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Long-term Effectiveness (long-term + effectiveness)
Selected AbstractsLong-Term Effectiveness of Screening for Hearing Loss: The Screening for Auditory Impairment,Which Hearing Assessment Test (SAI-WHAT) Randomized TrialJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 3 2010Bevan Yueh MD OBJECTIVES: To evaluate the effect of hearing screening on long-term hearing outcomes in a general population of older veterans. DESIGN: Hearing loss in the elderly is underdetected and undertreated. Routine hearing screening has been proposed, but it is not clear whether screening identifies patients who are sufficiently motivated to adhere to treatment. A four-arm randomized clinical trial was conducted to compare three screening strategies with no screening in 2,305 older veterans seeking general medical care. SETTING: Veterans Affairs Puget Sound Health Care System. INTERVENTIONS: The screening strategies were a tone-emitting otoscope, a widely used questionnaire about hearing handicap, and a combination of both tools. MEASUREMENTS: Hearing aid use 1 year after screening. RESULTS: Of participants who underwent screening with the tone-emitting otoscope, questionnaire, and combined testing, 18.6%, 59.2%, and 63.6%, respectively, screened positive for hearing loss (P<.01 for test of equality across three arms). Patients proceeded to formal audiology evaluation 14.7%, 23.0%, and 26.6% of the time in the same screening arms, compared with 10.8% in the control arm (P<.01 for test of equality across four arms). Hearing aid use 1 year after screening was 6.3%, 4.1%, and 7.4% in the same arms, compared with 3.3% in the control arm (P<.01). Hearing aid users experienced significant improvements in hearing-related function and communication ability. CONCLUSION: In older veterans, screening for hearing loss led to significantly more hearing aid use. Screening with the tone-emitting otoscope was more efficient. The results are most applicable to older populations with few cost barriers to hearing aids. [source] Long-Term Effectiveness of Operative Procedures for Stanford Type A Aortic DissectionsJOURNAL OF CARDIAC SURGERY, Issue 3 2004Rudolf Driever Methods: From 1990 to 1999, 50 patients (32 men (64.07%); 18 women, (36.0%); mean age 57.4 ± 11.1 years) underwent operation for ascending aortic dissection. Surgical strategies included aortic root replacement with a composite graft (21/50; 42.0%), valve replacement with supracoronary ascending aortic graft (3/50, 6%), and valve preservation or repair (26/50; 52.0%). Results: Overall hospital mortality rate was 18.0%. Follow-up was completed for 47 patients (94.0%) and ranged from 1 month to 10.5 years (mean 28.8 months). Actuarial survival for patients discharged from the hospital was 84% at 1 year, 75% at 5 years, and 66% at 10 years. There was no significant difference between the various procedures regarding mortality, neurological complications, long-term survival, and proximal reoperations. The ascending aorta alone was replaced in 8 of 50 patients (16%), ascending and hemiarch in 30 of 50 patients (60%), and arch and proximal descending aorta in 12 of 50 patients (24%). Hospital mortality (11.5%, 20.0%, and 16.7%, respectively; p > 0.05) and 5- and 10-year survival (p > 0.05) were not statistically dependent on the extension of the resection distally. Residual distal dissection was not associated with a decrease in late survival. With regard to emergency surgery (36/50) there was no significant difference in hospital mortality (p > 0.05) and 5-year survival (p > 0.05) between those who had undergone coronary angiography (19/36; 52.8%) on the day of surgery with those who had not (17/36; 47.2%). Conclusions: Preservation or repair of the aortic valve can be recommended in the majority of patients with type A dissection. Distal extension of the resection does not increase surgical risk. Residual distal dissection does not decrease late survival. Preoperative coronary angiography may not affect survival in patients undergoing emergency surgery. (J Card Surg 2004;19:240-245) [source] Long-term effectiveness of computer-generated tailored patient education on benzodiazepines: a randomized controlled trialADDICTION, Issue 4 2008Geeske Brecht Ten Wolde ABSTRACT Aims Chronic benzodiazepine use is highly prevalent and is associated with a variety of negative health consequences. The present study examined the long-term effectiveness of a tailored patient education intervention on benzodiazepine use. Design A randomized controlled trial was conducted comprising three arms, comparing (i) a single tailored intervention; (ii) a multiple tailored intervention and (iii) a general practitioner letter. The post-test took place after 12 months. Participants Five hundred and eight patients using benzodiazepines were recruited by their general practitioners and assigned randomly to one of the three groups. Intervention Two tailored interventions, the single tailored intervention (patients received one tailored letter) and the multiple tailored intervention (patients received three sequential tailored letters at intervals of 1 month), were compared to a short general practitioner letter that modelled usual care. The tailored interventions not only provided different and more information than the general practitioner letter; they were also personalized and adapted to individual baseline characteristics. The information in both tailored interventions was the same, but in the multiple tailored intervention the information was provided to the participants spread over three occasions. In the multiple tailored intervention, the second and the third tailored letters were based on short and standardized telephone interviews. Measurements Benzodiazepine cessation at post-test was the outcome measure. Findings The results showed that participants receiving the tailored interventions were twice as likely to have quit benzodiazepine use compared to the general practitioner letter. Particularly among participants with the intention to discontinue usage at baseline, both tailored interventions led to high percentages of those who actually discontinued usage (single tailored intervention 51.7%; multiple tailored intervention 35.6%; general practitioner letter 14.5%). Conclusions It was concluded that tailored patient education can be an effective tool for reducing benzodiazepine use, and can be implemented easily. [source] Long-term effectiveness of diet-plus-exercise interventions vs. diet-only interventions for weight loss: a meta-analysisOBESITY REVIEWS, Issue 3 2009T. Wu Summary Diet and exercise are two of the commonest strategies to reduce weight. Whether a diet-plus-exercise intervention is more effective for weight loss than a diet-only intervention in the long-term has not been conclusively established. The objective of this study was to systemically review the effect of diet-plus-exercise interventions vs. diet-only interventions on both long-term and short-term weight loss. Studies were retrieved by searching MEDLINE and Cochrane Library (1966 , June 2008). Studies were included if they were randomized controlled trials comparing the effect of diet-plus-exercise interventions vs. diet-only interventions on weight loss for a minimum of 6 months among obese or overweight adults. Eighteen studies met our inclusion criteria. Data were independently extracted by two investigators using a standardized protocol. We found that the overall standardized mean differences between diet-plus-exercise interventions and diet-only interventions at the end of follow-up were ,0.25 (95% confidence interval [CI],0.36 to ,0.14), with a P -value for heterogeneity of 0.4. Because there were two outcome measurements, weight (kg) and body mass index (kg m,2), we also stratified the results by weight and body mass index outcome. The pooled weight loss was 1.14 kg (95% CI 0.21 to 2.07) or 0.50 kg m,2 (95% CI 0.21 to 0.79) greater for the diet-plus-exercise group than the diet-only group. We did not detect significant heterogeneity in either stratum. Even in studies lasting 2 years or longer, diet-plus-exercise interventions provided significantly greater weight loss than diet-only interventions. In summary, a combined diet-plus-exercise programme provided greater long-term weight loss than a diet-only programme. However, both diet-only and diet-plus-exercise programmes are associated with partial weight regain, and future studies should explore better strategies to limit weight regain and achieve greater long-term weight loss. [source] Addressing soil gas vapor intrusion using sustainable building solutionsREMEDIATION, Issue 4 2009Ellen Moyer Soil gas vapor intrusion (VI) emerged in the 1990s as one of the most important problems in the investigation and cleanup of thousands of sites across the United States. A common practice for sites where VI has been determined to be a significant pathway is to implement interim building engineering controls to mitigate exposure of building occupants to VI while the source of contamination in underlying soil and groundwater is assessed and remediated. Engineering controls may include passive barriers, passive or active venting, subslab depressurization, building pressurization, and sealing the building envelope. Another recent trend is the emphasis on "green" building practices, which coincidentally incorporate some of these same engineering controls, as well as other measures such as increased ventilation and building commissioning for energy conservation and indoor air quality. These green building practices can also be used as components of VI solutions. This article evaluates the sustainability of engineering controls in solving VI problems, both in terms of long-term effectiveness and "green" attributes. Long-term effectiveness is inferred from extensive experience using similar engineering controls to mitigate intrusion of radon, moisture, mold, and methane into structures. Studies are needed to confirm that engineering controls to prevent VI can have similar long-term effectiveness. This article demonstrates that using engineering controls to prevent VI is "green" in accelerating redevelopment of contaminated sites, improving indoor air quality, and minimizing material use, energy consumption, greenhouse gas emissions, and waste generation. It is anticipated that engineering controls can be used successfully as sustainable solutions to VI problems at some sites, such as those deemed technically impracticable to clean up, where remediation of underlying soil or groundwater contamination will not be completed in the foreseeable future. Furthermore, green buildings to be developed in areas of potential soil or groundwater contamination may be designed to incorporate engineering controls to prevent VI. © 2009 Wiley Periodicals, Inc. [source] Long-term effectiveness of sowing high and low diversity seed mixtures to enhance plant community development on ex-arable fieldsAPPLIED VEGETATION SCIENCE, Issue 1 2007Jan Lep Abstract Questions: How is succession on ex-arable land affected by sowing high and low diversity mixtures of grassland species as compared to natural succession? How long do effects persist? Location: Experimental plots installed in the Czech Republic, The Netherlands, Spain, Sweden and the United Kingdom. Methods: The experiment was established on ex-arable land, with five blocks, each containing three 10 m × 10 m experimental plots: natural colonization, a low- (four species) and high-diversity (15 species) seed mixture. Species composition and biomass was followed for eight years. Results: The sown plants considerably affected the whole successional pathway and the effects persisted during the whole eight year period. Whilst the proportion of sown species (characterized by their cover) increased during the study period, the number of sown species started to decrease from the third season onwards. Sowing caused suppression of natural colonizing species, and the sown plots had more biomass. These effects were on average larger in the high diversity mixtures. However, the low diversity replicate sown with the mixture that produced the largest biomass or largest suppression of natural colonizers fell within the range recorded at the five replicates of the high diversity plots. The natural colonization plots usually had the highest total species richness and lowest productivity at the end of the observation period. Conclusions: The effect of sowing demonstrated dispersal limitation as a factor controlling the rate of early secondary succession. Diversity was important primarily for its,insurance effect': the high diversity mixtures were always able to compensate for the failure of some species. [source] Obstacles to Bottom-Up Implementation of Marine Ecosystem ManagementCONSERVATION BIOLOGY, Issue 5 2008KIRSTEN E. EVANS manejo de ecosistemas; manejo marino basado en ecosistemas; participación de partes interesadas; planificación de la conservación Abstract:,Ecosystem management (EM) offers a means to address multiple threats to marine resources. Despite recognition of the importance of stakeholder involvement, most efforts to implement EM in marine systems are the product of top-down regulatory control. We describe a rare, stakeholder-driven attempt to implement EM from the bottom up in San Juan County, Washington (U.S.A.). A citizens advisory group led a 2-year, highly participatory effort to develop an ecosystem-based management plan, guided by a preexisting conservation-planning framework. A key innovation was to incorporate social dimensions by designating both sociocultural and biodiversity targets in the planning process. Multiple obstacles hindered implementation of EM in this setting. Despite using a surrogate scheme, the information-related transaction costs of planning were substantial: information deficits prevented assessment of some biodiversity targets and insufficient resources combined with information deficits prevented scientific assessment of the sociocultural targets. Substantial uncertainty, practical constraints to stakeholder involvement, and the existence of multiple, potentially conflicting, objectives increased negotiation-related costs. Although information deficits and uncertainty, coupled with underinvestment in the transaction costs of planning, could reduce the long-term effectiveness of the plan itself, the social capital and momentum developed through the planning process could yield unforeseeable future gains in protection of marine resources. The obstacles we identified here will require early and sustained attention in efforts to implement ecosystem management in other grassroots settings. Resumen:,El manejo de ecosistemas es un medio para abordar múltiples amenazas a los recursos marinos. No obstante el reconocimiento de la importancia de la participación de las partes interesadas, la mayoría de los esfuerzos para implementar el manejo de ecosistemas en sistemas marinos son producto del control normativo de arriba hacia abajo. Describimos un intento raro, conducido por las partes interesadas, por implementar el manejo del ecosistema de abajo hacia arriba en el Condado San Juan, Washington (E.U.A.). Un grupo consultivo de ciudadanos dirigió un esfuerzo altamente participativo para desarrollar un plan de manejo basado en el ecosistema, guiados por un marco de planificación de la conservación preexistente. Una innovación clave fue la incorporación de dimensiones sociales al incluir objetivos tanto socioculturales como de biodiversidad en el proceso de planificación. Múltiples obstáculos dificultaron la implementación del manejo del ecosistema en este escenario. No obstante que se utilizó un plan sustituto, los costos de transacción de la planificación relacionados con la información fueron mayores de lo que el grupo pudo superar: los déficits de información impidieron la evaluación de algunos objetivos de biodiversidad y la insuficiencia de recursos combinada con los déficits de información impidieron la evaluación científica de los objetivos socioculturales. Los costos relacionados con la negociación incrementaron por la incertidumbre, por limitaciones prácticas en la participación de partes interesadas y la existencia de objetivos múltiples, potencialmente conflictivos. Aunque los déficits de información y la incertidumbre, aunados con la baja inversión en los costos de transacción de la planificación, pudieran reducir la efectividad a largo plazo del plan mismo, el capital social y el ímpetu desarrollados durante el proceso de planificación podrían producir ganancias futuras imprevisibles para la protección de recursos marinos. Los obstáculos que identificamos aquí requerirán de atención temprana y sostenida en los esfuerzos para implementar el manejo de ecosistemas en otros escenarios de base popular. [source] Review of the long-term effectiveness of cognitive behavioral therapy compared to medications in panic disorderDEPRESSION AND ANXIETY, Issue 2 2003Deepa N. Nadiga M.D. Abstract Panic disorder is a recurrent and disabling illness. It is believed that Cognitive Behavioral Therapy (CBT) has a long-term protective effect for this disorder. This would offer CBT considerable advantage over medication management of panic disorder, as patients often relapse when they are tapered off their medications. This is a review of the literature about the long-term effectiveness of CBT. We searched for follow-up studies of panic disorder using CBT. Of the 78 citations produced in the initial search, most had major methodological flaws, including ignoring losses to follow-up, not accounting for interval treatment, and unclear reporting. Three papers met strict methodological criteria, and two of these demonstrated a modest protective effect of CBT in panic disorder patients. We make recommendations for well-designed studies involving comparisons of medications and cognitive behavior therapy. Depression and Anxiety 17:58,64, 2003. © 2003 Wiley-Liss, Inc. [source] Lithium treatment in Aarhus: contributions and controversies through half a centuryACTA PSYCHIATRICA SCANDINAVICA, Issue 2004Per Vestergaard In 1954 the first of several hundred publications on the use of lithium for treatment of affective disorders, lithium's unwanted effects, and its pharmacology was authored at the Aarhus University Psychiatric Hospital, the majority with Professor, now emeritus, Mogens Schou playing the principal part. The early part of this long series of papers highlights the pharmacology of lithium with its renal excretion, low therapeutic index, and ensuing risk of intoxication, the prophylactic effect not only against manic episodes but also the depressive ones and finally the long-term renal structural and functional impairment. Later papers present the problems related to lithium's lower effectiveness in routine clinical use, the problems of non-adherence, the dose effect relationships, and the problems inherent to establishing effective treatment service delivery. The present priority of the Aarhus lithium group is the simple large scale pragmatic effectiveness studies in which, together with domestic and foreign collaborators, we compare the long-term effectiveness of lithium with new promising drugs with mood stabilizing properties. The story of treatment with lithium in aarhus highlights important steps in the development of effective and comprehensive treatments for bipolar patients. [source] Comparison between repaglinide and glipizide in Type 2 diabetes mellitus: a 1-year multicentre studyDIABETIC MEDICINE, Issue 5 2001S. Madsbad Abstract Aims To evaluate the long-term effectiveness and safety of repaglinide, a novel prandial glucose regulator, in comparison with glipizide in the treatment of patients with Type 2 diabetes. Methods Diet or tablet-treated patients with Type 2 diabetes (n = 256; age 40,75 years, body mass index (BMI) 20,35 kg/m2, HbA1c 4.2,12.8%), without signs of severe microvascular or macrovascular complications, were included in this double-blind, multicentre, parallel-group comparative trial. Patients were randomized at a 2:1 ratio to repaglinide, 1,4 mg at mealtimes, or glipizide, 5,15 mg daily. Results Changes in fasting blood glucose (FBG) and HbA1c during the 12 months of treatment showed a significant difference in favour of repaglinide. In oral hypoglycaemic agents (OHA)-naive patients, HbA1c decreased in the repaglinide and glipizide groups by 1.5% and 0.3%, respectively (P < 0.05 between groups). Fasting blood glucose decreased in the repaglinide group by 2.4 mmol/l and increased in the glipizide group by 1.0 mmol/l (P < 0.05 between groups). In the study population as a whole, repaglinide was able to maintain glycaemic control (HbA1c level) during the 1-year study period, whereas control deteriorated significantly with glipizide. Change in HbA1c from baseline was significantly better with repaglinide than with glipizide after 12 months (P < 0.05). In addition, FBG deteriorated significantly in the glipizide group compared with the repaglinide group (P < 0.05). No patients in either group experienced a major hypoglycaemic event; the number of patients experiencing minor hypoglycaemia was similar in the repaglinide and glipizide groups (15% and 19%, respectively). Conclusions Repaglinide, given as a prandial glucose regulator, is shown to be an effective and safe treatment of patients with Type 2 diabetes, and is better than glipizide in controlling HbA1c and FBG levels, overall, and in OHA-naive patients. Diabet. Med. 18, 395,401 (2001) [source] Long-term effectiveness of computer-generated tailored patient education on benzodiazepines: a randomized controlled trialADDICTION, Issue 4 2008Geeske Brecht Ten Wolde ABSTRACT Aims Chronic benzodiazepine use is highly prevalent and is associated with a variety of negative health consequences. The present study examined the long-term effectiveness of a tailored patient education intervention on benzodiazepine use. Design A randomized controlled trial was conducted comprising three arms, comparing (i) a single tailored intervention; (ii) a multiple tailored intervention and (iii) a general practitioner letter. The post-test took place after 12 months. Participants Five hundred and eight patients using benzodiazepines were recruited by their general practitioners and assigned randomly to one of the three groups. Intervention Two tailored interventions, the single tailored intervention (patients received one tailored letter) and the multiple tailored intervention (patients received three sequential tailored letters at intervals of 1 month), were compared to a short general practitioner letter that modelled usual care. The tailored interventions not only provided different and more information than the general practitioner letter; they were also personalized and adapted to individual baseline characteristics. The information in both tailored interventions was the same, but in the multiple tailored intervention the information was provided to the participants spread over three occasions. In the multiple tailored intervention, the second and the third tailored letters were based on short and standardized telephone interviews. Measurements Benzodiazepine cessation at post-test was the outcome measure. Findings The results showed that participants receiving the tailored interventions were twice as likely to have quit benzodiazepine use compared to the general practitioner letter. Particularly among participants with the intention to discontinue usage at baseline, both tailored interventions led to high percentages of those who actually discontinued usage (single tailored intervention 51.7%; multiple tailored intervention 35.6%; general practitioner letter 14.5%). Conclusions It was concluded that tailored patient education can be an effective tool for reducing benzodiazepine use, and can be implemented easily. [source] Importance of implementation and residual risk analyses in sediment remediationINTEGRATED ENVIRONMENTAL ASSESSMENT AND MANAGEMENT, Issue 1 2006Richard J Wenning Abstract Management strategies for addressing contaminated sediments can include a wide range of actions, ranging from no action, to the use of engineering controls, to the use of more aggressive, intrusive activities related to removing, containing, or treating sediments because of environmental or navigation considerations. Risk assessment provides a useful foundation for understanding the environmental benefits, residual hazards, and engineering limitations of different remedy alternatives and for identifying or ranking management options. This article, part of a series of panel discussion papers on sediment remediation presented at the Third International Conference on Remediation of Contaminated Sediments held 20,25 January 2005 in New Orleans, Louisiana, USA, reviews 2 types of risk that deserve careful consideration when evaluating remedy alternatives. The evaluation of remedy implementation risks addresses predominantly short-term engineering issues, such as worker and community health and safety, equipment failures, and accident rates. The evaluation of residual risks addresses predominantly longer-term biological and environmental issues, such as ecological recovery, bioaccumulation, and relative changes in exposure and effects to humans, aquatic biota, and wildlife. Understanding the important pathways for contaminant exposure, the human and wildlife populations potentially at risk, and the possible hazards associated with the implementation of different engineering options will contribute to informed decision making with regard to short- and long-term effectiveness, implementability, and potential environmental hazards. [source] Effect of Telephone Counseling on Physical Activity for Low-Active Older People in Primary Care: A Randomized, Controlled TrialJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 7 2007Gregory S. Kolt PhD OBJECTIVES: To assess the long-term effectiveness of a telephone counseling intervention on physical activity and health-related quality of life in low-active older adults recruited through their primary care physician. DESIGN: Randomized, controlled trial. SETTING: Three primary care practices from different socioeconomic regions of Auckland, New Zealand. PARTICIPANTS: One hundred and eighty-six low-active adults (aged 65) recruited from their primary care physicians' patient databases. INTERVENTION: Eight telephone counseling sessions over 12 weeks based on increasing physical activity. Control patients received usual care. MEASUREMENTS: Change in physical activity (as measured using the Auckland Heart Study Physical Activity Questionnaire) and quality of life (as measured using the Short Form-36 Health Survey (SF-36)) over a 12-month period. RESULTS: Moderate leisure physical activity increased by 86.8 min/wk more in the intervention group than in the control group (P=.007). More participants in the intervention group reached 2.5 hours of moderate or vigorous leisure physical activity per week after 12 months (42% vs 23%, odds ratio=2.9, 95% confidence interval=1.33,6.32, P=.007). No differences on SF-36 measures were observed between the groups at 12 months. CONCLUSION: Telephone-based physical activity counseling is effective at increasing physical activity over 12 months in previously low-active older adults. [source] Enhancing diversity of species-poor grasslands: an experimental assessment of multiple constraintsJOURNAL OF APPLIED ECOLOGY, Issue 1 2007RICHARD F. PYWELL Summary 1Many grasslands in north-west Europe are productive but species-poor communities resulting from intensive agriculture. Reducing the intensity of management under agri-environment schemes has often failed to increase botanical diversity. We investigated biotic and abiotic constraints on diversification by manipulating seed and microsite availability, soil fertility, resource competition, herbivory and deficiencies in the soil microbial community. 2The effectiveness of 13 restoration treatments was investigated over 4 years in a randomized block experiment established in two productive grasslands in central-east and south-west England. 3Severe disturbance involving turf removal followed by seed addition was the most effective and reliable means of increasing grassland diversity. Disturbance by multiple harrowing was moderately effective but was enhanced by molluscicide application to reduce seedling herbivory and by sowing the hemiparasite Rhinanthus to reduce competition from grasses. 4Low-level disturbance by grazing or slot-seeding was ineffective in increasing diversity. Inoculation with soil microbial communities from species-rich grasslands had no effect on botanical diversity. Nitrogen and potassium fertilizer addition accelerated off-take of phosphorus in cut herbage but did not cause a reduction in soil phosphorus or increase botanical diversity. 5Different grazing management regimes had little impact on diversity. This may reflect the constraining effect of the July hay cut on species dispersal and colonization. 6Synthesis and applications. Three alternative approaches to grassland diversification, with different outcomes, are recommended. (i) High intervention deturfing, which would create patches with low competitive conditions for rapid and reliable establishment of the target community. For reasons of cost and practicality this can only be done over small areas but will form source populations for subsequent spread. (ii) Moderate intervention (harrowing or slot-seeding) over large areas, which would establish a limited number of desirable, generalist species that perform well in restoration. This method is low cost and rapid but the increases in biodiversity are less predictable. (iii) Phased restoration, which would complement the above approaches. Productivity and competition are reduced over 3,5 years using Rhinanthus or fertilizers to accelerate phosphorus off-take. After this time harrowing and seeding should allow a wide range of more specialist species to establish. However, further research is required to determine the long-term effectiveness of these approaches. [source] Effects of a peripheral enamel bond on the long-term effectiveness of dentin bonding agents exposed to water in vitroJOURNAL OF BIOMEDICAL MATERIALS RESEARCH, Issue 1 2008Andre F. Reis Abstract This study evaluated the effects of water exposure on the in vitro microtensile bond strength (,TBS) of etch-and-rinse and self-etching adhesives to human dentin over a 1-year storage period. Five adhesive systems used were as follows: a one-step self-etching adhesive (One-up Bond F-OB), two two-step self-etching primers (Clearfil SE Bond-SE and Clearfil Protect Bond-CP), and two etch-and-rinse adhesives (Single Bond-SB and Prime&Bond NT-PB). Dentin surfaces were bonded, restored, and assigned to four subgroups, according to the degree of water exposure: 24 h of peripheral water exposure (24 h-PE) (having circumferential enamel); and 1 year of peripheral exposure (1 yr-PE), direct exposure (1 yr-DE) (dentin directly water-exposed), or directly exposed to oil only (no water exposure) (1 yr-DOE). A composite-enamel bond adjacent to the restoration is determined if the water exposure was peripheral or direct. After storage periods, specimens were serially sectioned, trimmed to an hourglass shape with a cross-sectional area of 1 mm2 at the interface, and tested in tension. Results were analyzed by two-way ANOVA and Tukey test (, = 0.05). No difference was found between 24 h-PE and 1 yr-PE for OB, CP, SB, and PB. However, ,TBS values significantly dropped after 1 yr-DE for SE, CP, SB, and PB. A decreased ,TBS was seen in SE after 1 yr-PE, but no differences existed between 1 yr-PE and 1 yr-DE. Similar or increased ,TBS values were noted in 1 yr-DOE for all adhesives. Water-storage for 1 year significantly decreased ,TBS for all adhesives. However, except for SE, the presence of a peripheral composite-enamel bond seemed to reduce the degradation rate in resin-dentin interfaces for all materials. © 2007 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 2008 [source] Modelling the effectiveness of contraception for controlling introduced populations of elephant in South AfricaAFRICAN JOURNAL OF ECOLOGY, Issue 4 2009Robin L. Mackey Abstract Re-introduced African elephant (Loxodonta africana Blumenbach) populations are growing at very high rates in many of southern Africa's reserves, have attained densities higher than previously thought possible and may be exhibiting irruptive growth. Active management of such populations is necessary to prevent the potentially negative effects on habitat and biodiversity that are associated with elephant overpopulation. One potentially feasible method of elephant management is immunocontraception, but very little is known about the long-term effectiveness of this method. Using demographic data from three South African elephant populations, we made model projections of the effects of contraception on population growth rates to determine whether contraception may be a feasible management tool for elephant. In comparison with noncontracepted populations, realistic reductions in population growth rate after 20 years of contraception were projected to be up to c. 64%, with 50% being a very feasible target. Through its ability to reduce population growth rates, immunocontraception should be an effective tool for preventing or minimizing irruption in elephants and, perhaps, other introduced ungulate species. Résumé Le taux de croissance des populations réintroduites d'éléphants d'Afrique (Loxodonta africana Blumenbach) est très élevé dans les réserves d'Afrique australe; elles ont atteint des densités plus élevées qu'on ne l'avait cru possible et elles pourraient présenter une croissance irruptive. La gestion active de telles populations est nécessaire pour empêcher les effets potentiellement négatifs liés à une surpopulation d'éléphants. Une méthode éventuellement possible pour la gestion des éléphants est l'immuno-contraception, mais on sait très peu de choses sur l'efficacitéà long terme de cette méthode. En utilisant les données démographiques portant sur trois populations d'éléphants d'Afrique du Sud, nous avons modélisé des projections des effets de la contraception sur le taux de croissance des populations pour déterminer si la contraception peut constituer un outil de gestion envisageable pour les éléphants. En comparaison avec les populations sans contraception, des projections réalistes de la réduction du taux de croissance de populations après 20 ans de contraception se chiffraient à environ 64%,50% représentant un objectif tout à fait réaliste. Par sa capacité de réduire le taux de croissance de la population, l'immuno-contraception devrait être un outil efficace pour empêcher ou pour réduire au minimum l'irruption des éléphants et, peut-être, celle d'autres espèces ongulés introduits. [source] Long-term results of subtotal colectomy for acquired hypertrophic megacolon in eight dogsJOURNAL OF SMALL ANIMAL PRACTICE, Issue 12 2008T. Nemeth Objectives: To evaluate the long-term results of subtotal colectomy for acquired hypertrophic megacolon in the dog. Methods: Eight dogs with acquired hypertrophic megacolon underwent subtotal colectomy with preservation of the ileocolic junction. Long-term follow-up was obtained by clinical records and telephone interviews with the owners. Results: Eight large-breed dogs (age range: 6 to 12 years; mean age: 10·75 years) were enrolled. The use of bone meal, low levels of exercise, chronic constipation with dyschesia and tenesmus refractory to medical management were factors predisposing dogs to acquired hypertrophic megacolon. The diagnosis was confirmed in all animals by abdominal palpation, plain radiography and postoperative histopathological findings. There were no intraoperative complications. One dog died as a result of septic peritonitis. The clinical conditions (that is, resolution of obstipation and stool consistency) of the remaining seven dogs were improved at discharge; all animals returned to normal defecation in five to 10 weeks (mean: 7·3 weeks) and were alive 11 to 48 months (mean: 40·5 months) after surgery. Clinical Significance: Predominantly bony diet and/or low levels of physical activity may predispose dogs to acquired hypertrophic megacolon. Our results emphasise the long-term effectiveness of subtotal colectomy with preservation of the ileocolic junction in this condition. [source] Comparative effectiveness of azathioprine in Crohn's disease and ulcerative colitis: prospective, long-term, follow-up study of 394 patientsALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 2 2008J. P. GISBERT Summary Background The long-term efficiacy for thiopurinic drugs in Crohn's disease (CD), and particularly in ulcerative colitis (UC), has been insufficiently studied. Aim To evaluate prospectively and compare the long-term effectiveness of azathioprine (AZA) in CD and UC. Methods Three hundred and ninety-four AZA treated patients were included consecutively included. Truelove-modified index and CDAI were used to assess effectiveness. Hospitalizations and surgical procedures were recorded. Results Two hundred and thirty-eight patients with CD and 156 with UC received AZA for a median of 38 months. Effectiveness: Partial response/remission was achieved in 34%/49% of CD patients and in 47%/42% of UC (nonstatistically significant differences). Steroid treatment: Prior to AZA, 49% of CD patients were receiving steroids, whereas only 8% needed steroids after therapy (P < 0.001). Corresponding figures in UC patients were 39% vs. 9% (P < 0.001). Hospitalizations: Prior to AZA, the rate of hospitalizations in CD was 0.190 per-patient-year, while after treatment, it decreased to 0.099 (P < 0.001). Corresponding hospitalization rates in UC were 0.108 vs. 0.038 (P < 0.001). Surgery: The rate of surgery in CD prior/after AZA was 0.038/0.011 per-patient-year (P < 0.001). The number of surgical interventions in UC prior/after AZA treatment was 26/0 (the rate per-patient-year was 0.018/0) (P < 0.001). Conclusions Our results confirm the effectiveness of AZA in inflammatory bowel disease, not only in the short term but also in the long term, resulting in a steroid sparing effect and in both a reduction in the number of hospitalizations and surgical procedures. AZA is similarly effective for both CD and UC patients. [source] Student-Run Health Clinic: Novel Arena to Educate Medical Students on Systems-Based PracticeMOUNT SINAI JOURNAL OF MEDICINE: A JOURNAL OF PERSONALIZED AND TRANSLATIONAL MEDICINE, Issue 4 2009Yasmin S. Meah MD Abstract In recent decades, the United States has experienced substantial growth in the number of student-run clinics for the indigent. Today, over 49 medical schools across the country operate over 110 student-run outreach clinics that provide primary care services to the poor and uninsured. Despite this development, little research has been published on the educational value of such student-led endeavors. Although much has been surmised, no general methodology for categorizing the learning experience in these clinics has been established. This article represents the first literature review of the novel method of educating students through the operation of a clinic for the underserved. It highlights the student-run clinic as a unique enhancement of medical education that may supplant current curricular arenas in teaching students about systems-based practice principles such as cost containment and financing, resource allocation, interdisciplinary collaboration, patient advocacy, and monitoring and delivery of quality care. The novelty of the student-run clinic is that students place themselves at the forefront of problem solving and system navigation to effectively care for severely disadvantaged populations. This article underscores the student-run clinic as a potentially ideal experiential learning method for preparing young physicians to confront a US healthcare system currently facing crises in cost, quality of care, and high rates of uninsurance. The article stresses the need for outcomes research on the long-term effectiveness of the student-run clinic experience in affecting medical student practice behaviors and attitudes in patient care settings that extend beyond the student-run clinic. Mt Sinai J Med 76:344,356, 2009. © 2008 Mount Sinai School of Medicine [source] Spinal Cord Stimulation for Failed Back Surgery SyndromeNEUROMODULATION, Issue 1 2001Jean-Christophe Leveque BA Objective. The purpose of this study is to evaluate the effectiveness of modern spinal cord stimulation (SCS) for the treatment of failed back surgery syndrome (FBSS). Materials and Methods. Thirty patients were treated with SCS between December 1992 and January 1998 for low back and radicular pain after multiple failed back surgeries. Permanent systems were implanted if trial stimulation led to > 50% pain reduction. Median long-term follow-up was 34 months (range, 6,66 months). Severity of pain was determined postoperatively by a disinterested third party. Results. Overall, 12 of the 16 patients (75%) who received permanent implants continued to report at least 50% relief of pain at follow-up. All six patients who underwent placement of laminectomy-styled electrode for SCS in the thoracic region had > 50% pain relief at long-term follow-up. Visual analog scores decreased an average of 3.2 (from 8.6 preoperatively to 5.4 postoperatively). Patients undergoing SCS placement via laminectomy in the thoracic region experienced an average decrease of 4.9 in VAS, whereas those who underwent percutaneous placement of thoracic leads had an average decrease of 2.5. Conclusions. SCS is an effective treatment for chronic low back and lower extremity pain which is refractory to conservative therapy and which is not amenable to corrective anatomic surgery. Though our patient population is small, our results imply that the laminectomy-style electrodes in the thoracic region achieve better long-term effectiveness than percutaneous leads. [source] Addressing soil gas vapor intrusion using sustainable building solutionsREMEDIATION, Issue 4 2009Ellen Moyer Soil gas vapor intrusion (VI) emerged in the 1990s as one of the most important problems in the investigation and cleanup of thousands of sites across the United States. A common practice for sites where VI has been determined to be a significant pathway is to implement interim building engineering controls to mitigate exposure of building occupants to VI while the source of contamination in underlying soil and groundwater is assessed and remediated. Engineering controls may include passive barriers, passive or active venting, subslab depressurization, building pressurization, and sealing the building envelope. Another recent trend is the emphasis on "green" building practices, which coincidentally incorporate some of these same engineering controls, as well as other measures such as increased ventilation and building commissioning for energy conservation and indoor air quality. These green building practices can also be used as components of VI solutions. This article evaluates the sustainability of engineering controls in solving VI problems, both in terms of long-term effectiveness and "green" attributes. Long-term effectiveness is inferred from extensive experience using similar engineering controls to mitigate intrusion of radon, moisture, mold, and methane into structures. Studies are needed to confirm that engineering controls to prevent VI can have similar long-term effectiveness. This article demonstrates that using engineering controls to prevent VI is "green" in accelerating redevelopment of contaminated sites, improving indoor air quality, and minimizing material use, energy consumption, greenhouse gas emissions, and waste generation. It is anticipated that engineering controls can be used successfully as sustainable solutions to VI problems at some sites, such as those deemed technically impracticable to clean up, where remediation of underlying soil or groundwater contamination will not be completed in the foreseeable future. Furthermore, green buildings to be developed in areas of potential soil or groundwater contamination may be designed to incorporate engineering controls to prevent VI. © 2009 Wiley Periodicals, Inc. [source] Highly symptomatic adult polycystic liver disease: options and results of surgical managementANZ JOURNAL OF SURGERY, Issue 8 2004Yu Meng Tan Background: The majority of patients afflicted with adult polycystic liver disease (APLD) are asymptomatic. For those who are symptomatic, there are a variety of treatment procedures that have been proposed but these lack verification through long-term studies with respect to safety and long-term effectiveness. Choice of surgical procedure is related to the severity of APLD and morphology of the cysts within the liver. The aim of the present study was to analyse the immediate and long-term results of fenestration and combined resection,fenestration at Singapore General Hospital. Methods: A retrospective analysis of clinical, operative, imaging and follow-up data was carried out for 12 patients (10 women and two men) with symptomatic APLD who underwent surgery from January 1992 to December 2000. The primary outcome measures assessed were postoperative alleviation of symptoms, performance status, complications, mortality and long-term recurrence of symptoms. Results: Nine patients underwent 12 fenestration procedures and three patients had combined resection,fenestration. Fenestration was carried out for eight of nine patients with a dominant cyst morphology and combination resection,fenestration was carried out for those three patients with diffuse cyst morphology. There was no operative mortality and all patients were discharged from hospital free of their preoperative symptoms. Overall morbidity rate was 58%. The mean follow up for the present cohort was 29.3 months. Only two patients had recurrence of symptoms. One patient with dominant cyst morphology who underwent laparoscopic fenestration had recurrence at 26 and 43 months but this was successfully treated finally with open fenestration. The other patient had diffuse cyst morphology and was treated with fenestration for recurrent cyst infection that recurred 1 month postoperatively. This required subsequent intravenous antibiotics and percutaneous drainage for resolution of symptoms. Conclusion: Treatment for symptomatic APLD should be based on the morphology of the liver cysts. Fenestration is a safe and acceptable procedure for patients with a dominant cyst pattern where liver size can be reduced after the cysts collapse. A combination of resection,fenestration is suitable for those with a diffuse cyst pattern where grossly affected segments are resected in combination with fenestration to allow for reduction in liver size. [source] Enhancing endocrine response with novel targeted therapies,CANCER, Issue S3 2008Why have the clinical trials to date failed to deliver on the preclinical promise? Abstract Acquired resistance to endocrine therapies has severely limited their long-term effectiveness in breast cancer. In recent years a clear rationale has developed for combining signal transduction inhibitors (STIs) with endocrine therapies to delay the emergence of acquired resistance and enhance endocrine responsiveness. A variety of biologic agents have been developed to target key proteins along the EGFR, HER2, MAPK, and P13K/Akt signal transduction cascades. While several of these agents have shown early promise in selected breast cancer models, translating these data into convincing clinical results has been generally disappointing to date. By applying more rigorous trial design and tumor selection criteria to future trials, it is much more likely that adding the new generation of targeted therapies can fulfill its promise in enhancing endocrine responsiveness and our ability to treat breast cancer patients. Cancer 2008. © 2007 American Cancer Society. [source] | |||||||||||||||||||