PEG, due to the lack of convincing evidence that it reduces expected complications such as aspiration pneumonia or for improving the prognosis of patients with severe dementia. Method: In this study we investigated the survival rate after PEG and the families' satisfaction in 78 inpatients who underwent PEG. We conducted the investigation by sending questionnaires to the families. Results: The results for the 69 cases (88%) in which the patient recovered showed that the 1-year survival rate was 64.0%, and the 2-year survival rate was 55.5%. Fifty-three per cent of patients' families indicated overall satisfaction regarding of PEG. Conclusions: The survival rates were relatively higher than those from previously reported studies. This may be attributed to variations in patients' clinical, socio-economic, or cultural backgrounds in therapeutic interventions. We recognized the importance of clarifying factors that would affect the living and functional prognosis and quality of life in elderly patients who underwent PEG. The indications for PEG are based on a comprehensive assessment of the relevant factors in individual cases, and by taking patients' and families' wishes into consideration. [source] The obstetric and gynaecological management of women with inherited bleeding disorders , review with guidelines produced by a taskforce of UK Haemophilia Centre Doctors' OrganizationHAEMOPHILIA, Issue 4 2006C. A. LEE Summary., The gynaecological and obstetric management of women with inherited coagulation disorders requires close collaboration between obstetrician/gynaecologists and haematologists. Ideally these women should be managed in a joint disciplinary clinic where expertise and facilities are available to provide comprehensive assessment of the bleeding disorder and a combined plan of management. The haematologist should arrange and interpret laboratory tests and make provision for appropriate replacement therapy. These guidelines have been provided for healthcare professionals for information and guidance and it is also intended that they are readily available for women with bleeding disorders. [source] Systematic review of the perceptions and experiences of accessing health services by adult victims of domestic violenceHEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 1 2008Louise Robinson RGN RHV BSc (Hons) MSc Abstract This systematic review synthesises evidence on the perceptions and experiences of adult victims of domestic violence when accessing healthcare services. The review was concerned with disclosure of domestic violence by adult victims when accessing health services, the responses of healthcare professionals to these victims, victims' perceived barriers to support, and the appropriateness of support and referrals. These aims required the review to focus on studies using in-depth qualitative methods to explore victims' perceptions and experiences. A comprehensive systematic search of 12 databases was carried out in June/July 2005. Application of the review protocol and inclusion criteria resulted in 10 studies (conducted in the UK, USA and Australia) being considered eligible for the review. Data were extracted from these studies and a quality assessment completed. Thematic analysis was carried out to enable the identification of recurrent themes within the included studies. Findings indicate that victims of domestic violence experience difficulties when accessing healthcare services. Victims perceive that these difficulties can be attributed to inappropriate responses by healthcare professionals, discomfort with the healthcare environment, perceived barriers to disclosing domestic violence, and a lack of confidence in the outcomes of disclosure to a health professional. The methodological quality of included studies was variable, but no papers were rejected based on quality issues. These results can contribute to and inform a comprehensive assessment of the experiences of adult victims of domestic violence when accessing healthcare services. The health service is in a unique position to contribute towards the assessment and identification of domestic violence and to provide access to appropriate support. The messages of this study are important for policy-makers and practitioners. [source] Identifying sequence variants in the human mitochondrial genome using high-resolution melt (HRM) profiling,HUMAN MUTATION, Issue 6 2009Steven F. Dobrowolski Abstract Identifying mitochondrial DNA (mtDNA) sequence variants in human diseases is complicated. Many pathological mutations are heteroplasmic, with the mutant allele represented at highly variable percentages. High-resolution melt (HRM or HRMA) profiling was applied to comprehensive assessment of the mitochondrial genome and targeted assessment of recognized pathological mutations. The assay panel providing comprehensive coverage of the mitochondrial genome utilizes 36 overlapping fragments (301,658,bp) that employ a common PCR protocol. The comprehensive assay identified heteroplasmic mutation in 33 out of 33 patient specimens tested. Allele fraction among the specimens ranged from 1 to 100%. The comprehensive assay panel was also used to assess 125 mtDNA specimens from healthy donors, which identified 431 unique sequence variants. Utilizing the comprehensive mtDNA panel, the mitochondrial genome of a patient specimen may be assessed in less than 1 day using a single 384-well plate or two 96-well plates. Specific assays were used to identify the myopathy, encephalopathy, lactic acidosis and stroke-like episodes (MELAS) mutation m.3243A>G, myoclonus epilepsy, ragged red fibers (MERRF) mutation m.8344A>G, and m.1555A>G associated with aminoglycoside hearing loss. These assays employ a calibrated, amplicon-based strategy that is exceedingly simple in design, utilization, and interpretation, yet provides sensitivity to detect variants at and below 10% heteroplasmy. Turnaround time for the genotyping tests is about 1,hr. Hum Mutat 30,1,8, 2009. © 2009 Wiley-Liss, Inc. [source] Protein- and mRNA-based phenotype,genotype correlations in DMD/BMD with point mutations and molecular basis for BMD with nonsense and frameshift mutations in the DMD gene,HUMAN MUTATION, Issue 2 2007Nathalie Deburgrave Abstract Straightforward detectable Duchenne muscular dystrophy (DMD) gene rearrangements, such as deletions or duplications involving an entire exon or more, are involved in about 70% of dystrophinopathies. In the remaining 30% a variety of point mutations or "small" mutations are suspected. Due to their diversity and to the large size and complexity of the DMD gene, these point mutations are difficult to detect. To overcome this diagnostic issue, we developed and optimized a routine muscle biopsy,based diagnostic strategy. The mutation detection rate is almost as high as 100% and mutations were identified in all patients for whom the diagnosis of DMD and Becker muscular dystrophy (BMD) was clinically suspected and further supported by the detection on Western blot of quantitative and/or qualitative dystrophin protein abnormalities. Here we report a total of 124 small mutations including 11 nonsense and frameshift mutations detected in BMD patients. In addition to a comprehensive assessment of muscular phenotypes that takes into account consequences of mutations on the expression of the dystrophin mRNA and protein, we provide and discuss genomic, mRNA, and protein data that pinpoint molecular mechanisms underlying BMD phenotypes associated with nonsense and frameshift mutations. Hum Mutat 28(2), 183,195, 2007. © 2006 Wiley-Liss, Inc. [source] Towards a simple dynamic process conceptualization in rainfall,runoff models using multi-criteria calibration and tracers in temperate, upland catchmentsHYDROLOGICAL PROCESSES, Issue 3 2010C. Birkel Abstract Empirically based understanding of streamflow generation dynamics in a montane headwater catchment formed the basis for the development of simple, low-parameterized, rainfall,runoff models. This study was based in the Girnock catchment in the Cairngorm Mountains of Scotland, where runoff generation is dominated by overland flow from peaty soils in valley bottom areas that are characterized by dynamic expansion and contraction of saturation zones. A stepwise procedure was used to select the level of model complexity that could be supported by field data. This facilitated the assessment of the way the dynamic process representation improved model performance. Model performance was evaluated using a multi-criteria calibration procedure which applied a time series of hydrochemical tracers as an additional objective function. Flow simulations comparing a static against the dynamic saturation area model (SAM) substantially improved several evaluation criteria. Multi-criteria evaluation using ensembles of performance measures provided a much more comprehensive assessment of the model performance than single efficiency statistics, which alone, could be misleading. Simulation of conservative source area tracers (Gran alkalinity) as part of the calibration procedure showed that a simple two-storage model is the minimum complexity needed to capture the dominant processes governing catchment response. Additionally, calibration was improved by the integration of tracers into the flow model, which constrained model uncertainty and improved the hydrodynamics of simulations in a way that plausibly captured the contribution of different source areas to streamflow. This approach contributes to the quest for low-parameter models that can achieve process-based simulation of hydrological response. Copyright © 2009 John Wiley & Sons, Ltd. [source] China's new Enterprise Bankruptcy Law,A great leap forward, but just how far?INTERNATIONAL INSOLVENCY REVIEW, Issue 2 2010Emily Lee The closure of many small and medium enterprises (SMEs) following the global financial crisis of 2008 spurred the Chinese government to follow its international counterparts in issuing an economic stimulus package. While it was effective in preventing many financially distressed SMEs from failure by boosting demand for its businesses, in the long run, such SMEs should be rescued through a statutory regime, which affords them temporary protection from creditors and provides them an opportunity to restructure their businesses. In doing so, the premature liquidation of SMEs would be prevented and SMEs with viable businesses but in temporary financial difficulties would be given a chance to succeed again. Although China's new Enterprise Bankruptcy Law (EBL) has shortcomings, it improves upon its predecessor legislation and, since it is still at an infantile stage of development, is bound for further reform. Despite the EBL's success in bringing Chinese corporate bankruptcy laws in line with international standards, full compliance with the UNCITRAL Model Law on Cross-Border Insolvency and UNCITRAL Legislative Guide on Insolvency Law remains to be seen. In September 2008, the South China Morning Post newspaper reported that the number of (applications for) corporate reorganization and bankruptcy cases had dropped, "leading to widespread speculation there are problems in the law's practical application".1 This article examines the implementation of the EBL, critiques key aspects of the EBL and argues for a comprehensive assessment of the EBL and for bringing the EBL in full compliance with the international standards on cross-border insolvency. Copyright © 2010 John Wiley & Sons, Ltd. [source] Continental-scale phenology: warming and chillingINTERNATIONAL JOURNAL OF CLIMATOLOGY, Issue 11 2010Mark D. Schwartz Abstract With abundant evidence of recent climate warming, most vegetation studies have concentrated on its direct impacts, such as modifications to seasonal plant and animal life cycle events (phenology). The most common examples are indications of earlier onset of spring plant growth and delayed onset of autumn senescence. However, less attention has been paid to the implications of continued warming for plant species' chilling requirements. Many woody plants that grow in temperate areas require a certain amount of winter chilling to break dormancy and prepare to respond to springtime warming. Thus, a comprehensive assessment of plant species' responses to warming must also include the potential impacts of insufficient chilling. When collected at continental scale, plant species phenological data can be used to extract information relating to the combined impacts of warming and reduced chilling on plant species physiology. In this brief study, we demonstrate that common lilac first leaf and first bloom phenology (collected from multiple locations in the western United States and matched with air temperature records) can estimate the species' chilling requirement (1748 chilling hours, base 7.2 °C) and highlight the changing impact of warming on the plant's phenological response in light of that requirement. Specifically, when chilling is above the requirement, lilac first leaf/first bloom dates advance at a rate of , 5.0/, 4.2 days per 100-h reduction in chilling accumulation, while when chilling is below the requirement, they advance at a much reduced rate of , 1.6/, 2.2 days per 100-h reduction. With continental-scale phenology data being collected by the USA National Phenology Network (http://www.usanpn.org), these and more complex ecological questions related to warming and chilling can be addressed for other plant species in future studies. Copyright © 2009 Royal Meteorological Society [source] Special acute care unit for older adults with Alzheimer's diseaseINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 2 2008Maria E. Soto Abstract Objective To describe the cognitive, functional, and nutritional features of patients admitted to a Special Acute Care Unit (SACU) for elderly patients with Alzheimer's disease (AD). Methods One-year observational study of patients with AD and other related disorders hospitalized in the SACU, Department of Geriatrics, Toulouse university Hospital during 2005. A comprehensive neurocognitive and non-cognitive geriatric assessment was performed. Data on full clinical evaluation, nutritional status, activities of daily living (ADL), gait and balance disturbance, behavioural and psychological symptoms (BPSD), and sociodemographics were recorded. Results Four-hundred and ninety-two patients were assessed. Their mean age was 81.1,±,7.7, the mean length of stay was 10.7,±,6.3 days, 62% were female, 63.9% were admitted from their own home and 30.4% from a nursing home. Eighty percent of patients had probable Alzheimer's disease or mixed dementia, less than 20% had other causes of dementia. Results of their comprehensive assessment showed a mean mini-mental state examination of 14.5,±,7.4; a mean total ADL score of 3.7,±,1.7. Seventy-seven percent had gait or balance disturbances; 90% of patients presented an unsatisfactory nutritional status. The most common reason for admission was BPSD. Conclusion AD complications are responsible for many acute admissions. Elderly patients suffering from dementia represent a population with unique clinical characteristics. Further randomised clinical trials are needed to evaluate the effectiveness of Special Acute Care Units for patients with AD and other related disorders. Copyright © 2007 John Wiley & Sons, Ltd. [source] Bathing Disability in Community-Living Older Persons: Common, Consequential, and ComplexJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 11 2004Aanand D. Naik MD Objectives: To identify the specific bathing subtasks that are affected in community-living-older persons with bathing disability and to determine the self-reported reasons for bathing disability. Design: Cross-sectional study. Setting: General community of greater New Haven, Connecticut. Participants: A total of 626 community-living persons, aged 73 and older, who completed a comprehensive assessment, including a detailed evaluation of bathing disability. Measurements: Trained research nurses assessed bathing disability (defined as requiring personal assistance or having difficulty washing and drying the whole body), the specific bathing subtasks that were affected, and the main reasons (up to three) for bathing disability. Results: Disability in bathing was present in 195 (31%) participants; of these, 97 required personal assistance (i.e., dependence), and 98 had difficulty bathing. Participants with bathing disability reported a mean±standard deviation of 4.0±2.4 affected subtasks. The prevalence rate of disability for the eight prespecified bathing subtasks ranged from 25% for taking off clothes to 75% for leaving the bathing position. The majority of participants (59%) provided more than one reason for bathing disability. The most common reasons cited by participants for their bathing disability were balance problems (28%), arthritic complaints (26%), and fall or fear of falling (23%). Conclusion: For community-living older persons, disability in bathing is common, involves multiple subtasks, and is attributable to an array of physical and psychological problems. Preventive and restorative interventions for bathing disability will need to account for the inherent complexity of this essential activity of daily living. [source] Establishing a Case-Finding and Referral System for At-Risk Older Individuals in the Emergency Department Setting: The SIGNET ModelJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 10 2001Lorraine C. Mion PhD Older emergency department (ED) patients have complex medical, social, and physical problems. We established a program at four ED sites to improve case finding of at-risk older adults and provide comprehensive assessment in the ED setting with formal linkage to community agencies. The objectives of the program are to (1) improve case finding of at-risk older ED patients, (2) improve care planning and referral for those returning home, and (3) create a coordinated network of existing medical and community services. The four sites are a 1,000-bed teaching center, a 700-bed county teaching hospital, a 400-bed community hospital, and a health maintenance organization (HMO) ED site. Ten community agencies also participated in the study: four agencies associated with the hospital/HMO sites, two nonprofit private agencies, and four public agencies. Case finding is done using a simple screening assessment completed by the primary or triage nurse. A geriatric clinical nurse specialist (GCNS) further assesses those considered at risk. Patients with unmet medical, social, or health needs are referred to their primary physicians or to outpatient geriatric evaluation and management centers and to community agencies. After 18 months, the program has been successfully implemented at all four sites. Primary nurses screened over 70% (n = 28,437) of all older ED patients, GCNSs conducted 3,757 comprehensive assessments, participating agency referrals increased sixfold, and few patients refused the GCNS assessment or subsequent referral services. Thus, case finding and community linkage programs for at-risk older adults are feasible in the ED setting. [source] Using ants as bioindicators in land management: simplifying assessment of ant community responsesJOURNAL OF APPLIED ECOLOGY, Issue 1 2002Alan N. Andersen Summary 1The indicator qualities of terrestrial invertebrates are widely recognized in the context of detecting ecological change associated with human land-use. However, the use of terrestrial invertebrates as bioindicators remains more a topic of scientific discourse than a part of land-management practice, largely because their inordinate numbers, taxonomic challenges and general unfamiliarity make invertebrates too intimidating for most land-management agencies. Terrestrial invertebrates will not be widely adopted as bioindicators in land management until simple and efficient protocols have been developed that meet the needs of land managers. 2In Australia, ants are one group of terrestrial insects that has been commonly adopted as bioindicators in land management, and this study examined the reliability of a simplified ant assessment protocol designed to be within the capacity of a wide range of land managers. 3Ants had previously been surveyed intensively as part of a comprehensive assessment of biodiversity responses to SO2 emissions from a large copper and lead smelter at Mt Isa in the Australian semi-arid tropics. This intensive ant survey yielded 174 species from 24 genera, and revealed seven key patterns of ant community structure and composition in relation to habitat and SO2 levels. 4We tested the extent to which a greatly simplified ant assessment was able to reproduce these results. Our simplified assessment was based on ant ,bycatch' from bucket-sized (20-litre) pitfall traps used to sample vertebrates as part of the broader biodiversity survey. We also greatly simplified the sorting of ant morphospecies by considering only large (using a threshold of 4 mm) species, and we reduced sorting time by considering only the presence or absence of species at each site. In this manner, the inclusion of ants in the assessment process required less than 10% of the effort demanded by the intensive ant survey. 5Our simplified protocol reproduced virtually all the key findings of the intensive survey. This puts effective ant monitoring within the capacity of a wide range of land managers. [source] | ||||||||||||||||||||||||||||||||||||||||||||||||||||