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Long-term Success (long-term + success)
Selected AbstractsCO2 Laser Treatment of Epidermal Nevi: Long-Term SuccessDERMATOLOGIC SURGERY, Issue 7 2002Sarah Boyce MD background. Epidermal nevi have been notoriously difficult to treat due to their large size and often conspicuous location. Variable results have been obtained with different laser treatments, and scarring and/or incomplete removal is typical after excisional or other destructive modalities. objective. To outline the successful use of a short-pulsed CO2 laser in the long-term eradication of epidermal nevi in three patients. methods. Three females (ages 15,19) presented with extensive grouped verrucous papules and plaques on the face, trunk, and extremities. A pulsed CO2 laser was used to vaporize the lesions using a 500 mJ pulse energy, 3 mm spotsize, and 7 watts of power. results. All lesions healed without incident. No lesional recurrence was observed 10 to 13 months after treatment except in one small area on the ankle in one patient. conclusions. Carbon dioxide laser vaporization of epidermal nevi provides good clinical effect and offers unique advantages for the treatment of these lesions, including effective intraoperative hemostasis with excellent lesional visualization. It is also possible to treat widespread areas in one laser treatment session. While the results of this series clearly show the benefit of CO2 laser treatment, epidermal nevi may not always respond so favorably, due in part to the variability in their depths of involvement. [source] Changes in the Isolated Delayed Component as an Endpoint of Catheter Ablation in Arrhythmogenic Right Ventricular Cardiomyopathy: Predictor for Long-Term SuccessJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 7 2008AKIHIKO NOGAMI M.D. Introduction: Although successful ablation of ventricular tachycardia (VT) is feasible in arrhythmogenic right ventricular cardiomyopathy (ARVC), long-term recurrence is common. The aim of this study was to assess the usefulness of a change in the isolated delayed component (IDC) as an endpoint of the catheter ablation in ARVC. Methods and Results: Eighteen patients (48 ± 11 years) with ARVC were studied. Detailed endocardial mapping of the right ventricle (RV) was performed during sinus rhythm. IDCs were recorded in 16 patients and the latest IDCs were related to the VT circuit. Catheter ablation was carried out in the areas with the IDCs. At the end of the session, the IDC was electrically dissociated in one, disappeared in five, exhibited second-degree block in one, was significantly delayed (,50 ms) in three, and remained unchanged in six. The change in the IDC was correlated with the change in the type II/III late potentials in the signal-averaged electrocardiography (ECG) and the inducibility of the clinical VT after the ablation. During a follow-up of 61 ± 38 months, VT recurred in six. The patients with a changed IDC had a significantly lower VT recurrence than those with no IDC or an unchanged IDC (P < 0.02). Conclusion: In patients with ARVC, (1) the IDCs during sinus rhythm are related to the clinical VT and can be a target for the ablation, (2) a change in the IDC can be used as an endpoint, and (3) qualitative analyses of the serial signal-averaged ECGs may be useful for the long-term follow-up. [source] Standardized Stimulation Protocol to Predict the Long-Term Success of Radiofrequency Ablation of Postinfarction Ventricular TachycardiaPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 1p2 2003DAVID O'DONNELL O'DONNELL, D., et al.: Standardized Stimulation Protocol to Predict the Long-Term Success of Radiofrequency Ablation of Postinfarction Ventricular Tachycardia.Background: The ability to predict the success of radiofrequency ablation (RFA) is an essential step in the management of ventricular tachycardia (VT) in patients with ischemic heart disease. Methods: This study tested a standardized programmed stimulation protocol and pre-specified definitions of procedural outcome. Consecutive patients referred for RFA of delayed post infarction VT were enrolled. Programmed stimulation was performed at the beginning and the end of an RFA procedure, and consisted of an 8 beat drive followed by up to 5 extrastimuli. Immediate success was defined as no inducible monomorphic VT, and a modified result was defined as the inducibility of VT with >2 extrastimuli beyond those required at baseline. Procedural failure was defined when these criteria were not met. Recurrences of sustained VT and arrhythmic deaths were monitored during long-term follow-up. Results: The study enrolled 112 patients. Immediate procedural success was achieved in 38%, a modified result in 34%, and procedural failure in 28% of patients. During a mean follow-up of 78 ± 16 months, recurrent sustained VT was observed in 25 patients. VT recurrence was 3% (3/79) in patients with a successful or modified result, compared with 67% (22/33) in those who had undergone unsuccessful procedures (P < 0.001). Conclusions: This standardized stimulation protocol and definitions of procedural success, enabled us to predict with high accuracy a VT recurrence-free long-term follow-up. This may have implications in recommending devices or other treatments after RFA for postinfarction VT. (PACE 2003; 26[Pt. II]:348,351) [source] How should we quantify the performance of KPro's?ACTA OPHTHALMOLOGICA, Issue 2009Purpose To report a method of standardized data collection and reporting and statistical assessment that can be used for all KPro´s available on the market. The database (will be presented) should be , Usable for different types of KPro´s , Easily adaptable to changes in technique , Allow for complete entry of relevant data Methods Visual Acuity data should be reported in different international surgical centres in a standardized manner: Best spectacle corrected VA, unless BCVA only possible with CL (> useful time of wear). A complete entry of all relevant data is possible in this database. The statistical analysis should be agreed upon by all centres. For Survival Time = Retention of KPro > the Kaplan-Meier method For Visual Acuity over the Course of Time > the Monte-Carlo method Results A database will be demonstrated that can be used free of charge by all KPro centres interested. The VISUAL ACUITY BY TIME- INDEX (VAT- Index) will also be presented, whose theoretical basis published in: Journal of Theoretical Medicine, 2002 / 4, 183-190, W. Hitzl and G. Grabner [bdquo]Application of the Monte Carlo Method for the Assessment of Long-term Success in Keratoprosthesis Surgery". Example of its use will be give, based in data, courtesy Barraquer Eye Clinic, Barcelona. Conclusion With the Kaplan-Meier method: + analysis is done quickly, uses all data available, hypotheses tests are available for comparisons and mean and median survival time can be computed - no information about relation between time and best corrected visual acuity and the definition of terminal event is arbitrary to a certain extent. Monte-Carlo method (VAT-index): + Method is based on a so-called non-parametric longitudinal model + Reliabel estimation of relation between time and best corrected visual acuity at any given time point (patient as well as surgeon is basically interested in this relation). + statistically valid analysis and better comparison of different KPro techniques + easy comparison of defined postoperative periods + comparison of different initial clinical findings and diseases possible + long-time follow-up of BCVA - shorter follow-up time as compared with Kaplan-Meier method (e.g. with strict [bdquo]80%data complete" criteria) [source] Focal Atrial Tachycardia Originating from the Left Atrial Appendage: Electrocardiographic and Electrophysiologic Characterization and Long-Term Outcomes of Radiofrequency AblationJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 5 2007WANG YUN-LONG M.D. Introduction: This study sought to investigate electrophysiologic characteristics and radiofrequency ablation (RFA) in patients with focal atrial tachycardia (AT) arising from the left atrial appendage (LAA). Methods: This study included seven patients undergoing RFA with focal AT. Activation mapping was performed during tachycardia to identify an earlier activation in the left atria and the LAA. The atrial appendage angiography was performed to identify the origin in the LAA before and after RFA. Results: AT occurred spontaneously or was induced by isoproterenol infusion rather than programmed extrastimulation and burst atrial pacing in any patient. The tachycardia demonstrated a characteristic P-wave morphology and endocardial activation pattern. The P wave was highly positive in inferior leads in all patients. Lead V1 showed upright or biphasic (±) component in all patients. Lead V2,V6 showed an isoelectric component in five patients or an upright component with low amplitude (<0.1 mV) in two patients. Earliest endocardial activity occurred at the distal coronary sinus (CS) ahead of P wave in all seven patients. Mean tachycardia cycle length was 381 ± 34 msec and the earliest endocardial activation at the successful RFA site occurred 42.3 ± 9.6 msec before the onset of P wave. RFA was acutely successful in all seven patients. Long-term success was achieved in seven of the seven over a mean follow-up of 24 ± 5 months. Conclusions: The LAA is an uncommon site of origin for focal AT (3%). There were consistent P-wave morphology and endocardial activation associated with this type of AT. The LAA focal ablation is safe and effective. Long-term success was achieved with focal ablation in all patients. [source] Peritoneal mesothelial cells and the extracellular matrixNEPHROLOGY, Issue 6 2001Susan Yung SUMMARY: Continuous ambulatory peritoneal dialysis (CAPD) is an important treatment for patients with end-stage renal failure. Long-term success is dependent on the functional and structural integrity of the peritoneal membrane. Conventional peritoneal dialysis fluids are non-physiological. They contain glucose at high concentrations to provide the osmotic drive for ultrafiltration, lactate to correct the metabolic acidosis of renal failure, and a low pH to prevent caramelization of glucose during heat sterilization. These components, in isolation or acting together, exert adverse influences on both the resident cellular and extracellular elements of the peritoneal membrane, as well as phagocytic cells which infiltrate the peritoneum during inflammation, culminating in detrimental structural and functional effects, compromising the viability of the peritoneum during dialysis. Peritoneal biopsy studies of patients on long-term CAPD have demonstrated an intercellular space between adjacent mesothelial cells which allows the penetration of peritoneal dialysis fluid into the underlying submesothelium. This, together with episodes of peritonitis, can initiate a chronic inflammatory reaction within the peritoneum characterized by increased synthesis of matrix proteins. Perturbation of the regulatory mechanisms which govern the balance of synthesis and degradation of extracellular matrix can lead to progressive fibrosis. Human peritoneal mesothelial cells (HPMC) have been shown to synthesize fibronectin, laminin, collagens, proteoglycans and hyaluronan in vitro, and thus play a role in the pathogenesis of peritoneal fibrosis. This review will give an overview of extracellular matrix (ECM) synthesis by HPMC, how changes in the synthesis are affected by CAPD and postulate how these changes can compromise the dialytic properties of the peritoneum. [source] Introduction Strategies Put to the Test: Local Adaptation versus HeterosisCONSERVATION BIOLOGY, Issue 3 2004PHILIPPINE VERGEER exogamia; introducciones multi-fuente; introducciones uni-fuente; Succisa pratensis Abstract:,Plant biodiversity has declined seriously because of both habitat deterioration and habitat fragmentation. As a result, many species have been forced into small, fragmented, and isolated populations and are believed to suffer from higher extinction risks. Genetic reinforcement and the establishment of new populations are now widely used to prevent extinction. However, the genetic background of transplants may seriously affect the long-term success of these populations because increased genetic variation may reduce the risk of inbreeding or lead to better performance by restored heterozygosity levels (heterosis). Introduced transplants, however, may be poorly adapted to the new local conditions. We tested the initial success of alternative introduction strategies. We evaluated the potential for inbreeding, heterosis, and/or local adaptation after introduction of artificial populations of Succisa pratensis. We introduced individuals from local and distant artificial populations that were created from either small or large populations. We created the artificial populations with the same census population size but varying effective population sizes by adjusting the relatedness of individuals. We analyzed the demographic consequences of inbreeding, heterosis, and/or local adaptation of these artificial populations. Reduced performance after selfing was manifested by a reduction in seed production, seed weight, germination, and flowering percentage. Seed production, seed weight, flowering percentage, and number of flowerheads were negatively affected by small population size. Local adaptation increased biomass and flowering percentage for local individuals. Seed weight and seed production exhibited significant heterosis. Our results demonstrate that threatened populations can benefit from introduction and genetic reinforcement of individuals from related populations. Significant differences among the artificial populations for several measured performance components suggest that introduction or reinforcement is best achieved through material from a local population or, when unavailable, from several large populations. Resumen:,La biodiversidad de plantas ha declinado seriamente tanto por el deterioro como la fragmentación de hábitats. Como resultado, muchas especies han sido relegadas a poblaciones pequeñas, fragmentadas y aisladas cuyos riesgos de extinción se piensa que son mayores. El reforzamiento genético y el establecimiento de poblaciones nuevas se utilizan ampliamente en la actualidad para prevenir la extinción. Sin embargo, los antecedentes genéticos de transplantes pueden afectar seriamente el éxito de estas poblaciones a largo plazo debido a que el incremento en la variación genética puede reducir el riesgo de endogamia o puede conducir a un mejor rendimiento por lograr niveles de heterocigosidad restaurados (heterosis). No obstante, los trasplantes introducidos pueden adaptarse deficientemente a las nuevas condiciones locales. Probamos el éxito inicial de estrategias de introducción alternativas. Evaluamos el potencial de endogamia, heterosis y/o adaptación local después de la introducción de poblaciones artificiales de Succisa pratensis. Introdujimos individuos de poblaciones locales y de poblaciones artificiales distantes que fueron creadas a partir de poblaciones tanto pequeñas como grandes. Las poblaciones artificiales fueron creadas con el mismo tamaño poblacional censal pero variaron en tamaños poblacionales efectivos al ajustar la parentela de los individuos. Analizamos las consecuencias demográficas de la endogamia, heterosis y/o adaptación local de estas poblaciones artificiales. Después de la autofecundación se manifestó una reducción en el rendimiento por reducción en la producción y peso de semillas y en el porcentaje de germinación y floración. La producción y peso de semillas, el porcentaje de floración y el número de botones florales fueron afectados negativamente por el tamaño poblacional pequeño. La adaptación local incrementó la biomasa y el porcentaje de floración en individuos locales. El peso y producción de semillas mostró heterosis significativa. Nuestros resultados demuestran que las poblaciones amenazadas pueden beneficiarse de la introducción y del reforzamiento genético de individuos de poblaciones emparentadas. Las diferencias significativas entre las poblaciones artificiales en varios de los componentes de rendimiento medidos sugiere que la introducción o reforzamiento se logra mejor con material de una población local o, cuando no disponible, con material de varias poblaciones grandes. [source] A Structural Analysis of the Effectiveness of Buying Firms' Strategies to Improve Supplier PerformanceDECISION SCIENCES, Issue 1 2000Daniel R. Krause Many manufacturing firms have increased the amount of component parts and services they outsource, while refocusing on their core capabilities. Outsourcing parts and services to independent, external suppliers means that suppliers' performance is increasingly critical to the long-term success of these buying firms. Buying firms are increasingly using disparate supplier development strategies to improve supplier performance including supplier assessment, providing incentives for improved performance, instigating competition among suppliers, and direct involvement of the buying firm's personnel with suppliers through activities such as training of suppliers' personnel. Using resource-based theory, internalization theory, and structural equation modeling, we examine the impact of these supplier development strategies on performance. We conclude that direct involvement activities, where the buying firm internalizes a significant amount of the supplier development effort, play a critical role in performance improvement. [source] Dental therapists' experience in the immediate management of traumatized teethDENTAL TRAUMATOLOGY, Issue 2 2006Teresa Loh Abstract,,, The optimal immediate management of traumatized teeth is known to be important for long-term success. One hundred and sixty-seven school dental therapists with General Certificate of Education ,Ordinary' (GCE ,O') level qualification were surveyed on their knowledge and experience on immediate management of dental trauma. The results showed only 41.2% felt comfortable with their present knowledge on the subject. A high proportion of the respondents (94.6%) indicated a need for more knowledge. All therapists concurred on the need to replant a permanent tooth and most (85.1%) agreed that this should be done within 30 min. More than half (54.8%) were not sure of the optimal storage medium for avulsed teeth. Their attitude towards acquiring knowledge in this aspect was good (80.5%) and all would take immediate action to settle appointments for trauma cases. [source] SYNTHESIS: Evolutionary consequences of fishing and their implications for salmonEVOLUTIONARY APPLICATIONS (ELECTRONIC), Issue 2 2008Jeffrey J. Hard Abstract We review the evidence for fisheries-induced evolution in anadromous salmonids. Salmon are exposed to a variety of fishing gears and intensities as immature or maturing individuals. We evaluate the evidence that fishing is causing evolutionary changes to traits including body size, migration timing and age of maturation, and we discuss the implications for fisheries and conservation. Few studies have fully evaluated the ingredients of fisheries-induced evolution: selection intensity, genetic variability, correlation among traits under selection, and response to selection. Most studies are limited in their ability to separate genetic responses from phenotypic plasticity, and environmental change complicates interpretation. However, strong evidence for selection intensity and for genetic variability in salmon fitness traits indicates that fishing can cause detectable evolution within ten or fewer generations. Evolutionary issues are therefore meaningful considerations in salmon fishery management. Evolutionary biologists have rarely been involved in the development of salmon fishing policy, yet evolutionary biology is relevant to the long-term success of fisheries. Future management might consider fishing policy to (i) allow experimental testing of evolutionary responses to exploitation and (ii) improve the long-term sustainability of the fishery by mitigating unfavorable evolutionary responses to fishing. We provide suggestions for how this might be done. [source] How to link biomanipulation and sustainable fisheries management: a step-by-step guideline for lakes of the European temperate zoneFISHERIES MANAGEMENT & ECOLOGY, Issue 3-4 2004T. Mehner Abstract Biomanipulation, the reduction of planktivorous fish to enhance filter-feeding zooplankton, has been used to rehabilitate eutrophied lakes. However, efficacy and long-term success were dependent on nutrient load, lake morphometry and biomanipulation measures. The ongoing focus on sustainable use of aquatic resources offers the chance to perform lake rehabilitation using a combined strategy of nutrient load reduction and traditional inland fisheries management techniques. Particularly in Central and Western Europe where piscivorous fish are the target species of most commercial and recreational fisheries, an enhancement of the piscivores by stocking and harvest regulations may act successfully in the co-management of ecosystem and fisheries. Guidelines are presented on how biomanipulation can be used as in lake rehabilitation by considering the objectives and constraints of traditional fisheries management. Alternatives in the decision tree are elucidated by examples from biomanipulations and lake management programmes in the temperate zone of Europe and North America. It is suggested that biomanipulation may support many lake rehabilitation programmes where fisheries' stakeholders are the principal user groups. [source] Effect of intermittent compression of upper arm veins on forearm vessels in patients with end-stage renal diseaseHEMODIALYSIS INTERNATIONAL, Issue 3 2005Rina R. Rus Abstract Native arteriovenous fistula is the best vascular access for chronic hemodialysis. Primary and long-term success depends, in part, on the state of arteries and veins at the time of the operation. The aim of our study was to investigate the effects of intermittent compression of upper arm veins on forearm vessels in patients with terminal renal disease. The study group was composed of 16 chronic hemodialysis patients who performed daily intermittent compression of the upper arm without vascular access by elastic band (Eschmarch). Ten chronic hemodialysis patients were included in the control group, which performed no specific activity. Forearm measurements were obtained at the beginning of the study and 4 and 8 weeks later during the course of intermittent compression of the upper arm veins. The forearm circumference and maximal handgrip strength were measured. The artery measures, including endothelium-dependent vasodilatation and forearm vein variables, were obtained by ultrasonography measurements. The forearm circumference, maximal handgrip strength, and artery variables, including endothelium-dependent vasodilatation, remained unchanged. The basal venous diameters (2.29 ± 0.19 mm at the beginning, 2.46 ± 0.19 mm after 4 weeks, and 2.53 ± 0.18 mm after 8 weeks) were significantly increased in the study group. The distensibility of veins was preserved in the study group. There were no significant changes in the control group. Our study demonstrated that daily intermittent compression of the upper arm veins increases the forearm vein diameter and preserves the distensibility of veins in patients with end-stage renal failure. [source] Advanced Material Strategies for Tissue Engineering ScaffoldsADVANCED MATERIALS, Issue 32-33 2009Lisa E. Freed Abstract Tissue engineering seeks to restore the function of diseased or damaged tissues through the use of cells and biomaterial scaffolds. It is now apparent that the next generation of functional tissue replacements will require advanced material strategies to achieve many of the important requirements for long-term success. Here, we provide representative examples of engineered skeletal and myocardial tissue constructs in which scaffolds were explicitly designed to match native tissue mechanical properties as well as to promote cell alignment. We discuss recent progress in microfluidic devices that can potentially serve as tissue engineering scaffolds, since mass transport via microvascular-like structures will be essential in the development of tissue engineered constructs on the length scale of native tissues. Given the rapid evolution of the field of tissue engineering, it is important to consider the use of advanced materials in light of the emerging role of genetics, growth factors, bioreactors, and other technologies. [source] First time and repeat cardioversion of atrial tachyarrhythmias , a comparison of outcomesINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 8 2010A. Arya Summary Introduction:, Repeat cardioversion may be necessary in over 50% of patients with persistent atrial fibrillation (AF), but identifying responders remains challenging. This study evaluates the long-term success of direct current cardioversion (DCCV) and the clinical and echocardiographical parameters that influence them, in over 1000 sedation-cardioversion procedures undertaken at Eastbourne General Hospital between 1996 and 2006. Methods:, A total of 770 patients of mean age (SD) 70.1(10.1) underwent 1013 DCCVs (first n = 665, repeat n = 348) for atrial tachyarrhythmias from 1996 to 2006. Time to persistent arrhythmia recurrence was compared between first and multiple DCCV, and the effect of age, gender, presence of heart disease, left atrial size, fractional shortening, arrhythmia duration, anti-arrhythmic drug therapy (AAD) and other concomitant cardiac medication was evaluated using the Kaplan,Meier method and Cox's Proportional-hazards model. Results:, In all, 33% of first and 29% of repeat DCCVs were in sinus rhythm (SR) at 12 months (m). There was no difference in median time to arrhythmia recurrence (SE) between first and multiple procedures: 1.5 ± 0.1 m (1.3,1.7) and 1.5 ± 0.0 m (1.4,1.6) respectively, p = 0.45. AAD use was significantly higher, arrhythmia duration shorter and more diabetic patients underwent repeat procedures. Amiodarone, OR 0.56, p = 0.04, sotalol, OR 0.61, p = 0.02 and arrhythmia duration, < 6 m, OR 0.72, p = 0.03 were independent predictors of improved outcome in first procedures only. In patients undergoing first procedures on amiodarone or sotalol, median time to arrhythmia recurrence was longer and 12 m SR rates higher, 6.0 ± 2.4 m (42%) than those who had a repeat procedure on the same medication, 1.5 ± 0.1 m (33%), p = 0.06. Conclusions:, The efficacy of first and subsequent DCCV procedures is similar, achieving a similar proportion of SR maintenance at 1 year. However, the benefits of AAD therapy are the greatest following first time procedures. Concomitant AAD therapy should be considered for all first time procedures for persistent AF. [source] Relationships among levels of government support, marketing activities, and financial health of nonprofit performing arts organizationsINTERNATIONAL JOURNAL OF NONPROFIT & VOLUNTARY SECTOR MARKETING, Issue 2 2007Theresa A. Kirchner This exploratory study researches and analyzes the empirical effects of financial levels of government support and marketing practices on the financial health of nonprofit performing arts organizations. Declining government subsidies and increasing competition from non-traditional sources have presented these organizations with unique opportunities and challenges that call for a market-centered, as well as an art-centered approach. Financial health is critical for the long-term success of a nonprofit performing arts organization. Few empirical studies have examined the interrelationships between these key variables. This study analyzes a sample of 63 American professional symphony orchestras employing 20 years of data. The correlations among financial levels of government support and marketing activities were positive and significant, the correlations among levels of government support and financial health were negative and significant, and the correlations between levels of marketing activity and financial health were negative and varied in significance. Causal analyses were less conclusive, but significant causal relationships were found for large symphony orchestras, indicating that segmentation research may be warranted. Implications and opportunities for future research are presented which have potential application for government agencies, academic researchers, and arts organization managers, boards of directors, and donors. Copyright © 2006 John Wiley & Sons, Ltd. [source] Value of Different Follow-Up Strategies to Assess the Efficacy of Circumferential Pulmonary Vein Ablation for the Curative Treatment of Atrial FibrillationJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 12 2005CHRISTOPHER PIORKOWSKI M.D. Background: The objective of this study was to compare transtelephonic ECG every 2 days and serial 7-day Holter as two methods of follow-up after atrial fibrillation (AF) catheter ablation for the judgment of ablation success. Patients with highly symptomatic AF are increasingly treated with catheter ablation. Several methods of follow-up have been described, and judgment on ablation success often relies on patients' symptoms. However, the optimal follow-up strategy objectively detecting most of the AF recurrences is yet unclear. Methods: Thirty patients with highly symptomatic AF were selected for circumferential pulmonary vein ablation. During follow-up, a transtelephonic ECG was transmitted once every 2 days for half a year. Additionally, a 7-day Holter was recorded preablation, after ablation, after 3 and 6 months, respectively. With both, procedures symptoms and actual rhythm were correlated thoroughly. Results: A total of 2,600 transtelephonic ECGs were collected with 216 of them showing AF. 25% of those episodes were asymptomatic. On a Kaplan-Meier analysis 45% of the patients with paroxysmal AF were still in continuous SR after 6 months. Simulating a follow-up based on symptomatic recurrences only, that number would have increased to 70%. Using serial 7-day ECG, 113 Holter with over 18,900 hours of ECG recording were acquired. After 6 months the percentage of patients classified as free from AF was 50%. Of the patients with recurrences, 30,40% were completely asymptomatic. The percentage of asymptomatic AF episodes stepwise increased from 11% prior ablation to 53% 6 months after. Conclusions: The success rate in terms of freedom from AF was 70% on a symptom-only-based follow-up; using serial 7-day Holter it decreased to 50% and on transtelephonic monitoring to 45%, respectively. Transtelephonic ECG and serial 7-day Holter were equally effective to objectively determine long-term success and to detect asymptomatic patients. [source] Hardness of Three Resin-Modified Glass-Ionomer Restorative Materials as a Function of Depth and TimeJOURNAL OF ESTHETIC AND RESTORATIVE DENTISTRY, Issue 4 2009HOWARD W. ROBERTS DMD ABSTRACT Statement of the Problem:, The polymerization of bulk-placed resin-modified glass-ionomer (RMGI) restoratives is compromised when penetration of the curing light is limited because of the materials' thickness. It is unknown if additional post light-curing resin polymerization and/or glass-ionomer setting occurs over time to ensure adequate polymerization. Purpose:, The primary objective was to evaluate the depth of cure of various thicknesses of RMGI restorative products over 1 year using Knoop hardness (KH) testing. Materials and Methods:, The materials were placed in Delrin molds having an internal diameter of 5.0 mm and heights of 2, 3, 4, and 5 mm and were photopolymerized with a halogen light-curing unit. Five specimens of each depth were prepared for each time period evaluated. Specimens were stored in darkness at 37 ± 2°C and 98 ± 2% humidity until being tested at 24 hours, 1 week, and 1, 3, 6, 9, and 12 months after fabrication. Mean KH values were calculated for the bottom and top surfaces of each thickness group and used to determine bottom/top hardness ratios. Data were compared using two-way analysis of variance (factors of time, thickness) at a 0.05 significance level with Scheffé's post hoc analysis, where required. Results:, The materials had relatively stable top surface KH, which permitted valid assessment of changes in bottom surface KH over time. The bottom surface KH of some RMGIs changed significantly over time (p < 0.001), but degrees of change were material dependent. Certain RMGIs demonstrated a potential for statistically significant post light-activation hardening; however, that too was material dependent. As compared with top surface KH, deeper layers of the thicker RMGI specimens consistently failed to achieve an adequate degree of polymerization. Conclusion:, Although certain RMGI materials demonstrate a potential for post light-activation chemically initiated resin polymerization and/or polyalkenoate acid/base reaction, these reactions may not be sufficient to ensure that the material is adequately polymerized for long-term success. This is particularly true when RMGI materials are placed in thicker layers where curing light penetration may be compromised. CLINICAL SIGNIFICANCE RMGI materials should not be placed in bulk but photopolymerized in layers to ensure adequate light activation. The results of this study suggest that Photac-Fil Quick be placed in layers no thicker than 2 mm while Fuji II LC and Vitremer may be placed in layers up to 3 mm in thickness. [source] A serological and molecular survey of hepatitis B in children 15 years after inception of the national hepatitis B vaccination program in eastern China,JOURNAL OF MEDICAL VIROLOGY, Issue 9 2009Ying Dong Abstract The emergence of mutations in the hepatitis B virus (HBV) S gene has threatened the long-term success of vaccination programs since the worldwide introduction of effective vaccines against hepatitis B. This study was conducted on 5,407 children (0,8 years old) in eastern China in 2007. We analyzed the prevalence of HBsAg, anti-HBs, and "a"-determinant mutations in the HBV S gene by microparticle enzyme immunoassays, PCR, and DNASTAR software. The total HBsAg prevalence was 1.52% (82/5,407) in the children and increased with age. In contrast, the positive rate (65.42%, 2,374/3,629) and the titers of anti-HBs decreased with age. The predominant infection was HBV of genotype C and serotype adr (45/51; 88% of cases). Mutations of I126T, amino acid 137 (nt553T deletion mutation), G145A, G145R, and F158S were found in the children; the mutations of amino acid 137 and F158S have not been reported previously. The total prevalence of mutant strains was 14% (7/51). To investigate whether the infection resulted from maternal transmission, we compared the S gene sequences in 16 mother,child pairs. Fourteen mother,child pairs exhibited the same HBV genotype, with 99.5,100% sequence homology in the S gene, while two pairs exhibited different genotypes. This study suggested that the hepatitis B vaccination strategies in eastern China have been successful. Although the emergence of "a"-determinant mutations in the HBV S gene have resulted in HBV infection in immunized children, this does not pose a threat to the vaccination strategies. The HBV-infected children had contracted the infection via vertical transmission. J. Med. Virol. 81:1517,1524, 2009. © 2009 Wiley-Liss, Inc. [source] Cellular HIV-1 DNA quantitation in patients during simplification therapy with protease inhibitor-sparing regimensJOURNAL OF MEDICAL VIROLOGY, Issue 7 2007Loredana Sarmati Abstract Simplified regimens containing protease-inhibitors (PI)-sparing combinations were used in patients with virological suppression after prolonged highly active antiretroviral therapy. This study evaluated the total HIV-1 DNA quantitation as a predictor of long-term success for PI-sparing simplified therapy. Sixty-two patients were enrolled in a prospective non-randomized cohort. All patients have been receiving a triple-therapy regimen, two nucleoside reverse transcriptase inhibitors (NRTIs) plus one PI, for at least 9 months and were characterized by undetectable plasma HIV-1 RNA levels (<50 cp/ml) for at least 6 months. Patients were changed to a simplified PI-sparing regimen to overcome PI-associated adverse effects. HIV-DNA levels in peripheral blood mononuclear cells (PBMCs) were evaluated at baseline and at the end of follow-up. Patients with proviral DNA levels below the median value (226 copies/106 PBMCs) had a significant higher CD4 cell count at nadir (P,=,0.003) and at enrolment (P,=,0.001) with respect to patients with HIV-DNA levels above the median value. At month 18, 53 out of 62 (85%) patients on simplified regimen showed virological success, 4 (6.4%) patients experienced virological failure and 5 (8%) patients showed viral blip. At logistic regression analysis, HIV-DNA levels below 226 copies/106 PBMCs at baseline were associated independently to a reduced risk of virological failure or viral blip during simplified therapy (OR 0.002, 95% CI 0.001,0.46, P,=,0.025). The substitution of PI with NRTI or non-NRTIs may represent an effective treatment option. Indeed, treatment failure or viral blip were experienced by 6% and 8% of the patients on simplified therapy, respectively. In addition, sustained suppression of the plasma viral load was significantly correlated with low levels of proviral DNA before treatment simplification. J. Med. Virol. 79:880,886, 2007. © 2007 Wiley-Liss, Inc. [source] Knee biomechanics after UKA and its relation to the ACL,a robotic investigationJOURNAL OF ORTHOPAEDIC RESEARCH, Issue 4 2006Jeremy F. Suggs Abstract Unicompartmental knee arthroplasty (UKA) has regained popularity in recent years. However, limited data exist on how UKA affects knee biomechanics. The role of the anterior cruciate ligament (ACL) after fixed bearing UKA remains controversial. In this study, a robotic testing system was used to apply a quadriceps/hamstrings load to cadaveric knee specimens in the intact state, after medial UKA, and after transection of the ACL in UKA. The load was applied to the knee from full extension to 120° of flexion in 30° increments. UKA generally did not affect anterior,posterior (AP) femoral position, but did cause external tibial rotation and variations in varus,valgus rotation compared to the intact knee. ACL transection after UKA shifted the femur posteriorly compared to the intact and UKA knees and increased internal tibial rotation compared to the UKA knee at low flexion. The AP motion of the articular contact position in the implant was increased after ACL transection. These data might help explain the mechanism of tibial component loosening and provide insight into further investigations of polyethylene wear in UKA. Based on the kinematic data, the ACL should be functional to provide patients the greatest opportunity for long-term success after medial UKA. © 2006 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res [source] Responsible business decisions: an over-arching frameworkJOURNAL OF PUBLIC AFFAIRS, Issue 3-4 2006Alan Gully Contemporary businesses face increasing pressures on formulating, implementing and monitoring their strategic policies. Their long-term success in attaining these strongly relies on developing a proactive two-way, or even multi-way, stakeholder dialogue to become aware of the moral aspects of decisions. Openness and transparency should help to provide stakeholders with information on how and why particular courses of action have been adopted. In order to be effective and efficient, responsible business decision-making requires the willpower and commitment by management to implement, monitor and evaluate the ethical action which ought to be based on the organisation's evolving values and priorities. Although inclusive relationships may be accomplished in several ways, the normative interpretation of stakeholder theory is the most appropriate methodology to enable moral judgement to be made. An over-arching framework is presented to assess, review and re-balance the different techniques for any business to achieve its intended outcomes through the triple bottom line. Copyright © 2006 John Wiley & Sons, Ltd. [source] Canine obesity , an overviewJOURNAL OF VETERINARY PHARMACOLOGY & THERAPEUTICS, Issue 2007J. GOSSELLIN Canine patients are generally regarded as being clinically obese when their body weight is at least 15% above ideal. The incidence of obesity in dogs is thought to be in the range of 20,40% of the general population and, since obesity is known to predispose or exacerbate a range of serious medical conditions, its importance cannot be overstated. Management of obesity through dietary restriction and increased exercise is often difficult to achieve and dependent upon owner compliance. Until recently there has been no authorized therapeutic medication available for weight reduction in dogs, and drugs used in people have proved unsuitable. However, with the development of microsomal triglyceride transfer protein inhibitors for canine use, such as dirlotapide, the veterinarian has a novel method with which to augment traditional weight control programmes. This approach has the additional advantage that weight loss is achieved without dietary restriction or change in exercise regimen, providing encouragement for the owner to comply with subsequent dietary and exercise recommendations, thereby increasing the likelihood for long-term success. [source] Histological changes occurring after endoluminal ablation with two diode lasers (940 and 1319 nm) from acute changes to 4 monthsLASERS IN SURGERY AND MEDICINE, Issue 10 2008FACS, Ronald G. Bush MD Abstract Background Endovenous laser ablation of the saphenous vein was studied from a histologic analysis to establish changes that occur from time of injury to 4 months when the vein is difficult to visualize by ultrasound. Methods Twenty-four patients were examined after treatment with either a 1319 nm diode laser (Sciton, Palo Alto, CA) or a 940 nm diode (Dornier, Kennasaw, GA) 12 patients were randomly assigned to the 940 nm group and 12 patients to the 1319 nm group. Histologic evaluations were only done once per patient. All patients had symptomatic saphenous insufficiency with varicosities. All were in CEAP class 3 or 4. Sections of treated veins were submitted for evaluation after staining with hematoxylin,eosin. The evaluations were done acutely, at 1 and 4 months. Ultrasound findings were also evaluated and compared at the same intervals. Results Acutely, all examined veins revealed loss of intima. In the 1319 nm group numerous vacuoles were present in the subintimal layer. On gross exam at 1 month, both groups showed vein wall thickening, intraluminal thrombus and inflammatory changes. Histologic evaluation showed thrombus was present with many fibroblasts and inflammatory cells. At 4 months, collagen was the predominant histologic finding. However, the changes were less in regards to the injury response with the 1,319 nm group as manifested by less collagen deposition at 4 months. Conclusion This study demonstrates the cellular sequence that occurs after endovenous ablation. Fibroblast infiltration is a result of the injury response which leads to negative modeling of the thrombus and eventual collagen deposition. Replacement of the thrombus with collagen is necessary for eventual long-term success. Lasers Surg. Med. 40:676,679, 2008. © 2008 Wiley-Liss, Inc. [source] Anastomotic biliary strictures after liver transplantation: Causes and consequencesLIVER TRANSPLANTATION, Issue 5 2006Robert C. Verdonk We retrospectively studied the prevalence, presentation, results of treatment, and graft and patient survival of grafts developing an anastomotic biliary stricture (AS) in 531 adult liver transplantations performed between 1979 and 2003. Clinical and laboratory information was obtained from the hospital files, and radiological studies were re-evaluated. Twenty-one possible risk factors for the development of AS (variables of donor, recipient, surgical procedure, and postoperative course) were analyzed in a univariate and stepwise multivariate model. Forty-seven grafts showed an anastomotic stricture: 42 in duct-to-duct anastomoses, and 5 in hepaticojejunal Roux-en-Y anastomoses. The cumulative risk of AS after 1, 5, and 10 years was 6.6%, 10.6%, and 12.3% respectively. Postoperative bile leakage (P = 0.001), a female donor/male recipient combination (P = 0.010), and the era of transplantation (P = 0.006) were independent risk factors for the development of an AS. In 47% of cases, additional (radiologically minor) nonanastomotic strictures were diagnosed. All patients were successfully treated by 1 or more treatment modalities. As primary treatment, endoscopic retrograde cholangiopancreaticography (ERCP) was successful in 24 of 36 (67%) cases and percutaneous transhepatic cholangiodrainage in 4 of 11 (36%). In the end 15 patients (32%) were operated, all with long-term success. AS presenting more than 6 months after transplantation needed more episodes of stenting by ERCP, and more stents per episode compared to those presenting within 6 months and recurred more often. Graft and patient survival were not impaired by AS. Liver Transpl 12:726,735, 2006. © 2006 AASLD. [source] Hepatitis B in liver transplant recipientsLIVER TRANSPLANTATION, Issue S2 2006Robert G. Gish Key Concepts: 1The use of low-dose immunosuppressive therapy along with pre- and posttransplantation nucleos(t)ide therapy and posttransplantation hepatitis B immunoglobulin (HBIG) has yielded marked improvements in survival. 2Lamivudine (Epivir-HBV), adefovir (Hepsera), entecavir (Baraclude), tenofovir (Viread), emtricitabine (Emtriva), and the combination drugs tenofovir + emtricitabine (Truvada) and abacavir + lamivudine (Epzicom) are effective nucleos(t)ide antiviral agents that, in some cases, may help reverse liver disease sufficiently to avoid transplant. 3In posttransplantation patients, virus suppression with some combination of HBIG and the nucleos(t)ide agents may prevent graft loss and death or the need for a second transplant. 4In both the pre- and posttransplantation setting, the goal of hepatitis B virus management is complete virus suppression. 5The use of low-dose intramuscular HBIG is evolving, with studies showing that dosing and cost can be reduced by 50,300% with a customized approach. 6Elimination of HBIG from the treatment paradigm is currently under evaluation and may be possible with the use of newer medications that have no or low resistance rates. 7Although there is growing evidence that some types of combination therapy may decrease the chance that drug resistance will develop and increase the likelihood of long-term success in preventing graft loss and death, additional research will be required to determine which combinations will work well in the long term, and which will not. Liver Transpl 12:S54,S64, 2006. © 2006 AASLD. [source] Distribution of individual inbreeding coefficients, relatedness and influence of stocking on native anadromous brown trout (Salmo trutta) population structureMOLECULAR ECOLOGY, Issue 9 2001D. E. Ruzzante Abstract We examined polymorphism at seven microsatellite loci in 4023 brown trout (Salmo trutta) collected from 32 tributaries to the Limfjord, Denmark (~200 km) and from two hatcheries used for stocking. Populations differ in their estimated sizes and stocking histories. Mean individual inbreeding coefficients do not differ among locations within rivers. Relatedness varies between sites within rivers indicating varied local dynamics at a very small geographical scale. Relatedness is sometimes lower than expected among an equal number of simulated individuals with randomized genotypes, suggesting structure within locations. Five per cent of the genetic variance is distributed among rivers (FST = 0.049), but in the western, less heavily stocked, area of the Limfjord a higher proportion of the genetic variance is distributed among rivers than among locations within rivers. The reverse is true of the eastern, more heavily stocked, area of the Limfjord. Here, a higher proportion of the genetic variance is distributed among locations within rivers than among rivers. Assignment tests reveal that the majority of trout (mean 77% of all fish) are more probably of local origin than hatchery origin but this proportion varies regionally, with rivers in the western area of the Limfjord showing a relatively high (mean 88%) and those in the eastern area showing a relatively low (mean 72%) proportion of locally assigned trout. These results can be interpreted as reflecting stocking impact. Also, the proportion of locally assigned trout correlates with the populations' stocking histories, with rivers presently subjected to stocking (hatchery trout) showing low (mean ~0.73), and rivers where stocking was discontinued showing high (mean ~0.84) proportions of local fish, probably reflecting lower survival of hatchery than of wild trout. There is evidence for isolation by distance at a large geographical scale when individual river populations are pooled into nine geographical regions but not at a small geographical scale when populations are considered individually. We reject the null hypothesis that stocking has had no impact on population structure but the relatively high proportion of locally assigned trout in populations where stocking with domestic fish no longer takes place suggests limited long-term success of stocking. [source] The impact of implementing new information systems on the priorities, management, and allocation of resources at colleges and universitiesNEW DIRECTIONS FOR HIGHER EDUCATION, Issue 136 2006Don HosslerArticle first published online: 9 FEB 200 The hidden dimensions of leadership and of the costs associated with the implementation of new information systems should be carefully considered. They can help determine the short- and long-term success of new systems. [source] Fostering a Community-Based Learning Culture: A Model for Success and Institutional BarriersNORTH AMERICAN DIALOGUE (ELECTRONIC), Issue 1 2006María (Lorena) Núñez This article offers a case study in Community-Based Learning by describing a collaborative gang-intervention effort developed for children in Los Angeles. Project GOLD (Goal Oriented Life Decisions), is an educational-intervention effort designed by representatives from Occidental College, Garvanza Elementary School, the LAPD, and the Los Angeles City Attorney's Office and implemented in the elementary school. Both authors are directly involved with the program and offer a first-hand description of the project. They also detail some of the obstacles and barriers to the program's sustainability. Even as Community-Based Learning (CBL) has become more acceptable and its value as a pedagogical approach is gaining attention, Project GOLD remains vulnerable because the resources are not yet there. Project GOLD and efforts like it will only truly succeed when CBL becomes institutionalized in colleges and universities, releasing professors and students into communities with the resources and support necessary for long-term success. [source] Altered Autonomic Cardiac Control Predicts Restenosis After Percutaneous Coronary InterventionPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 2 2006MATTHIAS GOERNIG Background: Early and late restenosis in up to 30% remains a major problem for long-term success after percutaneous coronary intervention (PCI). Compared to bare metal stents, the use of drug-eluting stents reduces restenosis below 10%, but implant coasts have to be considered. In restenosis noninvasive testing lacks diagnostic power. We applied a new approach to identify patients with a high risk for restenosis after PCI by combining heart rate (HR) and blood pressure variability (BPV) analyses. Methods: In 52 patients with clinical suspicion of restenosis and history of PCI, we investigated patterns of cardiovagal autonomic regulation prior to cardiac catheterization. The patients were separated in (i) patients with restenosis (CAD+R) and (ii) patients without restenosis (CAD,R), where restenosis is defined as a stenosis greater than 75% of luminal diameter in at least one main vessel. The following parameters/methods were evaluated: Canadian Cardiovascular Society grade (CCS-grade), vessel disease score (CAD-level), left ventricular ejection fraction (LVEF), heart rate variability (HRV), BPV, baroreflex sensitivity (BRS), as well as HR turbulence and blood pressure (BP) potentiation caused by premature ventricular complexes. Results: Whereas age, LVEF, CAD-level, CCS-grade, and mean BP did not differ between CAD+R and CAD,R, significant differences were found in (i) BPV: diastolic LF/P, systolic, and diastolic UVLF, (ii) in BRS: slope of tachycardic sequences, and (iii) in extrasystolic parameters: heart rate turbulence onset (HRTO) and potentiation of systolic BP (SBPP). Standard HRV parameters did not show significant differences between the groups. Using the two parameters diastolic LF/P (threshold >0.2) and HRTO (threshold >0) restenosis were predicted in 83.4%. Conclusions: These results demonstrate that indicators of sympathetic activation or vagal depression identify restenosis in patients after PCI, thus opening a perspective for a new noninvasive monitoring. [source] Devolution and outsourcing of municipal services in Kampala city, Uganda: an early assessment,PUBLIC ADMINISTRATION & DEVELOPMENT, Issue 5 2003Frederick Golooba-Mutebi The late 1980s saw the beginning of wide-ranging economic and political reforms in Africa, prompted by both external and internal pressures. Demands for political reform pushed for democratisation, including decentralisation of power and resources to lower levels of government. Alongside pressures for democratisation were those for economic liberalisation, including the rolling back of the state characterised by, among other things, reducing its role in service provision. This article looks at aspects of political and economic liberalisation in Uganda, involving devolution and outsourcing of service provision in Kampala city. It focuses on the city's experience with devolution and outsourcing of solid waste management. It shows that, pockets of resistance notwithstanding, the reforms enjoyed widespread popularity and led to many positive changes. In addition, it shows that they begot problems and encountered others that rendered the process of change more problematic than its advocates had anticipated. Its major conclusion is that while devolution and outsourcing are useful tools for improving service delivery, they cannot ensure long-term success in the absence of financial, technical and managerial capacity on the part of contractors and contracting authorities. Copyright © 2003 John Wiley & Sons, Ltd. [source] | |||||||||||||||||||||||||||||||||||||||||||