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Initial Assessment (initial + assessment)
Selected AbstractsManagement of critically ill children with traumatic brain injuryPEDIATRIC ANESTHESIA, Issue 6 2008GILLES A. ORLIAGUET MD PhD Summary The management of critically ill children with traumatic brain injury (TBI) requires a precise assessment of the brain lesions but also of potentially associated extra-cranial injuries. Children with severe TBI should be treated in a pediatric trauma center, if possible. Initial assessment relies mainly upon clinical examination, trans-cranial Doppler ultrasonography and body CT scan. Neurosurgical operations are rarely necessary in these patients, except in the case of a compressive subdural or epidural hematoma. On the other hand, one of the major goals of resuscitation in these children is aimed at protecting against secondary brain insults (SBI). SBI are mainly because of systemic hypotension, hypoxia, hypercarbia, anemia and hyperglycemia. Cerebral perfusion pressure (CPP = mean arterial blood pressure , intracranial pressure: ICP) should be monitored and optimized as soon as possible, taking into account age-related differences in optimal CPP goals. Different general maneuvers must be applied in these patients early during their treatment (control of fever, avoidance of jugular venous outflow obstruction, maintenance of adequate arterial oxygenation, normocarbia, sedation,analgesia and normovolemia). In the case of increased ICP and/or decreased CPP, first-tier ICP-specific treatments may be implemented, including cerebrospinal fluid drainage, if possible, osmotic therapy and moderate hyperventilation. In the case of refractory intracranial hypertension, second-tier therapy (profound hyperventilation with PaCO2 < 35 mmHg, high-dose barbiturates, moderate hypothermia, decompressive craniectomy) may be introduced, after a new cerebral CT scan. [source] Older and Younger Adults in Pain Management Programs in the United States: Differences and SimilaritiesPAIN MEDICINE, Issue 2 2006Harriėt M. Wittink PhD ABSTRACT Objectives., 1) To investigate health status of older (,60 years) and younger adults (<60 years) with chronic pain and to separately compare that with existing normative data; and 2) to examine more fully differences in health status between younger and older adults with chronic pain and explore their geographic variation across three multidisciplinary pain programs in the Pacific, Mountain, and New England regions of the United States. Design., We performed a cross-sectional analysis. Patients., Initial assessments of 6,147 patients dating from January 1998 to January 2003 were used. Outcomes Measures., We used the Treatment Outcomes of Pain Survey (TOPS), a disease-specific instrument that includes the Short Form-36. Results., The health status of the older pain patients in terms of their actual scores was comparable with that of younger pain patients across the three sites. Health status is impaired to a lesser degree in older than in younger adults with chronic pain as compared with normative adults. Statistically significant differences were found in a number of domains of the TOPS. Older adults with chronic pain present with pain intensity similar to that of younger patients with chronic pain, but report better mental health (P < 0.002), less fear-avoidance (P < 0.05), less passive coping (P < 0.0001), more life control (P < 0.05), and more lower body physical limitations (P < 0.005) than younger patients with chronic pain. Conclusions., Older adults with chronic pain differ in a number of important domains from younger adults with chronic pain: overall the former present with greater physical, and less psychosocial impairment. [source] Self-rated importance of religion predicts one-year outcome of patients with panic disorderDEPRESSION AND ANXIETY, Issue 5 2006F.R.C.P.(C.), Rudy Bowen M.D.C.M. Abstract Cognitive-behavioral therapy and medication are efficacious treatments for panic disorder, but individual attributes such as coping and motivation are important determinants of treatment response. A sample of 56 patients with panic disorder, treated with group cognitive-behavioral therapy, were reassessed 6 months and 12 months after initial assessment. We studied the effect of self-rated importance of religion, perceived stress, self-esteem, mastery, and interpersonal alienation on outcome as measured by the General Severity Index of the Brief Symptom Inventory (BSI.GSI). Importance of religion was a predictor of BSI.GSI symptom improvement at 1 year. Over time, improvement was seen for the religion is very important subgroup in the BSI.GSI and Perceived Stress Scales. This study suggests that one mechanism by which high importance of religion reduces psychiatric symptoms is through reducing perceived stress. Depression and Anxiety 23:266,273, 2006. © 2006 Wiley-Liss, Inc. [source] Reliability and validity of the Observational Gait Scale in children with spastic diplegiaDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 1 2003Anna H Mackey MS PT The aim of this study was to establish the reliability and validity of visual gait assessment in children with spastic diplegia, who were community or household ambulators, using a modified version of the Physicians Rating Scale, known as the Observational Gait Scale (OGS). Two clinicians viewed edited split-screen video recordings of 20 children/adolescents (11 males, 9 females; mean age 12 years, range 6 to 21 years) made at the time of three-dimensional gait analysis (3-DGA). Walking ability in each child was scored at initial assessment and reassessed from the same videos three months later using the first seven sections of the OGS. Validity of the OGS score was determined by comparison with 3-DGA. The OGS was found to have acceptable interrater and intrarater reliability for knee and foot position in mid-stance, initial foot contact, and heel rise with weighted kappas (wk) ranging from 0.53 to 0.91 (intrarater) and 0.43 to 0.86 (interrater). Comparison with 3-DGA suggests that these sections might also have high validity(wk range 0.38,0.94). Base of support and hind foot position had lower interrater and intrarater reliabilities (wk 0.29 to 0.71 and wk 0.30 to 0.78 respectively) and were not easily validated by 3-DGA. [source] Medication decisions and clinical outcomes in the Canadian National Outcomes Measurement Study in SchizophreniaACTA PSYCHIATRICA SCANDINAVICA, Issue 2006R. Williams Objective:, To evaluate over a 2-year period, patients from academic/non-academic centres, from each region of Canada, to determine whether location or other variables such as medication type, gender or income was associated with outcome as defined by non-hospitalization and persistence on original treatment. Method:, A total of 448 patients were recruited from academic and non-academic centres across all provinces of Canada and followed up for 2 years. Results:, Patients from British Columbia had significantly lower rates of hospitalization than patients from other provinces. Male patients showed greater symptomatic improvement at 2 years from initial assessment compared to females. Patients on clozapine, risperidone and olanzapine were least likely to be hospitalized. Conclusion:, There were some regional differences noted in both utilization of types of antipsychotic medications and hospitalization rates. In this sample of stable out-patients over 70% who started on monotherapy with clozapine, risperidone, olanzapine and quetiapine remained on the same medication over the 2-year study period. [source] Insight in early psychosis: a 1 year follow-upACTA PSYCHIATRICA SCANDINAVICA, Issue 2002A. Mintz Insight is an important prognostic indicator in early psychosis, as its presence can enhance treatment compliance, thus reducing the risk of clinical deterioration. The Calgary Early Psychosis Programme (EPP) is a comprehensive treatment programme for individuals experiencing their first episode of psychosis. Purpose, (i) to examine insight on admission and determine if change occurred in the first year of treatment and (ii) to determine if insight was associated with other symptoms. Methods, Participants were 180 consecutive admissions to EPP who completed a 1-year follow-up. Insight, positive and negative symptoms were measured with the PANSS. Depression was measured with the Calgary Depression Scale. Results, There was a significant improvement in insight from initial to 1-year follow-up (P < 0.001). Insight was positively correlated with positive and negative symptoms (P < 0.001) over time. Insight was negatively correlated with depression (P < 0.001) at the initial assessment. Conclusions, In these first episode patients, there is a significant improvement in insight over time. Insight is significantly related to positive and negative symptoms and to depression in the initial stages of the illness when the presence of depression is notable. [source] Central fat predicts deterioration of insulin secretion index and fasting glycaemia: 6-year follow-up of subjects at varying risk of Type 2 diabetes mellitusDIABETIC MEDICINE, Issue 4 2003A. D. Kriketos Abstract Aims To examine the relationships between body composition and changes in fasting glycaemia, and in indices of insulin secretion and insulin action over 6 years in females with a family history of Type 2 diabetes with or without prior gestational diabetes (,at risk' group, AR) and control females (control group, C). Methods At baseline and at follow-up, an oral glucose tolerance test and dual energy X-ray absorptiometry assessment of body composition were performed. Indices of insulin resistance (HOMA R,) and insulin secretion (HOMA ,,) were obtained from fasting insulin and glucose concentrations. Results At baseline, the groups were similar for age, body mass index, fasting levels of plasma glucose and insulin, HOMA R, and HOMA ,,. Despite similar total body fatness, AR had significantly greater waist circumference and central fat (both P < 0.02) compared with C. At follow-up there was a significant increase in central adiposity only in AR, and the fasting plasma glucose (FPG) level was higher in AR compared with C (5.0 ± 0.2 vs. 4.3 ± 0.2 mmol/l, P = 0.02). This rise in plasma glucose in AR was related to a decline in HOMA ,, (r = 0.45, P = 0.0065). Both the baseline and the increments in total and central abdominal fat mass were associated with the time-related decline in HOMA ,,. Conclusions Six years after initial assessment, AR showed deterioration in FPG levels due predominantly to a decline in insulin secretion index without major change in insulin resistance index. Importantly, baseline body fatness (especially central adiposity), as well as increases in fatness with time, were the major predictors of the subsequent decline of insulin secretion index and the consequent rise in FPG. [source] Suicide bombings: process of care of mass casualties in the developing worldDISASTERS, Issue 4 2009Masood Umer In recent times Pakistan's biggest city, Karachi, has witnessed numerous terrorist attacks. The city does not have an emergency response system and only one of the three public sector hospitals has a trauma centre. We describe the pattern of injuries and management of two terror-related mass casualty incidents involving suicide bombers in a developing nation with limited resources. The first incident occurred in May 2002 with 36 casualties, of whom 13 (36%) died immediately and 11 (30.5%) died at the primary receiving hospitals. The second incident was targeted against the local population in May 2004. The blast resulted in 104 casualties, of which 14 (13.46%) died at the site. All patients had their initial assessment and treatment based on Advanced Trauma and Life Support principles and documented on a trauma form. [source] White-eyed blowout fracture: Another lookEMERGENCY MEDICINE AUSTRALASIA, Issue 3 2009Patrick Mehanna Abstract Orbital floor fractures have the potential to cause significant morbidity both in the short and long terms and commonly present to the ED for initial assessment. Although treatment of the majority of these injuries involves clinic review and possible later surgery, there is a specific subset that present to emergency clinically suggestive of a head injury. This subset, ,white-eyed blowout', usually occurring under 18 years of age, with a history of trauma and little sign of soft tissue injury, describes a trap door orbital floor fracture with herniation and acute entrapment of orbital muscle and is regarded as a maxillofacial emergency. The injury presents with marked nausea, vomiting, headache and irritability suggestive of a head injury that commonly distracts from the true aetiology. It requires prompt diagnosis and treatment to avoid permanent morbidity. We present three cases and discuss their management. [source] A case series evaluation of a modified version of interpersonal psychotherapy (IPT) for the treatment of bulimic eating disorders: A pilot studyEUROPEAN EATING DISORDERS REVIEW, Issue 4 2009Jon Arcelus Abstract Objective To determine the therapeutic outcome of a modified form of (IPT-BNm) amongst patients with Bulimia Nervosa (BN) and Eating Disorders Not Otherwise Specified (EDNOS). Method Following initial assessment, 59 patients with diagnoses of BN or EDNOS entered treatment in the form of 16 sessions of IPT-BNm. At initial assessment, patients completed measures of general psychopathology (SCL-90), Self esteem (RSE), eating psychopathology (EDE-Q), interpersonal functioning (Inventory of Interpersonal Functioning; IIP-32) and depression (BDI). At the middle and end of treatment, EDE-Q, IIP-32 and BDI measures were repeated. Results By the middle of therapy, patients had made significant improvements in terms of their eating disordered cognitions and behaviours (including reductions in EDE-Q scores, bingeing and self-induced vomiting), interpersonal functioning and levels of depression. Conclusions IPT-BNm is an effective treatment for patients with Bulimic Eating Disorders and appears to work quickly, as there were significant reductions in eating disorders symptoms within the first eight sessions of treatment. Copyright © 2009 John Wiley & Sons, Ltd and Eating Disorders Association. [source] Utilization of the Ottawa Ankle Rules by Nurses in a Pediatric Emergency DepartmentACADEMIC EMERGENCY MEDICINE, Issue 2 2002Anna Karpas MD Objectives: To determine the ability of pediatric emergency department (ED) nurses to accurately apply the Ottawa Ankle Rules (OAR) and to evaluate whether the rate of negative ankle radiographs can be reduced by incorporating the OAR into an existing collaborative practice protocol (CPP). Methods: The authors' ED currently uses a CPP in which patients with ankle pain, swelling, deformity, or decreased range of motion on primary nursing assessment undergo radiography prior to physician evaluation. A cross-sectional study was conducted between June and November 2000. Patients aged 5-19 years with an ankle injury who met at least one of the CPP criteria were eligible for enrollment. The OAR were applied by the primary nurse after initial assessment. Ankle radiographs were ordered for all enrolled patients. The interobserver variability between nurses was evaluated on a random sample. Results: One hundred ninety subjects were enrolled in the study. The OAR were correctly interpreted by nurses in 98.4% of subjects. Agreement on the interobserver reliability sample was 100%. Of the 185 subjects, 31 (16.8%) had positive radiographs. Positive OAR results were noted in 30 of 31 subjects with positive radiographs. The sensitivity of the OAR was 97% (95% CI = 0.82 to 0.99) with a specificity of 25% (95% CI = 0.18 to 032). Use of the OAR would have reduced the radiography rate by 21%. Conclusions: Trained nurses can accurately apply and interpret the OAR. The incorporation of the OAR into the nursing assessment of children with acute ankle injuries may reduce the number of radiographs ordered. [source] An examination of groundwater within the Hawara Pyramid, EgyptGEOARCHAEOLOGY: AN INTERNATIONAL JOURNAL, Issue 5 2007K. Keatings The Hawara Pyramid is an outstanding monument. However, the mudbrick structure shows signs of erosion, and the passages and chambers are currently submerged. The problem of water ingress has mainly arisen since the 1880s. In this study, an initial assessment of the pyramid structure was made and causes of water ingress were investigated through analysis of water samples. Stable oxygen isotope measurements indicate that the source of water within the pyramid is the Bahr Selah canal. Water within the pyramid is highly saline compared to the Bahr Selah, and evaporation can only partly account for this high salinity. The composition of dissolved ions suggests that dissolution of salts in soils and from bedrock in the vicinity of the pyramid has enhanced the salinity of water percolating into the pyramid structure. Water ingress and salt deposition are at present the main threat to the integrity of the monument. © 2007 Wiley Periodicals, Inc. [source] Impact of new prostheses on the oral health related quality of life of edentulous patientsGERODONTOLOGY, Issue 1 2005J. L. Veyrune Objective:, A study was conducted to evaluate the impact of the placement of complete dentures by using the Global Oral Health Assessment Index (GOHAI). Background:, Oral health quality of life indicators can be used to evaluate the effects of dental treatments. Material and methods:, The 26 participants were treated in a French University Clinic during 2002. They were randomly divided into two groups. Each group received new prostheses, but evaluation of the quality of life was made at different periods [baseline, denture placement (group 1), 6 and 12 weeks (group 2) after placement]. A questionnaire was used to collect information on patient's satisfaction with the previous and new prostheses. Nonparametric tests were used to test the relationships between patients' satisfaction or baseline data and GOHAI variations with time as well as to compare mean values of GOHAI within each group. Results:, At baseline, the impact of oral health problems was apparent; the mean GOHAI-Add score was 45.8 (10.2). Six weeks after placement of the new denture, there was no difference in GOHAI scores compared with the initial assessment. An improvement in GOHAI score was observed 12 weeks after the participants received their new dentures (p < 0.05). Change in GOHAI-Add scores was negatively correlated with the initial GOHAI-Add score. Patients who preferred the new prosthesis enjoyed a positive change in GOHAI scores (p < 0.001). There was a relationship between participants' satisfaction with the new dentures and change in GOHAI scores (p < 0.05). Conclusion:, The GOHAI can be used to evaluate needs for and effect of the making of new complete dentures. [source] The geochemical characteristics of the Paranį River suspended sediment load: an initial assessmentHYDROLOGICAL PROCESSES, Issue 7 2003Pedro J. Depetris Abstract Most water in the Paranį River drainage basin is supplied by the tropical Upper Paranį (over 60% of the total annual water discharge, 550 km3). The total suspended solids (TSS) load (c. 80 × 106 t year,1), however, is essentially furnished (50,70%) by the mountainous, arid and mostly sediment-mantled upper Bermejo River drainage basin. This characteristic suggests that the Paranį River solid load (TSS, 600 km upstream from the mouth) is largely recycled sedimentary material, whose discharge-weighted mean chemical index of alteration is c. 71. The extended UCC-normalized multi-elemental diagrams are similar to those of other world rivers. Nevertheless, the detailed inspection of UCC-normalized rare earth element (REE) ,spidergrams' reveals a lithological source for the Paranį River TSS that might be compatible with either tholeiitic flood basalts (widespread in the upper drainage) or with young Andean intermediate volcanic rocks. In view of the Bermejo River's dominant role as a sediment contributor, we feel that the signature preserved in the Paranį's TSS is the latter. Conversely, the Uruguay River TSS REE signature is certainly determined by the extensive weathering products of Jurassic,Cretaceous tholeiitic basalts. Copyright © 2003 John Wiley & Sons, Ltd. [source] The behaviour style observation system for young children predicts teacher-reported externalizing behaviour in middle childhoodINFANT AND CHILD DEVELOPMENT, Issue 4 2009Alexa Martin-Storey Abstract The Behaviour Style Observation System for Young Children (BSOS) was used to predict preschool-aged children's externalizing and internalizing behaviour problems in middle childhood, 3,5 years after the initial assessment. This observational measurement tool was designed to sample and assess young children's disruptive, non-compliant, and unresponsive behaviour, during a brief (11,min) observation in the child's home. In the current study, the BSOS was used to predict parent and teacher ratings of child behaviour problems after school entry in a longitudinal sample (N=81) of at-risk children at time 2. The BSOS predicted teacher-reported externalizing problems at time 2. In contrast, parent reports of behaviour problems, although correlated with repeated parent reports at time 2, were not significantly predictive of teacher-reported behaviour problems at school age. The BSOS was not associated with either parent or teacher reports of internalizing problems. These findings emphasize the importance and utility of using observational measures when examining the continuity of behaviour problems in young children over time. Copyright © 2009 John Wiley & Sons, Ltd. [source] A preliminary investigation of the reliability and validity of the Brief Assessment Schedule Depression Cards and the Beck Depression Inventory-Fast Screen to screen for depression in older stroke survivorsINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 5 2008A. K. Healey Abstract Objective To conduct an initial assessment of the reliability and validity of the Brief Assessment Schedule Depression Cards (BASDEC) and the Beck Depression Inventory-Fast Screen (BDI-FS) to screen for depression in older stroke survivors. Methods Participants from four inpatient rehabilitation units completed the BASDEC and the BDI-FS together with the Hospital Anxiety and Depression Scale (HADS) for comparison. The Structured Clinical Interview for DSM-IV Axis 1 Disorders (SCID) was then completed with all participants to ascertain a criterion depression diagnosis. The BASDEC and BDI-FS were subsequently completed for a second time. Results Forty-nine stroke survivors (M,=,78.80, SD,=,6.79 years) were included. The BASDEC and BDI-FS demonstrated acceptable internal consistency and test,retest reliability. The BASDEC (cut-off ,7) resulted in a sensitivity of 1.0 and specificity of 0.95 for detecting major depression whereas the BDI-FS (cut-off ,4) had a sensitivity of 0.71 and specificity of 0.74. When participants with minor depression were included in analyses, sensitivity lowered to 0.69 (specificity,=,0.97) for the BASDEC and 0.62 (specificity,=,0.78) for the BDI-FS. Conclusions The BASDEC and BDI-FS were found to have acceptable reliability. The BASDEC demonstrated some advantage in criterion validity over the BDI-FS at the examined cut-offs. Copyright © 2007 John Wiley & Sons, Ltd. [source] Nursing, midwifery and allied health education programmes in AfghanistanINTERNATIONAL NURSING REVIEW, Issue 2 2005P. Herberg phd Background:, In 2001, Afghanistan was the centre of the world's attention. By 2002, following 23 years of internal conflict , including Soviet invasion, civil war and Taliban rule, plus 3 years of drought, the country was just beginning the process of re-establishing its internal structures and processes. In the health sector, this included the revival of the Ministry of Health (MOH). The MOH was assisted in its efforts by multiple partners, including the UN, donor and aid agencies, and a variety of non-governmental organizations. The author served as a consultant to the Aga Khan University School of Nursing, in partnership with the World Health Organization and the MOH, as it took on the work of strengthening nursing, midwifery and allied health education programmes for Afghanistan. Aim:, This paper will focus on the initial assessment of that sector. It will describe the situation as it existed in 2002, by examining the Kabul Institute of Health Sciences (IHS) and then turn briefly to the current state of affairs. Conclusions:, Despite the uncertainties of daily life in Afghanistan, the country has successfully initiated the reconstruction process. In the health sector, this can be seen in the work done at the Kabul IHS. Progress has been made in a number of areas, most notably in development and implementation of nursing and midwifery curricula. However, no one would deny that much more work is needed. [source] Prognosis of stage I pressure ulcers and related factorsINTERNATIONAL WOUND JOURNAL, Issue 4 2006Miwa Sato Abstract The prognosis of stage I pressure ulcers cannot be predicted; therefore, nursing interventions for preventing their deterioration have not been clearly established. This study describes the clinical course of stage I pressure ulcers and prospectively investigates the factors related to their deterioration. Thirty-one stage I pressure ulcers in 30 patients in a long-term care facility were studied, and morphological changes were assessed every day until the ulcers healed or deteriorated. The physiological changes were assessed by ultrasonography and thermography. Twenty ulcers healed, and 11 deteriorated. The characteristics of deterioration were as follows: (1) double erythema; (2) non blanchable erythema across the whole area determined by glass plate compression; (3) erythema away from the tip of the bony prominence; and (4) expanding erythema on the following day. We analysed the sensitivity, specificity, positive predictive value, negative predictive value and positive likelihood ratio for the diagnostic utility of the indicators of deterioration double erythema and distance from the tip of bony prominence, which can be instantly assessed without the use of any special device. The values were 36·4%, 95·0%, 80·0%, 73·1% and 7·28, respectively. These results suggest that clinicians can predict the prognosis of stage I pressure ulcers by initial assessment and provide appropriate care based on the assessment. [source] Parent's involvement in decisions when their child is admitted to hospital with suspected shunt malfunction: study protocolJOURNAL OF ADVANCED NURSING, Issue 10 2009Joanna Smith Abstract Title., Parent's involvement in decisions when their child is admitted to hospital with suspected shunt malfunction: study protocol. Aim., This paper outlines the protocol for a study aimed at exploring parent's involvement during professional,parent interactions and decisions about their child's care in the context of suspected shunt malfunction. Background., Hydrocephalus is a long-term condition treated primarily by the insertion of a shunt that diverts fluid from the brain to another body compartment. Shunts frequently malfunction, and parents of children with shunted hydrocephalus are responsible for recognizing and responding to shunt complications. Parents feel that interactions with professionals when they seek healthcare advice for their child do always not encourage active participation in care decisions. Methods., The study design is based on qualitative methodologies: a combination of conversation analysis applied to consultation recordings of professional,parent interactions when a child is admitted to hospital with suspected shunt malfunction, and semi-structured follow-up interviews with the same participants within 2 weeks of the consultation. Participants., This is a prospective study and participants will be purposefully selected. Parents of children who have been admitted to hospital with suspected shunt malfunction and healthcare professionals responsible for the initial assessment of the child will be invited to participate. Discussion., The study will identify how decisions about a child's care are negotiated between parents and healthcare professionals at key stages of the care pathway. In addition, examining interactions between healthcare professionals and parents may identify approaches that support or hinder parents in contributing to the decision-making processes when they seek advice from healthcare professionals. [source] An initial assessment of native and invasive tunicates in shellfish aquaculture of the North American east coastJOURNAL OF APPLIED ICHTHYOLOGY, Issue 2010M. R. Carman Summary The objective of the study was to assess the distribution of native and invasive tunicates in the fouling community of shellfish aquaculture gear along the U.S. east coast of the Atlantic. Since the 1980s, several species of invasive tunicates have spread throughout the coastal waters of the North American east coast and have become dominant fouling organisms on docks, boat hulls, mooring lines, and in shellfish aquaculture. Invasive and native tunicates negatively impact shellfish aquaculture through increased maintenance costs and reduced shellfish growth. While the presence of alien tunicates has been well documented at piers, harbors, and marinas, there are few published reports of invasive tunicate impacts to aquaculture. We surveyed shellfish aquaculture operations at Martha's Vineyard, Massachusetts and shellfish aquaculturists in other areas along the North American east coast and report high levels of fouling caused by seven invasive, three native, and two cryptogenic species of tunicates. All study sites were fouled by one or more tunicate species. Biofouling control treatments varied among aquaculture sites and were effective in removing tunicates. Invasive and native tunicates should be considered when assessing the economic impacts of fouling organisms to the aquaculture industry. [source] Stability of negative self-structures: A longitudinal comparison of depressed, remitted, and nonpsychiatric controlsJOURNAL OF CLINICAL PSYCHOLOGY, Issue 4 2007David J. A. Dozois To be considered a vulnerability marker for depression, a variable should, in addition to demonstrating sensitivity and specificity, also show evidence of temporal stability (i.e., remain present in the absence of depressive symptomatology). Although many cognitive factors are associated with depression, the majority of them appear to be episode rather than vulnerability markers. This study examined cognitive organization of positive and negative interpersonal and achievement content in clinically depressed, remitted, and nonpsychiatric controls. At initial assessment, a sample of 54 clinically depressed individuals and 37 never-depressed controls completed self-report measures of positive and negative automatic thoughts and two cognitive organizational tasks. They were retested 6 months later when half of the depressed group no longer met diagnostic criteria for major depression. Negative automatic thoughts decreased and positive automatic thoughts increased significantly in individuals who had improved clinically. The organization of negative interpersonal content remained stable despite symptom amelioration, but negative achievement content was less interconnected at follow-up in those patients who had improved. The structure of relational schemas, in particular, appears to be stable and may be an important cognitive vulnerability factor for depression. © 2007 Wiley Periodicals, Inc. J Clin Psychol 63: 319,338, 2007. [source] Let's find the evidence: an analogue study of confirmation bias in criminal investigationsJOURNAL OF INVESTIGATIVE PSYCHOLOGY AND OFFENDER PROFILING, Issue 3 2010Eric Rassin Abstract People involved in criminal proceedings (e.g. police officers, district attorneys, judges, and jury members) may run the risk of developing confirmation bias, or tunnel vision. That is, these parties may readily become convinced that the suspect is guilty, and may then no longer be open to alternative scenarios in which the suspect is actually innocent. This may be reflected in a preference for guilt-confirming investigation endeavours, as opposed to investigations that are aimed at confirming, or even excluding, alternative scenarios. In three studies, participants read a case file, and were subsequently instructed to select additional police investigations. Some of these additional endeavours were guilt-confirming (i.e. incriminating), whereas others were disconfirming (i.e. exonerating). Results suggest that additional investigation search was guided by an initial assessment of the suspect's guilt (Study 1). Furthermore, participants' tendency to select incriminating investigations increased with increased crime severity, and with the strength of the evidence present in the case file. Finally, the selection of incriminating investigations was associated with conviction rates (Study 3). However, in general, participants did not favour incriminating endeavours. That is, in the three studies, the percentages of selected incriminating endeavours did hardly or not exceed 50%. Copyright © 2010 John Wiley & Sons, Ltd. [source] Prognostic index to identify patients who may not benefit from whole brain radiotherapy for multiple brain metastases from lung cancerJOURNAL OF MEDICAL IMAGING AND RADIATION ONCOLOGY, Issue 1 2010P Sundaresan Summary Palliative whole brain radiotherapy (WBRT) is often recommended in the management of multiple brain metastases. Allowing for WBRT waiting time, duration of the WBRT course and time to clinical response, it may take 6 weeks from the point of initial assessment for a benefit from WBRT to manifest. Patients who die within 6 weeks (,early death') may not benefit from WBRT and may instead experience a decline in quality of life. This study aimed to develop a prognostic index (PI) that identifies the subset of patients with lung cancer with multiple brain metastases who may not benefit from WBRT because of ,early death'. The medical records of patients with lung cancer who had WBRT recommended for multiple brain metastases over a 10-year period were retrospectively reviewed. Patients were classified as either having died within 6 weeks or having lived beyond 6 weeks. Potential prognostic indicators were evaluated for correlation with ,early death'. A PI was constructed by modelling the survival classification to determine the contribution of these factors towards shortened survival. Of the 275 patients recommended WBRT, 64 (23.22%) died within 6 weeks. The main prognostic factor predicting early death was Eastern Cooperative Oncology Group (ECOG) status >2. Patients with a high PI score (>13) were at higher risk of ,early death'. Twenty-three per cent of patients died prior to benefit from WBRT. ECOG status was the most predictive for ,early death'. Other factors may also contribute towards a poor outcome. With further refinement and validation, the PI could be a valuable clinical decision tool. [source] Simulation and multi-attribute utility modelling of life cycle profitJOURNAL OF MULTI CRITERIA DECISION ANALYSIS, Issue 4 2001Tony RosqvistArticle first published online: 16 NOV 200 Abstract Investments on capital goods are assessed with respect to the life cycle profit as well as the economic lifetime of the investment. The outcome of an investment with respect to these economic criteria is generally non-deterministic. An assessment of different investment options thus requires probabilistic modelling to explicitly account for the uncertainties. A process for the assessment of life cycle profit and the evaluation of the adequacy of the assessment is developed. The primary goal of the assessment process is to aid the decision-maker in structuring and quantifying investment decision problems characterized by multiple criteria and uncertainty. The adequacy of the assessment process can be evaluated by probabilistic criteria indicating the degree of uncertainty in the assessment. Bayesian inference is used to re-evaluate the initial assessment, as evidence of the system performance becomes available. Thus authentication of contracts of guarantee is supported. Numerical examples are given to demonstrate features of the described life cycle profit assessment process. Copyright © 2001 John Wiley & Sons, Ltd. [source] Core-shell particles with glycopolymer shell and polynucleoside core via RAFT: From micelles to rodsJOURNAL OF POLYMER SCIENCE (IN TWO SECTIONS), Issue 6 2009Samuel Pearson Abstract Amphiphilic block copolymers were synthesized via the reversible addition fragmentation chain transfer (RAFT) copolymerisation of 2-methacrylamido glucopyranose (MAG) and 5,- O -methacryloyl uridine (MAU). Homopolymerisations of both monomers using (4-cyanopentanoic acid)-4-dithiobenzoate (CPADB) proceeded with pseudo first order kinetics in a living fashion, displaying linear evolution of molecular weight with conversion and low PDIs. A bimodal molecular weight distribution was observed for PMAU at low conversions courtesy of hybrid behavior between living and conventional free radical polymerization. This effect was more pronounced when a PMAG macroRAFT agent was chain extended with MAU, however, in both cases, good control was attained once the main RAFT equilibrium was established. A stability study on PMAU found that its hydrolysis is diffusion controlled, and is accelerated at physiological pH compared with neutral conditions. Self-assembly of four block copolymers with increasing hydrophobic (PMAU) block lengths produced micelles, which demonstrated an increased tendency to form rods as the PMAU block length increased. Interestingly, none of the block copolymers were surface-active. An initial assessment of PMAU's ability to bind the nucleoside adenosine through base pairing was highly promising, with DSC measurements indicating that adenosine is fully miscible in the PMAU matrix. © 2009 Wiley Periodicals, Inc. J Polym Sci Part A: Polym Chem 47: 1706,1723, 2009 [source] An initial assessment of the use of gradient elution in microemulsion and micellar liquid chromatographyJOURNAL OF SEPARATION SCIENCE, JSS, Issue 17-18 2004Simon M. Bryant Abstract Novel microemulsion and micellar HPLC separations have been achieved using gradient elution and columns packed with reverse phase material. Initial attempts at gradient microemulsion liquid chromatography proved impossible on use of a microemulsion successfully used in capillary electrophoresis. Optimisation of the microemulsion composition allowed the generation of stable microemulsions to achieve separations in HPLC. The novel use of organic-solvent micellar chromatography in gradient elution mode was shown to give efficient separations. A range of efficient separations of pharmaceuticals and related impurities were obtained. Acidic, basic, and neutral solutes were resolved covering a wide range of water solubilities and polarities. Elution times were in the order of 4,15 minutes. Separations were briefly compared to those accomplished with a micellar HPLC system. It is proposed that gradient elution in both microemulsion and micellar HPLC can be regarded as a highly successful means of achieving resolution of complex mixtures and should be considered for routine analysis and further investigation. [source] A Clinical Index for Disease Activity in Cats with Chronic EnteropathyJOURNAL OF VETERINARY INTERNAL MEDICINE, Issue 5 2010A.E. Jergens Background: There is a need for a clinically useful, quantitative index for measurement of disease activity in cats with chronic enteropathy (CE). Objective: To develop a numerical activity index that is of practical value to clinicians treating CE in cats. Animals: Eighty-two cats with CE. Methods: Retrospective case review of 59 cats diagnosed with inflammatory bowel disease (IBD). Prospective validation study of 23 cats having either IBD or food-responsive enteropathy (FRE). Multivariate regression analysis was used to identify which combination of clinical and laboratory variables were best associated with intestinal inflammation of IBD. This combination of variables was expressed in a score that was used as an activity index for the prospective assessment of disease activity and of the effect of treatment in cats with IBD or FRE. Results: The combination of gastrointestinal signs, endoscopic abnormalities, serum total protein, serum alanine transaminase/alkaline phosphatase activity, and serum phosphorous concentration had the best correlation with histopathologic inflammation and comprise the feline chronic enteropathy activity index (FCEAI). Positive treatment responses in cats with CE were accompanied by significant (P < .05) reductions in FCEAI scores after treatment. Conclusions and Clinical Importance: The FCEAI is a simple numerical measure of inflammatory activity in cats with CE. The scoring index can be reliably used in the initial assessment of disease severity for both IBD and FRE and as a measure of clinical response to treatment for these disorders. [source] The prevalence, clinical features and association of HLA-B27 in sacroiliitis associated with established Crohn's diseaseALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 2 2009T. R. ORCHARD Summary Background Sacroiliitis is a recognized complication of Crohn's disease and may occur distinct from progressive ankylosing spondylitis (AS). Aim To estimate prospectively the prevalence of sacroiliitis in patients with established Crohn's disease, to characterize the clinical features and to correlate these with the presence of HLA-B27. Methods All Crohn's disease patients under active follow-up of between 5 and 12 years duration were invited to participate. Patients underwent a clinical evaluation including symptom questionnaire, rheumatological examination and underwent HLA genotyping. Patients then underwent magnetic resonance imaging (MRI) of the sacroiliac joints. The clinical and radiological factors were correlated with HLA-B27 status. Results 56 patients underwent initial assessment and 44 had MRI scans. Seventeen of 44 (39%) patients had MRI evidence of sacroiliitis, of whom 5 fulfilled the criteria for AS. Symptoms of low back pain were elicited in a majority of these patients , 11/17 (65%) compared to 3 of 27 (11%) patients with normal scans (P = 0.003). There were no differences in functional indices with the exception of patients with AS. HLA-B27 was present in seven patients, and all seven had MRI evidence of sacroiliitis, five had AS. Conclusions Sacroiliitis is common in patients with established Crohn's disease and in the majority of cases, patients have symptoms of inflammatory low back pain if questioned carefully. HLA-B27 is not associated with isolated sacroiliitis, but is associated with AS. However, possession of HLA-B27 appears to convey a very high risk of developing axial inflammation in Crohn's disease. [source] Cancer Pain: An Age-Based AnalysisPAIN MEDICINE, Issue 10 2010Carmen R. Green MD Abstract Objective., Although cancer pain (consistent and breakthrough pain [BTP; pain flares interrupting well-controlled baseline pain]) is common among cancer patients, its characteristics, etiology, and impact on health-related quality of life (HRQOL) across the lifespan are poorly understood. Design., This longitudinal study examines age-based differences and pain-related interference in young and old patients with cancer-related pain over 6 months. Patients in the community with stage III or IV breast, prostate, colorectal, or lung cancer, or stage II,IV multiple myeloma with BTP completed surveys (upon initial assessment, 3 and 6 months) assessing consistent pain, BTP, depressed affect, active coping ability, and HRQOL using previously validated measures. Results., Respondents (N = 96) were 70% white and 66% female, with a mean age of 57 ± 10 years. There were no significant differences in pain severity based upon age. However, the younger group experienced more pain flares with greater frequency (P = 0.05). The oldest group had better emotional functioning at baseline but worse physical functioning at 6 months. Younger groups also had worse cognitive functioning at 6 months (P = 0.03). Pain interference was independent of age. Conclusions., These data provide evidence for the significant toll of cancer pain on overall health and well-being of young and old adults alike but demonstrate an increased toll for younger adults (especially financially). Beyond race and gender disparities, further health care disparities in the cancer and cancer pain were identified by age, illustrating the need for additional research across the lifespan in diverse cancer survivors. [source] A two-stage phase II trial design utilizing both primary and secondary endpointsPHARMACEUTICAL STATISTICS: THE JOURNAL OF APPLIED STATISTICS IN THE PHARMACEUTICAL INDUSTRY, Issue 2 2008Xun Lin Abstract Phase II trials in oncology drug development are usually conducted to perform the initial assessment of treatment activity. The common designs in this setting, for example, Simon 2-stage designs, are often developed based on testing whether a parameter of interest, usually a proportion (e.g. response rate), is less than a certain level or not. These designs usually consider only one parameter. However, sometimes we may encounter situations where we need to consider not a single parameter, but multiple parameters. This paper presents a two-stage design in which both primary and secondary endpoints are utilized in the decision rules. The family-wise Type 1 error rate and statistical power of the proposed design are investigated under a variety of situations by means of Monte-Carlo simulations. Copyright © 2007 John Wiley & Sons, Ltd. [source] | |||||||||||||||||||||||||||||||||||||||||||