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Effective Means (effective + mean)
Selected AbstractsTransition to adult care: experiences and expectations of adolescents with a chronic illnessCHILD: CARE, HEALTH AND DEVELOPMENT, Issue 5 2008L. K. Tuchman Abstract Background Effective means of transitioning adolescent patients with chronic illness from paediatric to adult medical care are poorly documented and supported by limited evidence. The purpose of this study is to describe expectations and concerns of adolescents with chronic illness regarding transition from subspecialty paediatric to adult-centred care during the transition process in order guide effective programme design and implementation. Methods Qualitative content and thematic analysis of semi-structured individual interviews with 22 adolescents with chronic illness, including cystic fibrosis, sickle cell disease, juvenile rheumatoid arthritis, and inflammatory bowel disease. Interviews took place at 1,3 time points over an 18-month study period. Results Transition topics included: timing of transfer to adult care, the transition process, attitudes about transition, and factors that might aid transition. During the study period, one-third of participants made the transition to adult-oriented health care. All participants who had transitioned to adult-oriented care reported participating in a structured transition programme. Concerns of those who had not initiated the transition process centred on re-establishing relationships and bringing a new team ,up to speed'. Most adolescents anticipating transfer to adult care identified only downsides and felt unprepared to transition at the time of the interview. Subjects who had transitioned noted benefits of the adult-oriented system, even if they had been ambivalent prior to transfer of care. Participants suggested that earlier discussions about transition, opportunities to meet new healthcare teams and visits to adult-oriented venues prior to transition might aid in the transition process. Conclusions Subspecialty paediatric providers should anticipate common fears and concerns of adolescents and discuss the benefits of transfer to adult-oriented care. Further evaluation of existing transition programmes is an area for future study and is necessary for improvement of the continuum of care for adolescents with chronic medical conditions. [source] Assessment of Proliferating Cell Nuclear Antigen Activity Using Digital Image Analysis in Breast Carcinoma Following Magnetic Resonance-Guided Interstitial Laser PhotocoagulationTHE BREAST JOURNAL, Issue 5 2003Soheila Korourian MD Abstract: This study examines proliferative activity in tumor cells of patients with histologically documented invasive breast carcinoma treated with magnetic resonance-guided interstitial laser photocoagulation (MR-GILP). Immunohistochemical marker for proliferating cell nuclear antigen (PCNA), a nuclear protein abundant in actively proliferating cells, is used. The study demonstrates the effectiveness of MR-GILP in ablating tumor cells of infiltrating breast cancer. The diagnosis of infiltrating breast carcinoma was confirmed by core needle biopsies. Using a specially designed magnetic resonance imaging (MRI) device, rotating delivery of excitation off-resonance (RODEO), tumors were measured ranging from 1.8 to 4.0 cm in greatest dimension. Seven formalin-fixed, paraffin-embedded archival tissues from seven patients with infiltrating carcinoma, status post-MR-GILP, were analyzed. Using PCNA immunoperoxidase (Biomeda Corp.), the proliferative capability of the remaining tumor cells around the focus of laser photocoagulation was determined. The lesions were digitally acquired using a Nikon Eclipse E800 microscope with an automated stage. Images were analyzed using Cool SNAP image editing software (version 1.0). Appropriate thresholds were set for positive staining and limited concentric radial measurements of equal area between all samples were compared at radial millimeter intervals from the center of laser ablation. The integrated area occupied by PCNA-positive cells per radial millimeter from the charcoal site (the center of the laser) increased as the distance from this site increased (a mean average at each radial measurement revealed: at the 1 mm radius the positive integrated area was 0.0024 mm2; at 2 mm, 0.0145 mm2; at 3 mm, 0.0351 mm2; at 4 mm, 0.0696 mm2; at 5 mm, 0.1025 mm2; and at 6 mm, 0.1263 mm2). MR-GILP is an effective mean of ablating breast carcinoma. This treatment option may represent an alternative to lumpectomy for a single lesion ,1 cm, or make patients with two separate lesions eligible for lumpectomy. [source] RIGHT-TO-CARRY CONCEALED HANDGUNS AND VIOLENT CRIME: CRIME CONTROL THROUGH GUN DECONTROL?,CRIMINOLOGY AND PUBLIC POLICY, Issue 3 2003TOMISLAV V. KOVANDZIC Research Summary: "Right-to-Carry" (RTC) concealed-handgun laws mandate that authorities issue concealed handgun permits to qualified applicants. The supposition by those supporting the laws is that allowing private citizens to carry concealed handguns in public can reduce violent crime by deterring prospective criminals afraid of encountering armed civilians. Critics of the laws argue that violent altercations are more likely to turn deadly when more people carry guns. Whether the laws cause violent crime to increase or to decrease has become an important public policy question, as most states have now adopted such legislation. The present study evaluates Florida's 1987 RTC law, which prior research suggests plays a key role in the RTC debate. Specifically, we use panel data for 58 Florida counties from 1980 to 2000 to examine the effects on violent crime from increases in the number of people with concealed-carry permits, rather than before-after dummy and time-trend variables used in prior research. We also address many of the methodological problems encountered in earlier RTC studies. We present numerous model specifications, and we find little evidence that increases in the number of citizens with concealed-handgun permits reduce or increase rates of violent crime. Policy Implications: The main policy implication of this research is that there appears to be little gained in the way of crime prevention by converting restrictive gun carrying laws to "shall-issue" laws, although the laws might still prove beneficial by (1) eliminating arbitrary decisions on gun permit applications, (2) encouraging gun safety, (3) making permit holders feel safer when out in public, (4) providing permit holders with a more effective means of self-defense, and (5) reducing the costs to police departments of enforcing laws prohibiting unlicensed gun carrying. [source] Rereading the Dominant Narrative of MentoringCURRICULUM INQUIRY, Issue 4 2000Alexandra Semeniuk Mentoring is currently being promoted as an effective means of easing new teachers' transition from preservice programs to the profession.. At the same time it is seen as a way of providing teacher development for those teachers with more experience. Furthermore researchers promote mentoring as a force for change to diminish isolation and promote teacher collaboration. In this article I present an overview,the dominant narrative,of some recent research on formalized mentoring programs in education. Bringing this material together reveals that researchers are virtually unanimous in their enthusiasm for these initiatives. A dialogue which took place between me and a colleague/friend about what we construed as our mentoring relationshippotentially serves as a counternarrative to this prevalent story. Through an analysis of the educational research and the personal narrative, I suggest that the widely accepted view of mentoring may need to be reread, particularly in relation to language: mentoring's meaning is now imprecise because it is used as an umbrella term for many kinds of affiliations in teaching. Inrereading our narrative I argue that my colleague/friend and I did not act as each other's mentor. Rather, our professional association became entwined with the friendship we developed over time. I maintain that by doing a similar rereading of the research on mentoring in education we might find richer and more precise language to describe how we as teachers can assist one another in becoming sophisticated professionals. [source] Enhancing the Growth of Natural Eyelashes: The Mechanism of Bimatoprost-Induced Eyelash GrowthDERMATOLOGIC SURGERY, Issue 9 20102Article first published online: 2 APR 2010, JOEL L. COHEN MD BACKGROUND Many women desire prominent eyelashes. In December 2008, bimatoprost ophthalmic solution 0.03% was approved for the treatment of hypotrichosis of the eyelashes in the United States. OBJECTIVE To review eyelash physiology and the proposed mechanisms by which the topical pros-tamide product bimatoprost enhances eyelash growth. METHODS AND MATERIALS Clinical and preclinical studies pertaining to the efficacy, safety, and mechanisms of action of bimatoprost are presented. RESULTS Treatment with bimatoprost increases the percentage of eyelash follicles in anagen at any one time. This probably accounts for its ability to lengthen lashes. Bimatoprost-induced stimulation of melanogenesis appears to result in darker lashes and, at the same time, appears to increase the size of the dermal papilla and hair bulb, affecting lash thickness and fullness. Such effects, largely demonstrated in animal studies, are consistent with the results of a recent Food and Drug Administration phase III clinical trial. The favorable safety profile of bimatoprost in human subjects is probably secondary to the limited exposure of ocular tissues resulting from topical application at the base of the upper lashes. CONCLUSION By influencing the eyelash hair cycle and follicles, bimatoprost ophthalmic solution 0.03% is a safe and effective means of enhancing eyelash growth. Dr. Cohen has served as a consultant and clinical trial participant for Allergan, Inc. [source] Results of a Survey of 5,700 Patient Monopolar Radiofrequency Facial Skin Tightening Treatments: Assessment of a Low-Energy Multiple-Pass Technique Leading to a Clinical End Point AlgorithmDERMATOLOGIC SURGERY, Issue 8 2007FRCP, FRCPC, JEFFREY S. DOVER MD INTRODUCTION Monopolar radiofrequency is an effective means of nonsurgical facial skin tightening. OBJECTIVE The objective of this study was to determine whether using larger tips at lower energy and multiple passes, using patient feedback on heat sensation and treating to a clinical end point of visible tightening, would yield better results than single passes with small tips at high energy, as measured by patient and physician satisfaction. METHODS Fourteen physicians from four specialties were surveyed to determine the answers to the following three questions. (1) Is patient's feedback on heat sensation a valid and preferred method for optimal energy selection? (2) Do multiple passes at moderate energy settings yield substantial and consistent efficacy? (3) Is treating to a clinical end point of visible tightening predictable of results? RESULTS A total of 5,700 patient treatments were surveyed. Comparisons were made using the original algorithm of high-energy, single pass to the new algorithm of lower energy and multiple passes with visible tightening as the end point of treatment. Using the original treatment algorithm, 26% of patients demonstrated immediate tightening, 54% observed skin tightening 6 months after treatment, 45% found the procedure too painful, and 68% of patients found the treatment results met their expectations. With the new multiple-pass algorithm, 87% observed immediate tightening, 92% had the tightening six months after treatment, 5% found the procedure too painful, while 94% found the treatment results met their expectations. CONCLUSIONS Patient feedback on heat sensation is a valid, preferable method for optimal energy selection in monopolar radiofrequency skin-tightening treatments. [source] Photoepilation Results of Axillary Hair in Dark-Skinned Patients by IPL: A Comparison Between Different Wavelength and Pulse WidthDERMATOLOGIC SURGERY, Issue 2 2006JONG HEE LEE MD BACKGROUND Recently, intense pulsed light (IPL) sources have been shown to provide long-term hair removal. OBJECTIVE This study examined the photoepilatory effects of different wavelengths and pulse width application in the same device and compared their efficiencies in Asian skin. METHODS Twenty-eight Korean women were treated using HR (600,950 nm filter) and 27 using HR-D (645,950 nm filter) in the axillar area. Four treatments were carried out at intervals of 4 to 6 weeks; follow-ups were conducted 8 months after the last treatment. Mean energy settings were 14.9±2.0 J/cm2 for HR and 17.1±0.6 J/cm2 for HR-D. Longer pulse widths were applied in case of HR-D treatment. Hair counts and photographic evaluation of skin sites were made at baseline and at the last follow-up. Final overall evaluations were performed by patients and clinicians. RESULTS Average clearances of 52.8% and 83.4% were achieved by HR and HR-D, respectively. No significant adverse effects were reported after HR-D treatment. One case each of hypopigmentation and hyperpigmentation was reported for HR. CONCLUSION An IPL source by removing 45 nm of the emitted spectra and applying longer pulse width was found to provide a safer and more effective means of photoepilation in Asian patients. [source] Safety and efficacy of vaccinesDERMATOLOGIC THERAPY, Issue 2 2009Brenda L. Bartlett ABSTRACT For the past two centuries, vaccines have provided a safe and effective means of preventing a number of infectious diseases. Although the safety of some vaccines has been questioned in recent years, the currently available vaccines are more than a millionfold safer than the diseases they are designed to prevent. Vaccines, however, should always be used in conjunction with other public health interventions. One important intervention is education because the general public can be led to believe that vaccines are unsafe and not needed by misinformation readily available electronically and in print. Not only are some vaccines available via injection but other vaccines are also given orally or intranasally. New vaccines are being studied for topical and intravaginal use. In addition, new systems are being developed for more efficient production of vaccines, especially for influenza. Vaccines are currently available for only a limited number of viral and bacterial diseases. In the future, it is anticipated that safe and effective vaccines will be developed against a number of other viral and bacterial infections as well as fungal and protozoan diseases. [source] An in vivo comparison of photoactivatable fluorescent proteins in an avian embryo modelDEVELOPMENTAL DYNAMICS, Issue 6 2007Danny A. Stark Abstract Tracing the lineage or neighbor relationships of cells in a migratory population or deep within an embryo is difficult with current methods. The recent explosion of photoactivatable fluorescent proteins (PAFPs) offers a unique cell labeling tool kit, yet their in vivo performance in intact embryos and applicability have not been thoroughly explored. We report a comparison study of PAGFP, PSCFP2, KikGR, and Kaede analyzed in the avian embryo using confocal and 2-photon microscopy. PAFPs were introduced into the chick neural tube by electroporation and each photoconverted in the neural crest or cells in the neural tube with exposure to 405 nm light, but showed dramatic differences in photoefficiency and photostability when compared at the same 2% laser power. KikGR and Kaede photoconverted with ratios only slightly lower than in vitro results, but cells rapidly photobleached after reaching maximal photoefficiency. PSCFP2 had the lowest photoefficiency and photoconverted nearly 70 times slower than the other dual-color PAFPs tested, but was effective at single-cell marking, especially with 2-photon excitation at 760 nm. The dual-color PAFPs were more effective to monitor cell migratory behaviors, since non-photoconverted neighboring cells were fluorescently marked with a separate color. However, photoconverted cells were limited in all cases to be visually distinguishable for long periods, with PSCFP2 visible from background the longest (48 hr). Thus, photoactivation in embryos has the potential to selectively mark less accessible cells with laser accuracy and may provide an effective means to study cell,cell interactions and short-term cell lineage in developmental and stem cell biology. Developmental Dynamics 236:1583,1594, 2007. © 2007 Wiley-Liss, Inc. [source] Visualizing neurons one-by-one in vivo: Optical dissection and reconstruction of neural networks with reversible fluorescent proteinsDEVELOPMENTAL DYNAMICS, Issue 8 2006Shinsuke Aramaki Abstract A great many axons and dendrites intermingle to fasciculate, creating synapses as well as glomeruli. During live imaging in particular, it is often impossible to distinguish between individual neurons when they are contiguous spatially and labeled in the same fluorescent color. In an attempt to solve this problem, we have taken advantage of Dronpa, a green fluorescent protein whose fluorescence can be erased with strong blue light, and reversibly highlighted with violet or ultraviolet light. We first visualized a neural network with fluorescent Dronpa using the Gal4-UAS system. During the time-lapse imaging of axonal navigation, we erased the Dronpa fluorescence entirely; re-highlighted it in a single neuron anterogradely from the soma or retrogradely from the axon; then repeated this procedure for other single neurons. After collecting images of several individual neurons, we then recombined them in multiple pseudo-colors to reconstruct the network. We have also successfully re-highlighted Dronpa using two-photon excitation microscopy to label individual cells located inside of tissues and were able to demonstrate visualization of a Mauthner neuron extending an axon. These "optical dissection" techniques have the potential to be automated in the future and may provide an effective means to identify gene function in morphogenesis and network formation at the single cell level. Developmental Dynamics 235:2192,2199, 2006. © 2006 Wiley-Liss, Inc. [source] Active immunization against (Pro3)GIP improves metabolic status in high-fat-fed miceDIABETES OBESITY & METABOLISM, Issue 9 2010I. A. Montgomery Aim: Ablation of gastric inhibitory polypeptide (GIP) receptor signalling can prevent many of the metabolic abnormalities associated with dietary-induced obesity-diabetes. The present study was designed to assess the ability of active immunization against (Pro3)GIP to counter metabolic dysfunction associated with diet-induced obesity in high-fat-fed mice. Methods: Normal male Swiss NIH mice were injected (s.c.) once every 14 days for 98 days with complexed (Pro3)GIP peptide, with transfer to a high-fat diet on day 21. Results: Active immunization against (Pro3)GIP resulted in circulating GIP antibody production and significantly (p < 0.05 p < 0.01) reduced circulating blood glucose concentrations compared to high-fat control mice from day 84 onwards. Glucose levels were not significantly different from lean controls. The glycaemic response to i.p. glucose was correspondingly improved (p < 0.01) in (Pro3)GIP-immunized mice. Furthermore, circulating and glucose-stimulated plasma insulin levels were significantly (p < 0.01 to p < 0.001) depressed compared to high-fat control mice. Liver triglyceride, pancreatic insulin and circulating LDL-cholesterol levels were also significantly reduced in (Pro3)GIP-immunized mice. These changes were independent of any effects on food intake or body weight. The glucose-lowering effect of native GIP was annulled in (Pro3)GIP-immunized mice consistent with the induction of biologically effective GIP-specific neutralizing antibodies. Conclusion: These results suggest that immunoneutralization of GIP represents an effective means of countering the disruption of metabolic processes induced by high-fat feeding. [source] ROLE OF ENDOSCOPY IN SCREENING OF EARLY PANCREATIC CANCER AND BILE DUCT CANCERDIGESTIVE ENDOSCOPY, Issue 2009Kiyohito Tanaka In the screening of early pancreatic cancer and bile duct cancer, the first issue was ,what are the types of abnormality in laboratory data and symptoms in case of early pancreatic cancer and bile duct cancer?' Early cancer in the pancreaticobiliary region has almost no symptoms, however epigastralgia without abnormality in the gastrointestinal (GI) tract is a sign of early stage pancreaticobiliary cancer. Sudden onset and aggravation of diabetes mellitus is an important change in the case of pancreatic cancer. Extracorporeal ultrasonography is a very useful procedure of checking up changes of pancreatic and biliary lesions. As the role of endoscopy in screening, endoscopic ultrasonography (EUS) is the most effective means of cancer detection of the pancreas, and endoscopic retrograde cholangiopancreatography (ERCP) is most useful of diagnosis tool for abnormalities of the common bile duct. Endoscopic retrograde cholangiopancreatography is an important modality as the procedure of sampling of diagnostic materials. Endoscopic ultrasonography-fine needle aspiration (EUS-FNA) has the role of histological diagnosis of pancreatic mass lesion also. Especially, in the case of pancreas cancer without evidence of cancer by pancreatic juice cytology and brushing cytology, EUS-FNA is essential. Intra ductal ultrasonography (IUDS) and perotral cholangioscopy (POCS) are useful for determination of mucosal extent in extrahepatic bile duct cancer. Further improvements of endoscopical technology, endoscopic procedures are expected to be more useful modalities in detection and diagnosis of early pancreatic and bile duct cancers. [source] REDUCING THE RISK OF PERISTOMAL INFECTION AFTER PEG PLACEMENTDIGESTIVE ENDOSCOPY, Issue 4 2005Iruru Maetani Percutaneous endoscopic gastrostomy (PEG) was first described in 1980 as an effective means of enteral nutrition where oral intake is not possible. PEG placement is safe and has now replaced the nasogastric tube in patients who need long-term feeding. Although it is relatively safe with a very low associated mortality, minor complications, especially local and systemic infection, remain a problem. Of these, peristomal wound infections are the most common complication of PEG. In patients indicated for this procedure who are aged and/or frail, this complication may pose a critical problem. In the commonly used pull or push methods for PEG placement, the PEG tube is readily colonized by oropharyngeal bacteria. Infection of the PEG site is considered to be associated with contamination of the PEG catheter. There are important measures that should be taken to prevent peristomal infection. A number of rigorous studies have shown that prophylactic antibiotics are effective in reducing the risk of peristomal infection. As methicillin-resistant Staphylococcus aureus (MRSA) or other resistant organisms are emerging as a major pathogen in peristomal infection, however, currently recommended antibiotic prophylaxis regimens might be inappropriate. Alternative regimens and other approaches to prevent contamination of the PEG tube during the procedure are required. [source] Changes in HIV/AIDS/STI Knowledge, Attitudes and Practices among Commercial Sex Workers and Military Forces in Port Loko, Sierra LeoneDISASTERS, Issue 3 2004Mandi M. Larsen Sierra Leone suffered from 11 years of civil war (1991,2002) resulting in tens of thousands of deaths and mutilations together with massive population displacement. In 2001, ARC International, Sierra Leone conducted a baseline survey of 201 commercial sex workers (CSWs) and 202 military respondents on the knowledge, attitudes and practices surrounding HIV/AIDS and STIs in Port Loko, Sierra Leone. In 2003, a comparable post-intervention survey of 202 CSWs and 205 military respondents was performed. Comparison of baseline and post-intervention results showed that HIV/AIDS knowledge increased among both groups, with those able to name three effective means of avoiding AIDS increasing from 5 per cent to 70 per cent among CSWs, and 11 to 75 per cent among the military. Reported condom use during last sex increased among CSWs from 38 to 68 per cent and among military from 39 to 68 per cent. These results demonstrate that, despite the challenges inherent in a post-conflict country, good-quality AIDS-prevention programmes can be effective. [source] Protection of seismic structures using semi-active friction TMDEARTHQUAKE ENGINEERING AND STRUCTURAL DYNAMICS, Issue 6 2010Chi-Chang Lin Abstract Although the design and applications of linear tuned mass damper (TMD) systems are well developed, nonlinear TMD systems are still in the developing stage. Energy dissipation via friction mechanisms is an effective means for mitigating the vibration of seismic structures. A friction-type TMD, i.e. a nonlinear TMD, has the advantages of energy dissipation via a friction mechanism without requiring additional damping devices. However, a passive-friction TMD (PF-TMD) has such disadvantages as a fixed and pre-determined slip load and may lose its tuning and energy dissipation abilities when it is in the stick state. A novel semi-active-friction TMD (SAF-TMD) is used to overcome these disadvantages. The proposed SAF-TMD has the following features. (1) The frictional force of the SAF-TMD can be regulated in accordance with system responses. (2) The frictional force can be amplified via a braking mechanism. (3) A large TMD stroke can be utilized to enhance control performance. A non-sticking friction control law, which can keep the SAF-TMD activated throughout an earthquake with an arbitrary intensity, was applied. The performance of the PF-TMD and SAF-TMD systems in protecting seismic structures was investigated numerically. The results demonstrate that the SAF-TMD performs better than the PF-TMD and can prevent a residual stroke that may occur in a PF-TMD system. Copyright © 2009 John Wiley & Sons, Ltd. [source] What neurobiology cannot tell us about addictionADDICTION, Issue 5 2010Harold Kalant ABSTRACT Molecular neurobiological studies have yielded enormous amounts of valuable information about neuronal response mechanisms and their adaptive changes. However, in relation to addiction this information is of limited value because almost every cell function appears to be involved. Thus it tells us only that neurons adapt to ,addictive drugs' as they do to all sorts of other functional disturbances. This information may be of limited help in the development of potential auxiliary agents for treatment of addiction. However, a reductionist approach which attempts to analyse addiction at ever finer levels of structure and function, is inherently incapable of explaining what causes these mechanisms to be brought into play in some cases and not in others, or by self-administration of a drug but not by passive exposure. There is abundant evidence that psychological, social, economic and specific situational factors play important roles in initiating addiction, in addition to genetic and other biological factors. Therefore, if we hope to be able to make predictions at any but a statistical level, or to develop effective means of prevention, it is necessary to devise appropriate integrative approaches to the study of addiction, rather than pursue an ever-finer reductive approach which leads steadily farther away from the complex interaction of drug, user, environment and specific situations that characterizes the problem in humans. [source] Employment-based abstinence reinforcement as a maintenance intervention for the treatment of cocaine dependence: a randomized controlled trialADDICTION, Issue 9 2009Anthony DeFulio ABSTRACT Context Due to the chronic nature of cocaine dependence, long-term maintenance treatments may be required to sustain abstinence. Abstinence reinforcement is among the most effective means of initiating cocaine abstinence. Practical and effective means of maintaining abstinence reinforcement programs over time are needed. Objective To determine whether employment-based abstinence reinforcement can be an effective long-term maintenance intervention for cocaine dependence. Design Participants (n = 128) were enrolled in a 6-month job skills training and abstinence initiation program. Participants who initiated abstinence, attended regularly and developed needed job skills during the first 6 months were hired as operators in a data entry business and assigned randomly to an employment-only (control, n = 24) or abstinence-contingent employment (n = 27) group. Setting A non-profit data entry business. Participants Unemployed welfare recipients who used cocaine persistently while enrolled in methadone treatment in Baltimore. Intervention Abstinence-contingent employment participants received 1 year of employment-based contingency management, in which access to employment was contingent upon provision of drug-free urine samples under routine and then random drug testing. If a participant provided drug-positive urine or failed to provide a mandatory sample, then that participant received a temporary reduction in pay and could not work until urinalysis confirmed recent abstinence. Main outcome measure Cocaine-negative urine samples at monthly assessments across 1 year of employment. Results During the 1 year of employment, abstinence-contingent employment participants provided significantly more cocaine-negative urine samples than employment-only participants [79.3% and 50.7%, respectively; P = 0.004, odds ratio (OR) = 3.73, 95% confidence interval (CI) = 1.60,8.69]. Conclusions Employment-based abstinence reinforcement that includes random drug testing is effective as a long-term maintenance intervention, and is among the most promising treatments for drug dependence. Work-places could serve as therapeutic agents in the treatment of drug dependence by arranging long-term employment-based contingency management programs. [source] Therapeutic Yield and Outcomes of a Community Teaching Hospital Code Stroke ProtocolACADEMIC EMERGENCY MEDICINE, Issue 4 2004Andrew W. Asimos MD Objectives: To describe the experience of a community teaching hospital emergency department (ED) Code Stroke Protocol (CSP) for identifying acute ischemic stroke (AIS) patients and treating them with tissue plasminogen activator (tPA) and to compare outcome measures with those achieved in the National Institute of Neurological Disorders and Stroke (NINDS) trial. Methods: This study was a retrospective review from a hospital CSP registry. Results: Over a 56-month period, CSP activation occurred 255 times, with 24% (n= 60) of patients treated with intravenous (IV) tPA. The most common reasons for thrombolytic therapy exclusion were mild or rapidly improving symptoms in 37% (n= 64), intracerebral hemorrhage (ICH) in 23% (n= 39), and unconfirmed symptom onset time for 14% (n= 24) of patients. Within 36 hours of IV tPA treatment, 10% (NINDS = 6%) of patients (n= 6) sustained a symptomatic ICH (SICH). Three months after IV tPA treatment, 60% of patients had achieved an excellent neurologic outcome, based on a Barthel Index of ,95 (NINDS = 52%), while mortality measured 12% (NINDS = 17%). Among IV tPA-treated patients, those developing SICH were significantly older and had a significantly higher mean initial glucose value. Treatment protocol violations occurred in 32% of IV tPA-treated patients but were not significantly associated with SICH (Fisher's exact test). Conclusions: Over the study period, the CSP yielded approximately one IV tPA-treated patient for every four screened and, despite prevalent protocol violations, attained three-month functional outcomes equal to those achieved in the NINDS trial. For community teaching hospitals, ED-directed CSPs are a feasible and effective means to screen AIS patients for treatment with thrombolysis. [source] Sample complexity reduction for two-dimensional electrophoresis using solution isoelectric focusing prefractionationELECTROPHORESIS, Issue 12 2008Matthew R. Richardson Abstract Despite its excellent resolving power, 2-DE is of limited use when analyzing cellular proteomes, especially in differential expression studies. Frequently, fewer than 2000 protein spots are detected on a single 2-D gel (a fraction of the total proteome) regardless of the gel platform, sample, or detection method used. This is due to the vast number of proteins expressed and their equally vast dynamic range. To exploit 2-DE unique ability as both an analytical and a preparative tool, the significant sample prefractionation is necessary. We have used solution isoelectric focusing (sIEF) via the ZOOM® IEF Fractionator (Invitrogen) to generate sample fractions from complex bacterial lysates, followed by parallel 2-DE, using narrow-range IPG strips that bracket the sIEF fractions. The net result of this process is a significant enrichment of the bacterial proteome resolved on multiple 2-D gels. After prefractionation, we detected 5525 spots, an approximate 3.5-fold increase over the 1577 spots detected in an unfractionated gel. We concluded that sIEF is an effective means of prefractionation to increase depth of field and improve the analysis of low-abundance proteins. [source] Effects of beverage alcohol price and tax levels on drinking: a meta-analysis of 1003 estimates from 112 studiesADDICTION, Issue 2 2009Alexander C. Wagenaar ABSTRACT Aims We conducted a systematic review of studies examining relationships between measures of beverage alcohol tax or price levels and alcohol sales or self-reported drinking. A total of 112 studies of alcohol tax or price effects were found, containing1003 estimates of the tax/price,consumption relationship. Design Studies included analyses of alternative outcome measures, varying subgroups of the population, several statistical models, and using different units of analysis. Multiple estimates were coded from each study, along with numerous study characteristics. Using reported estimates, standard errors, t -ratios, sample sizes and other statistics, we calculated the partial correlation for the relationship between alcohol price or tax and sales or drinking measures for each major model or subgroup reported within each study. Random-effects models were used to combine studies for inverse variance weighted overall estimates of the magnitude and significance of the relationship between alcohol tax/price and drinking. Findings Simple means of reported elasticities are ,0.46 for beer, ,0.69 for wine and ,0.80 for spirits. Meta-analytical results document the highly significant relationships (P < 0.001) between alcohol tax or price measures and indices of sales or consumption of alcohol (aggregate-level r = ,0.17 for beer, ,0.30 for wine, ,0.29 for spirits and ,0.44 for total alcohol). Price/tax also affects heavy drinking significantly (mean reported elasticity = ,0.28, individual-level r = ,0.01, P < 0.01), but the magnitude of effect is smaller than effects on overall drinking. Conclusions A large literature establishes that beverage alcohol prices and taxes are related inversely to drinking. Effects are large compared to other prevention policies and programs. Public policies that raise prices of alcohol are an effective means to reduce drinking. [source] GeoChip-based analysis of functional microbial communities during the reoxidation of a bioreduced uranium-contaminated aquiferENVIRONMENTAL MICROBIOLOGY, Issue 10 2009Joy D. Van Nostrand Summary A pilot-scale system was established for in situ biostimulation of U(VI) reduction by ethanol addition at the US Department of Energy's (DOE's) Field Research Center (Oak Ridge, TN). After achieving U(VI) reduction, stability of the bioreduced U(IV) was evaluated under conditions of (i) resting (no ethanol injection), (ii) reoxidation by introducing dissolved oxygen (DO), and (iii) reinjection of ethanol. GeoChip, a functional gene array with probes for N, S and C cycling, metal resistance and contaminant degradation genes, was used for monitoring groundwater microbial communities. High diversity of all major functional groups was observed during all experimental phases. The microbial community was extremely responsive to ethanol, showing a substantial change in community structure with increased gene number and diversity after ethanol injections resumed. While gene numbers showed considerable variations, the relative abundance (i.e. percentage of each gene category) of most gene groups changed little. During the reoxidation period, U(VI) increased, suggesting reoxidation of reduced U(IV). However, when introduction of DO was stopped, U(VI) reduction resumed and returned to pre-reoxidation levels. These findings suggest that the community in this system can be stimulated and that the ability to reduce U(VI) can be maintained by the addition of electron donors. This biostimulation approach may potentially offer an effective means for the bioremediation of U(VI)-contaminated sites. [source] Pathways to discovery in epilepsy research: Rethinking the quest for curesEPILEPSIA, Issue 1 2008Daniel H. Lowenstein Summary This paper, based on the 4th Annual Hoyer Lecture presented at the 2006 annual meeting of the American Epilepsy Society, first provides a general view of the current limitations in therapies aimed at achieving the goal of "no seizures, no side effects" for patients living with epilepsy. Some of the seminal discoveries in epilepsy research over the past 100 years are then reviewed, with an emphasis on the pivotal role of basic and clinical/translational science in leading the way to new and effective means for diagnosing and treating for epilepsy. The paper concludes with a view of the future course of epilepsy research. Scientific advances will increasingly rely on the collaboration of multidisciplinary teams of reseachers using the analytic and storage capabilities of machines, and linked together by communication tools such as the Internet and related technologies. [source] SPERM DONOR OR THWARTED FATHER?FAMILY COURT REVIEW, Issue 2 2009HOW WRITTEN AGREEMENT STATUTES ARE CHANGING THE WAY COURTS RESOLVE LEGAL PARENTAGE ISSUES IN ASSISTED REPRODUCTION CASES In recent years, the use of assisted reproduction has risen dramatically in the United States, allowing individuals who face various reproductive challenges, including infertility or absence of a heterosexual partner, to conceive biological children. While assisted reproduction has expanded to meet the needs of these parents, the legal system remains years behind, often leading to complicated child custody disputes between the parties. State legislatures have responded to the call for increased regulation of legal parentage in assisted reproduction in varying ways, although one popular statutory approach requires a known sperm provider to preserve his intention to parent in a written agreement with the woman. This article will argue that written agreement statutes are an effective means for resolving parentage disputes because of their ability to protect pre-insemination intent and encourage private ordering of conflicts among the parties. These issues will be explored through the lens of a recent case decided by the Kansas Supreme Court, In Re K.M.H., where the court enforced a written agreement statute against a sperm provider despite his equal protection and due process challenges. [source] Ground Water Chlorinated Ethenes in Tree Trunks: Case Studies, Influence of Recharge, and Potential Degradation MechanismGROUND WATER MONITORING & REMEDIATION, Issue 3 2004Don A. Vroblesky Trichloroethene (TCE) was detected in cores of trees growing above TCE-contaminated ground at three sites: the Carswell Golf Course in Texas, Air Force Plant PJKS in Colorado, and Naval Weapons Station Charleston in South Carolina. This was true even when the depth to water was 7.9 m or when the contaminated aquifer was confined beneath ,3 m of clay. Additional ground water contaminants detected in the tree cores were cis,1,2-dichloroethene at two sites and tetrachloroethene at one site. Thus, tree coring can be a rapid and effective means of locating shallow subsurface chlorinated ethenes and possibly identifying zones of active TCE dechlorination. Tree cores collected over time were useful in identifying the onset of ground water contamination. Several factors affecting chlorinated ethene concentrations in tree cores were identified in this investigation. The factors include ground water chlorinated ethene concentrations and depth to ground water contamination. In addition, differing TCE concentrations around the trunk of some trees appear to be related to the roots deriving water from differing areas. Opportunistic uptake of infiltrating rainfall can dilute prerain TCE concentrations in the trunk. TCE concentrations in core headspace may differ among some tree species. In some trees, infestation of bacteria in decaying heartwood may provide a TCE dechlorination mechanism within the trunk. [source] Continuous factor VIII infusion therapy in patients with haemophilia A undergoing surgical procedures with plasma-derived or recombinant factor VIII concentratesHAEMOPHILIA, Issue 5 2002D. Dingli Summary., We describe the experience of a single medical centre with continuous factor VIII (FVIII) infusion therapy in a cohort of patients undergoing elective surgery. Twenty-eight patients had a total of 45 procedures. Intraoperative haemostasis was considered excellent in all 45 cases. FVIII levels were maintained between 46% and 191% of normal (median, 103%) for 2,7 days. Bleeding occurred after five procedures (11%) at times when factor VIII levels were within haemostatic range. No patient required reoperation to control bleeding. There were no cases of sepsis related to continuous infusion of factor VIII. We conclude that continuous infusion: (1) is a safe and effective means of replacement therapy in patients with haemophilia undergoing surgery; (2) provides easier monitoring and more constant coagulation factor levels; and (3) has the potential to decrease the cost of replacement therapy by reducing overall usage of product. [source] Listening to the views of people affected by cancer about cancer research: an example of participatory research in setting the cancer research agendaHEALTH EXPECTATIONS, Issue 1 2006David Wright PhD Abstract Aim, The study ,Listening to the Views of People Affected by Cancer About Cancer Research' is currently exploring the views people affected by cancer have about cancer research and identifying their research priorities. Integral to this is the broader aim of ensuring an effective, collaborative participation of patients and carers in the design and conduct of the study. On the basis of experiences with the study to date, the latter is explored in this paper. Design, The study adopts a ,participatory research' approach entailing the formation of a ,reference group' and a subsequent patient and carer co-researcher group. Patient and carer members of these groups were identified through the patient forums of UK cancer networks and by approaching ,hard to reach' representatives directly through community groups and participating study sites. Findings, Experiences from this study illustrate that a ,participatory research' approach is appropriate in engaging patients and carers in the research process. Establishing a group of people affected by cancer in the study was found to be particularly effective in enhancing the design and conduct of the research. Conclusions, ,Participatory research' offers an effective means of involving patients and carers throughout the research process, thus strengthening the relevance and appropriateness of research findings and methods. [source] Comparison of indices of vitamin A status in children with chronic liver disease,HEPATOLOGY, Issue 4 2005Andrew P. Feranchak Malabsorption of fat-soluble vitamins is a major complication of chronic cholestatic liver disease. The most accurate way to assess vitamin A status in children who have cholestasis is unknown. The goal of this study was to assess the accuracy of noninvasive tests to detect vitamin A deficiency. Children with chronic cholestatic liver disease (n = 23) and noncholestatic liver disease (n = 10) were studied. Ten cholestatic patients were identified as vitamin A,deficient based on the relative dose response (RDR). Compared with the RDR, the sensitivity and specificity to detect vitamin A deficiency for each test was, respectively: serum retinol, 90% and 78%; retinol-binding protein (RBP), 40% and 91%; retinol/RBP molar ratio, 60% and 74%; conjunctival impression cytology, 44% and 48%; slit-lamp examination, 20% and 66%; tear film break-up time, 40% and 69%; and Schirmer's test, 20% and 78%. We developed a modified oral RDR via oral coadministration of d-alpha tocopheryl polyethylene glycol-1000 succinate and retinyl palmitate. This test had a sensitivity of 80% and a specificity of 100% to detect vitamin A deficiency. In conclusion, vitamin A deficiency is relatively common in children who have chronic cholestatic liver disease. Our data suggest that serum retinol level as an initial screen followed by confirmation with a modified oral RDR test is the most effective means of identifying vitamin A deficiency in these subjects. (HEPATOLOGY 2005;42:782,792.) [source] The Open Door: Hospitality and Honour in Twelfth/Early Thirteenth-Century EnglandHISTORY, Issue 287 2002Julie Kerr A renewed interest in etiquette and a growing preoccupation with rank in twelfth,century England heightened the importance of the public forum as an effective means to enhance reputation or, at the very least, to guard against shame. This article considers the significance of honour as an incentive behind hospitality in twelfth/early thirteenth,century England. The analysis is threefold and examines, first, how individuals were judged on their willingness to receive guests, secondly, the limits to their generosity, and thirdly, whether the outsider's rejection of hospitality injured the host's reputation. [source] On the effects of triangulated terrain resolution on distributed hydrologic model responseHYDROLOGICAL PROCESSES, Issue 11 2005Enrique R. Vivoni Abstract Distributed hydrologic models based on triangulated irregular networks (TIN) provide a means for computational efficiency in small to large-scale watershed modelling through an adaptive, multiple resolution representation of complex basin topography. Despite previous research with TIN-based hydrology models, the effect of triangulated terrain resolution on basin hydrologic response has received surprisingly little attention. Evaluating the impact of adaptive gridding on hydrologic response is important for determining the level of detail required in a terrain model. In this study, we address the spatial sensitivity of the TIN-based Real-time Integrated Basin Simulator (tRIBS) in order to assess the variability in the basin-averaged and distributed hydrologic response (water balance, runoff mechanisms, surface saturation, groundwater dynamics) with respect to changes in topographic resolution. Prior to hydrologic simulations, we describe the generation of TIN models that effectively capture topographic and hydrographic variability from grid digital elevation models. In addition, we discuss the sampling methods and performance metrics utilized in the spatial aggregation of triangulated terrain models. For a 64 km2 catchment in northeastern Oklahoma, we conduct a multiple resolution validation experiment by utilizing the tRIBS model over a wide range of spatial aggregation levels. Hydrologic performance is assessed as a function of the terrain resolution, with the variability in basin response attributed to variations in the coupled surface,subsurface dynamics. In particular, resolving the near-stream, variable source area is found to be a key determinant of model behaviour as it controls the dynamic saturation pattern and its effect on rainfall partitioning. A relationship between the hydrologic sensitivity to resolution and the spatial aggregation of terrain attributes is presented as an effective means for selecting the model resolution. Finally, the study highlights the important effects of terrain resolution on distributed hydrologic model response and provides insight into the multiple resolution calibration and validation of TIN-based hydrology models. Copyright © 2005 John Wiley & Sons, Ltd. [source] Wavelet analysis of inter-annual variability in the runoff regimes of glacial and nival stream catchments, Bow Lake, AlbertaHYDROLOGICAL PROCESSES, Issue 6 2003Melissa Lafrenière Abstract Continuous wavelet analyses of hourly time series of air temperature, stream discharge, and precipitation are used to compare the seasonal and inter-annual variability in hydrological regimes of the two principal streams feeding Bow Lake, Banff National Park, Alberta: the glacial stream draining the Wapta Icefields, and the snowmelt-fed Bow River. The goal is to understand how water sources and flow routing differ between the two catchments. Wavelet spectra and cross-wavelet spectra were determined for air temperature and discharge from the two streams for summers (June,September) 1997,2000, and for rainfall and discharge for the summers of 1999 and 2000. The diurnal signal of the glacial runoff was orders of magnitude higher in 1998 than in other years, indicating that significant ice exposure and the development of channelized glacial drainage occurred as a result of the 1997,98 El Niño conditions. Early retreat of the snowpack in 1997 and 1998 led to a significant summer-long input of melt runoff from a small area of ice cover in the Bow River catchment; but such inputs were not apparent in 1999 and 2000, when snow cover was more extensive. Rainfall had a stronger influence on runoff and followed quicker flow paths in the Bow River catchment than in the glacial catchment. Snowpack thickness and catchment size were the primary controls on the phase relationship between temperature and discharge at diurnal time scales. Wavelet analysis is a fast and effective means to characterize runoff, temperature, and precipitation regimes and their interrelationships and inter-annual variability. The technique is effective at identifying inter-annual and seasonal changes in the relative contributions of different water sources to runoff, and changes in the time required for routing of diurnal meltwater pulses through a catchment. However, it is less effective at identifying changes/differences in the type of the flow routing (e.g. overland flow versus through flow) between or within catchments. Copyright © 2003 John Wiley & Sons, Ltd. [source] | ||||||||||||||||||||||||||||||||||||||||||||||||||||