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Duration
Kinds of Duration Terms modified by Duration Selected AbstractsABSENCE OF CORRELATION BETWEEN QRS DURATION AND ECHOGRAPHIC PARAMETERS OF VENTRICULAR DESYNCHRONIZATION.ECHOCARDIOGRAPHY, Issue 2 2004CAN WE STILL TRUST THE ELECTROCARDIOGRAPHIC CRITERIA? Background: Identification of the responder candidates for multisite pacing is still difficult and severe heart failure, dilated left ventricle with reduced ejection fraction, prolonged QRS with left bundle branch block (LBBB) are still considered the principal indicators of ventricular desynchronization. The aim of the study was to assess if echographic ventricular desynchronization parameters measured in patients with dilated cardiomyopathy and severe heart failure are correlated with the duration of the QRS on surface electrocardiogram. Methods: This study included 51 patients aged 58.8 ± 7.4 years with idiopathic DCM. The following parameters were measured: QRS duration; effective contraction time (ECT) measured as the interval between QRS onset and closure of aortic valve, interventricular delay (IVD) measured as the time between onset of aortic and pulmonary flow, left ventricular mechanical delay (LVD) as the time from maximal interventricular septum contraction and posterior wall contraction, posterior (P), lateral (L), and posterolateral (PL) wall delays, as the time from QRS onset to maximal wall contraction. Regional post-systolic contraction was defined in a given wall as the difference (contraction delay , ECT)> 50 ms. Results: 29 patients presented complete LBBB, 22 patients had QRS duration < 120 ms. 39 patients had a post-systolic contraction of the PL wall (32 patients of the L wall and 26 patients of the P wall). 16 patients with QRS duration <120 had a post-systolic contraction of the PL wall (as for the LBBB the rest of 39 patients). In 40 patients the sequence of regional ventricular contraction was: P-L-PL wall (16 patients with QRS < 120). LVD was > 100 ms in 36 patients (26 patients with LBBB and 10 with QRS < 120). 27 patients with LBBB and 6 with QRS < 120 ms presented IVD > 30 ms. There was no correlation between the QRS duration and the parameters listed above. Conclusions: In a population of patients with severe heart failure and dilated cardiomyopathy there is no correlation between the duration of the QRS and echocardiographic parameters of ventricular desynchronization. These results show that mechanical ventricular desynchronization can be observed in patients with a QRS duration < 120 ms. Further studies are needed to evaluate if this population could beneficiate of multisite pacing therapy. [source] 043.16 CAPACITY, DURATION and SPATIAL RESOLUTION OF WORKING MEMORY IN A FOOD-STORING and A NON-STORING BIRDEUROPEAN JOURNAL OF NEUROSCIENCE, Issue 9 2000R. Biegler No abstract is available for this article. [source] The Role of Benzodiazepines in the Treatment of InsomniaJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 6 2001Meta-Analysis of Benzodiazepine Use in the Treatment of Insomnia PURPOSE: To obtain a precise estimate of the efficacy and common adverse effects of benzodiazepines for the treatment of insomnia compared with those of placebo and other treatments. BACKGROUND: Insomnia, also referred to as disorder of initiating or maintaining sleep, is a common problem and its prevalence among older people is estimated to be 23% to 34%.1 The total direct cost in the United States for insomnia in 1995 was estimated to be $13.9 billion.2 The complaint of insomnia in older people is associated with chronic medical conditions; psychiatric problems, mainly depression, chronic pain, and poor perceived general condition;1,3,4 and use of sleep medications.5 Thus in most cases, insomnia is due to some other underlying problem and is not just a consequence of aging.6 Accordingly, the management of insomnia should focus on addressing the primary problem and not just short-term treatment of the insomnia. Benzodiazepines belong to the drug class of choice for the symptomatic treatment of primary insomnia.7 This abstract will appraise a meta-analysis that compared the effect of benzodiazepines for short-term treatment of primary insomnia with placebo or other treatment. DATA SOURCES: Data sources included articles listed in Medline from 1966 to December 1998 and the Cochrane Controlled Trials Registry. The medical subject heading (MeSH) search terms used were "benzodiazepine" (exploded) or "benzodiazepine tranquillizers" (exploded) or "clonazepam,""drug therapy,""randomized controlled trial" or "random allocation" or "all random,""human," and "English language." In addition, bibliographies of retrieved articles were scanned for additional articles and manufacturers of brand-name benzodiazepines were asked for reports of early trials not published in the literature. STUDY SELECTION CRITERIA: Reports of randomized controlled trials of benzodiazepine therapy for primary insomnia were considered for the meta-analysis if they compared a benzodiazepine with a placebo or an alternative active drug. DATA EXTRACTION: Data were abstracted from 45 randomized controlled trials representing 2,672 patients, 47% of whom were women. Fifteen studies included patients age 65 and older and four studies involved exclusively older patients. Twenty-five studies were based in the community and nine involved inpatients. The duration of the studies ranged from 1 day to 6 weeks, with a mean of 12.2 days and median of 7.5 days. The primary outcome measures analyzed were sleep latency and total sleep duration after a sleep study, subjects' estimates of sleep latency and sleep duration, and subjects' report of adverse effects. Interrater reliability was checked through duplicate, independent abstraction of the first 21 articles. Overall agreement was between 95% and 98% (kappa value of 0.90 and 0.95 accordingly) for classification of the studies and validity of therapy, and 76% (kappa value of 0.51) for study of harmful effects. A scale of 0 to 5 was used to rate the individual reports, taking into account the quality of randomization, blinding, follow-up, and control for baseline differences between groups. Tests for homogeneity were applied across the individual studies and, when studies were found to be heterogeneous, subgroup analysis according to a predefined group was performed. MAIN RESULTS: The drugs used in the meta-analysis included triazolam in 16 studies; flurazepam in 14 studies; temazepam in 13 studies; midazolam in five studies; nitrazepam in four studies; and estazolam, lorazepam, and diazepam in two studies each. Alternative drug therapies included zopiclone in 13 studies and diphenhydramine, glutethimide, and promethazine in one study each. Only one article reported on a nonpharmacological treatment (behavioral therapy). The mean age of patients was reported in 33 of the 45 studies and ranged between 29 and 82. SLEEP LATENCY: In four studies involving 159 subjects, there was sleep-record latency (time to fall asleep) data for analysis. The pooled difference indicated that the latency to sleep for patients receiving a benzodiazepine was 4.2 minutes (95% CI = (,0.7) (,9.2)) shorter than for those receiving placebo. Patient's estimates of sleep latency examined in eight studies showed a difference of 14.3 minutes (95% CI = 10.6,18.0) in favor of benzodiazepines over placebo. TOTAL SLEEP DURATION: Analysis of two studies involving 35 patients in which total sleep duration using sleep-record results was compared indicated that patients in the benzodiazepine groups slept for an average of 61.8 minutes (95% CI = 37.4,86.2) longer than those in the placebo groups. Patient's estimates of sleep duration from eight studies (566 points) showed total sleep duration to be 48.4 minutes (95% CI = 39.6,57.1) longer for patients taking benzodiazepines than for those on placebo. ADVERSE EFFECTS: Analysis of eight studies (889 subjects) showed that those in the benzodiazepine groups were more likely than those in the placebo groups to complain of daytime drowsiness (odds ratio (OR) 2.4, 95% confidence interval (CI) = 1.8,3.4). Analysis of four studies (326 subjects) also showed that subjects in the benzodiazepine groups were more likely to complain of dizziness or lightheadedness than the placebo groups. (OR 2.6, 95% CI = 0.7,10.3). Despite the increased reported side effects in the benzodiazepine groups, drop-out rates were similar in the benzodiazepine and placebo groups. For patient reported outcome, there was no strong correlation found for sleep latency data, (r = 0.4, 95% CI = (,0.3) (,0.9)) or for sleep duration (r = 0.2, 95% CI = ,0.8,0.4) between benzodiazepine dose and outcome. COMPARISON WITH OTHER DRUGS AND TREATMENTS: In three trials with 96 subjects, meta-analysis of the results comparing benzodiazepines with zopiclone, did not show significant difference in sleep latency in the benzodiazepine and placebo groups, but the benzodiazepine groups had increased total sleep duration (23.1 min. 95% CI = 5.6,40.6). In four trials with 252 subjects, the side effect profile did not show a statistically significant difference (OR 1.5, CI 0.8,2.9). There was only one study comparing the effect of behavioral therapy with triazolam. The result showed that triazolam was more effective than behavioral therapy in decreasing sleep latency, but its efficacy declined by the second week of treatment. Behavioral therapy remained effective throughout the 9-week follow-up period. There were four small trials that involved older patients exclusively, with three of the studies having less than 2 weeks of follow-up. The results were mixed regarding benefits and adverse effects were poorly reported. CONCLUSION: The result of the meta-analysis shows that the use of benzodiazepines results in a decrease in sleep latency and a significant increase in total sleep time as compared with placebo. There was also a report of significantly increased side effects, but this did not result in increased discontinuation rate. There was no dose-response relationship for beneficial effect seen with the use of benzodiazepines, although the data are scant. Zopiclone was the only alternative pharmacological therapy that could be studied with any precision. There was no significant difference in the outcome when benzodiazepines were compared with zopiclone. There was only one study that compared the effect of benzodiazepines with nonpharmacological therapy; thus available data are insufficient to comment. [source] UNEMPLOYMENT DURATION, BENEFIT DURATION AND THE BUSINESS CYCLETHE ECONOMIC JOURNAL, Issue 479 2002Olympia Bover In this paper we study the effects of unemployment benefit duration and the business cycle on unemployment duration. We construct durations for individuals entering unemployment from a longitudinal sample of Spanish men in 1987,94. Estimated discrete hazard models indicate that receipt of unemployment benefits significantly reduces the hazard of leaving unemployment. At durations of three months, when the largest effects occur, the hazard for workers without benefits is twice as large as that for workers with benefits. Favourable business conditions increase the hazard of leaving unemployment. At sample-period magnitudes, this effect is significantly smaller than that of benefit receipt. [source] EXPONENTIAL DURATION: A MORE ACCURATE ESTIMATION OF INTEREST RATE RISKTHE JOURNAL OF FINANCIAL RESEARCH, Issue 3 2005Miles Livingston Abstract We develop a new method to estimate the interest rate risk of an asset. This method is based on modified duration and is always more accurate than traditional estimation with modified duration. The estimates by this method are close to estimates using traditional duration plus convexity when interest rates decrease. If interest rates rise, investors will suffer larger value declines than predicted by traditional duration plus convexity estimate. The new method avoids this undesirable value overestimation and provides an estimate slightly below the true value. For risk-averse investors, overestimation of value declines is more desirable and conservative. [source] HOW TO PREDICT FUTURE DURATION FROM PRESENT AGETHE PHILOSOPHICAL QUARTERLY, Issue 222 2006Bradley Monton The physicist J. Richard Gott has given an argument which, if good, allows one to make accurate predictions for the future longevity of a process, based solely on its present age. We show that there are problems with some of the details of Gott's argument, but we defend the core thesis: in many circumstances, the greater the present age of a process, the more likely a longer future duration. [source] AN ANALYSIS OF DURATION ON THE DISABILITY SUPPORT PENSION PROGRAM,AUSTRALIAN ECONOMIC PAPERS, Issue 2 2006LIXIN CAI The paper examines the factors that determine the duration on the Disability Support Pension (DSP) program using administrative data. We estimate two models based on two competing assumptions: the first model takes the standard assumption in duration models that all recipients will eventually leave the program. The second one takes into account the possibility that there may be some recipients who will never recover from their disabilities and hence not leave the program. Both models indicate that female recipients, recipients who enter DSP at a very young or very old age, recipients with a partner on income support, and recipients who transfer from unemployment benefits have the potential of a longer DSP duration. [source] LINEAGES WITH LONG DURATIONS ARE OLD AND MORPHOLOGICALLY AVERAGE: AN ANALYSIS USING MULTIPLE DATASETSEVOLUTION, Issue 4 2007Lee Hsiang Liow Lineage persistence is as central to biology as evolutionary change. Important questions regarding persistence include: why do some lineages outlive their relatives, neither becoming extinct nor evolving into separate lineages? Do these long-duration lineages have distinctive ecological or morphological traits that correlate with their geologic durations and potentially aid their survival? In this paper, I test the hypothesis that lineages (species and higher taxa) with longer geologic durations have morphologies that are more average than expected by chance alone. I evaluate this hypothesis for both individual lineages with longer durations and groups of lineages with longer durations, using more than 60 published datasets of animals with adequate fossil records. Analyses presented here show that groups of lineages with longer durations fall empirically into one of three theoretically possible scenarios, namely: (1) the morphology of groups of longer duration lineages is closer to the grand average of their inclusive group, that is, their relative morphological distance is smaller than expected by chance alone, when compared with rarified samples of their shorter duration relatives (a negative group morpho-duration distribution); (2) the relative morphological distance of groups of longer duration lineages is no different from rarified samples of their shorter duration relatives (a null group morpho-duration distribution); and (3) the relative morphological distance of groups of longer duration lineages is greater than expected when compared with rarified samples of their shorter duration relatives (a positive group morpho-duration distribution). Datasets exhibiting negative group morpho-duration distributions predominate. However, lineages with higher ranks in the Linnean hierarchy demonstrate positive morpho-duration distributions more frequently. The relative morphological distance of individual longer duration lineages is no different from that of rarified samples of their shorter duration relatives (a null individual morpho-duration distribution) for the majority of datasets studied. Contrary to the common idea that very persistent lineages are special or unique in some significant way, both the results from analyses of long-duration lineages as groups and individuals show that they are morphologically average. Persistent lineages often arise early in a group's history, even though there is no prior expectation for this tendency in datasets of extinct groups. The implications of these results for diversification histories and niche preemption are discussed. [source] Estimation of Frequency-Dependent Strong Motion Duration Via Wavelets and Its Influence on Nonlinear Seismic ResponseCOMPUTER-AIDED CIVIL AND INFRASTRUCTURE ENGINEERING, Issue 4 2008Luis A. Montejo The proposed procedure utilizes the continuous wavelet transform and is based on the decomposition of the earthquake record into a number of component time histories (named "pseudo-details") with frequency content in a selected range. The "significant" strong motion duration of each pseudo-detail is calculated based on the accumulation of the Arias intensity (AI). Finally, the FDSMD of the earthquake record in different frequency ranges is defined as the strong motion duration of the corresponding pseudo-detail scaled by a weight factor that depends on the AI of each pseudo-detail. The efficiency of this new strong motion definition as an intensity measure is evaluated using incremental dynamic analysis (IDA). The results obtained show that the proposed FDSMD influence the peak response of short-period structures with stiffness and strength degradation. [source] Squamous Cell Carcinoma of the Anal Margin with Pruritus Ani of Long DurationDERMATOLOGIC SURGERY, Issue 1 2003Yoshihiro Handa MD BACKGROUND. Anal margin is an unusual location for squamous cell carcinoma (SCC). On rare occasions, anal margin carcinoma is the cause of pruritus ani. OBJECTIVE. To describe a case of SCC of the anal margin with pruritus ani of long duration. RESULTS. A 52-year-old man had been aware of perianal itching for over 10 years. Examination of the perianal area revealed a reddish, eroded, hard nodule that was 2.0×1.5 ×0.3 cm in size located in the 3 o'clock position. The histopathologic diagnosis was well-differentiated SCC. The nodule was totally excised with a 1-cm margin. No recurrence or metastases were observed for 7 months. CONCLUSION. When pruritus ani does not respond to conservative therapy and when symptoms have existed for a long time, we should suspect the presence of malignancy. [source] Healing of Venous Ulcers of Long Duration with a Bilayered Living Skin Substitute: Results from a General Surgery and Dermatology DepartmentDERMATOLOGIC SURGERY, Issue 11 2001Harold Brem MD Background. A laboratory-grown bilayered living skin substitute (LSS) has been shown to accelerate the healing of venous ulcers. However, issues related to optimal wound bed preparation prior to the application of LSS have not been addressed. Objective. When combined with standard compression therapy and near elimination of wound exudate, bioengineered skin can achieve complete closure of venous ulcers which have been present for more than a year and which are difficult to heal. Methods. In the general surgery (center A) and dermatology (center B) departments at two separate medical centers, LSS was used to treat venous ulcers of more than 1 year's duration and which had been unresponsive to conventional therapy. Wound bed preparation at both centers had as common goals the removal of necrotic tissue, optimal formation of granulation tissue, and elimination of wound exudate. Results. There was great comparability between the two centers in the patients being treated, wound size and duration, and number of LSS applications. Both centers achieved a frequency of complete wound closure of greater than 70% within 6 months. Conclusion. At two separate clinical and specialty sites having a common goal of optimal wound preparation, treatment with LSS was associated with a high rate of complete closure of hard to heal venous ulcers. [source] Augmentation of clozapine with a second antipsychotic , a meta-analysis of randomized, placebo-controlled studiesACTA PSYCHIATRICA SCANDINAVICA, Issue 6 2009D. M. Taylor Objective:, Inadequate response to clozapine treatment is frequently encountered in practice and augmentation strategies have been developed in an attempt to improve response. Aims of the study were to evaluate the therapeutic effect of adding an antipsychotic drug to clozapine treatment. Method:, Meta-analysis of randomized, placebo-controlled studies of antipsychotic augmentation of clozapine treatment. Results:, Ten studies (including 522 subjects) met inclusion criteria. Antipsychotic augmentation showed significant benefit over the addition of placebo on only one outcome measure examined [mean effect size for rating scale score (BPRS/PANSS) ,0.180, 95% CI ,0.356 to ,0.004]. Antipsychotic augmentation showed no advantage on withdrawals from trials (risk ratio 1.261, 95% CI 0.679,2.345) or on CGI scores (effect size ,0.661, 95% CI ,1.475 to 0.151). Duration of study was not associated with outcome (P = 0.95). There was no evidence of publication bias. Conclusion:, In studies lasting up to 16 weeks, the addition of an antipsychotic to clozapine treatment has marginal therapeutic benefit. Longer and larger trials are necessary to demonstrate the precise therapeutic utility of antipsychotic co-therapy with clozapine. [source] How many well vs. unwell days can you expect over 10 years, once you become depressed?ACTA PSYCHIATRICA SCANDINAVICA, Issue 4 2009T. A. Furukawa Objective:, Prognostic studies of major depression have mainly focused on episode remission and relapse, and only a limited number of studies have examined long-term course of depressive symptomatology at threshold and subthreshold levels. Method:, The Group for Longitudinal Affective Disorders Study has conducted prospective serial assessments of a cohort of heretofore untreated major depressive episodes for 10 years under naturalistic conditions. Results:, Of the 94 patients in the cohort, the follow-up rate was 70% of the 11 280 person-months. Around 77% of the follow-up months were spent in euthymia, 16% in subthreshold depression and 7% in major depression. Duration of the index episode before reaching recovery was the only significant predictor of the ensuing well time. Conclusion:, On average, patients with major depression starting treatment today may expect to spend three quarters of the next decade in euthymia but the remaining one quarter in subthrehold or threshold depression. [source] Rising cortisol at childcare: Relations with nap, rest, and temperamentDEVELOPMENTAL PSYCHOBIOLOGY, Issue 1 2002Sarah E. Watamura Abstract An unexpected rise in cortisol across the day in full-day, center-based childcare has been recently observed. Most of the children in these studies exhibited the rise across the day at childcare, but the expected drop at home. Possible explanations include more or less napping at childcare than at home. This study measured cortisol during childcare at 10:30 a.m., pre-rest, post-rest, and 3:30 p.m. for 35 children, and at 10:30 a.m. and 3:30 p.m. at home for 8 children. Duration and quality of rest were coded during nap periods. For 91% of children, cortisol rose at childcare and for 75% dropped at home. None of the napping variables were related to the rise at childcare nor were differences found between home and childcare rest. Factors other than daytime rest periods seem likely to account for the rise in cortisol across the childcare day, possibly factors involving the interactional demands of group settings during this developmental period. © 2002 John Wiley & Sons, Inc. Dev Psychobiol 40: 33,42, 2002 [source] Hypofrontality in schizophrenia: a meta-analysis of functional imaging studiesACTA PSYCHIATRICA SCANDINAVICA, Issue 4 2004K. Hill Objective:, Hypofrontality is not a well-replicated finding in schizophrenia either at rest or under conditions of task activation. Method:, Studies comparing whole brain and frontal blood flow/metabolism in schizophrenic patients and normal controls were pooled. Voxel-based studies were also combined to examine the pattern of prefrontal activation in schizophrenia. Results:, Whole brain flow/metabolism was reduced in schizophrenia to only a small extent. Resting and activation frontal flow/metabolism were both reduced with a medium effect size. Duration of illness significantly moderated resting hypofrontality, but the moderating effects of neuroleptic treatment were consistent with an influence on global flow/metabolism only. Pooling of voxel-based studies did not suggest an abnormal pattern of activation in schizophrenia. Conclusion:, Meta-analysis supports resting hypofrontality in schizophrenia. Task-activated hypofrontality is also supported, but there is little from voxel-based studies to suggest that this is associated with an altered pattern of regional functional architecture. [source] Esophageal motility changes after endoscopic intravariceal sclerotherapy with absolute alcoholDISEASES OF THE ESOPHAGUS, Issue 2 2000Ghoshal Endoscopic sclerotherapy (EST) leads to structural and motility changes in the esophagus; the former are thought to be commoner after EST with absolute alcohol (AA), which is a commonly used sclerosant in India as it is cheap and effective. There are no previous studies on changes in esophageal motility after EST with AA. Accordingly, we studied patients with portal hypertension before (n = 24) and after (n = 22) variceal obliteration by EST with AA using a water perfusion esophageal manometry system. Contraction amplitude in the distal esophagus was reduced in the post-EST group compared with the pre-EST group (63.4 ± 24.9 vs. 18.2 ± 14.3 mmHg, p < 0.01). Duration of esophageal contraction in both the proximal and distal esophagus became prolonged in the post-EST compared with the pre-EST group (3.3 ± 0.8 vs. 5.4 ± 2.6 and 4.3 ± 1.1 vs. 6.6 ± 2.3 s, p < 0.001 for both). Lower esophageal sphincter (LES) pressure was reduced in the post-EST compared with the pre-EST group, although the difference was not significant statistically. Abnormal contraction waveforms were more frequent in the post-EST group. One patient in the post-EST group had persistent dysphagia in the absence of endoscopically documented stricture at the time of manometric study. This study shows frequent occurrence of esophageal dysmotility after EST with AA; however, esophageal dysmotility after EST was infrequently associated with motor dysphagia. [source] Duration of strong ground motion during Mexican earthquakes in terms of magnitude, distance to the rupture area and dominant site periodEARTHQUAKE ENGINEERING AND STRUCTURAL DYNAMICS, Issue 5 2001Eduardo Reinoso Abstract A study of the duration of strong ground motion using accelerometric data of subduction and normal-faulting Mexican earthquakes is presented. Duration is obtained based on the time between 2.5 and 97.5 per cent of the Arias intensity. An expression to predict this duration in terms of the magnitude, distance to the rupture area and site period is proposed and compared with predictions available in the literature. The effect of large duration for very distant sites and the contribution of soft soils to the duration of strong ground motion are widely discussed. We have found that large magnitude not only yields long duration at the source, but also proportionally longer duration with distance and with dominant site period compared to small magnitude. The duration obtained from the regression is used as a parameter to obtain input and hysteretic energy and on the use of damage models available in the literature. Finally, duration is used together with the random vibration theory to predict response spectra. Copyright © 2001 John Wiley & Sons, Ltd. [source] Predictors for Maintenance of Sinus Rhythm after Cardioversion in Patients with Nonvalvular Atrial FibrillationECHOCARDIOGRAPHY, Issue 5 2002Ökçün M.D. Recurrence of atrial fibrillation (AF) after cardioversion (CV) to sinus rhythm (SR) is determined by various clinical and echocardiographic parameters. Transesophageal echocardiographic (TEE) parameters have been the focus of clinicians' interests for restoring and maintaining SR. This study determined the clinical, transthoracic, and TEE parameters that predict maintenance of SR in patients with nonvalvular AF after CV. We enrolled 173 patients with nonvalvular AF in the study. TEE could not be performed in 26 patients prior to CV. Twenty-five patients had spontaneously CV prior to TEE. Six patients were excluded because of left atrial (LA) thrombus assessed by TEE. CV was unsuccessful in 6 patients. The remaining 110 consecutive patients (56 men, 54 women, mean age 69 ± 9 years), who had been successfully cardioverted to SR, were prospectively included in the study. Fifty-seven (52%) patients were still in SR 6 months after CV. Age, gender, the configuration of the fibrillation wave on the electrocardiogram, pulmonary venous diastolic flow, and the presence of diabetes, hypertension, coronary artery disease, mitral annulus calcification, and mitral valve prolapse (MVP) did not predict recurrence. Duration of AF, presence of chronic obstructive pulmonary disease (COPD), LA diameter, left ventricular ejection fraction (EF), left atrial appendage peak flow (LAAPF), LAA ejection fraction (LAAEF), pulmonary venous systolic flow (PVSF), and the presence of LA spontaneous echo contrast (LASEC) predicted recurrence of AF 6 months after CV. In multivariate analysis, LAAEF < 30% was found to be the only independent variable (P < 0.0012) predicting recurrence at 6 months after CV in patients with nonvalvular AF. LAAEF more than 30% had a sensitivity of 75% and a specificity of 88% in predicting maintenance of SR 6 months after CV in patients with nonvalvular AF. In conclusion, TEE variables often used to determine thromboembolic risk also might be used to predict the outcome of CV. [source] Course and outcome of childhood epilepsy: A 15-year follow-up of the Dutch Study of Epilepsy in ChildhoodEPILEPSIA, Issue 7 2010Ada Geerts Summary Purpose:, To study the course and outcome of childhood-onset epilepsy during 15-year follow-up (FU). Methods:, We extended FU in 413 of 494 children with new-onset epilepsy recruited in a previously described prospective hospital-based study by questionnaire. Results:, Mean FU was 14.8 years (range 11.6,17.5 years). Five-year terminal remission (TR) was reached by 71% of the cohort. Course during FU was favorable in 50%, improving in 29%, and poor or deteriorating in 16%. Mean duration of seizure activity was 6.0 years (range 0,21.5 years), strongly depending on etiology and epilepsy type. Duration was <1 year in 25% of the cohort and exceeded 12 years in another 25%. Antiepileptic drugs (AEDs) were used by 86% during a mean of 7.4 years: one-third had their last seizure within 1 year of treatment, and one-third continued treatment at the end, although some had a 5-year TR. At last contact, 9% of the cohort was intractable. In multivariate analysis, predictors were nonidiopathic etiology, febrile seizures, no 3-month remission, and early intractability. Eighteen patients died; 17 had remote symptomatic etiology. Standardized mortality ratio for remote symptomatic etiology was 31.6 [95% confidence interval (CI) 18.4,50.6], versus 0.8 [95% CI 0.02,4.2] for idiopathic/cryptogenic etiology. Discussion:, In most children with newly diagnosed epilepsy, the long-term prognosis of epilepsy is favorable, and in particular, patients with idiopathic etiology will eventually reach remission. In contrast, epilepsy remains active in ,30% and becomes intractable in ,10%. AEDs probably do not influence epilepsy course; they merely suppress seizures. Mortality is significantly higher only in those with remote symptomatic etiology. [source] Hemispheric Surgery in Children with Refractory Epilepsy: Seizure Outcome, Complications, and Adaptive FunctionEPILEPSIA, Issue 1 2007Sheikh Nigel Basheer Summary:,Purpose: To describe seizure control, complications, adaptive function and language skills following hemispheric surgery for epilepsy. Methods: Retrospective chart review of patients who underwent hemispheric surgery from July 1993 to June 2004 with a minimum follow-up of 12 months. Results: The study population comprised 24 children, median age at seizure onset six months and median age at surgery 41 months. Etiology included malformations of cortical development (7), infarction (7), Sturge-Weber Syndrome (6), and Rasmussen's encephalitis (4). The most frequent complication was intraoperative bleeding (17 transfused). Age <2 yr, weight <11 kg, and hemidecortication were risk factors for transfusion. Postoperative complications included aseptic meningitis (6), and hydrocephalus (3). At median follow-up of 7 yr, 79% of patients are seizure free. Children with malformations of cortical development and Rasmussen's encephalitis were more likely to have ongoing seizures. Overall adaptive function scores were low, but relative strengths in verbal abilities were observed. Shorter duration of epilepsy prior to surgery was related significantly to better adaptive functioning. Conclusions: Hemispheric surgery is an effective therapy for refractory epilepsy in children. The most common complication was bleeding. Duration of epilepsy prior to surgery is an important factor in determining adaptive outcome. [source] Intravenous and intratracheal administration of trimetoquinol, a fast-acting short-lived bronchodilator in horses with ,heaves'EQUINE VETERINARY JOURNAL, Issue 6 2006F. C. CAMARGO Summary Reason for performing study: Trimetoquinol (TMQ) is a potent ,-adrenoceptor agonist bronchodilator used in human medicine but has not been evaluated for potential use as a therapeutic agent for horses with ,heaves'. Objectives: To assess the pharmacodynamics of TMQ in horses with ,heaves' to determine potential therapeutic effects. Methods: Increasing doses of TMQ were administered to horses with ,heaves' by i.v. and intratracheal (i.t.) routes. Doses ranged 0.001,0.2 ,g/kg bwt i.v. and 0.01,2 ,g/kg bwt i.t. Cardiac and airways effects were assessed by measurement of heart rate (HR) and maximal change in pleural pressure (,Pplmax), respectively. Side effects of sweating, agitation and muscle trembling were scored subjectively. Duration of action to i.v. (0.2 ,g/kg bwt) and i.t. (2 ,g/kg bwt) TMQ was evaluated over 6 h. Results: Intravenous TMQ was an exceptionally potent cardiac stimulant. Heart rate increased at 0.01 ,g/kg bwt, and was still increasing after administration of highest dose, 0.2 ,g/kg bwt. Airway bronchodilation, measured as a decrease in ,Pplmax, also commenced at 0.01 ,g/kg bwt. By the i.t. route, TMQ was 50,100-fold less potent than by i.v. Side effects included sweating, agitation and muscle trembling. Overall, the onset of HR and bronchodilator effects was rapid, within about 3 min, but effects were over at 2 h. Conclusion: When administered i.v. and i.t., TMQ is a highly potent cardiac stimulant and a modest bronchodilator. It may not be an appropriate pharmacological agent by i.v. and i.t. routes for the alleviation of signs in horses with ,heaves'. Further studies of TMQ by oral and aerosol routes are necessary. Potential relevance: In horses, TMQ is a fast-acting bronchodilator with a short duration of action. It could be used as a rescue agent during an episode of ,heaves'. The i.v. and i.t. administration of TMQ is associated with side effects, similar to those reported for all other ,-agonists. However, other routes, such as aerosol and oral, may prove useful and safe for the alleviation of bronchoconstriction typical of ,heaves'. [source] Efficacy of four insect repellents against mosquito bites: a double-blind randomized placebo-controlled field study in SenegalFUNDAMENTAL & CLINICAL PHARMACOLOGY, Issue 5 2009Bernard Uzzan Abstract Insect-borne diseases represent a worldwide threat. In addition to fight against vectors (insecticides) and disease prevention (vaccination against yellow fever, chemoprophylaxis against malaria), insect repellents applied on the skin could help reduce the heavy burden related to these diseases. In a field study performed in Senegal, we compared the efficacy of one skin application between 3 and 4 p.m. of four spray repellents [icaridine 20%, para-menthane-diol (PMD) 20% and 50% and DEET 50%] against placebo, among 100 healthy male and female volunteers experienced with mosquito capture. Double-blind randomized cross-over placebo-controlled study (Latin-square design) during five consecutive nights (7 p.m. to midnight) in two villages was conducted. To avoid residual effect, right or left leg was alternately exposed during consecutive nights and the exposed leg was washed before next night. The statistical model was random and mixed effects anova. All four active repellents provided a significant and similar protection compared with placebo, lasting 8 h. However, there was a non-significant trend for a higher protection by DEET 50% than by PMD 20% (P = 0.07). Duration of protection was similar for all repellents. Their effects were similar among men and women, and against Anopheles or other species. No serious adverse drug reaction was noticed. Using a rigorous methodology and a large number of volunteers, our well-controlled study demonstrated an important and similar protective effect of all four repellents compared with placebo. Such field studies should be required before approval of any newly developed repellent. [source] Does rat global transient cerebral ischemia serve as an appropriate model to study emotional disturbances?FUNDAMENTAL & CLINICAL PHARMACOLOGY, Issue 6 2004Guy Bernard Bantsiele Abstract We used two validated psychopharmacological methods, the forced swimming test (FST 20 min and 5 min) and the elevated plus-maze (EPM), to quantify depression-like and anxiety-like behavior induced by transient global cerebral ischemia in the rat. We also validated use of these methods for the study of antidepressant (imipramine) and anti-anxiety drugs (diazepam). Twelve days after surgery to provoke transient global ischemia, spontaneous motor activity was 40% higher in ischemic rats than in sham-operated controls. Duration of immobility during the FST 20 min and 5 min was 28 and 30% shorter, respectively, than in controls. Treatment with imipramine (3 × 30 mg/kg i.p.) induced a significantly shorter duration of immobility during the FST 5 min, but with no difference between ischemia and control rats. The EPM demonstrated that ischemia did not induce any change in the six behavior parameters measured. Diazepam (1.5 mg/kg i.p.) induced significant anxiolytic effects which were similar in ischemic and sham-operated animals. Both tests failed to demonstrate perturbed performance but conversely, these findings did disclose the sensitivity of ischemia-exposed rats to the action of imipramine and diazepam, demonstrating the usefulness of these tests as psychopharmocological tools for evaluating the effect of psychotropics in the ischemic rat. [source] Genetic influences on behavioral inhibition and anxiety in juvenile rhesus macaquesGENES, BRAIN AND BEHAVIOR, Issue 4 2008J. Rogers In humans and other animals, behavioral responses to threatening stimuli are an important component of temperament. Among children, extreme behavioral inhibition elicited by novel situations or strangers predicts the subsequent development of anxiety disorders and depression. Genetic differences among children are known to affect risk of developing behavioral inhibition and anxiety, but a more detailed understanding of genetic influences on susceptibility is needed. Nonhuman primates provide valuable models for studying the mechanisms underlying human behavior. Individual differences in threat-induced behavioral inhibition (freezing behavior) in young rhesus monkeys are stable over time and reflect individual levels of anxiety. This study used the well-established human intruder paradigm to elicit threat-induced freezing behavior and other behavioral responses in 285 young pedigreed rhesus monkeys. We examined the overall influence of quantitative genetic variation and tested the specific effect of the serotonin transporter promoter repeat polymorphism. Quantitative genetic analyses indicated that the residual heritability of freezing duration (behavioral inhibition) is h2 = 0.384 (P = 0.012) and of ,orienting to the intruder' (vigilance) is h2 = 0.908 (P = 0.00001). Duration of locomotion and hostility and frequency of cooing were not significantly heritable. The serotonin transporter polymorphism showed no significant effect on either freezing or orienting to the intruder. Our results suggest that this species could be used for detailed studies of genetic mechanisms influencing extreme behavioral inhibition, including the identification of specific genes that are involved in predisposing individuals to such behavior. [source] Unemployment Duration in Non-Metropolitan Labor MarketsGROWTH AND CHANGE, Issue 2 2001Bradford F. Mills Non-metropolitan areas of the U.S have experienced significant structural economic changes in recent decades. These changes have raised concerns that some non-metropolitan workers may face significant costs to employment displacements associated with economic adjustments. This paper explores the roles that linkages to metropolitan labor markets, area labor market conditions, and individual attributes play in determining the rates of exit from unemployment to employment among non-metropolitan area residents. Adjacency to a metropolitan area is found to significantly increase transition rates from unemployment to employment among displaced non-metropolitan workers, but local economic conditions are found to have relatively weak or insignificant effects on transition rates. Also, lack of post-high school education and minority status both significantly reduce rates of exit from unemployment in non-metropolitan areas following employmentdisplacement. [source] Management of oral bleedings with recombinant factor VIIa in children with haemophilia A and inhibitorHAEMOPHILIA, Issue 1 2005P. Laguna Summary., Dental extraction in patients with haemophilia A and high-titre inhibitor is always a high-risk procedure, which often presents a lot of problems associated with bleeding. Prothrombin complex concentrates or recombinant activated factor VII (rFVIIa) has been used to control bleeding. rFVIIa was administered to five boys with severe haemophilia A complicated with inhibitor, who underwent seven dental extractions. The age of the patients ranged between 8 and 13 years (median 10 years). The concentrate was administered in doses of 90,100 ,g kg,1 body weight. Duration in the therapy and intervals between rFVIIa doses depended on the severity of bleeding. rFVIIa was proven to be highly effective and no side-effects of the product were observed. [source] Comparison of perioperative management and outcome of parathyroidectomy between older and younger patientsHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 11 2008Gideon Bachar MD Abstract Background. The aim of this study was to compare the clinical status, surgical course, and outcomes of patients with primary hyperparathyroidism (PHPT), over the age of 70, with younger patients. Methods. Between 1996 and 2006, 951 patients underwent parathyroidectomies for PHPT, of whom 190 were over the age of 70. Patient data were collected from chart reviews and a computerized database. Results. Fewer older patients were asymptomatic at presentation. No between-group differences in serum calcium were seen; however, parathyroid hormone (PTH) levels were higher in the older group. Hospitalization time was longer for the elderly. Duration of surgery, surgical success rates, and postoperative complications were similar between the 2 groups. Conclusion. Surgical treatment of PHPT has both physiological benefits and helps to preserve quality of life. Our findings suggest that there is no practical difference in perioperative management and surgical outcomes for older patients. Surgeons should consider parathyroidectomy in PHPT patients regardless of age. © 2008 Wiley Periodicals, Inc. Head Neck, 2008 [source] Pediatric submandibular triangle masses: a fifteen-year experience,HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 8 2004Neil G. Hockstein MD Abstract Background. The purpose of this study was to evaluate the surgical results of pediatric submandibular triangle masses, with specific attention to neoplastic processes. Methods. We retrospectively reviewed the medical records of 105 patients aged 6 months to 21 years who underwent surgery in the submandibular triangle at a major pediatric tertiary care hospital from 1987 to 2001. Results. One hundred five patients who underwent surgery in the submandibular triangle were included in the study. Twenty patients had neoplastic processes, six of which were of primary salivary origin (two mucoepidermoid carcinomas and four pleomorphic adenomas). Twenty-four patients underwent excision of inflamed or infected lymph nodes, and 23 patients underwent excision of inflamed or infected submandibular glands. Thirty-eight patients were included who underwent surgery for sialorrhea or to gain access for another surgical procedure. Complications included tumor recurrence, transient and permanent marginal mandibular nerve weakness, ranula, postoperative fluid collection, and cellulitis. Duration of follow-up ranged from no follow-up to 11 years. Conclusion. Surgical excision of submandibular triangle masses is uncommon. We present our experience with these lesions, with a discussion of diagnosis, surgical indications, and surgical complications. © 2004 Wiley Periodicals, Inc. Head Neck26: 675,680, 2004 [source] Estimation of stage-specific fibrosis progression rates in chronic hepatitis C virus infection: A meta-analysis and meta-regression,HEPATOLOGY, Issue 2 2008Hla-Hla Thein Published estimates of liver fibrosis progression in individuals with chronic hepatitis C virus (HCV) infection are heterogeneous. We aimed to estimate stage-specific fibrosis progression rates and their determinants in these individuals. A systematic review of published prognostic studies was undertaken. Study inclusion criteria were as follows: (1) presence of HCV infection determined by serological assays; (2) available information about age at assessment of liver disease or HCV acquisition; (3) duration of HCV infection; and (4) histological and/or clinical diagnosis of cirrhosis. Annual stage-specific transition probabilities (F0,F1, , , F3,F4) were derived using the Markov maximum likelihood estimation method and a meta-analysis was performed. The impact of potential covariates was evaluated using meta-regression. A total of 111 studies of individuals with chronic HCV infection (n = 33,121) were included. Based on the random effects model, the estimated annual mean (95% confidence interval) stage-specific transition probabilities were: F0,F1 0.117 (0.104,0.130); F1,F2 0.085 (0.075,0.096); F2,F3 0.120 (0.109,0.133); and F3,F4 0.116 (0.104,0.129). The estimated prevalence of cirrhosis at 20 years after the infection was 16% (14%,19%) for all studies, 18% (15%,21%) for cross-sectional/retrospective studies, 7% (4%,14%) for retrospective-prospective studies, 18% (16%,21%) for studies conducted in clinical settings, and 7% (4%,12%) for studies conducted in nonclinical settings. Duration of infection was the most consistent factor significantly associated with progression of fibrosis. Conclusion: Our large systematic review provides increased precision in estimating fibrosis progression in chronic HCV infection and supports nonlinear disease progression. Estimates of progression to cirrhosis from studies conducted in clinical settings were lower than previous estimates. (HEPATOLOGY 2008.) [source] Unions and the Duration of Workers' Compensation ClaimsINDUSTRIAL RELATIONS, Issue 4 2005MICHELE CAMPOLIETI This paper examines the effect of union status on workers' compensation claim duration in Canada. I find that unionized workers have shorter claims than nonunionized workers and that relatively little of this difference can be attributed to differences in worker or job characteristics. I interpret this as being consistent with a strong union effect that reduces union member's claim duration. Plausible explanations for this finding and directions for future research are also discussed. [source] | |||||||||||||||||||||||||||||||||||||||||||||||||