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Detailed Assessment (detailed + assessment)
Selected AbstractsA Detailed Assessment of Alterations in Bone Turnover, Calcium Homeostasis, and Bone Density in Normal PregnancyJOURNAL OF BONE AND MINERAL RESEARCH, Issue 3 2000A. J. Black Abstract The effects of pregnancy on bone turnover and the potential risk of developing an osteoporotic fracture in pregnancy are controversial. Utilizing biochemical markers of bone formation and resorption and dual-energy X-ray absorptiometry (DEXA), bone turnover before, during, and after pregnancy was studied in detail. Ten women (mean age 30 years; range 23,40) were recruited. Prepregnancy data were obtained and then a review was performed at 2-week intervals, once pregnancy was confirmed, until 14 weeks of gestation and thereafter monthly until term. Bone mineral density (BMD) was estimated by DEXA scanning of hip, spine, and forearm preconception and postpartum. In addition, BMD of the forearm at 14 weeks and 28 weeks gestation was obtained. All pregnancies had a successful outcome. Urinary free pyridinium cross-links, free pyridinoline (fPyr) and free deoxypyridinoline (fDPyr), were normal prepregnancy (mean [±SD]) 14.6 nmol/mmol (1.8) and 5.0 nmol/mmol (1.0) creat, respectively. By 14 weeks, they had increased to 20.8 nmol/mmol (4.3) and 6.1 nmol mmol (1.4) (both p < 0.02) and by 28 weeks to 26.3 nmol/mmol (5.6) and 7.4 nmol/mmol (1.6) (both p < 0.01). The ratio of fPyr to fDPyr remained constant. A similar significant increase was observed in N-telopeptide (NTx). Bone formation was assessed by measurement of carboxy-terminal propeptide of type 1 collagen (P1CP) and bone-specific alkaline phosphatase (BSAP). Neither were altered significantly before 28 weeks, but subsequently mean P1CP increased from 110 ,g/liter (23) to 235 ,g/liter (84) at 38 weeks and mean BSAP increased from 11.1 U/liter (5.0) to 28.6 U/liter (11.1) (p < 0.01 for both variables). Lumbar spine (L1,L4) BMD decreased from a prepregnancy mean of 1.075 g/cm (0.115) to 1.054 g/cm2 (0.150) postpartum (p < 0.05). Total hip BMD decreased from a prepregnancy mean of 0.976 g/cm2 (0.089) to 0.941 g/cm2 (0.097) (p < 0.05). Forearm BMD at midradius, one-third distal and ultradistal decreased but did not reach statistical significance. As assessed by these bone markers, in the first 2 trimesters of pregnancy, bone remodeling is uncoupled with a marked increase in bone resorption. A corresponding increase in formation markers is not observed until the third trimester. Spinal BMD exhibits a significant decrease from prepregnancy to the immediate postpartum period with a mean reduction in BMD of 3.5% in 9 months. [source] Microwave-assisted solid-phase peptide synthesis at 60 °C: alternative conditions with low enantiomerization,JOURNAL OF PEPTIDE SCIENCE, Issue 12 2009Carina Loffredo Abstract Several conditions have been used in the coupling reaction of stepwise SPPS at elevated temperature (SPPS-ET), but we have elected the following as our first choice: 2.5-fold molar excess of 0.04,0.08 M Boc or Fmoc-amino acid derivative, equimolar amount of DIC/HOBt (1:1) or TBTU/DIPEA (1:3), 25% DMSO/toluene, 60 °C, conventional heating. In this study, aimed to further examine enantiomerization under such condition and study the applicability of our protocols to microwave-SPPS, peptides containing L -Ser, L -His, L -Cys and/or L -Met were manually synthesized traditionally, at 60 °C using conventional heating and at 60 °C using microwave heating. Detailed assessment of all crude peptides (in their intact and/or fully hydrolyzed forms) revealed that, except for the microwave-assisted coupling of L -Cys, all other reactions occurred with low levels of amino acid enantiomerization (<2%). Therefore, herein we (i) provide new evidences that our protocols for SPPS at 60 °C using conventional heating are suitable for routine use, (ii) demonstrate their appropriateness for microwave-assisted SPPS by Boc and Fmoc chemistries, (iii) disclose advantages and limitations of the three synthetic approaches employed. Thus, this study complements our past research on SPPS-ET and suggests alternative conditions for microwave-assisted SPPS. Copyright © 2009 European Peptide Society and John Wiley & Sons, Ltd. [source] Neuroprotection trials in Parkinson's disease: Systematic review,,MOVEMENT DISORDERS, Issue 5 2009Robert G. Hart MD Abstract Treatments to slow the progression are a major unmet need in Parkinson's disease. Detailed assessment of randomized trials testing putative neuroprotective drugs was undertaken to inform the design, reporting, and interpretation of future studies. This study is a systematic review of trials testing neuroprotective drugs. Data were extracted independently by two coauthors. Fifteen completed, published trials involving 4,087 participants tested 13 different drugs in 18 double-blind comparisons with placebo. Seven comparisons involving 2,000 subjects assessed MAO-B inhibitors. The primary outcome was change in the Unified Parkinson's Disease Rating Scale score in eight trials and time to need for dopaminergic therapy in seven. Mean participant age was 62 years, 35% were women, the interval from diagnosis to entry averaged 11 months, and the number of participants averaged 272 (largest = 806). Follow-up averaged <16 months in all but two trials. Detailed randomization methods and success of double-blinding were reported in 20% and 13%, respectively. Based on the investigators' conclusions, six trials were interpreted as consistent with a neuroprotective effect, three as negative, and five as either confounded or not meeting criteria for futility. Neuroprotection trials have involved relatively uniform groups of participants early in the clinical disease course, with outcomes weighted heavily toward motor deterioration. Future trials should include participants with wider ranges of disease stages and assess broader neurological outcomes. © 2008 Movement Disorder Society [source] An integrated hydrological model for rain-induced landslide predictionEARTH SURFACE PROCESSES AND LANDFORMS, Issue 12 2002P. L. Wilkinson Abstract This paper describes an extension to the Combined Hydrology And Stability Model (CHASM) to fully include the effects of vegetation and slope plan topography on slope stability. The resultant physically based numerical model is designed to be applied to site-specific slopes in which a detailed assessment of unsaturated and saturated hydrology is required in relation to vegetation, topography and slope stability. Applications are made to the Hawke's Bay region in New Zealand where shallow-seated instability is strongly associated with spatial and temporal trends in vegetation cover types, and the Mid-Levels region in Hong Kong, an area subject to a variety of landslide mechanisms, some of which may be subject to strong topographic control. An improved understanding of process mechanism, afforded by the model, is critical for reliable and appropriate design of slope stabilization and remedial measures. Copyright © 2002 John Wiley & Sons, Ltd. [source] Are differences in guidelines for the treatment of nicotine dependence and non-nicotine dependence justified?ADDICTION, Issue 12 2009John R. Hughes ABSTRACT Despite the many similarities between nicotine dependence and other drug dependences, national guidelines for their treatment differ in several respects. The recent national guideline for the treatment of nicotine dependence has (i) less emphasis on detailed assessment; (ii) less emphasis on treatment of psychiatric comorbidity; (iii) less acceptance of reduction of use as an initial treatment goal; (iv) greater emphasis on pharmacological interventions; and (v) less emphasis on psychosocial treatment than national guidelines for non-nicotine dependences. These treatment differences may occur because (i) nicotine does not cause behavioral intoxication; (ii) psychiatric comorbidity is less problematic with nicotine dependence; (iii) psychosocial problems are less severe with nicotine dependence; and (iv) available pharmacotherapies for nicotine dependence are safer, more numerous and more easily available. However, it is unclear whether these treatment differences are, in fact, justifiable because of the scarcity of empirical tests. We suggest several possible empirical tests. [source] Waste minimization techniques and options for the wet and pretreatment sections of coil coating plantsENVIRONMENTAL PROGRESS & SUSTAINABLE ENERGY, Issue 3 2004Nicola J. Brown Abstract Waste minimization has proven successful in recent years for many companies in reducing their raw material and utility consumption and costs as well as their waste-treatment and disposal costs. Although waste minimization opportunities can be identified through observation of plant operation practices and through application of generalized heuristic principles, many opportunities are determined only through analysis of plant data. In this study, two preassessment techniques (scoping audit and true cost of waste assessment) and two techniques for a more detailed assessment (mass balances and monitoring and targeting) were evaluated to determine whether they identified similar waste minimization opportunities on two coil coating lines. All techniques identified similar waste minimization opportunities, although the true cost of waste assessment and the monitoring and targeting analysis were found to be the most accurate in prioritizing the waste minimization opportunities. The raw material "scope to save" percentage in the scoping audit requires modification for application to South African industry. General waste minimization options for the wet and pretreatment sections of the coil coating industry are also presented. © 2004 American Institute of Chemical Engineers Environ Prog, 23: 185,193, 2004 [source] The clinical outcomes of neonatal and childhood stroke: review of the literature and implications for future researchEUROPEAN JOURNAL OF NEUROLOGY, Issue 7 2004C. Härtel A detailed assessment of clinical outcomes after ischemic stroke in childhood is necessary to evaluate prognostic factors. Previous studies are difficult to compare because of differences in test instruments, study design, heterogeneity of cohorts and number of included cases. Depending on neurodevelopmental assessment methods, major and subtle/minor disabilities, especially in infants, may not have been detected. Most outcome studies reveal only limited information about behavioral changes and quality of life in children with ischemic stroke. Thus the assumption that children make a better recovery from stroke than adults due to the immature brain's capacity to reorganize function is not evidence-based. We systematically review the current literature with regard to the neurological and psychosocial development of affected children as well as their quality of life. Implications for future research strategies follow the review to encourage further clinical study of the neurobehavioral trajectory of childhood stroke. [source] Interplay of Properties and Functions upon Introduction of Mesoporosity in ITQ-4 ZeoliteADVANCED FUNCTIONAL MATERIALS, Issue 9 2010Danny Verboekend Abstract The introduction of mesoporosity in zeolites is often directly coupled to changes in their overall catalytic performance without the detailed assessment of other key functions required for the rational design of the catalytic process such as accessibility, adsorption, and transport. This study presents an integrated approach to study property,function relationships in hierarchical zeolites. Accordingly, desilication of the 1D ITQ-4 zeolite in alkaline medium is applied to develop different degrees of mesoporosity. Along with porosity modification, significant changes in composition, structure, and acidity occur. Relationships are established between the physicochemical properties of the zeolites and their characteristics in the adsorption and elution of light hydrocarbons (C2 to C5, alkanes and alkenes) as well as in the catalytic activity in low-density polyethylene (LDPE) pyrolysis. The recently introduced hierarchy factor can appropriately relate porosity changes to catalytic performance. [source] Detailed determination of smoke gas contents using a small-scale controlled equivalence ratio tube furnace methodFIRE AND MATERIALS, Issue 8 2007Per Blomqvist Abstract A series of tests including seven different materials and products have been conducted using a controlled equivalence ratio tube furnace test method. The main objective of the tests was to determine yields of fire-generated products at defined combustion conditions. The tube furnace test method was set up and run in close agreement with that described in BS 7990:2003. At the time of experimental work the new tube furnace method was in the process of becoming an international standard. It was thus of interest to make an assessment of the capability of the method for determining production yields of important toxic fire products from different types of materials and products. The test series included solid wood, flexible polyurethane (PUR), fire-retarded rigid PUR, a polyvinyl chloride (PVC) carpet, a high-performance data cable with fluorine-containing polymer matrix, a PVC-based cable sheathing material and fire-retarded polyethylene cable insulation material. Duplicate tests were generally conducted at both well-ventilated and vitiated combustion conditions with these materials. The smoke gases produced from the combustion were quantified for inorganic gases by FTIR technique in all tests. A more detailed analysis of the smoke gases was conducted for some of the materials. This extended analysis contained a detailed assessment of organic compounds including, e.g. volatile organic compounds, isocyanates, aldehydes and polycyclic aromatic hydrocarbons. The analysis further included measurement of the size distribution of fire-generated particles for some of the materials. The quantification of toxic inorganic gases produced by combustion at both well-ventilated and vitiated conditions was successful regarding repeatability and stability. Typical yields for the two fire stages investigated were determined for a wide range of materials and products. The detailed analysis of organic compounds further corroborated that the new tube furnace method can replicate defined combustion conditions. Copyright © 2007 John Wiley & Sons, Ltd. [source] Using Scanner Technology to Collect Expenditure Data,FISCAL STUDIES, Issue 3-4 2009Andrew Leicester C81; C83; C33; C41 Abstract In terms of collecting panel expenditure data, there are trade-offs between the demands imposed on respondents and the detail and coverage of data collected. Comprehensive spending data tend to be cross-sectional whilst panel studies include only limited, aggregated expenditure questions. Recently, economists have begun to use detailed, bar-code-level spending data from household panels collected by market research companies. However, there has not been a detailed assessment of the strengths and weaknesses of this collection method or its implications for the recorded data. This paper seeks to fill this gap by providing an in-depth examination of data from one company, Taylor Nelson Sofres (TNS), recording grocery purchases over five years. We assess how far the ongoing demands of participation lead to ,fatigue' in respondents' recording of their spending and the implications for household attrition, and we provide a detailed comparison of the expenditure data collected by TNS and the well-established Expenditure and Food Survey (EFS). Broadly, we suggest that problems of fatigue and attrition may not be particularly severe, though there are differences in expenditures that cannot be attributed to demographic or time effects and may be suggestive of survey mode effects. [source] Syntectonic infiltration by meteoric waters along the Sevier thrust front, southwest MontanaGEOFLUIDS (ELECTRONIC), Issue 4 2006A. C. RYGEL Abstract Structural, petrographic, and isotopic data for calcite veins and carbonate host-rocks from the Sevier thrust front of SW Montana record syntectonic infiltration by H2O-rich fluids with meteoric oxygen isotope compositions. Multiple generations of calcite veins record protracted fluid flow associated with regional Cretaceous contraction and subsequent Eocene extension. Vein mineralization occurred during single and multiple mineralization events, at times under elevated fluid pressures. Low salinity (Tm = ,0.6°C to +3.6°C, as NaCl equivalent salinities) and low temperature (estimated 50,80°C for Cretaceous veins, 60,80°C for Eocene veins) fluids interacted with wall-rock carbonates at shallow depths (3,4 km in the Cretaceous, 2,3 km in the Eocene) during deformation. Shear and extensional veins of all ages show significant intra- and inter-vein variation in ,18O and ,13C. Carbonate host-rocks have a mean ,18OV-SMOW value of +22.2 ± 3, (1,), and both the Cretaceous veins and Eocene veins have ,18O ranging from values similar to those of the host-rocks to as low as +5 to +6,. The variation in vein ,13CV-PDB of ,1 to approximately +6, is attributed to original stratigraphic variation and C isotope exchange with hydrocarbons. Using the estimated temperature ranges for vein formation, fluid (as H2O) ,18O calculated from Cretaceous vein compositions for the Tendoy and Four Eyes Canyon thrust sheets are ,18.5 to ,12.5,. For the Eocene veins within the Four Eyes Canyon thrust sheet, calculated H2O ,18O values are ,16.3 to ,13.5,. Fluid,rock exchange was localized along fractures and was likely coincident with hydrocarbon migration. Paleotemperature determinations and stable isotope data for veins are consistent with the infiltration of the foreland thrust sheets by meteoric waters, throughout both Sevier orogenesis and subsequent orogenic collapse. The cessation of the Sevier orogeny was coincident with an evolving paleogeographic landscape associated with the retreat of the Western Interior Seaway and the emergence of the thrust front and foreland basin. Meteoric waters penetrated the foreland carbonate thrust sheets of the Sevier orogeny utilizing an evolving mesoscopic fracture network, which was kinematically related to regional thrust structures. The uncertainty in the temperature estimates for the Cretaceous and Eocene vein formation prevents a more detailed assessment of the temporal evolution in meteoric water ,18O related to changing paleogeography. Meteoric water-influenced ,18O values calculated here for Cretaceous to Eocene vein-forming fluids are similar to those previously proposed for surface waters in the Eocene, and those observed for modern-day precipitation, in this part of the Idaho-Montana thrust belt. [source] An overview of 45 published database resources for complementary and alternative medicineHEALTH INFORMATION & LIBRARIES JOURNAL, Issue 2 2010Katja Boehm Background:, Complementary and alternative medicine (CAM) has succeeded to implement itself in the academic context of universities. In order to get information on CAM, clinicians, researchers and healthcare professionals as well as the lay public are increasingly turning to online portals and databases, which disseminate relevant resources. One specific type of online information retrieval systems, namely the database, is being reviewed in this article. Question:, This overview aims at systematically retrieving and describing all databases covering the field of CAM. One of the requirements for inclusion was that the database would also have to be published in a medical journal. Data sources:, The databases amed, CAMbase, embase, and medline/PubMed were searched between December 2008 and December 2009 for publications relevant to CAM databases. The authors' specialist library was also searched for grey literature to be included. Study selection:, All included databases were then visited online and information on the context, structure and volume of the database was extracted. Main results:, Forty-five databases were included in this overview. Databases covered herbal therapies (n = 11), traditional Chinese medicine (n = 9) and some dealt with a vast number of CAM modalities (n = 9), amongst others. The amount of time the databases had been in existence ranged from 4 to 53 years. Countries of origin included the USA (n = 14), UK (n = 7) and Germany (n = 6), amongst others. The main language in 42 of 45 databases was English. Conclusions:, Although this overview is quite comprehensive with respect to the field of CAM, certain CAM practices such as chiropractic, massage, reflexology, meditation or yoga may not have been covered adequately. A more detailed assessment of the quality of the included databases might give additional insights into the listed resources. The creation of a personalised meta-search engine is suggested, towards which this overview could be seen as a first step. [source] Bioaccessibility studies of ferro-chromium alloy particles for a simulated inhalation scenario: A comparative study with the pure metals and stainless steelINTEGRATED ENVIRONMENTAL ASSESSMENT AND MANAGEMENT, Issue 3 2010Klara Midander Abstract The European product safety legislation, REACH, requires that companies that manufacture, import, or use chemicals demonstrate safe use and high level of protection of their products placed on the market from a human health and environmental perspective. This process involves detailed assessment of potential hazards for various toxicity endpoints induced by the use of chemicals with a minimum use of animal testing. Such an assessment requires thorough understanding of relevant exposure scenarios including material characteristics and intrinsic properties and how, for instance, physical and chemical properties change from the manufacturing phase, throughout use, to final disposal. Temporary or permanent adverse health effects induced by particles depend either on their shape or physical characteristics, and/or on chemical interactions with the particle surface upon human exposure. Potential adverse effects caused by the exposure of metal particles through the gastrointestinal system, the pulmonary system, or the skin, and their subsequent potential for particle dissolution and metal release in contact with biological media, show significant gaps of knowledge. In vitro bioaccessibility testing at conditions of relevance for different exposure scenarios, combined with the generation of a detailed understanding of intrinsic material properties and surface characteristics, are in this context a useful approach to address aspects of relevance for accurate risk and hazard assessment of chemicals, including metals and alloys and to avoid the use of in vivo testing. Alloys are essential engineering materials in all kinds of applications in society, but their potential adverse effects on human health and the environment are very seldom assessed. Alloys are treated in REACH as mixtures of their constituent elements, an approach highly inappropriate because intrinsic properties of alloys generally are totally different compared with their pure metal components. A large research effort was therefore conducted to generate quantitative bioaccessibility data for particles of ferro-chromium alloys compared with particles of the pure metals and stainless steel exposed at in vitro conditions in synthetic biological media of relevance for particle inhalation and ingestion. All results are presented combining bioaccessibility data with aspects of particle characteristics, surface composition, and barrier properties of surface oxides. Iron and chromium were the main elements released from ferro-chromium alloys upon exposure in synthetic biological media. Both elements revealed time-dependent release processes. One week exposures resulted in very small released particle fractions being less than 0.3% of the particle mass at acidic conditions and less than 0.001% in near pH-neutral media. The extent of Fe released from ferro-chromium alloy particles was significantly lower compared with particles of pure Fe, whereas Cr was released to a very low and similar extent as from particles of pure Cr and stainless steel. Low release rates are a result of a surface oxide with passive properties predominantly composed of chromium(III)-rich oxides and silica and, to a lesser extent, of iron(II,III)oxides. Neither the relative bulk alloy composition nor the surface composition can be used to predict or assess the extent of metals released in different synthetic biological media. Ferro-chromium alloys cannot be assessed from the behavior of their pure metal constituents. Integr Environ Assess Manag 2010;6:441,455. © 2009 SETAC [source] Volumetric methods for evaluating energy loss and heat transfer in cavity flows,INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN FLUIDS, Issue 12 2007Stuart Norris Abstract Methods have been developed for calculating irreversible energy losses and rates of heat transfer from computational fluid dynamics solutions using volume integrations of energy dissipation or entropy production functions. These methods contrast with the more usual approach of performing first law energy balances over the boundaries of a flow domain. Advantages of the volumetric approach are that the estimates involve the whole flow domain and are hence based on more information than would otherwise be used, and that the energy dissipation or entropy production functions allow for detailed assessment of the mechanisms and regions of energy loss or entropy production. Volume integrations are applied to the calculation of viscous losses in a lid-driven cavity flow, and to the viscous losses and heat transfer due to natural convection in a side-heated cavity. In the convection problem comparison with the entropy increase across a stationary heat conducting layer leads to a novel volume integral expression for the Nusselt number. The predictions using this method compare well with traditional surface integrals and benchmark results. Copyright © 2007 John Wiley & Sons, Ltd. [source] A multimodel assessment of future climatological droughts in the United Kingdom,INTERNATIONAL JOURNAL OF CLIMATOLOGY, Issue 14 2009Jean-Philippe Vidal Abstract This paper presents a detailed assessment of future rainfall drought patterns over the United Kingdom. Previously developed bias-corrected high-resolution gridded precipitation time series are aggregated to the scale relevant for water resources management, in order to provide 21st-century time series for 183 hydrologic areas, as computed by six General Circulation Models (GCMs) under two emissions scenarios. The control run data are used as a ,learning time series' to compute the Standardized Precipitation Index (SPI) at four different time scales. SPI values for three 30-year future time slices are computed with respect to these learning time series in order to assess the changes in drought frequency. Multimodel results under the A2 scenario show a dramatic increase in the frequency of short-term extreme drought class for most of the country. A decrease of long-term droughts is expected in Scotland, due to the projected increase in winter precipitation. The analysis for two catchment case studies also showed that changes under the B2 scenario are generally consistent with those of the A2 scenario, with a reduced magnitude in changes. The overall increase with time in the spread of individual GCM results demonstrates the utility of multimodel statistics when assessing the uncertainty in future drought indices to be used in long-term water resources planning. Copyright © 2009 Royal Meteorological Society [source] The World Mental Health (WMH) Survey Initiative version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI)INTERNATIONAL JOURNAL OF METHODS IN PSYCHIATRIC RESEARCH, Issue 2 2004Ronald C. Kessler Abstract This paper presents an overview of the World Mental Health (WMH) Survey Initiative version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI) and a discussion of the methodological research on which the development of the instrument was based. The WMH-CIDI includes a screening module and 40 sections that focus on diagnoses (22 sections), functioning (four sections), treatment (two sections), risk factors (four sections), socio-demographic correlates (seven sections), and methodological factors (two sections). Innovations compared to earlier versions of the CIDI include expansion of the diagnostic sections, a focus on 12-month as well as lifetime disorders in the same interview, detailed assessment of clinical severity, and inclusion of information on treatment, risk factors, and consequences. A computer-assisted version of the interview is available along with a direct data entry software system that can be used to keypunch responses to the paper-and-pencil version of the interview. Computer programs that generate diagnoses are also available based on both ICD-10 and DSM-IV criteria. Elaborate CD-ROM-based training materials are available to teach interviewers how to administer the interview as well as to teach supervisors how to monitor the quality of data collection. Copyright © 2004 Whurr Publishers Ltd. [source] The On-Road Difficulties of Older Drivers and Their Relationship with Self-Reported Motor Vehicle CrashesJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 11 2009Joanne M. Wood PhD OBJECTIVES: To quantify the driving difficulties of older adults using a detailed assessment of driving performance and to link this with self-reported retrospective and prospective crashes. DESIGN: Prospective cohort study. SETTING: On-road driving assessment. PARTICIPANTS: Two hundred sixty-seven community-living adults aged 70 to 88 randomly recruited through the electoral roll. MEASUREMENTS: Performance on a standardized measure of driving performance. RESULTS: Lane positioning, approach, and blind spot monitoring were the most common error types, and errors occurred most frequently in situations involving merging and maneuvering. Drivers reporting more retrospective or prospective crashes made significantly more driving errors. Driver instructor interventions during self-navigation (where the instructor had to brake or take control of the steering to avoid an accident) were significantly associated with higher retrospective and prospective crashes; every instructor intervention almost doubled prospective crash risk. CONCLUSION: These findings suggest that on-road driving assessment provides useful information on older driver difficulties, with the self-directed component providing the most valuable information. [source] Assessment and Intervention to Teach Age Recognition Skills: a Suggested Programme Using the Example of a Case Study to IllustrateJOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES, Issue 3 2000Dorothy M. Bell A 43-year-old man with mild intellectual disabilities was referred after several contacts with the law when he had been seen in the street talking to children who were unknown to him. Some staff members feared that he had a sexual interest in children. Other colleagues considered that the behaviour was innocent, reflecting his friendly nature, but that it was a behaviour which was misinterpreted by others. The present paper charts the assessment of this man's difficulties and abilities over a wide range of relevant areas, and a reassessment following an intensive period of one-to-one training on age-recognition skills. Although the training was unsuccessful, the measures used assisted in making a detailed assessment and providing clear instructions to care staff, all of which was to the subject's long-term benefit. The present paper also illustrates the way in which difficulties of this nature can be assessed and uses allied assessment measures which may be helpful in looking at the whole picture of any person with such problems. It also considers how these areas may then be addressed. Although, in this case, the subject was unable to learn to discriminate specific age groups despite intensive training, he was consequently able to be advised in a manner which should keep him from getting into trouble in the future and the now detailed knowledge of his abilities in all these areas is valuable for his long-term support in the community. [source] Three-Dimensional Anatomy of the Left Atrium by Magnetic Resonance Angiography: Implications for Catheter Ablation for Atrial FibrillationJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 7 2006MOUSSA MANSOUR M.D. Background: Pulmonary vein isolation (PVI) has become one of the primary treatments for symptomatic drug-refractory atrial fibrillation (AF). During this procedure, delivery of ablation lesions to certain regions of the left atrium can be technically challenging. Among the most challenging regions are the ridges separating the left pulmonary veins (LPV) from the left atrial appendage (LAA), and the right middle pulmonary vein (RMPV) from the right superior (RSPV) and right inferior (RIPV) pulmonary veins. A detailed anatomical characterization of these regions has not been previously reported. Methods: Magnetic resonance angiography (MRA) was performed in patients prior to undergoing PVI. Fifty consecutive patients with a RMPV identified by MRA were included in this study. Ridges associated with the left pulmonary veins were examined in an additional 30 patients who did not have a RMPV. Endoluminal views were reconstructed from the gadolinium-enhanced, breath-hold three-dimensional MRA data sets. Measurements were performed using electronic calipers. Results: The width of the ridge separating the LPV from the LAA was found to be 3.7 ± 1.1 mm at its narrowest point. The segment of this ridge with a width of 5 mm or less was 16.6 ± 6.4 mm long. The width of the ridges separating the RMPV from the RSPV and the RIPV was found to be 3.0 ±1.5 mm and 3.1 ±1.8 mm, respectively. There were no significant differences between LPV ridges for patients with versus without a RMPV. Conclusion: The width of the ridges of atrial tissue separating LPV from the LAA and the RMPV from its neighboring veins may explain the technical challenge in obtaining stable catheter positions in these areas. A detailed assessment of the anatomy of these regions may improve the safety and efficacy of catheter ablation at these sites. [source] Cost-Effectiveness of Screening for Unhealthy Alcohol Use with %Carbohydrate Deficient Transferrin: Results From a Literature-Based Decision Analytic Computer ModelALCOHOLISM, Issue 8 2009Alok Kapoor Background:, The %carbohydrate deficient transferrin (%CDT) test offers objective evidence of unhealthy alcohol use but its cost-effectiveness in primary care conditions is unknown. Methods:, Using a decision tree and Markov model, we performed a literature-based cost-effectiveness analysis of 4 strategies for detecting unhealthy alcohol use in adult primary care patients: (i) Questionnaire Only, using a validated 3-item alcohol questionnaire; (ii) %CDT Only; (iii) Questionnaire followed by %CDT (Questionnaire-%CDT) if the questionnaire is negative; and (iv) No Screening. For those patients screening positive, clinicians performed more detailed assessment to characterize unhealthy use and determine therapy. We estimated costs using Medicare reimbursement and the Medical Expenditure Panel Survey. We determined sensitivity, specificity, prevalence of disease, and mortality from the medical literature. In the base case, we calculated the incremental cost-effectiveness ratio (ICER) in 2006 dollars per quality-adjusted life year ($/QALY) for a 50-year-old cohort. Results:, In the base case, the ICER for the Questionnaire-%CDT strategy was $15,500/QALY compared with the Questionnaire Only strategy. Other strategies were dominated. When the prevalence of unhealthy alcohol use exceeded 15% and screening age was <60 years, the Questionnaire-%CDT strategy costs less than $50,000/QALY compared to the Questionnaire Only strategy. Conclusions:, Adding %CDT to questionnaire-based screening for unhealthy alcohol use was cost-effective in our literature-based decision analytic model set in typical primary care conditions. Screening with %CDT should be considered for adults up to the age of 60 when the prevalence of unhealthy alcohol use is 15% or more and screening questionnaires are negative. [source] Phrenic nerve diabetic neuropathy in rats: unmyelinated fibers morphometryJOURNAL OF THE PERIPHERAL NERVOUS SYSTEM, Issue 2 2009Valéria Paula S. Fazan Abstract We have demonstrated that phrenic nerves' large myelinated fibers in streptozotocin (STZ)-induced diabetic rats show axonal atrophy, which is reversed by insulin treatment. However, studies on structural abnormalities of the small myelinated and the unmyelinated fibers in the STZ-model of neuropathy are limited. Also, structural changes in the endoneural vasculature are not clearly described in this model and require detailed study. We have undertaken morphometric studies of the phrenic nerve in insulin-treated and untreated STZ-diabetic rats and non-diabetic control animals over a 12-week period. The presence of neuropathy was assessed by means of transmission electron microscopy, and morphometry of the unmyelinated fibers was performed. The most striking finding was the morphological evidence of small myelinated fiber neuropathy due to the STZ injection, which was not protected or reversed by conventional insulin treatment. This neuropathy was clearly associated with severe damage of the endoneural vessels present on both STZ groups, besides the insulin treatment. The STZ-diabetes model is widely used to investigate experimental diabetic neuropathies, but few studies have performed a detailed assessment of either unmyelinated fibers or capillary morphology in this animal model. The present study adds useful information for further investigations on the ultrastructural basis of nerve function in diabetes. [source] Measurement properties of the Villalta scale to define and classify the severity of the post-thrombotic syndromeJOURNAL OF THROMBOSIS AND HAEMOSTASIS, Issue 5 2009S. R. KAHN Summary., The post-thrombotic syndrome (PTS) is a frequent and important complication of deep venous thrombosis (DVT). The diagnosis of PTS is based primarily on the presence of typical symptoms and clinical signs. In the 1990s, a clinical scale known as the Villalta scale was proposed as a measure that could be used to diagnose and classify the severity of PTS. The objective of the present paper was to review the published evidence on the measurement properties of the Villalta scale. Results of the review demonstrate that the Villalta scale is a reliable and valid measure of PTS in patients with previous, objectively confirmed DVT. The scale is acceptable to research subjects and research personnel, and shows responsiveness to clinical change in PTS. Aspects of the Villalta scale that merit further evaluation include test,retest reliability, more detailed assessment of ulcer severity and assessment of responsiveness across the full range of PTS severity. Research aimed at improving the measurement of PTS will also help to improve the overall validity of findings generated by clinical studies of PTS. [source] A detailed assessment of the pattern of moxidectin tissue distribution after pour-on treatment in calvesJOURNAL OF VETERINARY PHARMACOLOGY & THERAPEUTICS, Issue 6 2003J. M. Sallovitz The use of topical (pour-on) administration of endectocide drugs in cattle has reached world-wide acceptance. However, only limited information is available on the kinetic behaviour for topically administered moxidectin (MXD). To improve our understanding of the relationship between pharmacokinetics and efficacy for pour-on preparations, MXD concentration profiles were measured in tissues of endo- and ectoparasites location over 35 days postadministration. MXD distribution to the fluid content and mucosal tissue of the abomasum and different intestinal sections (duodenum, ileum, caecum and colon) was assessed. The comparative patterns of MXD distribution to skin and hypodermic tissue from different anatomical sites (backline, rib cage, thigh and face) were also investigated following the pour-on administration. Wide tissue distribution and long residence time characterized the kinetics of topically administered MXD. MXD was recovered between 1 and 35 days post-treatment in all the tissues investigated. The highest MXD availabilities were observed in the skin layers at the site of administration (backline) and in the fat tissue. The fluid contents of different intestinal sections showed MXD concentrations higher than those measured in their respective mucosal tissues, particularly at day 1 post-treatment. MXD concentrations in the skin (epidermis + dermis) were higher than those measured in the hypodermic tissue. Large differences in the availability of MXD in skin from different anatomical regions (backline > rib cage > thigh > face) were observed. The low plasma and the high skin availability indicate the formation of a skin depot of the drug, being released slowly to the plasma and reaching concentrations in systemic tissues (abomasal mucosa, lungs, etc.) similar to those measured after subcutaneous administration. These findings demonstrate that target parasites may be exposed to markedly different drug concentrations according to their location sites, which is particularly relevant for ectoparasites located in different anatomical regions. Knowledge of the tissue distribution of topically administered endectocides contributes to understand the differences observed in efficacy and/or persistence of activity and to optimize their use in cattle. [source] Cropping strategies, soil fertility investment and land management practices by smallholder farmers in communal and resettlement areas in ZimbabweLAND DEGRADATION AND DEVELOPMENT, Issue 5 2009J. G. Cobo Abstract Three smallholder villages located in typical communal (from 1948), old (1987) and new (2002) resettlement areas, on loamy sand, sandy loam and clay soils, respectively, were selected to explore differences on natural resource management and land productivity. Focus group discussions and surveys were carried out with farmers. Additionally, farmers in three wealth classes per village were chosen for a detailed assessment of their main production systems. Maize grain yields (t,ha,1) in the communal (1·5,4·0) and new resettlement areas (1·9,4·3) were similar but significantly higher than in the old resettlement area (0·9,2·7), despite lower soil quality in the communal area. Nutrient input use was the main factor controlling maize productivity in the three areas (R2,=,59,83%), while soil quality accounted for up to 12%. Partial N balances (kg,ha,1,yr,1) were significantly lower in the new resettlement (,9·1 to +14·3) and old resettlement (+7·4 to +9·6) than in the communal area (+2·1 to +59·6) due to lower nutrient applications. Averaged P balances were usually negative. Consistently, maize yields, nutrient applications and partial N balances were higher in the high wealth class than in poorer classes. This study found that most farmers in the new resettlement area were exploiting the inherent soil nutrient stocks more than farmers in the other two areas. We argue that effective policies supporting an efficient fertilizer distribution and improved soil management practices, with clearer rights to land, are necessary to avoid future land degradation and to improve food security in Zimbabwe, particularly in the resettlement areas. Copyright © 2009 John Wiley & Sons, Ltd. [source] Validation of the gastrointestinal quality of life index for patients with potentially operable periampullary carcinomaBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 1 2000Dr E. J. M. Nieveen van Dijkum Background: A disease-specific quality of life questionnaire is not available for patients with periampullary carcinoma, although cancer-specific questionnaires and the Gastrointestinal Quality of Life Index (GIQLI) have been used. The aim of this study was to validate the GIQLI for patients with periampullary tumours and to evaluate if subscales of the GIQLI could be identified to allow a more detailed assessment of the patients' quality of life. Methods: Patients with periampullary carcinoma, included in a study concerning diagnostic laparoscopy, were asked about symptoms and completed a questionnaire comprising the Medical Outcomes Study (MOS) 24 questionnaire, the GIQLI and one question of the Rotterdam Symptom Check List (RSCL). Clinical interpretation and statistical factor analysis were used to identify subscales of the GIQLI. Results: The GIQLI could be divided into four subscales, measuring physical well-being, mental well-being, digestion and defaecation. All four subscales had a good internal reliability and the construct validity was supported by the pattern of correlations with the MOS and RSCL as well as differences in subscale scores for patients with or without certain symptoms. Conclusion: In patients with periampullary tumours the GIQLI can be divided into four subscales, measuring different aspects of quality of life. These subscales provide insight into the different problems affecting the patient. © 2000 British Journal of Surgery Society Ltd [source] Parenting fostered adolescents: skills and strategiesCHILD & FAMILY SOCIAL WORK, Issue 4 2003Jo Lipscombe ABSTRACT This paper discusses findings from a recently completed study of adolescent foster care, which included a detailed assessment of the parenting approaches and strategies used by the foster carers of adolescents in long-term placements. Sixty-eight foster carers were interviewed at two points in time. The first interview was conducted two months after the start of a new adolescent placement and the second after the placement had been continuing for a year, or at the point of disruption if this occurred earlier. The interview schedules were designed specifically for this study and were based upon well-established techniques developed in other studies of parenting. They enabled the researchers to make summary ratings for each carer on established dimensions of parenting such as control and discipline, responsiveness and the level of engagement with the child. The researchers assessed how these strategies changed and developed in relation to the young person's behaviour and whether these approaches influenced either the likelihood of placement disruption or the quality of the placement for the child. This paper describes the parenting strategies used by the foster carers, highlighting the areas of parenting that significantly affected the placement outcomes and the corresponding implications for policy and practice. [source] Rapid confrontation screening for peripheral visual field defects and extinctionCLINICAL AND EXPERIMENTAL OPTOMETRY, Issue 1 2009Andrew J Anderson Screening for unsuspected visual field defects should form a part of all routine eye examinations. Here, we review a procedure for finger-counting confrontation screening that tests the periphery of all visual field quadrants of each eye, yet requires a total of only four responses from the patient. In addition, the test simultaneously screens for the extinction phenomenon that can accompany unilateral brain damage. Due to its efficiency, we recommend that this procedure form the standard way that screening finger-counting confrontation be performed, with abnormal findings prompting a more detailed assessment of visual fields and further neurological examination as necessary. Our paper is not intended to suggest that finger-counting confrontation is superior to other forms of visual field screening and indeed the literature suggests its sensitivity is limited. [source] Challenging behaviours in nursing home residents with dementia: a randomized controlled trial of multidisciplinary interventionsINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 1 2002Janet Opie Abstract Objectives To test the premise that individually tailored psychosocial, nursing and medical interventions to nursing home residents with dementia will reduce the frequency and severity of behavioural symptoms. Methods A four-member team comprising a psychiatrist, psychologist and nurses conducted detailed assessments of 99 nursing home residents with advanced dementia who were rated by staff as having frequent, severe behavioural disturbances. Residents were then randomly assigned to an ,early' or ,late' intervention group and observed for four weeks. Interventions encompassed psychosocial strategies, nursing approaches, psychotropic medications and management of pain. Outcome measures included the frequency and severity of disruptive behaviours and assessments of change by senior nursing home staff. Results While improvements in behaviour were noted in both groups from the outset of observations, pointing to a powerful Hawthorne effect, consultancies were associated with a modest but statistically significant decrease in challenging behaviours. Staff assessments of the interventions were highly favourable. Conclusions The consultancies were effective and well received by staff. The change-inducing nature of any new endeavour is an integral part of research in a long-term setting. Copyright © 2002 John Wiley & Sons, Ltd. [source] CONTRIBUTIONS TO UNDERSTANDING SEAWEEDS IN COASTAL COMMUNITIESJOURNAL OF PHYCOLOGY, Issue 2001Article first published online: 24 SEP 200 Dawes, C. J. Department of Biology, University of South Florida, Tampa, Florida 33620 The goal of my presentation is to review several studies that have enhanced our understanding of the effects of abiotic factors on coastal and estuarine seaweed populations. Accordingly, I will introduce a few key papers dealing with five major abiotic factors-i.e. salinity, temperature, desiccation, water motion, and illumination. Foremost, the salinity tolerance studies of Russell and Bolton (1975) have broad applicability to estuarine seaweeds, while the osmoregulatory studies of Bisson and Kirst (1979) are also significant. Biebl's (1972) review of his earlier studies on temperature tolerances in diverse seaweeds were pivotal. Johnston and Raven's (1986) studied the effects of desiccation on the fucoid brown alga Ascophyllum nodosum, while similar studies on the saccate brown seaweed Colpomenia peregrina were conducted by Oates (1985). Lewis (1968) conducted early synoptic evaluations of the effects of water movement on rocky shore communities, while Kitching and Ebling (1967) gave detailed assessments of seaweed populations within estuarine tidal rapids in Ireland. Basically estuarine tidal rapids represent areas of enhanced nutrients, oxygen and light availability, plus reduced sedimentation (Mathieson et al. (1983). The physiological effects of light have probably been evaluated more than any single abiotic factor and two areas of importance are cited here. The critical papers by Levring (1947) on submarine illumination and those of Ramus (1978) and Littler and Littler (1980) on algal form and light response. Several areas of future studies are also suggested, which may further enhance our understanding of seaweed adaptations. In summary, five major abiotic factors affecting coastal and estuarine seaweed populations will be discussed, their importance to seaweeds noted, and "key" findings for several significant papers summarized. [source] The movement of African elephants in a human-dominated land-use mosaicANIMAL CONSERVATION, Issue 5 2009M. D. Graham Abstract Land outside of gazetted protected areas is increasingly seen as important to the future of elephant persistence in Africa. However, other than inferential studies on crop raiding, very little is understood about how elephants Loxodonta africana use and are affected by human-occupied landscapes. This is largely a result of restrictions in technology, which made detailed assessments of elephant movement outside of protected areas challenging. Recent advances in radio telemetry have changed this, enabling researchers to establish over a 24-h period where tagged animals spend their time. We assessed the movement of 13 elephants outside of gazetted protected areas across a range of land-use types on the Laikipia plateau in north-central Kenya. The elephants monitored spent more time at night than during the day in areas under land use that presented a risk of mortality associated with human occupants. The opposite pattern was found on large-scale ranches where elephants were tolerated. Furthermore, speed of movement was found to be higher where elephants were at risk. These results demonstrate that elephants facultatively alter their behaviour to avoid risk in human-dominated landscapes. This helps them to maintain connectivity between habitat refugia in fragmented land-use mosaics, possibly alleviating some of the potential negative impacts of fragmentation. At the same time, however, it allows elephants to penetrate smallholder farmland to raid crops. The greater the amount of smallholder land within an elephant's range, the more it was utilized, with consequent implications for conflict. These findings underscore the importance of (1) land-use planning to maintain refugia; (2) incentives to prevent further habitat fragmentation; (3) the testing and application of conflict mitigation measures where fragmentation has already taken place. [source] | ||||||||||||||||||||||||||||||||||