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Complex Area (complex + area)
Selected AbstractsDiabetes control and complications: the role of glycated haemoglobin, 25 years onDIABETIC MEDICINE, Issue 7 2004S. L. Jeffcoate Abstract The long-term complications of diabetes have major consequences for individual subjects and growing healthcare delivery and cost implications for society. Evidence for the benefits of good glycaemic control, as monitored by glycated haemoglobin measurements, has been developed in the 25 years since they were introduced to the point where HbA1c assays play central roles in patient management, clinical guidance and audit, and clinical trial design. In this review this evidence is examined and three classes of uncertainty identified that diminish confidence in the effectiveness of these roles for HbA1c. 1Analytical variability between different methods for HbA1c has restricted the application of clinical targets and this problem has recently been addressed by reference method standardization. There are two approaches to this which result in different HbA1c values and this discrepancy needs to be resolved. 2Biological variability in HbA1c values between individuals also restricts its predictive role when applied to populations. The correlations between HbA1c measurements and various components of glycaemia (overall, fasting, postprandial) are still uncertain and differences in protein glycation and de-glycation are greater between subjects than often thought. The influence of variability in erythrocyte life span is an area where research is needed, especially in diabetic subjects. 3Clinical variability is the most important and complex area of uncertainty. A predictive link between HbA1c and clinical outcomes is not as clear-cut as often stated. The correlation with the development of microvascular disease is well established in Type 1 diabetes, but in Type 2 subjects (90% of those with diabetes) the evidence that HbA1c monitoring is of value in predicting or preventing macrovascular disease is not strong, although it is the major cause of morbidity and early death in this group. It is recommended that, as a matter of urgency, these issues be examined, particularly within the context of self-care in diabetes. Diabet. Med. **, ***,*** (2003) [source] Insights into biaxial extensional tectonics: an examplefrom the Sand,kl, Graben, West Anatolia, TurkeyGEOLOGICAL JOURNAL, Issue 1 2003Mustafa Cihan Abstract West Anatolia, together with the Aegean Sea and the easternmost part of Europe, is one of the best examples of continental extensional tectonics. It is a complex area bounded by the Aegean,Cyprus Arc to the south and the North Anatolian Fault Zone (NAFZ) to the north. Within this complex and enigmatic framework, the Sand,kl, Graben (10,km wide, 30,km long) has formed at the eastern continuation of the Western Anatolian extensional province at the north-northwestward edge of the Isparta Angle. Recent studies have suggested that the horst,graben structures in West Anatolia formed in two distinct extensional phases. According to this model the first phase of extension commenced in the Early,Middle Miocene and the last, which is accepted as the onset of neotectonic regime, in Early Pliocene. However, it is controversial whether two-phase extension was separated by a short period of erosion or compression during Late Miocene,Early Pliocene. Both field observations and kinematic analysis imply that the Sand,kl, Graben has existed since the Late Pliocene, with biaxial extension on its margins which does not necessarily indicate rotation of regional stress distribution in time. Although the graben formed later in the neotectonic period, the commencement of extension in the area could be Early Pliocene (c. 5,Ma) following a severe but short time of erosion at the end of Late Miocene. The onset of the extensional regime might be due to the initiation of westward motion of Anatolian Platelet along the NAFZ that could be triggered by the higher rate of subduction at the east Aegean,Cyprus Arc in the south of the Aegean Sea. Copyright © 2003 John Wiley & Sons, Ltd. [source] Correlation between sea surface topography and bathymetry in shallow shelf waters in the Western MediterraneanGEOPHYSICAL JOURNAL INTERNATIONAL, Issue 3 2002G. Rodríguez Velasco Summary In this paper, gravimetric and altimetric data are used to assess an estimation of the sea surface topography in the Western Mediterranean Sea. This is a complex area from different points of view, due to the presence of several islands, coastal lines, shallow waters and a peculiar hydrologic equilibrium due to its proximity to the Atlantic water exchange area. First, a gravimetric geoid was computed using the least-squares collocation (LSC) procedure with the classical remove-restore technique. We also present a local mean sea surface generated from repeat ERS-1 altimeter data fitted to TOPEX. We chose this satellite because it offers a better spatial resolution than the TOPEX data. The time span used in the computations is one year. This is a useful interval for averaging out the regular seasonal variations, which are very large in this area. We present the comparisons between the gravimetric geoidal heights and the adjusted sea surface. This is a way to obtain a rough estimation of the sea surface topography (SST) since we also include the errors in the two surfaces and other oceanic signals. The differences obtained are physically reasonable with a mean of 17 cm and standard deviation (s.d.) of 39 cm. A significant similarity is observed between the features reproduced by these differences and the bathymetry in the area, suggesting some sort of correlation between both magnitudes for the studied region. If we accept such correlation, the SST may be described as a function of depth. This procedure lets us filter out the short wavelength part of the geoid from the first SST estimation. [source] What is the real gain after liver transplantation?LIVER TRANSPLANTATION, Issue S2 2009James Neuberger Key Points 1. For most liver allograft recipients, both the quality and length of life are greatly improved after transplantation. However, neither the quality of life nor the length of life in the survivors returns to that seen in age-matched and sex-matched normal subjects. 2. The gain in survival after transplantation can be estimated by a comparison of the actual outcome after transplantation and the predicted survival in the absence of transplantation. 3. The reduction in graft and patient survival, in comparison with a normal age-matched and sex-matched population, is determined by several factors: short-term survival is affected by the patient's condition pre-transplant and the quality of the graft, and for longer term survival, recurrent disease accounts for most of the differences seen between different indications. Some of the causes of premature death (such as infection, de novo malignancy, and cardiovascular and cerebrovascular disease) that are increased in the liver allograft recipient may be reduced by improved management with more aggressive surveillance and treatment. 4. The aims of selection and allocation vary in different health care systems: transparency, objectivity, equity of access, justice, mortality awaiting transplantation, utility, and transplant benefit are all important but often competing demands. Understanding the associated increase in survival will allow for a rational approach to this complex area. Liver Transpl 15:S1,S5, 2009. © 2009 AASLD. [source] Testing an empirically derived mental health training model featuring small groups, distributed practice and patient discussionMEDICAL EDUCATION, Issue 2 2009Rachael C Murrihy Objectives, Internationally, family doctors seeking to enhance their skills in evidence-based mental health treatment are attending brief training workshops, despite clear evidence in the literature that short-term, massed formats are not likely to improve skills in this complex area. Reviews of the educational literature suggest that an optimal model of training would incorporate distributed practice techniques; repeated practice over a lengthy time period, small-group interactive learning, mentoring relationships, skills-based training and an ongoing discussion of actual patients. This study investigates the potential role of group-based training incorporating multiple aspects of good pedagogy for training doctors in basic competencies in brief cognitive behaviour therapy (BCBT). Methods, Six groups of family doctors (n = 32) completed eight 2-hour sessions of BCBT group training over a 6-month period. A baseline control design was utilised with pre- and post-training measures of doctors' BCBT skills, knowledge and engagement in BCBT treatment. Results, Family doctors' knowledge, skills in and actual use of BCBT with patients improved significantly over the course of training compared with the control period. Conclusions, This research demonstrates preliminary support for the efficacy of an empirically derived group training model for family doctors. Brief CBT group-based training could prove to be an effective and viable model for future doctor training. [source] Comparative phylogeography of unglaciated eastern North AmericaMOLECULAR ECOLOGY, Issue 14 2006DOUGLAS E. SOLTIS Abstract Regional phylogeographical studies involving co-distributed animal and plant species have been conducted for several areas, most notably for Europe and the Pacific Northwest of North America. Until recently, phylogeographical studies in unglaciated eastern North America have been largely limited to animals. As more studies emerge for diverse lineages (including plants), it seems timely to assess the phylogeography across this region: (i) comparing and contrasting the patterns seen in plants and animals; (ii) assessing the extent of pseudocongruence; and (iii) discussing the potential applications of regional phylogeography to issues in ecology, such as response to climatic change. Unglaciated eastern North America is a large, geologically and topographically complex area with the species examined having diverse distributions. Nonetheless, some recurrent patterns emerge: (i) maritime , Atlantic vs. Gulf Coast; (ii) Apalachicola River discontinuity; (iii) Tombigbee River discontinuity; (iv) the Appalachian Mountain discontinuity; (v) the Mississippi River discontinuity; and (vi) the Apalachicola River and Mississippi River discontinuities. Although initially documented in animals, most of these patterns are also apparent in plants, providing support for phylogeographical generalizations. These patterns may generally be attributable to isolation and differentiation during Pleistocene glaciation, but in some cases may be older (Pliocene). Molecular studies sometimes agree with longstanding hypotheses of glacial refugia, but also suggest additional possible refugia, such as the southern Appalachian Mountains and areas close to the Laurentide Ice Sheet. Many species exhibit distinct patterns that reflect the unique, rather than the shared, aspects of species' phylogeographical histories. Furthermore, similar modern phylogeographical patterns can result from different underlying causal factors operating at different times (i.e. pseudocongruence). One underemphasized component of pseudocongruence may result from the efforts of researchers to categorize patterns visually , similar patterns may, in fact, not fully coincide, and inferring agreement may obscure the actual patterns and lead to erroneous conclusions. Our modelling analyses indicate no clear spatial patterning and support the hypothesis that phylogeographical structure in diverse temperate taxa is complex and was not shaped by just a few barriers. [source] Current and emerging concepts in tumour metastasis,THE JOURNAL OF PATHOLOGY, Issue 1 2010Caroline Coghlin Abstract Disseminated cancer accounts for most deaths due to malignancy. Despite this, research has focused predominantly on tumour development and progression at the primary site. Recently, attention has shifted towards the field of tumour metastasis. Several new and exciting concepts that have emerged in the past few years may shed light on this complex area. The established canonical theory of tumour metastasis, as a process emerging from a stepwise accumulation of genetic events fuelled by clonal evolution, has been challenged. New evidence suggests that malignant cells can disseminate at a much earlier stage than previously recognized in tumourigenesis. These findings have direct relevance to clinical practice and shed new light on tumour biology. Gene-profiling studies support this theory, suggesting that metastatic ability may be an innate property shared by the bulk of cells present early in a developing tumour mass. There is a growing recognition of the importance of host factors outside the primary site in the development of metastatic disease. The role of the ,pre-metastatic niche' is being defined and with this comes a new understanding of the function of bone marrow-derived progenitor cells in directing the dissemination of malignant cells to distant sites. Current research has highlighted the crucial roles played by non-neoplastic host cells within the tumour microenvironment in regulating metastasis. These new concepts have wide-ranging implications for our overall understanding of tumour metastasis and for the development of cancer therapeutics. Copyright © 2010 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd. [source] The mismanagement of the assets of older people: the concerns and actions of aged care practitioners in QueenslandAUSTRALASIAN JOURNAL ON AGEING, Issue 1 2003Cheryl Tilse Objective: To explore the types of financial abuse coming to their attention of aged care workers, the practice responses and the barriers to effective responses. Method: A mailed survey of 159 ACAT members, allied health professionals and other aged care workers across metropolitan, regional and remote Queensland. Results: Financial abuse is coming to the attention of a broad range of aged care workers. It takes a variety of forms with a consistent pattern reported across urbanlregionallrural locations and differing ethnic groups. Although a range of resources exists, one third of respondents reported limitations in their capacity to intervene appropriately. Conclusions: This complex area requires a greater understanding of the dimensions of financial abuse, further evaluation of the effectiveness of current mechanisms, professional and community education and additional support for workers seeking to intervene. [source] Voluntariness, intention, and the defence of mental disorder: toward a rational approach,BEHAVIORAL SCIENCES & THE LAW, Issue 5 2003Bernadette McSherry B.A.(Hons), D.Jur., Grad.Dip.Psych., LL.B.(Hons), LL.M. This article addresses how mental disorder may be used in common law countries to negate the requirements of voluntariness and intention in serious criminal offences as well as to provide the basis for current versions of the insanity defence. The notion that mental disorder can cause conduct to become completely involuntary or unintentional is questionable, given current thinking in the behavioral sciences. This article argues that different forms of mental disorder should be subsumed within a separate defence of mental disorder. Providing that a range of dispositional options is available, the law in this complex area would be simplified and brought into line with current psychological notions of goal-directed behavior. Copyright © 2003 John Wiley & Sons, Ltd. [source] Dispersal history of a spider (Stegodyphus lineatus) across contiguous deserts: vicariance and range expansionBIOLOGICAL JOURNAL OF THE LINNEAN SOCIETY, Issue 4 2005JES JOHANNESEN Israel marks a crossroads between three continents encompassing several phytogeographical and zoogeographical zones. In this complex area, the flow of species from different biogeographical regions creates opportunities to study how geographical division and colonization routes affect current distribution and structure of resident populations of organisms associated with desert and arid environments, habitats that may have persisted throughout Pleistocene glacial periods. The present paper analyses the population history of the spider Stegodyphus lineatus in the contiguous Negev and Judean deserts in Israel using allozyme and mtDNA variation. The distinct patterns of variation indicate that Judean and Negev populations are vicariant lineages. The residence time was longer in Judea, where populations were more polymorphic for mtDNA, showed isolation by distance and were less structured than in the Negev. The Negev population, possibly linked to other Mediterranean populations of S. lineatus, consisted of two subdivisions derived from a recent eastward expansion across the central Negev watershed. Despite differences in age and level of structure, all lineages show similar dispersal processes dominated by restricted gene flow. The distribution patterns of allozyme and mtDNA markers are unrelated to geographical patterns of precipitation and vegetation. Rather, they follow large-scale topographic features, namely the water divide between Mediterranean and Afro-Syrian rift drainages and between eastern and western Negev drainages. © 2005 The Linnean Society of London, Biological Journal of the Linnean Society, 2005, 84, 739,754. [source] Deep fascia on the dorsum of the ankle and foot: Extensor retinacula revisitedCLINICAL ANATOMY, Issue 2 2007Marwan F. Abu-Hijleh Abstract This study revisits the anatomy of the deep fascia over the distal leg, ankle, and dorsum of the foot. The arrangement of the deep fascia in these regions was recorded in 14 lower limbs of adult cadavers using photographs and drawings. The fascial layer from all three sites was subsequently removed in toto, and serial thickness measurements were made along its entire length. In addition, fiber disposition was studied under polarized light, and sections were stained to demonstrate collagen. The arrangement of deep fascia is complex. A common and novel finding at all levels is a crisscross, lattice-like arrangement of fibers. There was little evidence of the clearly defined sturdy band of the superior extensor retinaculum (SER) or of the Y-shaped inferior retinaculum (IER) commonly illustrated in topographical anatomy texts. The SER is a complex area with several thickenings commencing about 3 cm proximal to the tip of the lateral malleolus and gradually increasing to reach a maximum of 270 ,m about 5 cm above the malleolus, then gradually returning to original thickness, about 9 cm above the malleolus. Fibers crossing diagonally to each other are a feature of the region. The IER characteristically has two forms: either a cross-shaped band (9 specimens) or a thickened "node" with small extensions radiating toward the malleoli (5 specimens), located about 1,2 cm distal to the lateral malleolus and centred over the common tendon of extensor digitorum where it has maximum thickness (430 ,m). The deep fascia is thickened and firmly attached over both malleoli and to the tarsals and metatarsals along both borders of the foot. In general, the deep fascial structures were thicker in males than those in females. Clin. Anat. 20:186,195, 2007. © 2006 Wiley-Liss, Inc. [source] Migration velocity analysis for tilted transversely isotropic mediaGEOPHYSICAL PROSPECTING, Issue 1 2009Laxmidhar Behera ABSTRACT Tilted transversely isotropic formations cause serious imaging distortions in active tectonic areas (e.g., fold-and-thrust belts) and in subsalt exploration. Here, we introduce a methodology for P-wave prestack depth imaging in tilted transversely isotropic media that properly accounts for the tilt of the symmetry axis as well as for spatial velocity variations. For purposes of migration velocity analysis, the model is divided into blocks with constant values of the anisotropy parameters , and , and linearly varying symmetry-direction velocity VP0 controlled by the vertical (kz) and lateral (kx) gradients. Since determination of tilt from P-wave data is generally unstable, the symmetry axis is kept orthogonal to the reflectors in all trial velocity models. It is also assumed that the velocity VP0 is either known at the top of each block or remains continuous in the vertical direction. The velocity analysis algorithm estimates the velocity gradients kz and kx and the anisotropy parameters , and , in the layer-stripping mode using a generalized version of the method introduced by Sarkar and Tsvankin for factorized transverse isotropy with a vertical symmetry axis. Synthetic tests for several models typical in exploration (a syncline, uptilted shale layers near a salt dome and a bending shale layer) confirm that if the symmetry-axis direction is fixed and VP0 is known, the parameters kz, kx, , and , can be resolved from reflection data. It should be emphasized that estimation of , in tilted transversely isotropic media requires using nonhyperbolic moveout for long offsets reaching at least twice the reflector depth. We also demonstrate that application of processing algorithms designed for a vertical symmetry axis to data from tilted transversely isotropic media may lead to significant misfocusing of reflectors and errors in parameter estimation, even when the tilt is moderate (30°). The ability of our velocity analysis algorithm to separate the anisotropy parameters from the velocity gradients can be also used in lithology discrimination and geologic interpretation of seismic data in complex areas. [source] Migration velocity analysis and waveform inversionGEOPHYSICAL PROSPECTING, Issue 6 2008William W. Symes ABSTRACT Least-squares inversion of seismic reflection waveform data can reconstruct remarkably detailed models of subsurface structure and take into account essentially any physics of seismic wave propagation that can be modelled. However, the waveform inversion objective has many spurious local minima, hence convergence of descent methods (mandatory because of problem size) to useful Earth models requires accurate initial estimates of long-scale velocity structure. Migration velocity analysis, on the other hand, is capable of correcting substantially erroneous initial estimates of velocity at long scales. Migration velocity analysis is based on prestack depth migration, which is in turn based on linearized acoustic modelling (Born or single-scattering approximation). Two major variants of prestack depth migration, using binning of surface data and Claerbout's survey-sinking concept respectively, are in widespread use. Each type of prestack migration produces an image volume depending on redundant parameters and supplies a condition on the image volume, which expresses consistency between data and velocity model and is hence a basis for velocity analysis. The survey-sinking (depth-oriented) approach to prestack migration is less subject to kinematic artefacts than is the binning-based (surface-oriented) approach. Because kinematic artefacts strongly violate the consistency or semblance conditions, this observation suggests that velocity analysis based on depth-oriented prestack migration may be more appropriate in kinematically complex areas. Appropriate choice of objective (differential semblance) turns either form of migration velocity analysis into an optimization problem, for which Newton-like methods exhibit little tendency to stagnate at nonglobal minima. The extended modelling concept links migration velocity analysis to the apparently unrelated waveform inversion approach to estimation of Earth structure: from this point of view, migration velocity analysis is a solution method for the linearized waveform inversion problem. Extended modelling also provides a basis for a nonlinear generalization of migration velocity analysis. Preliminary numerical evidence suggests a new approach to nonlinear waveform inversion, which may combine the global convergence of velocity analysis with the physical fidelity of model-based data fitting. [source] Effects of topography on the spatial distribution of evapotranspiration over a complex terrain using two-source energy balance model with ASTER dataHYDROLOGICAL PROCESSES, Issue 16 2009H. K. Kafle Abstract Spatial distribution of evapotranspiration (ET) over a complex terrain is estimated using a new approach of the conventional two-source energy balance (TSEB) model by considering the effect of topography (difference in slope and aspect). We name this approach topography considered two-source energy balance (T2SEB) model. The novelty of this model is the estimation of incoming shortwave solar radiation considering slope, aspect, altitude, latitude, longitude, and the day of calculation in the TSEB model, so that the new model should have wider applicability than existing models over topographically complex areas. In this study, high spatial resolution Advanced Spaceborne Thermal Emission and Reflection Radiometer (ASTER) data and meteorological data are used. ET over a complex terrain of Nagoya, Japan, on three different dates, 4 November 2005, 25 May 2004 and 30 October 2003, is estimated using both TSEB and T2SEB models. To validate both models, estimated results are compared with ground observation data at the flux tower site. Moreover, estimated results from TSEB and T2SEB models are compared in five different locations of different topography within the study area. Variation of net radiation absorbed by the surface (Rn) with topographical variables is also studied with the help of scatter plots. Estimated results for all three dates agreed within ±75 W m,2 with calculated values from both models at the flux tower site. TSEB underestimated/overestimated ET in sunlit/shaded areas in hilly areas. The T2SEB model estimated ET in hilly areas better than the TSEB model. Copyright © 2009 John Wiley & Sons, Ltd. [source] Extreme population subdivision throughout a continuous range: phylogeography of Batrachoseps attenuatus (Caudata: Plethodontidae) in western North AmericaMOLECULAR ECOLOGY, Issue 20 2007IÑIGO MARTÍNEZ, SOLANO Abstract Low-vagility species with deep evolutionary histories are key to our understanding of the biogeographical history of geologically complex areas, such as the west coast of North America. We present a detailed study of the phylogeography of the salamander Batrachoseps attenuatus (Caudata: Plethodontidae) using sequences of the mitochondrial gene cob from 178 individuals sampled from throughout the species' range. Sequences of three other mitochondrial genes (16S, cox1, nad4) and a nuclear gene (RAG-1) were used to investigate the deeper evolutionary history of the species. We found high levels of genetic diversity and deep divergences within a mostly continuous distribution, with five genetically well-differentiated and geographically structured mitochondrial DNA clades. Significant association between geographical and genetic distances within these clades suggests demographic stability, whereas Fu's FS tests suggest demographic expansions in three of them. Mantel tests identify two biogeographical barriers, the San Andreas Fault and the Sacramento,San Joaquin Delta, as important in the diversification of lineages. The timing of the main splitting events between intraspecific lineages was estimated by applying relaxed molecular clock methods combining several mutation rates and a fossil calibration. The earliest splitting events are old (Pliocene/Miocene), with more recent (Pleistocene) subdivisions in some clades. Disjunct populations distributed along the western foothills of the Sierra Nevada colonized this area relatively recently from a single refugium east of San Francisco Bay. The combination of fine-scale, comprehensive sampling with phylogenetic, historical demographic and hypothesis-based tests allowed delineation of a complex biogeographical scenario with general implications for the study of codistributed taxa. [source] | ||||||||||||||||