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Continuing
Terms modified by Continuing Selected AbstractsHotel NHS and the acute abdomen , admit first, investigate laterINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 12 2009K. Aryal Summary Aim:, To determine the financial consequences of a policy of admission first, followed by definitive investigation for patients with an admission diagnosis of suspected acute abdomen. Results:, Over a 1-month period, 122 patients were admitted with a suspected surgical diagnosis of acute abdomen (55 men, 67 women); age range 16,95 years (median: 56.5). Based on surgical operation required (n = 36), death after admission (n = 6, three postoperative deaths) and/or severe surgical illness (n = 17), 56 required surgical inpatient admission, while 66 did not. The patients who did not require admission spent significantly shorter time in hospital than those who required admission (median: 5 days vs. 8.5 days; p = 0.0000). Total hospital hotel and investigation cost (not including ITU or theatre costs) for all 122 patients was £330,468. Overall, £205,468 was consumed by these 56 patients who required admission, while £125,000 was spent on 66 patients whose clinical course did not justify admission; 92% of which was spent on hospital hotel costs and 8% on the cost of imaging and/or endoscopy. Discussion and conclusion:, On a national basis, emergency General Surgery admissions account for 1000 Finished Consultant Episodes per 100,000 population. The findings of this study suggest that this equates to a national NHS spend of £650 million each year, for the hotel costs of patients that could arguably avoid surgical admission altogether. Continuing to admit patients with a suspected acute abdomen first and then requesting definitive investigation makes neither clinical nor economic sense. [source] Self-help in the long-term treatment of obesityOBESITY REVIEWS, Issue 2 2001J. D. Latner Summary Despite the short-term success of professional behavioural techniques for obesity, weight losses are typically regained following treatment. The long-term maintenance of treatment effects will probably require ongoing, continuing care. Continuing care may be economically feasible when administered through self-help treatment modalities. Self-help confers a number of psychological benefits, such as self-reliance and an increased sense of empowerment. The effectiveness and cost-effectiveness of various modalities of self-help are reviewed, including purely self-prompted help, self-administered manuals, computer-assisted therapy, professionally assisted correspondence courses, and non-profit and commercial self-help groups. Stepped-care models suggest using a combination of these approaches when appropriate. However, logistical difficulties present themselves in stepped-care approaches with obesity, such as the complicating effects of severity and comorbidity on stepped-care status. Self-help groups are a promising venue for the provision of continuing care and as an adjunct to more intensive, specialty therapies. [source] TIME MATTERS IN TEAM PERFORMANCE: EFFECTS OF MEMBER FAMILIARITY, ENTRAINMENT, AND TASK DISCONTINUITY ON SPEED AND QUALITYPERSONNEL PSYCHOLOGY, Issue 3 2003DAVID A. HARRISON We compared the speed and quality of performance for familiar, initially unfamiliar but continuing, and one-shot (single session) teams. We also proposed and observed entrainment effects for task time limits. Over the course of weekly sessions with changing tasks, continuing teams reached speed levels of the initially familiar teams, but the one-shot teams were consistently slower. Continuing teams also tended to have higher-quality output than the one-shot teams. There were no differences in how quickly each type of group entrained to time limits on the tasks. Entrainment was not robust to task discontinuity (Task A, then B). However, entrainment on repeated trials of a task persisted even when a different type of task "interrupted" those repeated trials (Task A, then B, then A again). Results compel a richer incorporation of time as a medium for complex task sequences, and time-based constructs as a feature of team membership in the study of group effectiveness. [source] Latest news and product developmentsPRESCRIBER, Issue 2 2007Article first published online: 1 MAR 200 Venlafaxine: same suicide risk Venlafaxine (Efexor) is probably not associated with a higher risk of suicide than citalopram, fluoxetine or dosulepin, even when prescribed for patients at higher risk, according to an analysis of the UK General Practice Research Database (BMJ, doi:10.1136/bmj.39041.445104.BE. Published 12 December 2006). The retrospective cohort study found that venlafaxine was associated with a significantly higher risk of completed and attempted suicide in adults than the other antidepressants but, after adjusting for risk factors, the authors concluded that much, if not all, of the difference could be explained by confounding. Raised glucose with thiazides not clinically significant? A new analysis of the ALLHAT trial suggests that the small increase in blood glucose levels associated with long-term thiazide therapy is not associated with an increased risk of cardiovascular events (Arch Intern Med 2006;166:2191-201). The ALLHAT trial compared cardiovascular outcomes in over 18 000 patients with hypertension who were treated with chlortali- done (Hygroton), amlodipine and lisinopril. After two years, fasting blood glucose had increased in all groups (by 0.47, 0.31 and 0.19mmol per litre respectively); compared with chlortalidone, the odds of developing diabetes were 45 per cent lower with lisinopril and 27 per cent lower with amlodipine. However, there was no significant link between fasting blood glucose levels and cardiovascular events, end-stage renal disease or death; developing diabetes was associated with an increased risk of CHD overall but this was not statistically significant for chlortalidone in particular. Withdrawing alendronate after five years' treatment Discontinuing treatment of osteoporosis with alendronate after five years does not significantly increase fracture risk for many women, a US study has shown (J Am Med Assoc 2006;296:2927-38). In this five-year extension to the Fracture Intervention Trial, 1099 women who had taken alendronate for five years were randomised to continue treatment or switch to placebo for a further five years. In those taking placebo, bone mineral density decreased by 2.4 per cent at the hip and 3.7 per cent in the spine but remained above pre- treatment levels. Continuing with alendronate was associated with a lower risk of clinical vertebral fractures (2.4 vs 5.3 per cent) but no significant reduction in morphometric vertebral fractures (9.8 vs 11.3 per cent respectively). The cumulative risk of nonvertebral fractures was 19 per cent in each group. The authors conclude that women at very high risk of clinical vertebral fractures may benefit from continuing alendronate, but for many discontinuation does not appear to increase fracture risk. Instructions on labels Patients with low levels of literacy are at high risk of not understanding medicines labelling (Ann Intern Med 2006;145:887-94). In 395 English-speaking adults, 71 per cent correctly repeated simple label instructions, but only 35 per cent could demonstrate the correct number of tablets involved. Low literacy levels were associated with a twofold increased risk of misunderstanding labelling. Statins campaign The National Prescribing Centre (NPC) has launched a campaign to increase prescribing of low-cost statins. Resources available from its website at www.npc.co.uk/statins.htm are divided into four categories: policy and guidance, therapeutics, implementation resources and monitoring tools. Formats include documents and case studies, Powerpoint presentations and E-learning workshops. patients feeling rested on waking and daytime functioning. The Z-drugs were also believed to cause fewer adverse effects. GPs believe in ,Z' drugs A survey of GPs in Lincolnshire has revealed that their beliefs about nonbenzodiazepine hypnotics are inconsistent with NICE guidance and published evidence (Br J Gen Pract 2006; 56:964-7). Responders believed that zaleplon (Sonata), zopiclone and zolpidem were superior to benzodiazepines in increasing sleep time, patients feeling rested on waking and daytime functioning. The Z-drugs were also believed to cause fewer adverse effects. The authors note that, while benzodiazepine prescribing is declining, that of the Z-drugs is increasing, and they suggest this may be explained by misplaced beliefs about their relative effectiveness and safety. Pharmacy EHC guidance Pharmacists can supply emergency hormonal contraception (EHC) in advance but should consider when it is clinically appropriate to do so, according to revised guidance from the Royal Pharmaceutical Society. The move follows support for advance supply from the British Pregnancy Advisory Service and Marie Stopes International. Pharmacists are advised to decline repeated requests and recommend contraception instead, and to counsel users on using EHC safely and appropriately. More support from NICE NICE has developed two databases to support implementation of its recommendations. The shared learning database (www.nice.org.uk/ sharedlearning) includes experiences of implementing NICE guidance. The second, known as ERNIE (Evaluation and Review of NICE Implementation Evidence), includes data provided by NICE on uptake of its advice and external information (www.nice.org.uk/ernie). Mental health briefings The DoH (www.dh.gov.uk) has published several briefing documents to explain the main changes to mental health legislation, covering professional roles, criteria for detention and supervised community treatment (SCT). SCT applies to patients with a stable chronic mental disorder who have been discharged from hospital and who, but for their treatment, may pose a risk to themselves or others. Patients remain the responsibility of the mental health team. Copyright © 2007 Wiley Interface Ltd [source] Prevent major failures and accidents with well-trained and empowered operatorsPROCESS SAFETY PROGRESS, Issue 2 2010Muhammad Idrees Abstract This article shares Engro's experience at its ammonia plant involving the prevention of major failures of the synthesis gas compressor turbine by taking prompt action to shutdown the compressor. Engro's strategy of providing operations training to enable and empower its people to make the right decisions at right time is the major learning of this article, whereby a manual shutdown before the automatic instrumentation trip of the machine was initiated. This article also describes the techniques used by the operations team to train and empower their people. Despite a plant outage of more than 10 days to replace the rotor, we believe the manual shutdown averted a more disastrous situation. Continuing to run the turbine may have resulted in a safety incident or an even longer plant shutdown for significant repairs. A well-trained and empowered operator is always helpful by making prompt decisions to shut down equipment, rather than relying solely on instrumentation to protect equipment. The following is a discussion of the training program which enables and empowers the operator to make correct decisions and take the correct action at the right time. © 2009 American Institute of Chemical Engineers Process Saf Prog, 2010 [source] Health Care Information Technology in Rural America: Electronic Medical Record Adoption Status in Meeting the National AgendaTHE JOURNAL OF RURAL HEALTH, Issue 2 2008James A. Bahensky MS ABSTRACT:,Continuing is a national political drive for investments in health care information technology (HIT) that will allow the transformation of health care for quality improvement and cost reduction. Despite several initiatives by the federal government to spur this development, HIT implementation has been limited, particularly in the rural market. The status of technology use in the transformation effort is reviewed by examining electronic medical records (EMRs), analyzing the existing rural environment, identifying barriers and factors affecting their development and implementation, and recommending needed steps to make this transformation occur, particularly in rural communities. A review of the literature for HIT in rural settings indicates that very little progress has been made in the adoption and use of HIT in rural America. Financial barriers and a large number of HIT vendors offering different solutions present significant risks to rural health care providers wanting to invest in HIT. Although evidence in the literature has demonstrated benefits of adopting HIT such as EMRs, important technical, policy, organizational, and financial barriers still exist that prevent the implementation of these systems in rural settings. To expedite the spread of HIT in rural America, federal and state governments along with private payers, who are important beneficiaries of HIT, must make difficult decisions as to who pays for the investment in this technology, along with driving standards, simplifying approaches for reductions in risk, and creating a workable operational plan. [source] Transcatheter versus Surgical Closure of Secundum Atrial Septal Defect in Adults: Impact of Age at Intervention.CONGENITAL HEART DISEASE, Issue 3 2007A Concurrent Matched Comparative Study Abstract Objectives., To compare the short- and mid-term outcomes of surgical (SUR) vs. transcatheter closure of secundum atrial septal defect (ASD) using Amplatzer septal occluder (ASO) in adults with a very similar spectrum of the disease; and to identify predictors for the primary end point. Design., Single-center, concurrent comparative study. Surgically treated patients were randomly matched (2:1) by age, sex, date of procedure, ASD size, and hemodynamic profile. Setting., Tertiary referral center. Patients., One hundred sixty-two concurrent patients with ASD submitted to ASO (n = 54) or SUR closure (n = 108) according with their preferences. Main Outcome Measures., Primary end point was a composite index of major events including failure of the procedure, important bleeding, critical arrhythmias, serious infections, embolism, or any major cardiovascular intervention-related complication. Predictors of these major events were investigated. Results., Atrial septal defects were successfully closed in all patients, and there was no mortality. The primary event rate was 13.2% in ASO vs. 25.0% in SUR (P = .001). Multivariate analysis showed that higher rate of events was significantly associated with age >40 years; systemic/pulmonary output ratio <2.1; and systolic pulmonary arterial pressure >50 mm Hg; while in the ASO group the event rate was only associated with the ASD size (>15 cm2/m2; relative risk = 1.75, 95% confidence interval 1.01,8.8). There were no differences in the event-free survival curves in adults with ages <40 years. Conclusions., The efficacy for closure ASD was similar in both groups. The higher morbidity observed in SUR group was observed only in the patients submitted to the procedure with age >40 years. The length of hospital stay was shorter in the ASO group. Surgical closure is a safe and effective treatment, especially in young adults. There is certainly nothing wrong with continuing to do surgery in countries where the resources are limited. [source] Usefulness of Serial Assessment of Natriuretic Peptides in the Emergency Department for Patients With Acute Decompensated Heart FailureCONGESTIVE HEART FAILURE, Issue 4 2008Salvatore DiSomma MD The value of natriuretic peptides, both B-type natriuretic peptide (BNP) and N-terminal prohormone brain natriuretic peptide (NTproBNP), for determining diagnosis, severity, and prognosis of emergency department (ED) patients with acute decompensated heart failure (ADHF) has been well documented. Emerging data support the hypothesis that repeated natriuretic peptide determinations in the acute phase of ADHF may assist in confirming the diagnosis, monitoring drug therapy, and evaluating the adequacy of patient stabilization. Data from the authors' group demonstrate that in patients admitted to the ED for acute dyspnea, serial NTproBNP measurement at admission and 4, 12, and 24 hours later was useful in confirming the diagnosis of ADHF compared with patients with chronic obstructive pulmonary disease. Moreover, in the same patients receiving intensive intravenous diuretic therapy, there was a progressive reduction of NTproBNP blood levels from hospitalization to discharge (P<.001), accompanied by clinical improvement and stabilization of heart failure. More recently, the authors also demonstrated that in ADHF patients improving with diuretics, a progressive reduction in BNP levels was observed, starting 24 hours after ED admission and continuing until discharge. Comparing BNP and NTproBNP, there was a significant correlation between NTproBNP and BNP levels but not between NTproBNP's and BNP's percent variation compared with baseline. In ADHF, serial ED measurements of BNP are useful for monitoring the effects of treatment. A reduction in BNP from admission to discharge is indicative of clinical improvement. [source] Effects of buspirone and alprazolam treatment on the startle-potentiated startle responseDEPRESSION AND ANXIETY, Issue 3 2004Randall L. Commissaris Ph.D. Abstract The startle potentiated startle (SPS) paradigm has been reported to be an effective procedure for studying the conditioned enhancement of acoustic startle in the absence of electric shocks or extinction. This study examines the effects of two anxiolytic treatments, buspirone and alprazolam, on this SPS effect. Subjects were tested in the SPS paradigm 2 days a week (Monday and Thursday) for 10 weeks. Each startle test session consisted of 10 Noise Alone trials (115 dB acoustic noise burst presented for 40 ms) and 10 Light+Noise trials (115 dB acoustic stimuli presented during the latter 40 ms of a 3,540 ms period in which a 15-watt light was illuminated). Although there was no difference in startle amplitude on Noise Alone trials when compared to Light+Noise trials initially, by the end of the first test session and continuing throughout the duration of the experiment, startle amplitude on Light+Noise trials was significantly (approximately 50,75%) greater than on Noise Alone trials. After five control (i.e., no injection) SPS test sessions, once-weekly drug challenges were conducted over the course of 7 weeks. In these weekly drug challenges, subjects received acute treatment with various doses of the benzodiazepine anxiolytic alprazolam (0.25, 0.5, 1.0 mg/kg) or the novel anxiolytic buspirone (1.0, 2.0, 4.0 mg/kg); subjects also received vehicle treatment (0.5% methylcellulose) on one treatment day. All treatments were administered intraperitoneally (IP), 15 min before the start of startle testing. Consistent with previous reports, buspirone increased and alprazolam decreased startle amplitude on the Noise Alone trials; these effects were dose-related. Both agents reduced the magnitude of the SPS effect when it was expressed as the Light+Noise startle amplitude minus the Noise Alone startle amplitude. These findings are similar to the effects of these treatments in the traditional shock-based fear-potentiated startle paradigm. Depression and Anxiety 19:146,151, 2004. © 2004 Wiley-Liss, Inc. [source] No evidence for switching the antidepressant: systematic review and meta-analysis of RCTs of a common therapeutic strategyACTA PSYCHIATRICA SCANDINAVICA, Issue 3 2010T. Bschor Bschor T, Baethge C. No evidence for switching the antidepressant: systematic review and meta-analysis of RCTs of a common therapeutic strategy. Objective:, Switching antidepressants is a common strategy for managing treatment-resistant depressed patients. However, no systematic reviews have been conducted to date. Method:, We systematically searched MEDLINE/EMBASE/Cochrane Central Register of Controlled Trials and additional sources. We included double-blind studies of patients with depressive symptomatology who were not responding to initial antidepressant monotherapy and were subsequently randomized to another antidepressant or to continue the same antidepressant. Results were pooled for meta-analysis of response + remission rates using a fixed-effects model. Results:, A total of three studies were included. Switching to another antidepressant was not superior to continuing the initial antidepressant in any of these studies. Our meta-analysis showed no significant advantages to either strategy and no significant heterogeneity of results [OR for response rates: 0.85 (95% CI: 0.55,1.30) favoring continuing]. Conclusion:, There is a discrepancy between the published evidence and the frequent decision to switch antidepressants, indicating an urgent need for more controlled studies. Pending such studies we recommend that physicians rely on more thoroughly evaluated strategies. [source] The neurobiological profile of girls with ADHDDEVELOPMENTAL DISABILITIES RESEARCH REVIEW, Issue 4 2008E. Mark Mahone Abstract Since boys are more commonly diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) than girls, the majority of theories and published research studies of ADHD have been based on samples comprised primarily (or exclusively) of boys. While psychosocial impairment in girls with ADHD is well established, the neuropsychological and neurobiological basis of these deficits is less consistently observed. There is growing evidence that boys' and girls' brains develop and mature at different rates, suggesting that the trajectory of early anomalous brain development in ADHD may also be sex-specific. It remains unclear, however, whether earlier brain maturation observed in girls with ADHD is protective. In this review, we outline the current theory and research findings that seek to establish a unique neurobiological profile of girls with ADHD, highlighting sex differences in typical brain development and among children with ADHD. The review highlights findings from neurological, neurocognitive, and behavioral studies. Future research directions are suggested, including the need for longitudinal neuroimaging and neurobehavioral investigation beginning as early as the preschool years, and continuing through adolescence and adulthood, with consideration of identified sex differences in the development of ADHD. © 2008 Wiley-Liss, Inc. Dev Disabil Res Rev 2008;14:276,284. [source] Twice daily biphasic insulin aspart improves postprandial glycaemic control more effectively than twice daily NPH insulin, with low risk of hypoglycaemia, in patients with type 2 diabetesDIABETES OBESITY & METABOLISM, Issue 6 2003J. S. Christiansen Objective:, Biphasic insulin aspart 30 (BIAsp30) is a dual release formulation, containing 30% soluble and 70% protamine-crystallized insulin aspart. This study compared the glycaemic control and safety profiles achieved with either twice daily BIAsp30 or NPH insulin in patients with type 2 diabetes not optimally controlled by oral hypoglycaemic agents (OHAs), NPH insulin or a combination of both. Methods:, In this 16-week multinational, parallel-group, double-blind trial, 403 such patients were randomized to receive either BIAsp30 or NPH insulin immediately before breakfast and evening meals. OHAs were discontinued at randomization. Efficacy was assessed by glycosylated haemoglobin (HbA1c) and self-recorded daily 8-point blood glucose (BG) profiles. Hypoglycaemic and other adverse events were the chosen safety parameters. Results:, HbA1c concentration decreased by >0.6% (p < 0.0001 vs. baseline) in both groups, with metabolic control continuing to improve throughout the trial without reaching a stable level. Patients who switched from once or twice daily NPH monotherapy to twice daily BIAsp30 achieved a significantly greater reduction in HbA1c (0.78%) than those randomized to twice daily NPH insulin (0.58%; p = 0.03). BIAsp30 decreased mean daily postprandial glycaemic exposure to a greater extent than NPH insulin (mean difference = 0.69 mmol/l; p < 0.0001), reflecting greater decreases in the postbreakfast and postdinner increments (of 1.26 and 1.33 mmol/l, respectively), although postlunch increment was relatively increased (by 0.56 mmol/l). Despite the greater reduction in overall postprandial glycaemic exposure in the BIAsp30 group, the overall safety profile of BIAsp30 was equivalent to that of NPH insulin with <2% of patients experiencing major hypoglycaemia, and approximately 33% reporting minor hypoglycaemic episodes, in both groups. Conclusion:, Twice daily BIAsp30 reduced postprandial glucose exposure to a significantly greater extent than NPH insulin and was at least as effective at reducing HbA1c in patients with type 2 diabetes. Both insulins were well tolerated. In patients poorly controlled on OHAs or NPH alone, glycaemic control can be improved by switching to twice daily BIAsp30, without increasing hypoglycaemic risk. [source] Characteristics of Emergency Medicine Program DirectorsACADEMIC EMERGENCY MEDICINE, Issue 2 2006Michael S. Beeson MD Objectives: To characterize emergency medicine (EM) program directors (PDs) and compare the data, where possible, with those from other related published studies. Methods: An online survey was e-mailed in 2002 to all EM PDs of programs that were approved by the Accreditation Council of Graduate Medical Education. The survey included questions concerning demographics, work hours, support staff, potential problems and solutions, salary and expenses, and satisfaction. Results: One hundred nine of 124 (88%) PDs (69.7% university, 27.5% community, and 2.8% military) completed the survey; 85.3% were male. Mean age was 43.6 years (95% confidence interval [CI] = 42.6 to 44.7 yr). The mean time as a PD was 5.7 years (95% CI = 4.9 to 6.5 yr), with 56% serving five years or less. The mean time expected to remain as PD is an additional 6.0 years (95% CI = 5.2 to 6.8). A 1995 study noted that 50% of EM PDs had been in the position for less than three years, and 68% anticipated continuing in their position for less than five years. On a scale of 1 to 10 (with 10 as highest), the mean satisfaction with the position of PD was 8.0 (95% CI = 7.2 to 8.3). Those PDs who stated that the previous PD had mentored them planned to stay a mean of 2.0 years longer than did those who were not mentored (95% CI of difference of means = 0.53 to 3.53). Sixty-five percent of PDs had served previously as an associate PD. Most PDs (92%) have an associate or assistant PD, with 54% reporting one; 25%, two; and 9%, three associate or assistant PDs. A 1995 study noted that 62% had an associate PD. Ninety-two percent have a program coordinator, and 35% stated that they have both a residency secretary and a program coordinator. Program directors worked a median of 195 hours per month: clinical, 75 hours; scholarly activity, 20 hours; administrative, 80 hours; and teaching and residency conferences, 20 hours; compared with a median total hours of 220 previously reported. Lack of adequate time to do the job required, career needs interfering with family needs, and lack of adequate faculty help with residency matters were identified as the most important problems (means of 3.5 [95% CI = 3.2 to 3.7], 3.4 [95% CI = 3.2 to 3.6], and 3.1 [95% CI = 2.9 to 3.3], respectively, on a scale of 1 to 5, with 5 as maximum). This study identified multiple resources that were found to be useful by >50% of PDs, including national meetings, lectures, advice from others, and self-study. Conclusions: Emergency medicine PDs generally are very satisfied with the position of PD, perhaps because of increased support and resources. Although PD turnover remains an issue, PDs intend to remain in the position for a longer period of time than noted before this study. This may reflect the overall satisfaction with the position as well as the increased resources and support now available to the PD. PDs have greater satisfaction if they have been mentored for the position. [source] The worldwide airline network and the dispersal of exotic species: 2007,2010ECOGRAPHY, Issue 1 2009Andrew J. Tatem International air travel has played a significant role in driving recent increases in the rates of biological invasion and spread of infectious diseases. By providing high speed, busy transport links between spatially distant, but climatically similar regions of the world, the worldwide airline network (WAN) increases the risks of deliberate or accidental movements and establishment of climatically sensitive exotic organisms. With traffic levels continuing to rise and climates changing regionally, these risks will vary, both seasonally and year-by-year. Here, detailed estimates of air traffic trends and climate changes for the period 2007-2010 are used to examine the likely directions and magnitudes of changes in climatically sensitive organism invasion risk across the WAN. Analysis of over 144 million flights from 2007-2010 shows that by 2010, the WAN is likely to change little overall in terms of connecting regions with similar climates, but anticipated increases in traffic and local variations in climatic changes should increase the risks of exotic species movement on the WAN and establishment in new areas. These overall shifts mask spatially and temporally heterogenous changes across the WAN, where, for example, traffic increases and climatic convergence by July 2010 between parts of China and northern Europe and North America raise the likelihood of exotic species invasions, whereas anticipated climatic shifts may actually reduce invasion risks into much of eastern Europe. [source] Conserving the Richmond Birdwing Butterfly over two decades: Where to next?ECOLOGICAL MANAGEMENT & RESTORATION, Issue 1 2008Don Sands Summary The Richmond Birdwing Butterfly, restricted to subtropical areas of Australia, is threatened with extinction in the Queensland part of its range because of clearing and fragmenting rainforests containing its larval food vines. Habitat fragmentation and drought have exacerbated risks of inbreeding depression and a range of other threats exist, including invasions of the exotic Dutchmans Pipe Vine which is toxic to Richmond Birdwing larvae. This article outlines the Richmond Birdwing Butterfly project from its beginnings in the Double Helix Club project and recently the Richmond Birdwing Recovery Network. It provides details of the biology of the butterfy and its food vines, as well as discussing elements for consideration in a future recovery plan including (i) protecting the remaining breeding sites; and, for the shorter term (ii) continuing to propagate and plant food plants at appropriate localities that previously supported the butterfly. [source] Genetic damage detected in CD-1 mouse pups exposed perinatally to 3,-azido-3,-deoxythymidine and dideoxyinosine via maternal dosing, nursing, and direct gavageENVIRONMENTAL AND MOLECULAR MUTAGENESIS, Issue 1 2004Jack B. Bishop Abstract Human immunodeficiency virus (HIV)-infected pregnant women are administered nucleoside-analogue antiretrovirals to reduce maternal-infant viral transmission. The current protocol recommends treating newborns for 6 additional weeks postpartum. The treatment is effective, but the risk of drug-induced chromosomal damage in neonates remains undefined. We used a mouse model to investigate this concern. In a multigeneration reproductive toxicity study, female CD-1 mice received 3,-azido-3,-deoxythymidine (AZT) and dideoxyinosine (ddI) (50/250, 75/375, 150/750 mg/kg/day AZT/ddI) by gavage twice daily in equal fractions beginning prior to mating and continuing throughout gestation and lactation. Direct pup dosing (same regimen) began on postnatal day (PND) 4. Peripheral blood erythrocytes of male pups were screened for micronuclei, markers of chromosomal damage, on PNDs 1, 4, 8, and 21. Extraordinary increases in micronucleated cells were noted in pups for each treatment group at each sampling time; treated dams exhibited smaller yet significant increases in micronucleated erythrocytes. The frequencies of micronucleated cells in untreated pups were higher than in the untreated dams, and all pups had markedly elevated levels of circulating reticulocytes compared to dams. These observations suggest that fetal and neonatal mouse hematopoietic precursor cells have heightened sensitivity to genotoxic agents, perhaps due to rapid cell proliferation during the perinatal period of development. The amount of genetic damage observed in treated pups raises concern for the potential of similar damage in humans. Investigations of chromosomal integrity in exposed newborns and children are recommended. Environ. Mol. Mutagen. 43:3,9, 2004. © 2004 Wiley-Liss, Inc. [source] Trajectories of smoking among freshmen college students with prior smoking history and risk for future smoking: data from the University Project Tobacco Etiology Research Network (UpTERN) studyADDICTION, Issue 9 2008Craig R. Colder ABSTRACT Aims Little is known about smoking during the transition to college. The current study examined trajectories of smoking among college freshmen, how trajectories predicted later smoking and the social context of smoking. Design Weekly assessments of daily smoking were collected via the web during the first year of college for a large cohort with a previous history of smoking. Participants and setting A total of 193 college freshmen from a large public university with a previous history of smoking who smoked frequently enough to be included in trajectory analysis. Measurements Measures included weekly reports of daily smoking, family smoking, perceived peer attitudes and smoking, social norms and social smoking environment. Findings Seven trajectories were identified: one of low-level sporadic smoking, one of low-level smoking with a small increase during the year, two classes with a substantial decrease during the year, two classes with relatively small decreases and one class with a substantial increase in smoking. Trajectories of smoking in the freshman year predicted levels of sophomore year smoking, and some social context variables tended to change as smoking increased or decreased for a given trajectory class. Conclusions The transition into college is marked by changes in smoking, with smoking escalating for some students and continuing into the sophomore year. Shifts in social context that support smoking were associated with trajectories of smoking. Despite the focus of developmental models on smoking in early adolescence, the transition into college warrants further investigation as a dynamic period for smoking. [source] Caloric restriction for longevity: I. Paradigm, protocols and physiological findings in animal researchEUROPEAN EATING DISORDERS REVIEW, Issue 5 2004Kelly M. Vitousek Abstract The initial article in this series reviews basic findings in the field of caloric restriction for longevity (CRL). To eating disorder specialists, the data are disconcerting. The chronic dieting and subnormal weight we endeavour to prevent and treat in humans appear highly beneficial when imposed on animals. In the laboratory, organisms from nematodes to monkeys thrive when forced to undereat, as long as they receive sufficient micronutrients. The most remarkable results are obtained through the most extreme measures: mice, for example, do best if limited to a third of expected caloric intake, beginning soon after weaning and continuing throughout adulthood. Deprivation can be achieved through an ,anorexic' protocol of steady underconsumption or a ,bulimic' pattern in which periods of fasting alternate with bouts of binge eating. The benefits of such regimens include delayed senescence, postponement and/or attenuation of age-related disease and dramatic increases in average and maximum lifespan. Although some biological functions are impaired (including growth, reproduction and perhaps resistance to certain stressors), the cost/benefit ratio clearly favours CRL when calculated on the basis of physical outcomes in late age. Advocacy of comparable regimens for people, however, is ill-considered. Enthusiasm for CRL can be sustained only by detaching deprivation from the context of daily life, ignoring psychological effects, and dismissing data on human semi-starvation and eating disorders. The experiences of participants in Biosphere 2 and individuals with anorexia nervosa suggest that the price of CRL is unacceptably high when a wider range of outcome variables is examined. Copyright © 2004 John Wiley & Sons, Ltd and Eating Disorders Association. [source] Research sensitivities to palliative care patientsEUROPEAN JOURNAL OF CANCER CARE, Issue 3 2002J. Addington-Hall phd Research sensitivities to palliative care patients This paper considers the methodological challenges of researching the health care experiences of palliative care patients and their families. Difficulties in defining a ,palliative care patient' are highlighted, and the question of whether there are specific ethical issues when researching palliative care explored. Methodological issues are discussed, including the negotiation of access via health professionals, the choice of appropriate data collection methods and tools, the consequences of high attrition rates and the use of retrospective surveys of bereaved relatives. Key areas for research are identified. These include patients' and families' experiences of research participation, the impact of being approached on those who decline, how the characteristics of those who participate differ from those who do not and the likely impact of this on findings. Research is also needed into patient and family motivations for participation, and whether and how these change as the disease progresses. To ensure that the voices of palliative care patients and their families are heard by both service providers and policy-makers, research in this area needs to address the methodological challenges raised in this paper, as well as continuing to explore users' views. [source] Class and Other Identifications in Managerial Careers: The Case of the Lemon DressGENDER, WORK & ORGANISATION, Issue 5 2004Christina Hughes This article responds to concerns that research in the field of careers needs to bring together an action perspective with a recognition of the continuing impact of structural and cultural imperatives. To do so this article presents a symptomatic study. Through the concept of pedagogies of the everyday, this combines an action orientation with a recognition of how such pedagogies operate within networks of power. Specifically, the article argues that the development of new gendered understandings of management careers requires greater recognition of the continuing, though now relatively neglected, saliency of class. The article offers a summary of contemporary theorizations of class and concludes with a discussion of possible future directions for this field of research. [source] THE ,LITTLE ICE AGE': RE-EVALUATION OF AN EVOLVING CONCEPTGEOGRAFISKA ANNALER SERIES A: PHYSICAL GEOGRAPHY, Issue 1 2005JOHN A. MATTHEWS ABSTRACT. This review focuses on the development of the ,Little Ice Age' as a glaciological and climatic concept, and evaluates its current usefulness in the light of new data on the glacier and climatic variations of the last millennium and of the Holocene. ,Little Ice Age' glacierization occurred over about 650 years and can be defined most precisely in the European Alps (c. AD 1300,1950) when extended glaciers were larger than before or since. ,Little Ice Age' climate is defined as a shorter time interval of about 330 years (c. AD 1570,1900) when Northern Hemisphere summer temperatures (land areas north of 20°N) fell significantly below the AD 1961,1990 mean. This climatic definition overlaps the times when the Alpine glaciers attained their latest two highstands (AD 1650 and 1850). It is emphasized, however, that ,Little Ice Age' glacierization was highly dependent on winter precipitation and that ,Little Ice Age' climate was not simply a matter of summer temperatures. Both the glacier-centred and the climate-centred concepts necessarily encompass considerable spatial and temporal variability, which are investigated using maps of mean summer temperature variations over the Northern Hemisphere at 30-year intervals from AD 1571 to 1900. ,Little Ice Age'-type events occurred earlier in the Holocene as exemplified by at least seven glacier expansion episodes that have been identified in southern Norway. Such events provide a broader context and renewed relevance for the ,Little Ice Age', which may be viewed as a ,modern analogue' for the earlier events; and the likelihood that similar events will occur in the future has implications for climatic change in the twenty-first century. It is concluded that the concept of a ,Little Ice Age' will remain useful only by (1) continuing to incorporate the temporal and spatial complexities of glacier and climatic variations as they become better known, and (2) by reflecting improved understanding of the Earth-atmosphere-ocean system and its forcing factors through the interaction of palaeoclimatic reconstruction with climate modelling. [source] Upward continuation with topographic datuming operator: the integrated wave equation datuming scheme revisedGEOPHYSICAL PROSPECTING, Issue 6 2009Kai Yang ABSTRACT The integrated wave equation datuming scheme is an integrated datuming method to implement the wave equation velocity replacement with a one-way extrapolator for overthrust data. The integrated wave equation datuming scheme is accomplished by downward continuing the data from the topography to a non-planar base of the weathering layer, followed by an upward continuation from the base of the weathering layer to a final planar datum. Both the downward and the upward continuation are accomplished by a one-way extrapolator by a classical ,two-step' implementation. The topographic datuming operator is a distinctive technique by which the shots and receivers are downward continued simultaneously. Although its inadaptability to non-planar datum and the strong lateral variation of the near-surface structure constrains its application to the downward continuation of the overthrust data, we found that the ,one-step' feature of the topographic datuming operator is extremely suitable for the upward continuation. In this paper, the topographic datuming operator is incorporated into the integrated wave equation datuming scheme to perform upward continuation instead of a one-way extrapolator , thus a revised integrated wave equation datuming scheme is constructed. Compared with the previous scheme, the computatiol cost of the revised integrated wave equation datuming scheme is greatly reduced, thus the applicability of the integrated wave equation datuming scheme is further improved. The synthetic and real data examples demonstrate its effectiveness and efficiency. [source] American foundations and the development of international knowledge networksGLOBAL NETWORKS, Issue 1 2002Inderjeet Parmar This article examines the role and influence of three American foundations , Rockefeller, Carnegie, and Ford , in developing international knowledge networks that significantly impacted upon the Third World, helping to consolidate US hegemony after 1945, fostering pro-US values, methods and research institutions. The international networks were modelled on prior domestic initiatives resulting in the effective intellectual hegemony of ,liberal internationalism', of empirical scientific research methods, and of policy-oriented studies. Such domestic hegemony constructed a key basis of America's rise to globalism, which after 1945 required a continuing and enhanced foundation role, especially with the onset of the Cold War. The article, which examines the role of the US foundations in relation to intellectual hegemony construction in Latin America, Indonesia, and Africa, concludes that the evidence is best explained by Gramscian theory, and calls for further empirical research in this vital area. [source] Still the Anomalous Democracy?GOVERNMENT AND OPPOSITION, Issue 1 2009Institutions in Italy, Politics Until the early 1990s, the Italian political system was regarded as anomalous among advanced democracies because of its failure to achieve alternation in government. Since then, that problem has been overcome, but Italy has been popularly viewed as continuing to be different to other democracies because it is ,in transition' between regimes. However, this position itself is becoming increasingly difficult to sustain because of the length of time of this so-called transition. Rather than focus on what is rather an abstract debate, it may be more fruitful to analyse what, in substance, is distinctive about Italian politics in this period: the manner in which a debate over fundamental institutional (including electoral) reform has become entangled in day-to-day politics. This can best be exemplified through an analysis of two key electoral consultations held in 2006: the national elections and the referendum on radically revising the Italian Constitution. [source] Application of devices for safe laparoscopic hepatectomyHPB, Issue 4 2008H. KANEKO Abstract The continuing evolution of a variety of laparoscopic instrument and device has been gradually applied to the laparoscopic hepatectomy in many countries. Recent experience has persuaded us that there are great potential benefits derived from laparoscopic hepatectomy and much has been learned about patient selection, the grade of surgical difficulty with respect to tumor location, and the required instrumentation. Among these efforts, various ways of hepatic parenchymal transection with mechanical devices have been attempted and continuing to innovate to perform safe laparoscopic hepatectomy Important technologic developments and improved endoscopic procedures are being established equipment modifications. For safe laparoscopic hepatectomy, it is important to have all necessary equipment. The intraoperative laparoscopic ultrasonography, microwave coagulators, ultrasonic dissection, argon beam coagulators, laparoscopic coagulation shears, endolinear staplers and TissueLink monopolar sealer are essential. This procedure is in need that well experienced endoscopic surgeon and well-experienced liver surgeon should be collaborated in laparoscopic hepatectomy and the indications are strictly followed based upon the location and size of tumors. Finally critical determinant for success and safe laparoscopic hepatectomy is through familiarity with the relevant laparoscopic instruments and equipments. Laparoscopic hepatectomy is expected to develop further in the future as a new surgical instrument, equipment and method, which improves patients' quality of life. [source] Consultants, lawyers, and the ,union free' movement in the USA since the 1970sINDUSTRIAL RELATIONS JOURNAL, Issue 3 2002John Logan This paper provides a qualitative analysis of the services that the anti,union consultants and law firms have provided to American employers during the past three decades and an account of the campaign tactics of several ,superstars' of the union,free movement. It describes a multi,million dollar industry that has helped employers to circumvent the intent of federal labour law through a vast array of union,busting tactics, implemented before the union arrives and continuing until after it is defeated: tactics that are designed, at every juncture, to undermine employees' free choice of bargaining representatives. [source] Differential Frontal Cortex Activation Before Anticipatory and Reactive Saccades in InfantsINFANCY, Issue 2 2001Gergely Csibra Neural correlates of anticipatory and reactive saccades were studied in 4-month-old infants by recording high-density event-related potentials. Infants were presented with a fixed sequence of stimulus presentation to which they rapidly showed anticipatory saccades, as well as continuing with some reactive (stimulus-driven) saccades. As in a previous study, no clear evidence was found for adultlike, saccade-related potentials, although some presaccadic differences between reactive and anticipatory saccades were observed. Infants also showed different stimulus offset-related effects preceding the 2 types of trials with a right-frontal positivity when an anticipatory look follows, but only left-frontal positivity when a reactive saccade follows. [source] Motivation and Meaning in Contemporary Art: From Tate Modern to the Primary School ClassroomINTERNATIONAL JOURNAL OF ART & DESIGN EDUCATION, Issue 3 2001Jacqueline Dear ,Art Now in the Classroom', was a joint venture between Goldsmiths College Education Department, Tate Modern and six Primary Schools in and around the London area (Sandhurst, Pilgrim's Way, Hawesdown, Hawkesmoore, Lauriston and Myatt Garden.) It ran from September to November 2000, beginning initially with the placement of two Goldsmiths students at each school then continuing with school visits to Tate Modern, and four Fridays spent working in the classroom, culminating in an exhibition at Tate Modern where the children from all six primary schools got to see their own work publicly displayed. This paper is an account of the work produced by the children from Sandhurst Primary School and an assessment of both the educational opportunities it provided for the primary classes involved and for the Goldsmiths students involved. The aims of the project were to demonstrate effective ways to work collaboratively with contemporary art, to support the development of teaching strategies at KS2 and KS3 and to offer possible approaches for working with contemporary material in the classroom. [source] Subtle deficits of attention after surgery: quantifying indicators of sub syndrome deliriumINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 10 2010David Peter Lowery Abstract Objective To determine whether attentional impairments are reliable neuropsychological markers of sub syndrome delirium. Method A prospective cohort study with repeated assessment beginning pre-operatively and continuing through the first post-operative week. Computerized assessments of attention and the Mini-Mental State Examination were administered with one hundred patients admitted for elective orthopedic surgery, 70 years and over and free of dementia. Acute change of cognitive status was used to identify cases of sub syndrome delirium. Results There were significant differences of post-surgical performance between the ,no delirium' and ,sub-syndrome delirium' groups of reaction time, global cognition, accuracy and greater variability of reaction time (p,<,0.041). There were significant within subject main effects on reaction time (p,=,0.001), variability of reaction time (p,=,0.022) and MMSE (p,=,0.000) across the cohort; but no significant interaction effect of ,diagnosis' * ,time' on the computerized measures of attention (p,>,0.195). Conclusion The distinction between people with sub syndrome delirium and no delirium is difficult to quantify but computerized measures of attention might provide a sensitive indicator. Sub syndrome delirium is an observable marker of a clinical abnormality that should be exploited to improve care management for vulnerable patients. Copyright © 2010 John Wiley & Sons, Ltd. [source] Hohenberg,Kohn theory including spin magnetism and magnetic fields,INTERNATIONAL JOURNAL OF QUANTUM CHEMISTRY, Issue 5 2005Walter Kohn Beginning with work by U. von Barth and L. Hedin in 1972 and continuing with recent papers in 2001 by K. Capelle and G. Vignale and by H. Eschrig and W. E. Pickett, questions have been raised about the meaning and validity of Hohenberg,Kohn theory when spin magnetism and/or magnetic fields are present. This article offers clarifications of some of these questions. In particular, it also concludes that these questions do not affect spin-density functional theory for nondegenerate ground states as currently practiced. © 2004 Wiley Periodicals, Inc. Int J Quantum Chem, 2004 [source] | |||||||||||||||||||||||||||||||||||||||||||||||||