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Selected AbstractsBiopsy forceps: Reusable or disposable?JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 7 2006Zvi Fireman Abstract Reusable and disposable biopsy forceps are both widely available for use in gastrointestinal endoscopy units. Biopsy forceps have design and material features that may interfere with cleaning, and reusable devices must be designed to function safely and effectively following sterilization in a healthcare setting. During the last decade, endoscopic accessories have evolved from reusable to disposable in many parts of the world. Although use of disposable devices helps reduce the potential risk of cross-contamination and spread of infection, there remains the factor of cost. Major concerns for reuse of endoscopic accessories center on two main areas: sterility, and the capability of the equipment to perform its function satisfactorily after repeated uses and sterilizations. Reusable biopsy forceps perform a designated number of procedures, thus becoming more cost-effective than disposable forceps, which are impossible to clean and sterilize. The potential risk of infectious disease transmission must be taken into account. There is also the consideration that reprocessing of disposable forceps may damage or destroy the fragile devices. [source] Synergy and sustainability in rural procedural medicine: Views from the coalfaceAUSTRALIAN JOURNAL OF RURAL HEALTH, Issue 1 2010Andrew Swayne Abstract Objective:,The practice of rural and remote medicine in Australia entails many challenges, including a broad casemix and the remoteness of specialist support. Many rural practitioners employ advanced procedural skills in anaesthetics, surgery, obstetrics and emergency medicine, but the use of these skills has been declining over the last 20 years. This study explored the perceptions of rural general practitioners (GPs) on the current and future situation of procedural medicine. Design:,The qualitative results of data from a mixed-method design are reported. Free-response survey comments and semistructured interview transcripts were analysed by a framework analysis for major themes. Setting:,General practices in rural and remote Queensland. Participants:,Rural GPs in Rural and Remote Metropolitan Classification 4,7 areas of Queensland. Main outcome measure:,The perceptions of rural GPs on the current and future situation of rural procedural medicine. Results:,Major concerns from the survey focused on closure of facilities and downgrading of services, cost and time to keep up skills, increasing litigation issues and changing attitudes of the public. Interviews designed to draw out solutions to help rectify the perceived circumstances highlighted two major themes: ,synergy' between the support from medical teams and community in ensuring ,sustainability' of services. Conclusions:,This article presents a model of rural procedural practice where synergy between staff, resources and support networks represents the optimal way to deliver a non-metropolitan procedural service. The findings serve to remind educators and policy-makers that future planning for sustainability of rural procedural services must be broad-based and comprehensive. [source] Inductive Inference by Using Information CompressionCOMPUTATIONAL INTELLIGENCE, Issue 2 2003Ben Choi Inductive inference is of central importance to all scientific inquiries. Automating the process of inductive inference is the major concern of machine learning researchers. This article proposes inductive inference techniques to address three inductive problems: (1) how to automatically construct a general description, a model, or a theory to describe a sequence of observations or experimental data, (2) how to modify an existing model to account for new observations, and (3) how to handle the situation where the new observations are not consistent with the existing models. The techniques proposed in this article implement the inductive principle called the minimum descriptive length principle and relate to Kolmogorov complexity and Occam's razor. They employ finite state machines as models to describe sequences of observations and measure the descriptive complexity by measuring the number of states. They can be used to draw inference from sequences of observations where one observation may depend on previous observations. Thus, they can be applied to time series prediction problems and to one-to-one mapping problems. They are implemented to form an automated inductive machine. [source] An educational computer tool for simulating long-term soil erosion on agricultural landscapesCOMPUTER APPLICATIONS IN ENGINEERING EDUCATION, Issue 3 2009F. J. Jiménez-Hornero Abstract Due to its economic and environmental impacts, soil erosion has been a major concern to farmers, engineers and policy makers in recent years. Water and tilling are two of the main agents responsible for this phenomenon and considerable efforts have been made to model them in previous work but not with educational purposes. A computer tool for facilitating any user's simulation of long-term landscape evolution in a plot due to the combined action of water and tillage erosion is presented here. It integrates a graphic user interface with two well-verified erosion models, each one independently devoted to reproduce the effects of water and tilling. This computer tool permits to the student the consideration of the erosivity index and the presence of a crop in the plot, when simulating water erosion, as well as the planning of a different type of tilling each year. Each kind of tilling corresponds to a different combination of tillage tools with their own date, tillage depth and tillage direction. A handy ASCII (XYZ) file is generated containing the long-term soil erosion spatial pattern as result. From this information, the student can derive other results that will help to understand soil erosion. An example is presented here with the aim of showing how to use this computer tool to simulate this phenomenon on an agricultural landscape with a complex topography. © 2009 Wiley Periodicals, Inc. Comput Appl Eng Educ 17: 253,262, 2009; Published online in Wiley InterScience (www.interscience.wiley.com); DOI 10.1002/cae.20193 [source] Inflamed adipose tissue, insulin resistance and vascular injuryDIABETES/METABOLISM: RESEARCH AND REVIEWS, Issue 8 2008Christian X. Andersson Abstract Type 2 diabetes is the most common metabolic disorder today and has reached epidemic proportions in many countries. Insulin resistance and inflammation play a central role in the pathogenesis of type 2 diabetes and are present long before the onset of the disease. During this time, many of the complications associated with type 2 diabetes are initiated. Of major concern is the two- to fourfold increase in cardiovascular morbidity and mortality in this group compared to a nondiabetic population. Obesity, characterized by enlarged fat cells, and insulin resistance are, like type 2 diabetes, associated with impaired adipogenesis and a low-grade chronic inflammation that to a large extent emanates from the adipose tissue. Both these processes contribute to unfavourable alterations of the circulating levels of several bioactive molecules (adipokines) that are secreted from the adipose tissue, many of which have documented inhibitory effects on insulin sensitivity in the liver and peripheral tissues and, in addition, have negative effects on the cardiovascular system. Here we review current knowledge of the adipose tissue as an endocrine organ, the local and systemic effects of a chronic state of low-grade inflammation residing in the adipose tissue, and, in particular, the effects of inflammation and circulating adipokines on the vascular wall. Copyright © 2008 John Wiley & Sons, Ltd. [source] PNET-like features of synovial sarcoma of the lung: A pitfall in the cytologic diagnosis of soft-tissue tumorsDIAGNOSTIC CYTOPATHOLOGY, Issue 4 2001Pascale Hummel M.D. Abstract Fine-needle aspiration (FNA) cytology of soft-tissue tumors is evolving. As more experience is gained, we are becoming aware of potential pitfalls. We describe 2 cases of synovial sarcoma of the lung, primary and metastatic, in patients who had FNA biopsy performed on a lung mass. The cytologic smears showed extremely cellular groups of malignant small round cells, intersected by small blood vessels, with numerous loose single cells, in a background of macrophages and mature lymphocytes. The tumors displayed monomorphic cells forming rosettes and displaying occasional mitoses. A diagnosis of neuroendocrine tumor/primitive neuroepithelial tumor (PNET) was suspected. Furthermore, this suspicion was supported by immunohistochemical stains, which showed positivity for a neuroendocrine marker, Leu 7 (case 1), and for a neural marker, CD 99 (O 13 or HBA 71) (both cases); and negativity for cytokeratins (case 1). The resection specimen of case 1 had mostly tightly packed small round cells, with occasional rosettes, similar to the FNA biopsy, and focal areas composed of spindle cells, organized in a focal fibrosarcoma-like and hemangiopericytoma-like pattern. A balanced translocation between chromosomes X and 18, demonstrated by both karyotyping and fluorescent in situ hybridization (FISH), enabled us to make a diagnosis of synovial sarcoma, which was histologically classified as poorly differentiated. Case 2 was a metastatic biphasic synovial sarcoma of the arm, with a prominent epithelial component. Synovial sarcoma, when composed mainly of small round cells on cytologic smears, is a great mimicker of neuroendocrine/PNET tumors, with light microscopic and immunohistochemical overlap. Awareness of this potential pitfall may aid in preventing a misdiagnosis. Its recognition is of major concern, especially for the poorly differentiated variant, because it is associated with a worse prognosis. Diagn. Cytopathol. 24:283,288, 2001. © 2001 Wiley-Liss, Inc. [source] Role of meta-analysis of clinical trials for Alzheimer's diseaseDRUG DEVELOPMENT RESEARCH, Issue 3 2002Jesús M. López Arrieta Abstract Alzheimer's disease (AD) is a growing worldwide medical, social, and economic problem. In all countries, both prevalence and incidence of this disorder increase with age. The task of translating scientific clinical research into effective interventions for dementia has proved to be a difficult challenge. Data about the effects of therapeutic interventions come from several sources of evidence, ranging from studies with little potential for systematic bias and minimal random error, such as well-designed randomized controlled trials, through controlled but nonrandomized cohort and case-control studies, all the way to opinions based on laboratory evidence or theory. Although clinical trials are widespread in AD, there is increasing recognition that the results of studies do not necessarily apply to the type of patients that are seen by clinicians because of differences in patient characteristics, comorbidities, cotherapies, severity of disease, compliance, local circumstances, and patients preferences, which may differ sufficiently from those in the trial situation to attenuate or change the benefit-to-risk ratio. There are several methods to address those issues, like pragmatic trials and n-of-1 trials. When data from randomized clinical trials do not provide clear answers from sufficiently similar studies in the magnitude of effect sizes, lack of statistical significance, or identification of subgroups, systematic reviews and meta-analysis may help to provide a better summary of the data. A major difference between a traditional review and a systematic is the systematic nature in which studies are chosen and appraised. Traditional reviews are written by experts in the field who use differing and often subjective criteria to decide what studies to include and what weight to give them, and hence the conclusions are often very diverse, depending on the reviewer. Publication and selection bias is a major concern of traditional reviews. Systematic reviews and meta-analysis are being increasingly used in dementia, propelled by the Cochrane Dementia and Cognitive Improvement Group, to make decisions about treatment, management, and care and to guide future research. This narrative review describes the rationale for randomized clinical trials and systematic reviews in dementia, particularly AD. Drug Dev. Res. 56:401,411, 2002. © 2002 Wiley-Liss, Inc. [source] Structural seismic response analysis based on multiscale approach of computing fault,structure systemEARTHQUAKE ENGINEERING AND STRUCTURAL DYNAMICS, Issue 4 2009T. Ichimura Abstract Structural safety for earthquake waves emitted from a nearby fault is a major concern. For a large complex structure, it might be desired to estimate its seismic response by analyzing a fault,structure system: a full three-dimensional model in which a source fault and a target structure are modeled so that fault processes, wave propagation and amplification processes, and resulting dynamic responses of the structure can be computed numerically. To analyze this fault,structure system, this paper proposes an efficient approach based on multiscale analysis, i.e. waves emitted from the source fault are computed in the entire system in the geological length-scale; then they are refined in a small part of the system that includes the structure, and the seismic response of the structure is accurately computed in the engineering length-scale. Using a long highway tunnel as an example, this paper examines the validity of the proposed approach. The usefulness and applicability of the proposed approach to estimate the structural seismic responses are discussed. Copyright © 2008 John Wiley & Sons, Ltd. [source] Hatred of Democracy ... and of the Public Role of Education?EDUCATIONAL PHILOSOPHY AND THEORY, Issue 5-6 2010Introduction to the Special Issue on Jacques Rancičre Abstract The article presents an introduction to the Special Issue on the French philosopher Jacques Rancičre who raises a provocative voice in the current public debate on democracy, equality and education. Instead of merely criticizing current practices and discourses, the attractiveness of Rancičre's work is that he does try to formulate in a positive way what democracy is about, how equality can be a pedagogic or educational (instead of policy) concern, and what the public and democratic role of education is. His work opens up a space to rethink and to study, as well as to ,re-practice', what democracy and equality in education are about. He questions the current neutralisation of politics that is motivated by a hatred of democracy. This questioning is for Rancičre also a struggle over words. Against the old philosophical dream of defining the meaning of words, Rancičre underlines the need for the struggle over their meaning. The aim of the article is to clarify how and why education, equality, and democracy are a major concern throughout his work and to offer an introduction to the articles collected in the Special Issue. [source] Nature conservation and urban development control in the Portuguese planning system: a new impetus against old praxis?ENVIRONMENTAL POLICY AND GOVERNANCE, Issue 5 2008Teresa Fidelis Abstract Natura 2000 areas bring a new incentive to assess the performance of land-use planning in protecting environmental values from the impacts of development pressures. In the last decades, urban growth and consequent environmental impacts on natural areas have been a major concern for the Portuguese land-use planning system. Sprawl around sensitive areas has been revealed to be a persistent phenomenon in spite of the increasing challenges underlying land-use plans. This article critically analyses the content of three main documents recently adopted by the Portuguese government , the ,National Strategy for Sustainable Development', the ,National Policy Programme for Spatial Planning' and the ,Sector Plan for Natura 2000' , seeking prospects to innovate future plans at lower levels in order to prevent additional pressures on natural areas. First, the article reviews the recent theoretical debate on planning for the protection of natural areas. Results evidenced by recent EU evaluation reports are used to propose a set of guidelines to evaluate planning guidance at national level. Second, it critically analyses the three planning documents, bearing in mind the main features of the planning system and the proposed guidelines. The article is concluded with a discussion of their potential, exploring whether they bring a new impetus to the role of land-use planning against an outdated and persistent praxis, or whether, on the contrary, further efforts to strengthen planning guidance remain to be formulated. Copyright © 2008 John Wiley & Sons, Ltd and ERP Environment. [source] Elucidating the factors influencing the biodegradation of cylindrospermopsin in drinking water sourcesENVIRONMENTAL TOXICOLOGY, Issue 3 2008Maree J. Smith Abstract The cyanotoxin cylindrospermopsin (CYN) is produced by several species of cyanobacteria and can be persistent in drinking waters supplies, which is of major concern to water authorities because of its potential to severely compromise human health. Consequently, there is a need to fully understand the persistence of CYN in water supplies, in particular, to determine whether this toxin is readily degraded by endemic aquatic organisms. This study provides insights into the environmental factors that can influence the biodegradation of this toxin in Australian drinking water supplies. Biodegradation of CYN was only evident in water supplies that had a history of toxic Cylindrospermopsis raciborskii blooms. In addition, lag periods were evident prior to the onset of biodegradation; however, repeated exposure of the endemic organisms to CYN resulted in substantial decreases in the lag periods. Furthermore, the concentration of CYN was shown to influence biodegradation with a near linear relationship (R2 of 0.9549) existing between the biodegradation rate and the initial CYN concentration. Temperature was also shown to affect the biodegradation of CYN, which is important since CYN is now being detected in more temperate climates. The presence of copper-based algicides inhibited CYN degradation, which has significant implications since copper-based algicides are commonly used to control cyanobacterial growth in water bodies. The results from this study indicate that the biodegradation of CYN in natural water bodies is a complex process that can be influenced by many environmental factors, some of which include CYN concentration, temperature, and the presence of copper-based algicides. © 2008 Wiley Periodicals, Inc. Environ Toxicol, 2008. [source] Regulatory T cells for the prevention of graft- versus -host disease: Professionals defeat amateursEUROPEAN JOURNAL OF IMMUNOLOGY, Issue 11 2009Matthias Edinger Abstract CD4+CD25+ Treg are pivotal for the maintenance of self-tolerance and the adoptive transfer of Treg is envisaged for the treatment of autoimmune diseases and the induction of tolerance after allogeneic organ or stem cell transplantation. Owing to the paucity of natural Treg in peripheral blood, isolation of Treg for therapeutic purposes is cumbersome and not easily translatable into clinical trials. To circumvent such hurdles, many groups are exploring the de novo induction of Treg from conventional T cells for potential clinical applications. In this issue of the European Journal of Immunology, a paper examines the therapeutic efficacy of natural and induced Treg in a model of graft- versus -host disease and report that induced Treg rapidly lose their Treg features in an allogeneic environment and are unable to prevent disease. Thus, the stability of induced Treg is of major concern as discussed in this Commentary. [source] Effects of wetting and drying cycles on in situ soil particle mobilizationEUROPEAN JOURNAL OF SOIL SCIENCE, Issue 2 2008S. Majdalani Summary Understanding particle mobilization and transport in soils is a major concern for environmental protection and water resource management as they can act as vectors for sorbing pollutants. In natural soils, the existence of a finite size and renewable pool of dispersible particles has been hypothesized. Even though freeze-thaw and wetting-drying cycles have been identified as possible mechanisms of pool replenishment between rainfall events, to date the underlying phenomena ruling the renewal of particle pools are still largely unexplored. We carried out a series of infiltration-drainage experiments to study systematically the effects of periods without rain (pauses) on in situ particle mobilization in undisturbed soil columns. We found that, for a given column, pause duration between two rainfall events has a major influence on subsequent particle mobilization: the mass of leached particles increases with pause duration until it reaches a maximum (mass for a 200-hours pause is 15 time greater than for a 1-hour pause), and then it decreases for even longer pauses. This behaviour was correlated with soil water content, and can be explained by soil matrix weakening due to differential capillary stresses during drying. The consequences of this finding are important because the 15-fold increase in mass of leached particles, when pause duration is changed from 1 hour to 4 days, might overwhelm variations caused by changes in other parameters such as the ionic strength of the incoming solution or the rainfall intensity. [source] The effect of aging biosolids on the availability of cadmium and zinc in soilEUROPEAN JOURNAL OF SOIL SCIENCE, Issue 2 2001S. Stacey Summary A major concern with the safe re-use of biosolids on land is the potential for release of metals from organic matter in the biosolids, due to decomposition proceeding as biosolids age. To quantify the effects of biosolid aging on Cd and Zn bioavailability, two sewage sludges (Lagoon sludge and Filtered sludge) and a garden compost were incubated at 25°C and 35°C for 100 days. Changes in availability of Cd and Zn were determined using isotope dilution principles, with the materials being labelled with carrier-free 109Cd and 65Zn. We determined isotopically exchangeable metal pools (E values) and plant available metal pools (L values) by measuring specific activities of Cd and Zn in soil extracts and in wheat plants, respectively. Changes in carbon content over time were determined using 13C-NMR spectroscopy and chemical extraction methods, and related to changes in availability of metal pools as determined by isotopic procedures. Hot-water-extractable carbon content, assumed to represent easily decomposable organic matter, decreased during the 100 days by 80,190 mg kg,1. The Compost and Lagoon sludge showed no change in L values for Cd or Zn with time, but in the Filtered sludge the L values for Cd and Zn increased significantly, by 43% and 56%, respectively. The isotopically exchangeable pools of Cd and Zn did not change with incubation treatment of the biosolids. These data indicate that the potential for metal release from biosolids as organic matter decomposes depends to a large extent on the biosolid composition. [source] Electrode design for skin electroporation with minimal nerve stimulationEXPERIMENTAL DERMATOLOGY, Issue 9 2004U. Pliquett Electroporation is an efficient tool for transdermal delivery of water-soluble molecules sizing up to several kDa. The main barrier to these agents is the stratum corneum, a 15 mm thin layer of dead keratinized cells. Once this layer is charged (approximately 50 V) by an outer electric field, structural rearrangements of the lipids create aqueous pathways (electroporation). Due to the high electric field within the stratum corneum, (E = 50 V/15 µm = 33 kV/cm) electrophoresis can drive charged molecules into the deeper skin layers. A major concern is the high electric field required, because nerve stimulation is inconvenient for the patient. Taking advantage of the fact that up to a depth of 50 µm no nervous receptors appear, a confinement of the field within the upper 15 µm would circumvent sensation. Field confinement within the stratum corneum is arranged by a special electrode geometry, an array of 300 µm holes within a 0.5 mm thick dielectric. The bottom, facing the stratum corneum, is metalized with a gap to the holes. The size of this gap (3,10 µm) is critical for the penetration depth of the electric field between the metalized bottom and a distant electrode at the other side of the holes. A drug reservoir is implemented below the distant electrode and the dielectric. [source] The withdrawal of antimicrobial treatment as a mechanism for defeating resistant microorganismsFEMS IMMUNOLOGY & MEDICAL MICROBIOLOGY, Issue 3 2008David J. Stokes Abstract Antimicrobial resistance is a major concern in health care and farming settings throughout the world. The level of antimicrobial resistance continues to increase and the requirement for a novel and possibly dramatic change in therapy choices is required. One possible mechanism for overcoming resistance is the actual removal of antimicrobial treatment from the therapeutic armoury. This review examines the potential for success of a policy advocating the reduction of antimicrobial use and additionally the withdrawal of such treatments. Evidence from agriculture suggests that the removal of certain drugs from animal husbandry can result in concomitant falls in certain drug resistances in human patients. [source] Freshwater crayfish farming technology in the 1990s: a European and global perspectiveFISH AND FISHERIES, Issue 4 2000H.E.G. Ackefors This paper aims to describe the state of crayfish farming technology in the USA, Australia and Europe, and to discuss some of the prerequisites for this industry. Data from Europe are partly based on replies from a questionnaire sent out to scientists in all European countries. For other parts of the world, the crayfish literature has been reviewed and data from the August 2000 meeting of the International Association of Astacology are also included. Issues addressed in this review are cultivated species, production and productivity figures, production technique with regard to enclosures, reproduction and feed items, disease problems, predators, pond vegetation and water quality. Fewer than a dozen crayfish species are cultivated. The most attractive ones for culture and stocking in natural waters have been transferred to more than one continent. Pond rearing techniques predominate in all countries, and the technology required to achieve the spawning and rearing of juveniles is relatively simple. Pieces of fish, carrots and potatoes are frequent supplementary feed items; plants, cereals, pieces of meat, zooplankton and pellets are also common. Diseases are not usually a major concern, except in Europe where the American plague fungus, Aphanomyces astaci, has eradicated many European crayfish populations. Predators identified as common include insects and amphibians, as well as fishes, birds and mammals. Many water macrophytes are common in crayfish farms. These may either serve a useful function or cause problems for the crayfish farmer. Water temperature is the crucial factor for crayfish production. Water parameters such as pH and certain inorganic ion concentrations may also be of concern. Acidic waters that occur in some areas are generally detrimental to crayfish. The total yield from crayfish production from farming and fishery is in the order of 120 000,150 000 tonnes, more than four times the quantity given by FAO statistics. The largest crayfish producer is the Peoples' Republic of China, followed by the USA (70 000 and 50 000 tonnes in 1999, respectively). Of the quantity produced in the USA in 1999, about 35 000 tonnes was farmed. The yield in Europe was about 4500 tonnes in 1994, and of this quantity only 160 tonnes came from aquaculture. There are no official statistics for crayfish fishery production in Australia, but about 400 tonnes came from aquaculture in 1999. [source] The Labour Party and Higher Education: The Nature of the RelationshipHIGHER EDUCATION QUARTERLY, Issue 3 2003Jean Bocock Higher education policy has rarely been a major concern of the Labour Party in the second half of the twentieth century. This article explores the reasons for this and analyses the ideological coalition of the Labour Party in the context of the Welfare State and the commitments to moderate social democratic reformism. Three strands in particular are explored: the dominance of vocational, technological and professional priorities in HE expansion; the influence of utilitarian thinking, broadly construed; and the various social purpose, equality perspectives of those on the Left of the Party. Alongside these strands, has been Labour's reluctance to adopt interventionist policies especially in relation to the so-called elite Universities, and the persistent advocacy of ,modernisation'. Finally, the article considers, within a context of the debate in general political analysis, the potential of the Labour Party within this period to achieve significant reform in the field of higher education, drawing inter alia on the work of Ralph Miliband. [source] University Strategy in an Age of Uncertainty: The Effect of Higher Education Funding on Old and New UniversitiesHIGHER EDUCATION QUARTERLY, Issue 1 2003Heather RolfeArticle first published online: 27 OCT 200 This paper explores the effects of changes in funding arrangements, and particularly in tuition fees, on universities and their strategic responses to these changes. Using data from interviews with senior managers in four universities, it finds the most prestigious, pre-1992, university largely unaffected by tuition fees and the others responding to changes in application patterns and intake. However, the effects of tuition fees on university strategy are not easily separated from other changes in the funding of Higher Education, and universities' strategies were strongly influenced by the need to reduce costs and to generate income. A second major concern of all four universities was quality, both of inputs such as students and staff and of outputs, in degree results and ratings in employability, research, teaching and other activities. Marketing was assuming a position of increasing importance, with universities striving to develop a ,brand' to attract students, staff and funding. [source] Long-term outcome of tenofovir disoproxil fumarate use against hepatitis B in an HIV-coinfected cohortHIV MEDICINE, Issue 5 2009G Alvarez-Uria Objectives Tenofovir disoproxil fumarate (TDF) is active against hepatitis B virus (HBV) and HIV. However, the long-term efficacy of tenofovir disoproxil fumarate (TDF) is not well known and the appearance of resistance is a major concern. We have studied the efficacy of TDF against HBV in patients treated at an Infectious Diseases Unit. Methods We carried out a retrospective observational study of the efficacy of TDF against HBV replication in a cohort of 52 HIV-coinfected patients who received TDF for at least 6 months. Results The median duration of follow-up of TDF treatment was 34 months. Forty-one patients (79%) were positive for HBV envelope antigen (HBeAg) and 35 had received previous lamivudine monotherapy for a median duration of 32 months. Virological breakthrough was observed in nine cases (17%). At the end of the follow-up period, HBV DNA levels were <1000 copies/mL in 42 patients (81%) and <200 copies/mL in 31 patients (60%). There were no significant differences between the lamivudine-naďve and lamivudine-experienced groups. In the lamivudine-experienced group, the duration of previous lamivudine monotherapy was associated with failure to achieve HBV DNA levels <200 copies/mL (P=0.036). Adding lamivudine or emtricitabine to TDF did not improve virological suppression. In 39 patients who achieved <200 HBV DNA copies/mL during TDF treatment, virological breakthrough was seen only in two patients (5%) after a median follow-up duration of 39.7 months. Conclusions TDF was able to control HBV replication in most HIV-coinfected patients after a median follow-up duration of 34 months, regardless of previous lamivudine treatment. However, a sizeable proportion of patients developed virological breakthrough. [source] Radiofrequency ablation-assisted liver resection: review of the literature and our experienceHPB, Issue 4 2006Peng Yao Abstract Background: Surgical resection is the best established treatment known to provide long-term survival and possibility of cure for liver malignancy. Intraoperative blood loss has been the major concern during major liver resections, and mortality and morbidity of surgery are clearly associated with the amount of blood loss. Different techniques have been developed to minimize intraoperative blood loss during liver resection. The radiofrequency ablation (RFA) technique has been used widely in the treatment of unresectable liver tumors. This review concentrates on the use of RFA to provide an avascular liver resection plane. Methods and results: The following review is based on two types of RFA device during liver resection: single needle probe RFA and the In-Line RFA device. Conclusion: Liver resection assisted by RFA is safe and is associated with very limited blood loss. [source] Mobility of major ions and nutrients in the unsaturated zone during paddy cultivation: a field study and solute transport modelling approachHYDROLOGICAL PROCESSES, Issue 20 2007N. Rajmohan Abstract Study of the movement of water and solute within soil profiles is important for a number of reasons. Accumulation of prominent contaminants from agricultural chemicals in the unsaturated zone over the years is a major concern in many parts of the world. As a result, the unsaturated zone has been a subject of great research interest during the past decade. Hence, an intensive field study was conducted in a part of Palar and Cheyyar river basins to understand the variation of major ions and nutrients in the soil zone during paddy cultivation. The chloride and nitrate data were used to model the movement of these chemicals in the unsaturated zone using the HYDRUS-2D model. The field study shows that fertilizer application and irrigation return flow increases the major ions and nutrients concentration in the unsaturated zone. Further, the nutrient concentrations are regulated by plant uptake, fertilizer application and infiltration rate. Additionally, denitrification and soil mineralization processes also regulate the nitrogen concentration in the unsaturated zone. The solute transport modelling study concluded that the simulated results match reasonably with the observed trends. Simulated concentrations of chloride and nitrate for a 5-year period indicate that the concentrations of these ions fluctuate in a cyclic manner (from 60 to 68 mg l,1 and from 3·4 to 3·5 mg l,1 respectively in groundwater) with no upward and downward trend. The influence of excessive fertilizer application on groundwater was also modelled. The model predicts an increase of about 17 mg l,1 of chloride and 2·3 mg l,1 of nitrogen in the groundwater of this area when the application of fertilizers is doubled. The model indicates that the present level of use of agrochemicals is no threat to the groundwater quality. Copyright © 2007 John Wiley & Sons, Ltd. [source] Exposure modeling on a river basin scale in support of risk assessment for chemicals in european river basinsINTEGRATED ENVIRONMENTAL ASSESSMENT AND MANAGEMENT, Issue 1 2009Jos van Gils Abstract Following the 2000 European Water Framework Directive and recent insights into sediment management on a river basin scale, we discuss in this paper an exposure model aiming to support a risk assessment for chemicals on a basin-wide scale. It establishes spatial relations between causes (pollution sources) and effects (ecological risk), taking into account the geometry, hydrology, and fine sediment dynamics of European river basins. The model, called EXPOBASIN, explicitly takes into account the interaction of chemicals with fine sediment particles, which is important for many policy-relevant chemicals, such as trace metals and polycyclic aromatic hydrocarbons, and it addresses the potential release of historically polluted sediments as a result of extreme floods, which is a major concern in different European river basins. Bioavailability and bioaccumulation are included in the assessment. As a result, the exposure can be quantified not only in terms of water concentrations, but also in terms of sediment concentrations and concentrations in biota. The primary question to be answered by EXPOBASIN is how chemicals, pollution sources, or both rank quantitatively and objectively on a basin-wide scale. Near the end of 2009, the tool will become available to all European water managers and their technical advisors, as a result of the European Union 6th Framework Programme project MODELKEY The calibration and validation of EXPOBASIN has only just started and will be completed in 2008/2009. Applications to 3 case study areas are planned in this respect. This paper presents the key building blocks of EXPOBASIN and shows some sample results illustrating the raking of pollution sources and chemicals. At the end of the paper, some perspectives for future developments are outlined. [source] Human immunodeficiency virus,hepatitis C coinfection: swapping new problems for newer onesINTERNAL MEDICINE JOURNAL, Issue 7 2001J. Sasadeusz Abstract Recent successes in HIV therapy have uncovered other health problems for HIV-infected individuals. Hepatitis C has become an especially significant problem, partly due to its faster progression in an immunocompromised setting. In addition, the higher viral loads in coinfected patients likely result in more efficient perinatal and perhaps even sexual transmission. Therapy has largely been neglected, despite data suggesting its efficacy in HIV,HCV coinfected patients. Studies of combination interferon and ribavirin studies are lacking, although underway. A major concern is the potential inactivation of certain thymidine analogues by ribavirin. Some antiretroviral therapies, such as ritonavir, indinavir and nevirapine, may enhance liver toxicity in coinfected patients and should be avoided if possible. The role of chronic low-grade liver function abnormalities remains uncertain and requires further investigation. (Intern Med J 2001; 31: 418,421) [source] The stability of stars of triangular equilibrium plate elementsINTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN ENGINEERING, Issue 7 2009E. A. W. Maunder Abstract Equilibrium models for finite element analyses are becoming increasingly important in complementary roles to those from conventional conforming models, but when formulating equilibrium models questions of stability, or admissibility of loads, are of major concern. This paper addresses these questions in the context of flat plates modelled with triangular hybrid elements involving membrane and/or flexural actions. Patches of elements that share a common vertex are considered, and such patches are termed stars. Stars may be used in global analyses as assemblies of elements forming macro-elements, or in local analyses. The conditions for stability, or the existence and number of spurious kinematic modes, are determined in a general algebraic procedure for any degree of the interpolation polynomials and for any geometric configuration. The procedure involves the determination of the rank of a compatibility matrix by its transformation to row echelon form. Examples are presented to illustrate some of the characteristics of spurious kinematic modes when they exist in stars with open or closed links. Copyright © 2008 John Wiley & Sons, Ltd. [source] Current safety and tolerability issues in men with erectile dysfunction receiving PDE5 inhibitorsINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 9 2007W. J. G. Hellstrom Summary Aims:, Treatment of erectile dysfunction (ED) has been greatly advanced by the advent of phosphodiesterase type-5 (PDE5) inhibitors. Upon the introduction of these agents, their cardiovascular (CV) safety was a major concern, mainly due to their vasodilatory effects. We conducted an electronic literature review of data concerning the safety and tolerability issues of men with ED receiving PDE5 inhibitors. Results:, Although safety concerns have been raised, evaluation of CV safety and related adverse events in clinical trials has not revealed any atypical safety issues. Discussion:, No causal association has been established to date between non-arteritic anterior ischaemic optic neuropathy (NAION) and PDE5 inhibitors. In addition, there are established guidelines which provide recommendations for the safe and effective use of these agents in treating men with ED and associated comorbidities. Conclusions:, Clinical trial and postmarketing surveillance data confirm the safety and tolerability profile of the PDE5 inhibitors, even in patients with endothelial dysfunction-associated comorbidities. [source] The effect of misclassification on the estimation of association: a reviewINTERNATIONAL JOURNAL OF METHODS IN PSYCHIATRIC RESEARCH, Issue 2 2005Michael Höfler Abstract Misclassification, the erroneous measurement of one or several categorical variables, is a major concern in many scientific fields and particularly in psychiatric research. Even in rather simple scenarios, unless the misclassification probabilities are very small, a major bias can arise in estimating the degree of association assessed with common measures like the risk ratio and the odds ratio. Only in very special cases , for example, if misclassification takes place solely in one of two binary variables and is independent of the other variable (,non-differential misclassification') , is it guaranteed that the estimates are biased towards the null value (which is 1 for the risk ratio and the odds ratio). Furthermore, misclassification, if ignored, usually leads to confidence intervals that are too narrow. This paper reviews consequences of misclassification. A numerical example demonstrates the problem's magnitude for the estimation of the risk ratio in the easy case where misclassification takes place in the exposure variable, but not in the outcome. Moreover, uncertainty about misclassification can broaden the confidence intervals dramatically. The best way to overcome misclassification is to avoid it by design, but some statistical methods are useful for reducing bias if misclassification cannot be avoided. Copyright © 2005 Whurr Publishers Ltd. [source] Pharmacological prophylaxis of venous thromboembolism in contemporary radical retropubic prostatectomy: Does concomitant pelvic lymphadenectomy matter?INTERNATIONAL JOURNAL OF UROLOGY, Issue 11 2008Benjamin C Jessie Abstract The prevention of venous thromboembolism is a major concern in cancer patients undergoing pelvic surgery. Radical retropubic prostatectomy is a common treatment for localized prostate cancer and has been identified as a high risk procedure for postoperative venous thromboembolism. However, most patients diagnosed with prostate cancer in the current era have clinically localized, low volume disease and the risk of venous thromboembolism is very low. Multiple guidelines exist for the prevention of venous thromboembolism in patients undergoing radical retropubic prostatectomy and pharmacological venous thromboembolism prophylaxis is recommended. Most urological surgeons in the USA however, do not routinely utilize pharmacological prophylaxis. A major concern arises when radical retropubic prostatectomy is performed with a concomitant pelvic lymphadenectomy. Pharmacological prophylaxis is known to increase the rate of lymph drainage and the rate of lymphocele formation. Evidence suggests that lymphocele may be an independent risk factor for venous thromboembolism in the postoperative period. These factors raise concern over current guidelines calling for routine use of pharmacological venous thromboembolism prophylaxis in radical retropubic prostatectomy especially when lymphadenectomy is performed simultaneously. [source] The Socio-economic Integration of the Ethiopian Community in IsraelINTERNATIONAL MIGRATION, Issue 3 2004Shira Offer ABSTRACT Using data from the 1995 Israeli Census of Population, this study examines the demographic, human capital, and labour force characteristics of the Ethiopian community in Israel and its determinants of employment. The results provide strong evidence for the overall disadvantaged socio-economic status of the Ethiopian community and reveal substantial gaps in educational and occupational attainment between Ethiopian Israelis and members of other ethnic groups in Israeli society. Ethiopian Israelis have substantially lower levels of education, lower employment rates, and are more likely to have low-skilled occupations. However, multivariate analyses show that the determinants of employment of Ethiopian Israelis are relatively similar to those of other ethnic groups. Education and veteran status are found to be especially important factors associated with increased odds of employment. Although the rates of return from education are lower among Israelis of Ethiopian origin compared to other ethnic groups, this study suggests that education constitutes the major avenue for upward mobility in the Ethiopian community. Nevertheless, considering their current disadvantaged position, the question of whether Ethiopian immigrants will manage in the long run to climb up the socio-economic ladder and significantly improve their status, or whether they run the risk of becoming a marginalized ethnic group in Israeli society, remains a major concern. Implications for the formation of a new cleavage in Israeli society and the emergence of a stratification system based on race are discussed. [source] International Migration Policies: 1950-2000INTERNATIONAL MIGRATION, Issue 6 2001Reginald Appleyard Policies on international migration since the Second World War reflect the enormous changes in economic, social and political situations around the world. The implications of changes in the volume and composition of international migration have increasingly become an issue of major concern to governments in all countries. Following emigration from Europe to countries of the New World as a result of war-damaged economies, reconstruction witnessed high demand for migrant labour, mainly from parts of southern Europe. But by the early 1970s, decline in economic growth, unexpected impacts of the guest-worker scheme, and an increase in refugees from Third World countries led, in due course, to an era of restriction on entry of asylum-seekers and tighter controls over undocumented migration to developed countries. A "new era" evolved during the 1990s, characterized by growing interdependence of major economic powers. Globalization led not only to a significant demand for highly-skilled and professional workers, but also to decision-making on some aspects of the migration process being transferred from the national to the regional level, and an increase in the influence of multinational corporations. The globalization process, and the growing influence of international trade regimes, may well represent the first steps towards a new "international migration regime" that incorporates all types of migration. [source] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||