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Major Contributing Factor (major + contributing_factor)
Selected AbstractsDrinking patterns, dependency and life-time drinking history in alcohol-related liver diseaseADDICTION, Issue 4 2009Jennifer Hatton ABSTRACT Aims To examine the hypothesis that increases in UK liver deaths are a result of episodic or binge drinking as opposed to regular harmful drinking. Design A prospective survey of consecutive in-patients and out-patients. Setting The liver unit of a teaching hospital in the South of England. Participants A total of 234 consecutive in-patients and out-patients between October 2007 and March 2008. Measurements Face-to-face interviews, Alcohol Use Disorders Identification Test, 7-day drinking diary, Severity of Alcohol Dependence Questionnaire, Lifetime Drinking History and liver assessment. Findings Of the 234 subjects, 106 had alcohol as a major contributing factor (alcoholic liver disease: ALD), 80 of whom had evidence of cirrhosis or progressive fibrosis. Of these subjects, 57 (71%) drank on a daily basis; only 10 subjects (13%) drank on fewer than 4 days of the week,of these, five had stopped drinking recently and four had cut down. In ALD patients two life-time drinking patterns accounted for 82% of subjects, increasing from youth (51%), and a variable drinking pattern (31%). ALD patients had significantly more drinking days and units/drinking day than non-ALD patients from the age of 20 years onwards. Conclusions Increases in UK liver deaths are a result of daily or near-daily heavy drinking, not episodic or binge drinking, and this regular drinking pattern is often discernable at an early age. [source] Human sewage identified as likely source of white pox disease of the threatened Caribbean elkhorn coral, Acropora palmataENVIRONMENTAL MICROBIOLOGY, Issue 5 2010Kathryn Patterson Sutherland Summary Caribbean elkhorn coral, Acropora palmata, has been decimated in recent years, resulting in the listing of this species as threatened under the United States Endangered Species Act. A major contributing factor in the decline of this iconic species is white pox disease. In 2002, we identified the faecal enterobacterium, Serratia marcescens, as an etiological agent for white pox. During outbreaks in 2003 a unique strain of S. marcescens was identified in both human sewage and white pox lesions. This strain (PDR60) was also identified from corallivorious snails (Coralliophila abbreviata), reef water, and two non-acroporid coral species, Siderastrea siderea and Solenastrea bournoni. Identification of PDR60 in sewage, diseased Acropora palmata and other reef invertebrates within a discrete time frame suggests a causal link between white pox and sewage contamination on reefs and supports the conclusion that humans are a likely source of this disease. [source] Effects of pulp and paper mill effluent on fish: A temporal assessment of fish health across sampling cyclesENVIRONMENTAL TOXICOLOGY & CHEMISTRY, Issue 2 2010Timothy J. Barrett Abstract The Canadian environmental effects monitoring (EEM) program is a regulated, cyclical, industry-funded program designed to determine whether receiving water impacts exist when a mill is in compliance with its discharge limits. The results from three cycles of the fish monitoring program (1992 to 2004) are available from over 200 surveys of fish compared between sites located upstream and downstream of pulp and paper mill effluent outfalls. Previous meta-analyses have shown a national average response pattern across cycles characterized by an increase in endpoints measuring energy storage and growth and a decrease in a reproductive endpoint, consistent with a response of nutrient enrichment in combination with some form of metabolic disruption. Although the national average pattern of effects was temporally consistent, there was some variability in the magnitude of effects among cycles. Questions were raised as to whether the intercycle variability was due to changes in effluent quality or due, at least in part, to other factors. The present study compares responses over the first three cycles, and shows that the choice of sentinel species is likely to be a major contributing factor to the variability in observed effects. Subset analyses using studies from mills that used the same sentinel species across cycles reveal fairly uniform responses and little evidence of significant improvements in overall fish health from cycles one to three. However, a meta-analysis using 1991 data collected from 10 mills before the implementation of the EEM program and data from the same mills collected during cycles one to three of the program reveal significantly reduced effects on relative liver weight and potential improvements in other endpoints. Environ. Toxicol. Chem. 2010;29:440,452. © 2009 SETAC [source] Blood morphine levels in naltrexone-exposed compared to non-naltrexone-exposed fatal heroin overdosesADDICTION BIOLOGY, Issue 3 2003DIANE ARNOLD-REED The aim of this study was to investigate the association between prior exposure to naltrexone and increased risk of fatal heroin overdose using a review of toxicology reports for heroin-related fatalities between July 1997 to August 1999 for two groups: those treated with oral naltrexone and those who were not treated. Additional information for the oral naltrexone group was obtained from clinic files. Naltrexone-treated deaths were identified from the patient database at the Australian Medical Procedures Research Foundation (AMPRF), Perth, Western Australia (WA) through the Western Australian Department of Health, Data Linkage Project. Non-treated cases were identified from the database at the Forensic Science Laboratory, State Chemistry Centre (WA). We identified and investigated blood morphine concentrations following 21 fatal heroin overdoses with prior exposure to naltrexone and in 71 non-naltrexone-exposed cases over the same time period. The proportion of deaths where heroin use was a major contributing factor was little different in the non-naltrexone compared to the naltrexone-exposed group. Furthermore, in ,acute opiate toxicity' deaths, blood morphine levels were lower in non-naltrexone-exposed compared with naltrexone-exposed cases. Although there was a higher number of deaths designated as rapid (i.e. occurring within 20 minutes) in the naltrexone-exposed (89%) compared with the non-exposed group (72%) this was not statistically significant. Other drug use in relation to heroin-related fatalities is discussed. Findings do not support the hypothesis that prior exposure to naltrexone increases sensitivity to heroin toxicity. [source] Inactivation of oxidized and S -nitrosylated mitochondrial proteins in alcoholic fatty liver of rats,HEPATOLOGY, Issue 5 2006Kwan-Hoon Moon Increased oxidative/nitrosative stress is a major contributing factor to alcohol-mediated mitochondrial dysfunction. However, which mitochondrial proteins are oxidatively modified under alcohol-induced oxidative/nitrosative stress is poorly understood. The aim of this study was to systematically investigate oxidized and/or S -nitrosylated mitochondrial proteins and to use a biotin- N -maleimide probe to evaluate their inactivation in alcoholic fatty livers of rats. Binge or chronic alcohol exposure significantly elevated nitric oxide, inducible nitric oxide synthase, and ethanol-inducible CYP2E1. The biotin- N -maleimide-labeled oxidized and/or S -nitrosylated mitochondrial proteins from pair-fed controls or alcohol-fed rat livers were subsequently purified with streptavidin-agarose. The overall patterns of oxidized and/or S -nitrosylated proteins resolved by 2-dimensional polyacrylamide gel electrophoresis were very similar in the chronic and binge alcohol treatment groups. Seventy-nine proteins that displayed differential spot intensities from those of control rats were identified by mass spectrometry. These include mitochondrial aldehyde dehydrogenase 2 (ALDH2), ATP synthase, acyl-CoA dehydrogenase, 3-ketoacyl-CoA thiolase, and many proteins involved in chaperone activity, mitochondrial electron transfer, and ion transport. The activity of 3-ketoacyl-CoA thiolase involved in mitochondrial ,-oxidation of fatty acids was significantly inhibited in alcohol-exposed rat livers, consistent with hepatic fat accumulation, as determined by biochemical and histological analyses. Measurement of activity and immunoblot results showed that ALDH2 and ATP synthase were also inhibited through oxidative modification of their cysteine or tyrosine residues in alcoholic fatty livers of rats. In conclusion, our results help to explain the underlying mechanism for mitochondrial dysfunction and increased susceptibility to alcohol-mediated liver damage. (HEPATOLOGY 2006;44:1218,1230.) [source] New avenues to be opened for social protection in the Arab world: the case of Egypt,INTERNATIONAL JOURNAL OF SOCIAL WELFARE, Issue 1 2004Markus Loewe This article looks at social protection in the Arab world. Giving the example of Egypt, it asks why poverty is so widespread and why , despite the country's numerous social protection systems , social risks are a major contributing factor to it. It concludes that reforms are due. The existing systems are well funded but inefficient and more to the benefit of the better-off than the poor. A reform approach is proposed which builds on both conventional and more innovative strategies: campaigns should be launched to raise public awareness of social risks; social assistance spending should be increased; and the operating public pension schemes should be reformed. At the same time, new avenues have to be opened to meet the specific needs of informal sector workers who have extreme difficulty in being covered by social insurance or social assistance. To this purpose, micro-insurance is a promising approach for the Arab-world region. [source] Qualifications Recognition Reform for Skilled Migrants in Australia: Applying Competency-based Assessment to Overseas-qualified NursesINTERNATIONAL MIGRATION, Issue 6 2002Lesleyanne Hawthorne The past two decades have coincided with unprecedented Australian selection of skilled migrants, in particular professionals from non-English speaking background (NESB) source countries. By 1991, the overseas-born constituted 43 to 49 per cent of Australia's engineers, 43 per cent of computer professionals, 40 per cent of doctors, 26 per cent of nurses, and rising proportions in other key professions. Within one to five years of arrival, just 30 per cent of degree-qualified migrants were employed. However, few diploma holders had found work in any profession, and select NESB groups were characterized by acute labour market disadvantage. Throughout the 1980s and 1990s, barriers to credential recognition were identified as a major contributing factor to these inferior employment outcomes. This paper describes the evolution of Australia's qualifications recognition reform agenda for NESB migrants, including progressive growth in support of a shift from paper to competency-based assessment (CBA). Within this context, the paper examines the degree to which improvements were achieved in the 1990s in the field of nursing , the first major Australian profession to embrace CBA, and one promoted by the National Office of Overseas Skills Recognition as an exemplar of the reform process. Assessment protocols and outcomes are analysed within two contrasting contexts: pre-migration at Australian overseas posts, and within Australia following overseas-qualified nurses' (OQNs) arrival. Based on empirical data from a wide range of sources, the paper identifies the development of a major paradox. Substantial improvements in qualifications recognition were indeed achieved for NESB nurses through CBA in Australia, in particular in the dominant immigrant-receiving states of Victoria and New South Wales. At the same time, it is argued, a significant tightening of recognition procedures was occurring at Australian overseas posts where CBA was unavailable. The Immigration Department placed pre-migration assessment more, rather than less, exclusively in the hands of the professional nursing bodies, in a period coinciding with their harsher, rather than more lenient, treatment of NESB migrants' qualifications. Minimal improvement in recognition of overseas qualifications was achieved in other professions. [source] A new source of aging?JOURNAL OF COSMETIC DERMATOLOGY, Issue 2 2009Helen Knaggs MD Summary There has been a considerable increase in understanding how skin ages, along with significant progress toward the correction and prevention of the visible signs of aging. However, there are still many unknown factors regarding why we age , and why we all seem to age differently. An area of high interest is the biological or intrinsic processes that affect our appearance over time. This article describes a recent discovery of a membrane bound enzyme proven to be present in skin and increases its activity as biological age increases. The enzyme is located on the external surface of both fibroblast and keratinocytes, and generates free radicals. Therefore, as we age there appears to be a biological mechanism that further increases the production of free radicals. Additionally, there appears to be a relationship between activity of the enzyme and appearance. Data showed that subjects who look younger than their biological age had lower enzyme activity and conversely, subjects who looked older than their biological age had higher enzyme activity. Free radicals are believed to be a major contributing factor in the production of fine lines and wrinkles by destroying the collagen and elastin network keeping skin supple and firm. [source] Synapse loss in dementiasJOURNAL OF NEUROSCIENCE RESEARCH, Issue 10 2010Ryan Clare Abstract Synaptic transmission is essential for nervous system function, and its dysfunction is a known major contributing factor to Alzheimer's-type dementia. Antigen-specific immunochemical methods are able to characterize synapse loss in dementia through the quantification of various synaptic proteins involved in the synaptic cycle. These immunochemical methods applied to the study of Alzheimer's disease (AD) brain specimens have correlated synaptic loss with particularly toxic forms of amyloid-, protein and have also established synapse loss as the best correlate of dementia severity. A significant but comparatively circumscribed amount of literature describes synaptic decline in other forms of dementia. Ischemic vascular dementia (IVD) is quite heterogeneous, and synapse loss in IVD seems to be variable among IVD subtypes, probably reflecting its variable neuropathologic correlates. Loss of synaptic protein has been identified in vascular dementia of the Binswanger type and Spatz-Lindenberg's disease. Here we demonstrate a significant loss of synaptophysin density within the temporal lobe of frontotemporal dementia (FTD) patients. © 2010 Wiley-Liss, Inc. [source] Impact of Chronic Alcohol Ingestion on Cardiac Muscle Protein ExpressionALCOHOLISM, Issue 7 2010Rachel L. Fogle Background:, Chronic alcohol abuse contributes not only to an increased risk of health-related complications, but also to a premature mortality in adults. Myocardial dysfunction, including the development of a syndrome referred to as alcoholic cardiomyopathy, appears to be a major contributing factor. One mechanism to account for the pathogenesis of alcoholic cardiomyopathy involves alterations in protein expression secondary to an inhibition of protein synthesis. However, the full extent to which myocardial proteins are affected by chronic alcohol consumption remains unresolved. Methods:, The purpose of this study was to examine the effect of chronic alcohol consumption on the expression of cardiac proteins. Male rats were maintained for 16 weeks on a 40% ethanol-containing diet in which alcohol was provided both in drinking water and agar blocks. Control animals were pair-fed to consume the same caloric intake. Heart homogenates from control- and ethanol-fed rats were labeled with the cleavable isotope coded affinity tags (ICATÔ). Following the reaction with the ICATÔ reagent, we applied one-dimensional gel electrophoresis with in-gel trypsin digestion of proteins and subsequent MALDI-TOF-TOF mass spectrometric techniques for identification of peptides. Differences in the expression of cardiac proteins from control- and ethanol-fed rats were determined by mass spectrometry approaches. Results:, Initial proteomic analysis identified and quantified hundreds of cardiac proteins. Major decreases in the expression of specific myocardial proteins were observed. Proteins were grouped depending on their contribution to multiple activities of cardiac function and metabolism, including mitochondrial-, glycolytic-, myofibrillar-, membrane-associated, and plasma proteins. Another group contained identified proteins that could not be properly categorized under the aforementioned classification system. Conclusions:, Based on the changes in proteins, we speculate modulation of cardiac muscle protein expression represents a fundamental alteration induced by chronic alcohol consumption, consistent with changes in myocardial wall thickness measured under the same conditions. [source] Burden of disease related to Parkinson's disease in Spain in the year 2000MOVEMENT DISORDERS, Issue 11 2005Esther Cubo MD Abstract We measured the burden caused by Parkinson's disease (PD) in Spain during the year 2000 and compared it against PD burden worldwide and in the European A subregion. Burden of disease (BoD) is an important factor in health policy. Disability-adjusted life years (DALY) as a measure of BoD is the result of adding years of life lost (YLL) and years lived with disability (YLD). The burden of PD (BPD) has not been studied in Spain. YLL were obtained from the Spanish death certificates and YLD from the estimated number of incident PD cases and the average PD duration. PD disability was calculated, using the Disability Weights for Diseases in the Netherlands. Prior PD DALY data for Europe and the world were obtained from the 2001 World Health Organization World Health Report. A discount rate of 3% and age-weighting modulation factor with K = 1 were used. In Spain, PD generated 67,582 DALY, comprising 6,351 (9.4%) YLL and 61,231 (90.6%) YLD. Most PD DALY (57.5%) occurred in the population 60 to 74 years of age. When PD DALY estimates were adjusted using the world population in 2000, Spain registered a PD DALY rate of 84 per 100,000 population, higher than both the world and European A subregion rates (24 and 35 per 100,000 population, respectively). PD burden in Spain in 2000 was high, with disability being the major contributing factor. Although BPD in Spain was greater than both world and European A subregion BPD, these differences should nevertheless be interpreted with caution. © 2005 Movement Disorder Society [source] Acotiamide hydrochloride (Z-338), a novel prokinetic agent, restores delayed gastric emptying and feeding inhibition induced by restraint stress in ratsNEUROGASTROENTEROLOGY & MOTILITY, Issue 9 2008K. Seto Abstract, Acotiamide hydrochloride (Z-338) is a member of new class prokinetic agents currently being developed for the treatment of functional dyspepsia (FD). DNA microarray analysis showed that acotiamide altered the expressions of stress-related genes such as , -aminobutyric acid (GABA) receptors, GABA transporters and neuromedin U (NmU) in the medulla oblongata or hypothalamus after administration of acotiamide. Therefore, effects of acotiamide on stress-related symptoms, delayed gastric emptying and feeding inhibition, in rats were examined. Acotiamide significantly improved both delayed gastric emptying and feeding inhibition in restraint stress-induced model, but did not affect both basal gastric emptying and feeding in intact rats, indicating that acotiamide exerted effects only on gastric emptying and feeding impaired by the stress. On the other hand, mosapride showed significant acceleration of gastric emptying in intact and restraint stress-induced model, and itopride showed no effect on restraint stress-induced delayed gastric emptying. In addition, gene expression of NmU increased by restraint stress was suppressed by administration of acotiamide, while acotiamide had no effect on delayed gastric emptying induced by an intracerebroventricular administration of NmU, suggesting that the suppressive effect of acotiamide on gene expression of NmU might be important to restore delayed gastric emptying or feeding inhibition induced by restraint stress. These findings suggest that acotiamide might play an important role in regulation of stress response. As stress is considered to be a major contributing factor in the development of FD, the observed effects may be relevant for symptom improvement in FD. [source] Adverse effects of asbestos exposure and smoking on lung functionAMERICAN JOURNAL OF INDUSTRIAL MEDICINE, Issue 5 2006Xiaorong Wang MD Abstract Background Exposure to asbestos is a well-recognized cause of both malignant and nonmalignant diseases of lung parenchyma and pleura. This study was conducted to determine the adverse effects of exposure to asbestos and smoking on pulmonary function. Methods Four hundred and sixty-eight workers who were occupationally exposed to asbestos for an average of 13 years were selected from an asbestos-product factory in China. Of them, 85 workers were diagnosed with asbestosis. Additionally, 282 workers who had no experience of exposure to industrial dust were included as a control group. A questionnaire was administered during a face-to-face interview and spirometric maneuvers and single-breath CO diffusing capacity (DLco) were performed. Results Multivariate regression analysis showed that exposure to asbestos was more strongly associated with decreased forced vital capacity (FVC) and DLco, and asbestosis more strongly associated with decreased FVC, while smoking was a major contributing factor to reduced FEV1/FVC. The results were confirmed by a further analysis where the subjects were grouped exclusively by smoking, asbestos exposure, and chest radiographic changes. No interaction or joint effect was observed between asbestos exposure and smoking. Conclusions This analysis suggested that asbestos and smoking might play independent roles, in which asbestos caused mainly a restrictive impairment, and smoking was a major causal factor for airway obstruction in the workers who were intensively exposed to asbestos. Am. J. Ind. Med. 49:337,342, 2006. © 2006 Wiley-Liss, Inc. [source] The Effect of Sales Force Adoption on New Product Selling PerformanceTHE JOURNAL OF PRODUCT INNOVATION MANAGEMENT, Issue 6 2000Erik Jan Hultink Although several studies have suggested that the sales force is a major contributing factor to new product success, few studies have focused on new product adoption by the sales force, particularly with respect to its relationship with selling performance. The present article presents empirical evidence on the impact of sales force adoption on selling performance. We defined sales force adoption as the combination of the degree to which salespeople accept and internalize the goals of the new product (i.e., commitment) and the extent to which they work hard to achieve those goals (i.e., effort). It was hypothesized that the impact of sales force adoption on selling performance will be contingent on supervisory factors (sales controls, internal marketing of the new product, training, trust, and supervisor's field attention), and market volatility. Therefore, this article also provides evidence of the conditions under which sales force adoption of a new product is more or less effective in engendering successful selling performance. The hypothesized relationships were tested with data provided by 97 high technology firms from The Netherlands. The results show that sales force adoption is positively related to selling performance. This finding suggests that salespeople who simultaneously exhibit commitment and effort will achieve higher levels of new product selling performance. Outcome based control, internal marketing and market volatility are also positively related to new product selling performance. The effect of sales force adoption on selling performance is stronger where outcome based control is used and where the firm provides information on the background of the new product to salespeople through internal marketing. Training and field attention weaken the adoption-performance linkage. These findings may indicate that salespeople in The Netherlands interpret training as "micromanaging" and field attention as "looking over their shoulder." We conclude with implications of our study for research and managerial practice. [source] Analysis of Testosterone Effects on Sonic Hedgehog Signaling in Juvenile, Adolescent and Adult Sprague Dawley Rat PenisTHE JOURNAL OF SEXUAL MEDICINE, Issue 3 2010Christopher W. Bond MS ABSTRACT Introduction., Smooth muscle apoptosis is a major contributing factor to erectile dysfunction (ED) development in prostatectomy and diabetic patients and animal models. A critical regulator of penile smooth muscle and apoptosis is Sonic hedgehog (SHH). The SHH protein is decreased in ED models and SHH treatment of cavernous nerve (CN) injured rats prevents smooth muscle apoptosis. A close association between androgen deficiency and ED has been suggested in the literature, but few studies have examined the molecular effects on penile smooth muscle and on known signaling mechanisms that regulate morphology. Aim., Examine testosterone and SHH interaction in eugonadal adult, adolescent and juvenile rats by performing castration studies and treatment with supraphysiological testosterone. Methods., The eugonadal adult Sprague Dawley rats were either treated with testosterone for 7 or 14 days (N = 14) or were castrated for 4 or 7 days (N = 12). The juvenile rats were treated with testosterone for 8 days (N = 7). The adolescent rats were castrated and sacrificed at P88 (N = 8). The control rats had empty vehicle (N = 22) or sham surgery (N = 20). Main Outcome Measures., The active form of SHH protein and mRNA were quantified by semi-quantitative immunohistochemical analysis and real-time reverse transcriptase polymerase chain reaction (RT-PCR). Results., Testosterone treatment did not alter SHH signaling in juvenile rats. Shh mRNA increased 3.2-fold and SHH protein increased 1.2-fold in rats castrated during puberty. In adult rats, castration decreased Shh mRNA 3.2-fold but did not alter SHH protein. Testosterone supplement in adult rats increased Shh mRNA 2.3-fold and decreased SHH protein 1.3-fold. Conclusions., SHH signaling is independent of testosterone in normal juvenile rats and is sensitive to testosterone during adolescence, while testosterone supplement in the adult adversely impacts SHH signaling in a very similar manner to that observed with CN injury. Bond CW, Angeloni NL, and Podlasek CA. Analysis of testosterone effects on sonic hedgehog signaling in juvenile, adolescent and adult Sprague Dawley rat penis. J Sex Med 2010;7:1116,1125. [source] Unexpected reduction in the incidence of birth trauma and birth asphyxia related to instrumental deliveries during the study period: was this the Hawthorne effect?BJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 3 2003W.C. Leung Objective The study was originally designed to identify the risk factors that could predict those difficult instrumental deliveries resulting in birth trauma and birth asphyxia. Design A prospective study on all singleton deliveries in cephalic presentation with an attempt of instrumental delivery over a 12-month period (13 March 2000 to 12 March 2001). Setting A local teaching hospital. Sample Six hundred and seventy deliveries. Methods A codesheet was designed to record the demographic data, characteristics of first and second stages of labour and neonatal outcome. In particular, the doctor had to enter the pelvic examination findings before the attempt of instrumental delivery. Main outcome measures Birth trauma and birth asphyxia. Results There was a significant reduction in the incidence of birth trauma and birth asphyxia related to instrumental deliveries during the study period (0.6%) when compared with that (2.8%) in the pre-study period (1998 and 1999) (RR 0.27, 95% CI 0.11,0.70). There was more trial of instrumental deliveries in the operating theatre although this was not statistically significant (RR 1.19, 95% CI 0.88,1.60). The instrumental delivery rate decreased during the study period (RR 0.88, 95% CI 0.82,0.94). The caesarean section rate for no progress of labour, the incidence of direct second stage caesarean section and the incidence of failed instrumental delivery did not increase during the study period. Conclusions Apart from the merits of regular audit exercise and increasing experience of the staff, the Hawthorne effect might be the major contributing factor in the reduction of birth trauma and birth asphyxia related to instrumental deliveries during the study period. [source] Emergency Department Utilization in the United States and Ontario, CanadaACADEMIC EMERGENCY MEDICINE, Issue 6 2007DrPH, Guohua Li MD Objectives:The current crisis in the emergency care system is characterized by worsening emergency department (ED) overcrowding. Lack of health insurance is widely perceived to be a major contributing factor to ED overcrowding in the United States. This study aimed to compare ED visit rates in the United States and Ontario, Canada, according to demographic and clinical characteristics. Methods:This was a cross sectional study consisting of a nationally representative sample of 40,253 ED visits included in the 2003 National Hospital Ambulatory Medical Care Survey in the United States, and all ED visits recorded during 2003 by the National Ambulatory Care Reporting System in Ontario, Canada. The main outcome was the number of ED visits per 100 population per year. Results:The annual ED visit rate in the United States was 39.9 visits (95% confidence interval = 37.2 to 42.6) per 100 population, virtually identical to the rate in Ontario, Canada (39.7 visits per 100 population). In both the United States and Ontario, Canada, those aged 75 years and older had the highest ED visit rate and women had a slightly higher ED visit rate than men. The most common discharge diagnosis was injury/poisoning, accounting for 25.6% of all ED visits in the United States and 24.7% in Ontario, Canada. Overall, 13.9% of ED patients in the United States were admitted to hospitals, compared with 10.5% in Ontario, Canada. Conclusions:ED visit rates and patterns are similar in the United States and Ontario, Canada. Differences in health insurance coverage may not have a substantial impact on the overall utilization of emergency care. [source] Modulation of amyloid-, aggregation and toxicity by inosose stereoisomersFEBS JOURNAL, Issue 8 2008Mark Nitz Amyloid-, (A,) aggregation and amyloid formation are key pathological features of Alzheimer's disease, and are considered to be two of the major contributing factors to neurodegeneration and dementia. Identification of small molecule inhibitors that are orally available, have low toxicity and high central nervous system bioavailability is one approach to the potential development of a disease-modifying treatment for Alzheimer's disease. We have previously identified inositol stereoisomers as exhibiting stereospecific inhibition of A, aggregation and toxicity in vitro and in vivo. We report here the effects of inosose versus inositol stereoisomers on A, fibrillogenesis as determined using CD and fluorescence spectroscopy and negative-stain electron microscopy. The inososes differ from inositols by the oxidation of one of the hydroxyl groups to a ketone. These molecules help in the further elucidation of the structure,activity relationships of inositol,A, interactions and identify both allo -inositol and epi -2-inosose as in vitro inhibitors of A, aggregation. [source] Demand side management for water heating installations in South African commercial buildingsINTERNATIONAL JOURNAL OF ENERGY RESEARCH, Issue 4 2001P. G. Rousseau Abstract The largest percentage of the sanitary hot water used in South African buildings is heated by means of direct electrical resistance heaters. This is one of the major contributing factors of the undesirable high morning and afternoon peaks imposed on the national electricity supply grid. Water heating therefore continues to be of concern to ESKOM, the country's only electrical utility company. The so-called in-line water heating system design methodology was developed to address this problem. This paper investigates the potential impact of in-line systems on the national peak electrical demand. A computer simulation model was developed that combines a deterministic mathematical model with a statistical approach in order to predict the diversity factors associated with both the existing and in-line design methodologies. A study was also conducted to estimate the total installed water heating capacity in the national commercial building sector. This figure can be combined with the simulated diversity factor to determine the peak electrical demand. The deterministic model includes the detailed simulation of the hot water storage vessel, the electrical heater and the system control algorithm. The mathematical model for the storage vessel is based on an electrical analogue approach that includes the effects of conduction as well as forced and natural convection. This model was verified extensively with the aid of laboratory measurements and compared with existing storage vessel models. It was found that the new storage vessel model could predict the supply temperature within 2 per cent for a system configuration with the heater in parallel outside the reservoir and within 12 per cent for a configuration with the heater situated inside the reservoir. This compares favourably with existing models found in the literature. The complete simulation based on the statistical approach showed that extensive application of the new design methodology could result in a reduction of approximately 75 MW in the total maximum peak demand imposed on the electricity supply grid in wintertime. This is 58 per cent of the current peak demand due to commercial water heating and 12.5 per cent of the peak load reduction target set by ESKOM until the year 2015. Copyright © 2001 John Wiley & Sons, Ltd. [source] Prevention of Hip Fractures in Long-Term Care: Relevance of Community-Derived DataJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 4 2010Richard G. Crilly MD Osteoporosis and falling are two major contributing factors to fractures in older persons; the relevant contribution of these may vary according to age, setting, and frailty. The purpose of this review was to examine the existing evidence on osteoporosis treatments to determine whether participants in clinical trials include or resemble the older and frailer adult population living in long-term care (LTC). The trials (N=50) used to support major Canadian guidelines for osteoporosis treatment were reviewed because these are used to recommend treatment for all older adults, and several more-recent studies were added. Trials conducted specifically with participants living in LTC were also reviewed (N=6). The majority of studies (96.0%) on osteoporosis treatments were conducted with community-dwelling participants, with many excluding participants resembling the LTC population. Mean ages ranged from 52 to 84, although for the majority of studies, the mean age was younger than 70. Similarly, 80.0% of studies conducted in LTC included only residents who were ambulatory, mobile, able to transfer independently, or not permanently bedridden. Mean ages in these studies ranged from 83 to 85. These findings suggest that frail older adults, particularly the oldest and frailest adults in LTC, are neglected in clinical trials of osteoporosis fracture prevention. There is little evidence to support the application of community-based guidelines to the LTC population, and studies directly involving this population are needed. The role of age, frailty, and the mechanics of falls in hip fracture are discussed. [source] Use of a systematic review to assist the development of Campylobacter control strategies in broilersJOURNAL OF APPLIED MICROBIOLOGY, Issue 2 2006A. Adkin Abstract Aims:, Produce an evidence-based ranking of the major contributing factors and sources of Campylobacter occurrence in broilers produced in England, Scotland and Wales , Great Britain (GB). Method and Results:, Relevant data were extracted from 159 research papers and findings were grouped into 14 sources of on-farm contamination and 37 contributing factors. A relevancy score was developed to take into account various measures from each study of applicability to GB broilers and strength of findings. Results indicate that major sources of Campylobacter include a depopulation event, another house on-farm, on-farm staff, and other animals on farm. The depopulation schedule (staggered slaughter) and multiple houses on-farm were identified as contributing factors associated with increasing the risk, and those decreasing the risk were use of a hygiene barrier, parent company and certain seasons of rearing. Conclusions:, Although the review was more resource intensive compared to narrative studies, the system allows an increased level of transparency and the ability to investigate patterns and trends. Significance and Impact of the Study:, This paper provides the first evidence-based ranking of the major sources and contributing factors for Campylobacter presence in broilers in GB using a systematic review. [source] | |||||||||||||||||||