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Alternative Proposal (alternative + proposal)
Selected AbstractsA critical reappraisal of treatment response criteria in systemic mastocytosis and a proposal for revisionsEUROPEAN JOURNAL OF HAEMATOLOGY, Issue 5 2010A. Pardanani Abstract Mast cell disease (MCD) is a hematopoietic stem cell neoplasm that is associated with infiltration of one or more organs with cytologically abnormal mast cells (MC). MCD is frequently but not always associated with a KIT mutation and, in some cases, is associated with clonal expansion of non-MC lineage cells. In adults, there is almost always MC infiltration of the bone marrow, which is a cardinal feature of systemic mastocytosis (SM). While, as members of the wider community of physician scientists, we recognize the contribution of the current consensus treatment response criteria for SM, as individuals with more than average clinical experience in SM, we would like to point out their limitations and engage in a constructive discussion that will hopefully lead to a consideration for revisions. We present here an alternative proposal for treatment response assessments we believe is more objective, reproducible, and importantly, SM-subtype specific, given the recent progress in our understanding of the natural history of this disease. We believe this proposal is timely given the prospects for new clinical trials in SM, and the related regulatory aspects of new drug approval that are currently not adequately addressed. The intent of this exercise is not to undermine the complexity of the disease or previous work by other investigators, but to come up with ideas for response criteria that are more practical and consider meaningful patient outcome. [source] Children's and young people's experiences of chronic renal disease: a review of the literature, methodological commentary and an alternative proposalJOURNAL OF CLINICAL NURSING, Issue 6 2006Philip Darbyshire MN Aim., The aims of this paper were to review and critique existing research literature on children's and young people's experiences of chronic renal disease and to propose alternative approaches that may be more fruitful in addressing existing research shortcomings. Background., Chronic renal disease, which results in approximately 1·6,4 new cases per year per million population in the 0,15 years age group, is a serious illness that causes severe and irreversible reduction in kidney function. Despite modern medical advances, its significance and implications for the lives of the children and young people concerned are profound. Method., Salient literature for this review was obtained using the major health and social science electronic databases such as Medline, CINAHL, Psyclit and Sociofile. Manual searching of relevant books, journals and ,grey literature', combined with the genealogy approach, extended and strengthened the search. Conclusions., Research in this area focuses mainly on two areas, namely psychological adjustment and adaptation to end-stage renal disease. This research is grounded within a framework of empirical psychology that values objectivity, measurement and quantification. This predominantly psychometric approach is critiqued for simplifying the complex experience of end-stage renal disease and for pathologizing children and young people with this disease. We identify a significant gap in the research literature, namely the lack of research that takes into account these children's and young peoples'own perspectives of their experiences. Relevance to clinical practice., Chronic renal disease has a significant impact on children's and young people's lives. Understanding the experiences of these children is important for the provision of effective healthcare. Conducting child-centred qualitative research in this area would allow us to explore vital questions of meaning, perception and understanding. If health and social care organizations claim to provide ,consumer-focused' services, it behoves us to develop first a clearer understanding of the lives and experiences of children and families who seek our help and to use this knowledge and understanding to plan and provide more grounded and responsive services. [source] Evolution of the spermatozoon in muroid rodentsJOURNAL OF MORPHOLOGY, Issue 3 2005William G. Breed Abstract In the rodent superfamily Muroidea, a model for the evolution of sperm form has been proposed in which it is suggested that a hook-shaped sperm head and long tail evolved from a more simple, nonhooked head and short tail in several different subfamilies. To test this model the shape of the sperm head, with particular emphasis on its apical region, and length of sperm tail were matched to a recent phylogeny based on the nucleotide sequence of several protein-coding nuclear genes from 3 families and 10 subfamilies of muroid rodents. Data from the two other myomorph superfamilies, the Dipodoidea and kangaroo rats in the Geomyoidea, were used for an outgroup comparison. In most species in all 10 muroid subfamilies, apart from in the Murinae, the sperm head has a long rostral hook largely composed of acrosomal material, although its length and cross-sectional shape vary across the various subfamilies. Nevertheless, in a few species of various lineages a very different sperm morphology occurs in which an apical hook is lacking. In the outgroups the three species of dipodid rodents have a sperm head that lacks a hook, whereas in the heteromyids an acrosome-containing apical hook is present. It is concluded that, as the hook-shaped sperm head and long sperm tail occur across the muroid subfamilies, as well as in the heteromyid rodents, it is likely to be the ancestral condition within each of the subfamilies with the various forms of nonhooked sperm heads, that are sometimes associated with short tails, being highly derived states. These findings thus argue against a repeated evolution in various muroid lineages of a complex, hook-shaped sperm head and long sperm tail from a more simple, nonhooked sperm head and short tail. An alternative proposal for the evolution of sperm form within the Muroidea is presented in the light of these data. J. Morphol. © 2005 Wiley- Liss, Inc. [source] Algorithms for vector field generation in mass consistent modelsNUMERICAL METHODS FOR PARTIAL DIFFERENTIAL EQUATIONS, Issue 4 2010Ciro Flores Abstract Diagnostic models in meteorology are based on the fulfillment of some time independent physical constraints as, for instance, mass conservation. A successful method to generate an adjusted wind field, based on mass conservation equation, was proposed by Sasaki and leads to the solution of an elliptic problem for the multiplier. Here we study the problem of generating an adjusted wind field from given horizontal initial velocity data, by two ways. The first one is based on orthogonal projection in Hilbert spaces and leads to the same elliptic problem but with natural boundary conditions for the multiplier. We derive from this approach the so called E,algorithm. An innovative alternative proposal is obtained from a second approach where we consider the saddle,point formulation of the problem,avoiding boundary conditions for the multiplier, and solving this problem by iterative conjugate gradient methods. This leads to an algorithm that we call the CG,algorithm, which is inspired from Glowinsk's approach to solve Stokes,like problems in computational fluid dynamics. Finally, the introduction of new boundary conditions for the multiplier in the elliptic problem generates better adjusted fields than those obtained with the original boundary conditions. © 2009 Wiley Periodicals, Inc. Numer Methods Partial Differential Eq 2010 [source] MECHANISMS MEDIATING PRESSURE NATRIURESIS: WHAT WE KNOW and WHAT WE NEED TO FIND OUTCLINICAL AND EXPERIMENTAL PHARMACOLOGY AND PHYSIOLOGY, Issue 5-6 2005Roger G Evans SUMMARY 1.,It is well established that pressure natriuresis plays a key role in long-term blood pressure regulation, but our understanding of the mechanisms underlying this process is incomplete. 2.,Pressure natriuresis is chiefly mediated by inhibition of tubular sodium reabsorption, because both total renal blood flow and glomerular filtration rate are efficiently autoregulated. Inhibition of active sodium transport within both the proximal and distal tubules likely makes a contribution. Increased renal interstitial hydrostatic pressure (RIHP) likely inhibits sodium reabsorption by altering passive diffusion through paracellular pathways in ,leaky' tubular elements. 3.,Nitric oxide and products of cytochrome P450-dependent arachidonic acid metabolism are key signalling mechanisms in pressure natriuresis, although their precise roles remain to be determined. 4.,The key unresolved question is, how is increased renal artery pressure ,sensed' by the kidney? One proposal rests on the notion that blood flow in the renal medulla is poorly autoregulated, so that increased renal artery pressure leads to increased renal medullary blood flow (MBF), which, in turn, leads to increased RIHP. An alternative proposal is that the process of autoregulation of renal blood flow leads to increased shear stress in the preglomerular vasculature and, so, release of nitric oxide and perhaps products of cytochrome P450-dependent arachidonic acid metabolism, which, in turn, drive the cascade of events that inhibit sodium reabsorption. 5.,Central to the arguments underlying these opposing hypotheses is the extent to which MBF is autoregulated. This remains highly controversial, largely because of the limitations of presently available methods for measurement of MBF. [source] An alternative proposal for the mechanism behind the successful effect of TENS in the management of idiopathic faecal incontinenceCOLORECTAL DISEASE, Issue 8 2010Y. Beyazit No abstract is available for this article. [source] African Countries and the WTO's Dispute Settlement MechanismDEVELOPMENT POLICY REVIEW, Issue 1 2007Amin Alavi The WTO Dispute Settlement Mechanism was designed, inter alia, to secure the ,rule of law' within international trade and provide all members with opportunities to exercise their rights under multilateral trade agreements. But, after ten years, no sub-Saharan African country has yet used the option to initiate a dispute. This article examines what prevents the WTO Africa Group from using the system and critically reviews the solutions they have proposed to remedy this. It concludes by discussing how this reflects broader problems concerning African participation in WTO, and puts forward some alternative proposals. [source] The new Quest for Healing: when Therapy and Spirituality Intermingle,INTERNATIONAL REVIEW OF MISSION, Issue 380-381 2007Bernard Ugeux For some decades one has noted an increased interest in spirituality outside the traditional religions of the West, viz. the three monotheisms. New spiritual quests often develop on the fringes of the churches, and sometimes even as a reaction to the churches' vision of what it means to be human. In this regard, those interested in spirituality often see their spiritual search as something linked to a general care for wellbeing or health, and reproach Christianity for being too disembodied. The association of the spiritual with the therapeutical leads to a certain permeability between the spiritual and therapeutical in terms of the claims each makes. It also leads to the creation of new alternative proposals. This porousness runs the risk of bringing confusion to everything, and using the spiritual and religious to serve therapeutic needs. However, the way in which the claims of the spiritual and therapeutical realms evolve presents a challenge to Christianity. This can be put in terms of, ,What place does Christianity attribute to the body, affectivity, pleasure, and legitimate personal development?' Some individuals and groups in the Christian churches, rather than trying to justify existing approaches, propose more "incarnated" ones that will respond to the new audience in a Christian way. From a theological, pastoral and missiological viewpoint, Christian communities are thus intended to become communities of healing and reconciliation, although not at any price. If Christian spirituality also has to favour the empowering and development of a person , for Christ has assumed everything of humanity, except sin , one should not reduce salvation to healing or ignore the paschal mystery as a way of avoiding the element of pain that this mystery contains. In short, Christianity is invited to do a work of inculturation that not only keeps in mind contemporary developments but also is accompanied by an authentic interdisciplinary discernment. [source] | |||||||||||||