Major Improvements (major + improvement)

Distribution by Scientific Domains

Selected Abstracts

Diagnosis and management of nail psoriasis

David de Berker
Nail disease is a common chronic problem for psoriatics, with only limited scope for major improvement. Both the disease and its treatment can be categorized according to its features and treatment modalities or the significance of the therapy for the clinician and patient. Certain treatments are matched with certain features and some treatments are of potential value in all patients with nail psoriasis. [source]

Nocturnal Home Hemodialysis: Focus on the Partner

H Vos
Background. Nocturnal home hemodialysis (NHD, 6 times weekly 6,8 hours) results in a better clinical and psychosocial condition of dialysis patients. However, this intensive therapy has important consequences for partners, who bear at least some responsibilities during the treatment. Methods. Since December 2001, we included 15 patients in a Dutch NHD project (,Nocturne'). All patients are assisted by their spouses. An aim of Nocturne is to study the effects of NHD on partners and other family members with questionnaires and interviews by a social worker. Results. NHD affects daily life of partners much more than conventional therapies. Partners feel very involved with the treatment. The invasion of the treatment in bed, the noise and light produced by the machine, the daily assisting of the patient, less freedom, and co-responsibility for the treatment are felt as a burden, specially during the first months of the treatment. However, the improved clinical condition of their spouse, resulting in less fatigue, less disability, less uremic symptoms, less complications, more attention for and contribution to family life, better quality of life and better mood are considered major improvements, with important positive effects for the quality of life of all family members. Additionally, partners consider the fact that they make an important positive contribution to their spouse's health valuable. All partners judged NHD, despite some negative consequences, as a major improvement of their life. Conclusion. The positive effects of NHD are more important than the negative consequences for partners of patients. However, partners need active support by nurses or social workers, specially during the first months of the treatment. [source]

The rationale of value-laden medicine

Michael H. Kottow MA(Soc) MD
Abstract Medicine is becoming increasingly confident that scientific advances, especially in the area of genetics, will allow a major improvement in the control and eradication of disease. This development seems to go hand in hand with health-enhancement strategies, erasing the distinction between the states of health and disease, and blurring the specific goals of medical services. Medicine tends to become an increasingly technocentric practice that relies heavily on expert knowledge and on epidemiological evidence, neglecting the lived-body experience of being ill, and tending to transform costly medical services into commodities only affordable by the affluent. This paper argues that disease is not merely a functional description, but rather a definitely value-laden organismic state that is experienced by the patient, needs to be explored and treated by medical practitioners, and requires the assessment and participation of social institutions concerned with the delivery and support of medical services. Each of these perspectives introduces its own set of values, both in the clinical encounter and in public health programmes. Bioethics seems to be the appropriate discipline to discuss all these values involved, and help assign them properly in order to rescue the caring concern of medicine for the sick, as well as uphold a principle of fairness in publicly funded medical services. [source]

Basic scheduling problems with raw material constraints

Alexander Grigoriev
Abstract One of the achievements of scheduling theory is its contribution to practical applications in industrial settings. In particular, taking finiteness of the available production capacity explicitly into account, has been a major improvement of standard practice. Availability of raw materials, however, which is another important constraint in practice, has been largely disregarded in scheduling theory. This paper considers basic models for scheduling problems in contemporary manufacturing settings where raw material availability is of critical importance. We explore single scheduling machine problems, mostly with unit or all equal processing times, and Lmax and Cmax objectives. We present polynomial time algorithms, complexity and approximation results, and computational experiments. © 2005 Wiley Periodicals, Inc. Naval Research Logistics, 2005. [source]

Improving the early management of blood glucose in emergency admissions with chest pain

Martin K Rutter MRCP (UK) Locum Consultant Physician
Abstract Hyperglycaemia is associated with a worse prognosis after myocardial infarction and good blood glucose control in the peri-infarct period has been shown to improve outcome. Our primary study was undertaken with the aims of assessing the prevalence and management of hyperglycaemia in patients admitted with acute chest pain. Ninety-three patients admitted to either Coronary Care (CCU) or Emergency Medical Admission Units (EMAU) with chest pain were studied and of these 14 (15%) had severe hyperglycaemia (>11.0,mmol/L). Blood glucose was not measured in seven (8%) patients and in only 1/14 (7%) patient were established guidelines for the management of hyperglycaemia applied. A revision of management protocol was undertaken and after 18 months we repeated the review of management of hyperglycaemia. Of 114 patients 22 (21%) had severe hyperglycaemia, blood glucose was not measured in ten (9%) and management guidelines were followed in 13 (65%). A major improvement in management of blood glucose in emergency admissions with chest pain has been demonstrated. Further staff education, discussion and review of protocol are indicated to improve and maintain performance on CCU and EMAU. Copyright © 2001 John Wiley & Sons, Ltd. [source]

Improved method for isotopic and quantitative analysis of dissolved inorganic carbon in natural water samples

Nelly Assayag
We present here an improved and reliable method for measuring the concentration of dissolved inorganic carbon (DIC) and its isotope composition (,13CDIC) in natural water samples. Our apparatus, a gas chromatograph coupled to an isotope ratio mass spectrometer (GCIRMS), runs in a quasi-automated mode and is able to analyze about 50 water samples per day. The whole procedure (sample preparation, CO2(g),CO2(aq) equilibration time and GCIRMS analysis) requires 2 days. It consists of injecting an aliquot of water into a H3PO4 -loaded and He-flushed 12,mL glass tube. The H3PO4 reacts with the water and converts the DIC into aqueous and gaseous CO2. After a CO2(g),CO2(aq) equilibration time of between 15 and 24,h, a portion of the headspace gas (mainly CO2+He) is introduced into the GCIRMS, to measure the carbon isotope ratio of the released CO2(g), from which the ,13CDIC is determined via a calibration procedure. For standard solutions with DIC concentrations ranging from 1 to 25,mmol,·,L,1 and solution volume of 1,mL (high DIC concentration samples) or 5,mL (low DIC concentration samples), ,13CDIC values are determined with a precision (1,) better than 0.1,. Compared with previously published headspace equilibration methods, the major improvement presented here is the development of a calibration procedure which takes the carbon isotope fractionation associated with the CO2(g),CO2(aq) partition into account: the set of standard solutions and samples has to be prepared and analyzed with the same ,gas/liquid' and ,H3PO4/water' volume ratios. A set of natural water samples (lake, river and hydrothermal springs) was analyzed to demonstrate the utility of this new method. Copyright © 2006 John Wiley & Sons, Ltd. [source]

Quantifying organ donation rates by donation service area

Akinlolu O. Ojo
Previous measures of OPO performance based on population counts have been deemed inadequate, and the need for new methods has been widely accepted. This article explains recent developments in OPO performance evaluation methodology, including those developed by the SRTR. As a replacement for the previously established measure of OPO performance , donors per million population , using eligible deaths as a national metric has yielded promising results for understanding variations in donation rates among the donation service areas assigned to each OPO. A major improvement uses "notifiable deaths" as a denominator describing a standardized maximal pool of potential donors. Notifiable deaths are defined as in-hospital deaths among ages 70 years and under, excluding certain diagnosis codes related to infections, cancers, etc. A most proximal denominator for determining donation rates is "eligible deaths," which includes only those deaths meeting the criteria for organ donation upon initial assessment. Neither measure is based on the population of a geographic unit, but on restricted upper limits of deaths that could be potential donors in any one locale (e.g., hospital or OPO). The inherent strengths and weaknesses of metrics such as donors per eligible deaths, donors per notifiable deaths, and number of organs per donor are discussed in detail. [source]

Peripheral nerve field stimulation for pruritus relief in a patient with notalgia paraesthetica

Bernadette Ricciardo
ABSTRACT This case study is presented to exemplify the application of peripheral nerve field stimulation in the treatment of recalcitrant notalgia paraesthetica. The patient was a 60-year-old woman with severe and disabling notalgia paraesthetica. The itch persisted despite the use of several medications , topical and oral. Following a successful trial of peripheral nerve field stimulation with a temporary electrode, two subcutaneous electrodes were inserted into the affected area with a battery implanted subcutaneously in her right buttock. The patient was reviewed at 5 months post implantation. She reported a greater than 85% improvement in her itch. She also reported a major improvement in her quality of life, with particular improvement in her ability to sleep through the night. This case illustrates the possible utilization of peripheral nerve field stimulation in the treatment of notalgia paraesthetica, which is a common yet poorly understood and treated condition. Replication and controlled studies are required to determine the general applicability of this approach. [source]

Impact of fesoterodine on quality of life: pooled data from two randomized trials

Con J. Kelleher
OBJECTIVE To evaluate the effect of fesoterodine on health-related quality of life (HRQoL) in patients with overactive bladder (OAB) syndrome. PATIENTS AND METHODS Pooled data from two randomized placebo-controlled phase III studies were analysed. Eligible patients with frequency and urgency or urgency urinary incontinence were randomized to placebo or fesoterodine 4 or 8 mg for 12 weeks; one trial also included tolterodine extended release (tolterodine-ER) 4 mg. HRQoL was assessed using the King's Health Questionnaire (KHQ), International Consultation on Incontinence Questionnaire,Short Form (ICIQ-SF), a six-point Likert scale measuring the severity of bladder-related problems, and treatment response. RESULTS By the end of treatment, all active-treatment groups had significantly improved HRQoL compared with those on placebo, as shown by an improvement in the KHQ and ICIQ-SF scores, treatment response rate, and a major improvement in self-reported bladder-related problems. The fesoterodine 8-mg group had statistically significant improvements over placebo in eight of nine KHQ domains. Fesoterodine 4 mg and tolterodine-ER produced statistically significant improvements in seven of nine KHQ domains. Fesoterodine 8 mg gave better results than 4 mg in two domains; Emotions and Symptom Severity (P < 0.05). A major improvement (,2 points) in bladder-related problems was reported by 33% of patients on fesoterodine 4 mg, 38% on fesoterodine 8 mg, and 34% on tolterodine-ER, vs 21% on placebo (P < 0.001). CONCLUSIONS Fesoterodine significantly improved HRQoL in patients with OAB. Both fesoterodine 4 and 8 mg produced significant improvements on most KHQ domains, the ICIQ-SF, treatment response rate, and a Likert scale measuring bladder-related problems. [source]

Decision-analytical model with lifetime estimation of costs and health outcomes for one-time screening for abdominal aortic aneurysm in 65-year-old men,

M. Henriksson
Background: Abdominal aortic aneurysm (AAA) causes about 2 per cent of all deaths in men over the age of 65 years. A major improvement in operative mortality would have little impact on total mortality, so screening for AAA has been recommended as a solution. The cost-effectiveness of a programme that invited 65-year-old men for ultrasonographic screening was compared with current clinical practice in a decision-analytical model. Methods: In a probabilistic Markov model, costs and health outcomes of a screening programme and current clinical practice were simulated over a lifetime perspective. To populate the model with the best available evidence, data from published papers, vascular databases and primary research were used. Results: The results of the base-case analysis showed that the incremental cost per gained life-year for a screening programme compared with current practice was ,7760, and that for a quality-adjusted life-year was ,9700. The probability of screening being cost-effective was high. Conclusion: A financially and practically feasible screening programme for AAA, in which men are invited for ultrasonography in the year in which they turn 65, appears to yield positive health outcomes at a reasonable cost. Copyright © 2005 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source]

Multicentre retrospective analysis of the outcome of artificial anal sphincter implantation for severe faecal incontinence

Dr D. F. Altomare
Background: A new prosthetic device, the ActiconTM artificial anal sphincter, has recently been introduced for treating severe faecal incontinence. The results of this procedure in 28 patients are presented. Methods: The patients underwent operation for severe faecal incontinence in four Italian university hospitals and patients were reviewed after a median follow-up of 19 (range 7,41) months. Results: Early infections occurred in four patients, requiring removal of the device in three. Dehiscence of the perineal wound occurred in nine patients. After activation of the device, the cuff had to be removed in a further four patients (for rectal erosion in two, anal pain in one and late infection in one). The cuff was accidentally broken in one patient. A new anal cuff was repositioned successfully in two patients. Overall, five patients had complete removal of the device and two removal of the cuff only. Twenty-one patients available for long-term evaluation had a major improvement in faecal continence. Median resting anal pressure increased from 27 mmHg before surgery to 32 mmHg after operation. Preoperative squeeze pressure was 42 mmHg while maximum postoperative anal pressure with the activated device was 67 mmHg. The median American Medical System incontinence score decreased significantly from 98·5 to 5·5 (P < 0·001). Similar figures were observed using the Continence Grading Scale (from 14·9 to 2·6; P < 0·001). Twelve patients developed symptoms of obstructed defaecation while two patients complained of anal pain. Conclusion: Improved continence was achieved after neosphincter implantation in three-quarters of the patients. Early infection and rectal erosion, together with difficulty in evacuating, are still major concerns with this technique. © 2001 British Journal of Surgery Society Ltd [source]

Cervical screening: how often should women be screened?

A. Herbert
Introduction As a result of major improvements that have been made to cervical screening during the last 15 years, and implementation of call and recall to invite all women aged 20,64 for screening, the incidence of cervical carcinoma has fallen by 42% since 19901. Cervical cancer is now a rare disease, largely thanks to the widespread uptake of screening by the women at risk. Despite the manifest success of the NHS Cervical Screening Programme (NHSCSP), there is pressure on one hand to improve its sensitivity by the introduction of new technology, including human papillomavirus (HPV) testing2, and on the other hand to reduce the cost of the programme, which is more than £130m per year. The main method suggested to reduce costs is the restriction of routine screening to an interval of 5 years3,5. [source]

M25 roadworks reveal earliest UK Neanderthal occupation at Dartford

GEOLOGY TODAY, Issue 5 2010
Francis Wenban-Smith
As anyone travelling on the roads of southeast England between 2006 and 2008 has probably been aware, major improvements have recently been made at the junction of the M25 and A2 motorways, south of the main Dartford crossing of the River Thames (Fig. 1). The roadworks, funded by the UK Highways Agency, with the main contractors Jacobs Babtie and Costain, were accompanied by archaeological investigations carried out by Oxford Archaeology between 2003 and 2006. The archaeological programme had a major Palaeolithic/Pleistocene element under my direction (Fig. 2) that has produced evidence of Neanderthal occupation early in the last glaciation (the Devensian, which lasted from 115 000 to 10 000 bp), during a period when Britain had until now, been thought to have been entirely deserted. Figure 1. Site location and areas of investigation. Figure 2. The author examines flint artefacts. [source]

Nocturnal Home Hemodialysis: Focus on the Partner

H Vos
Background. Nocturnal home hemodialysis (NHD, 6 times weekly 6,8 hours) results in a better clinical and psychosocial condition of dialysis patients. However, this intensive therapy has important consequences for partners, who bear at least some responsibilities during the treatment. Methods. Since December 2001, we included 15 patients in a Dutch NHD project (,Nocturne'). All patients are assisted by their spouses. An aim of Nocturne is to study the effects of NHD on partners and other family members with questionnaires and interviews by a social worker. Results. NHD affects daily life of partners much more than conventional therapies. Partners feel very involved with the treatment. The invasion of the treatment in bed, the noise and light produced by the machine, the daily assisting of the patient, less freedom, and co-responsibility for the treatment are felt as a burden, specially during the first months of the treatment. However, the improved clinical condition of their spouse, resulting in less fatigue, less disability, less uremic symptoms, less complications, more attention for and contribution to family life, better quality of life and better mood are considered major improvements, with important positive effects for the quality of life of all family members. Additionally, partners consider the fact that they make an important positive contribution to their spouse's health valuable. All partners judged NHD, despite some negative consequences, as a major improvement of their life. Conclusion. The positive effects of NHD are more important than the negative consequences for partners of patients. However, partners need active support by nurses or social workers, specially during the first months of the treatment. [source]

Trends in adult stature of peoples who inhabited the modern Portuguese territory from the Mesolithic to the late 20th century

H. F. V. Cardoso
Abstract This study documents long-term changes in stature from the Mesolithic to the late 20th century in the territory of modern Portugal. Data utilised originated from published sources and from a sample of the Lisbon identified skeletal collection, where long bone lengths were collected. Mean long bone lengths were obtained from 20 population samples and compiled into nine periods. Pooled long bone lengths for each period were then converted to stature estimates. Results show three major trends: (1) a slow increase in stature from prehistory to the Middle Ages; (2) a negative trend from the Middle Ages to the late 19th century; and (3) a very rapid increase in mean stature during the second half of the 20th century. The political and territorial stability of the Kingdom of Portugal may have contributed to the greater heights of the medieval Portuguese, compared with the Roman and Modern periods. The negative secular trend was rooted in poor and unsanitary living conditions and the spread of infectious disease, brought about by increased population growth and urbanisation. Although the end of the Middle Ages coincided with the age of discoveries, the population may not have benefited from the overall prosperity of this period. The 20th century witnessed minor and slow changes in the health status of the Portuguese, but it was not until major improvements in social and economic conditions that were initiated in the 1960s, and further progress in the 1970s, that the Portuguese grew taller than ever before. Since the Middle Ages other European countries have experienced similar oscillations, but showed an earlier recovery in stature after the industrial period. Copyright © 2008 John Wiley & Sons, Ltd. [source]

Balancing work and welfare: activation and flexicurity policies in The Netherlands, 1980,2000

Wim Van Oorschot
As a result of the flexibilisation of labour and the trend towards the ,activating welfare state', social policies show an increasing interconnection of work and welfare issues. The Netherlands is no exception. It is generally believed that the Dutch welfare state is successfully activating its unemployed labour potential (often referred to as the ,Dutch Miracle'), and that flexible and part-time work is protected by adequate ,flexicurity'. This article critically reviews Dutch activation and flexicurity policies. It concludes that there is still more unemployment than the miracle-story suggests; that important target groups of activation policies have not profited from ,the miracle'; that part-time workers have sufficient social protection but that social security for flex-workers still needs major improvements, despite favourable adjustments of labour law. [source]

Irrigation and drainage systems research and development in the 21st century,

Bart Schultz
irrigation; drainage; développement durable; système de réseau Abstract One critical problem confronting mankind today is how to manage the intensifying competition for water between expanding urban centres, traditional agricultural activities and in-stream water uses dictated by environmental concerns. In the agricultural sector, the dwindling number of economically attractive sites for large-scale irrigation and drainage projects limits the prospects of increasing the gross cultivated area. Therefore, the required increase in agricultural production will necessarily rely largely on a more accurate estimation of crop water requirements on the one hand, and on major improvements in the construction, operation, management and performance of existing irrigation and drainage systems, on the other. The failings of present systems and the inability to sustainably exploit surface and groundwater resources can be attributed essentially to poor planning, design, system management and development. This is partly due to the inability of engineers, planners and managers to adequately quantify the effects of irrigation and drainage projects on water resources and to use these effects as guidelines for improving technology, design and management. To take full advantage of investments in agriculture, a major effort is required to modernize irrigation and drainage systems and to further develop appropriate management strategies compatible with the financial and socio-economic trends, and the environment. This calls for a holistic approach to irrigation and drainage management and monitoring so as to increase food production, conserve water, prevent soil salinization and waterlogging, and to protect the environment. All this requires, among others, enhanced research and a variety of tools such as water control and regulation equipment, remote sensing, geographic information systems, decision support systems and models, as well as field survey and evaluation techniques. To tackle this challenge, we need to focus on the following issues: affordability with respect to the application of new technologies; procedures for integrated planning and management of irrigation and drainage systems; analysis to identify causes and effects constraining irrigation and drainage system performance; evapotranspiration and related calculation methods; estimation of crop water requirements; technologies for the design, construction and modernization of irrigation and drainage systems; strategies to improve irrigation and drainage system efficiency; environmental impacts of irrigation and drainage and measures for creating and maintaining sustainability; institutional strengthening, proper financial assessment, capacity building, training and education. Copyright © 2002 John Wiley & Sons, Ltd. Résumé Aujourd'hui le problème critique pour l'humanité est comment manier la compétition intensifiante pour de l'eau entre les centres urbains en expansion, pour des activités traditionnellement agricoles et pour l'usage de l'eau fluviale prescrit par des conditions écologistes. Dans le secteur agricole les perspectives d'agrandir les champs cultivés bruts sont limitées par le nombre diminuant des terrains économiquement attractifs pour des projets d'irrigation et du drainage de grande envergure. Par conséquent l'augmentation nécessaire de la production agricole comptera surtout sur une évaluation plus précise du besoin des plantes d'un côté, et de l'autre sur de grandes améliorations dans la construction, dans l'opération, dans le management et dans la performance des systèmes d'irrigation et du drainage. On peut attribuer les défauts des systèmes actuels et l'incompétence d'exploiter durablement les ressources hydriques de surface et souterraines au planification, au système de la gestion de l'eau et au système du développement. Cela est partiellement dû à l'incapacité des ingénieurs, des planificateurs et des gérants, de quantifier adéquatement les effets des projets d'irrigation et de drainage sur les ressources hydriques et d'utiliser ces résultats pour améliorer la technologie, la planification et la gestion de l'eau. Pour profiter le mieux possible des investissements dans l'agriculture, on exige un effort considérable pour moderniser les systèmes d'irrigation et de drainage et pour développer des stratégies de gestion de l'eau qui doivent être appropriées et compatibles avec les tendances financières et socio-économiques et avec l'environnement. Ceci a besoin d'une procédure holistique pour la gestion et le monitorage de l'eau, pour augmenter la production d'aliments, pour conserver l'eau, pour prévenir la salination du sol et pour protéger l'environnement. Tout cela demande, entre autres choses, une recherche d'avant-garde et une variété d'instruments comme les contrôles du régime hydrique et les appareils de régulation, la télédétection, les systèmes de l'information géographique, les systèmes et les modèles de support de décision et de même les levés sur le terrain et les techniques d'évaluation. Pour entreprendre ce défi nous devons nous concentrer sur les questions suivantes: capacité de mettre enoeuvre des technologies nouvelles; le développement des procédures pour intégrer la planification et la gestion des systèmes d'irrigation et de drainage; l'analyse pour identifier les causes et les effets de forcer à la performance des systèmes d'irrigation et de drainage; l'évapotranspiration et les méthodes de calcul en question; l'évaluation des exigences hydriques des cultures; les technologies pour le dessein, la construction et la modernisation des projets d'irrigation et de drainage; les stratégies pour améliorer l'efficacité des systèmes d'irrigation et de drainage; les impacts des projets d'irrigation et de drainage et des mesures appropriées pour créer et entretenir la durabilité; l'amélioration du contexte institutionnel, l'évaluation financière, la formation et l'amélioration des compétences techniques. Copyright © 2002 John Wiley & Sons, Ltd. [source]

Toward accurate relative energy predictions of the bioactive conformation of drugs

Keith T. Butler
Abstract Quantifying the relative energy of a ligand in its target-bound state (i.e. the bioactive conformation) is essential to understand the process of molecular recognition, to optimize the potency of bioactive molecules and to increase the accuracy of structure-based drug design methods. This is, nevertheless, seriously hampered by two interrelated issues, namely the difficulty in carrying out an exhaustive sampling of the conformational space and the shortcomings of the energy functions, usually based on parametric methods of limited accuracy. Matters are further complicated by the experimental uncertainty on the atomic coordinates, which precludes a univocal definition of the bioactive conformation. In this article we investigate the relative energy of bioactive conformations introducing two major improvements over previous studies: the use sophisticated QM-based methods to take into account both the internal energy of the ligand and the solvation effect, and the application of physically meaningful constraints to refine the bioactive conformation. On a set of 99 drug-like molecules, we find that, contrary to previous observations, two thirds of bioactive conformations lie within 0.5 kcal mol,1 of a local minimum, with penalties above 2.0kcal mol,1 being generally attributable to structural determination inaccuracies. The methodology herein described opens the door to obtain quantitative estimates of the energy of bioactive conformations and can be used both as an aid in refining crystallographic structures and as a tool in drug discovery. © 2008 Wiley Periodicals, Inc. J Comput Chem 2009 [source]

Effects of rapid response systems on clinical outcomes: Systematic review and meta-analysis

Sumant R. Ranji MD
Abstract BACKGROUND A rapid response system (RRS) consists of providers who immediately assess and treat unstable hospitalized patients. Examples include medical emergency teams and rapid response teams. Early reports of major improvements in patient outcomes led to widespread utilization of RRSs, despite the negative results of a subsequent cluster-randomized trial. PURPOSE To evaluate the effects of RRSs on clinical outcomes through a systematic literature review. DATA SOURCES MEDLINE, BIOSIS, and CINAHL searches through August 2006, review of conference proceedings and article bibliographies. STUDY SELECTION Randomized and nonrandomized controlled trials, interrupted time series, and before-after studies reporting effects of an RRS on inpatient mortality, cardiopulmonary arrests, or unscheduled ICU admissions. DATA EXTRACTION Two authors independently determined study eligibility, abstracted data, and classified study quality. DATA SYNTHESIS Thirteen studies met inclusion criteria: 1 cluster-randomized controlled trial (RCT), 1 interrupted time series, and 11 before-after studies. The RCT showed no effects on any clinical outcome. Before-after studies showed reductions in inpatient mortality (RR = 0.82, 95% CI: 0.74-0.91) and cardiac arrest (RR = 0.73, 95% CI: 0.65-0.83). However, these studies were of poor methodological quality, and control hospitals in the RCT reported reductions in mortality and cardiac arrest rates comparable to those in the before-after studies. CONCLUSIONS Published studies of RRSs have not found consistent improvement in clinical outcomes and have been of poor methodological quality. The positive results of before-after trials likely reflects secular trends and biased outcome ascertainment, as the improved outcomes they reported were of similar magnitude to those of the control group in the RCT. The effectiveness of the RRS concept remains unproven. Journal of Hospital Medicine 2007;2:422,432. © 2007 Society of Hospital Medicine. [source]

Recent developments in the high-performance chelation ion chromatography of trace metals

Pavel N. Nesterenko
Abstract There have been a number of significant developments in the high-performance chelation ion chromatography (HPCIC) of trace metals in recent years. This review focuses on these developments, while giving important information on the fundamental parameters controlling the chelation sorption mechanism, including type of chelating group, stability constants, kinetics, and column temperature. The discussion pays particular attention to the types and properties of efficient chelating stationary phases which have been fabricated for certain groups of metals. The review also describes a number of major improvements in postcolumn reaction detection including the use of the latest reagents and noise reduction strategies to improve sensitivity and reduce LOD. In the final section, an indication of the applicability of HPCIC to a range of complex sample types is given with some key examples and chromatograms using the latest high-efficiency chelating phases. [source]


Kellie B. Vaché
ABSTRACT: Simulated water quality resulting from three alternative future land-use scenarios for two agricultural watersheds in central Iowa was compared to water quality under current and historic land use/land cover to explore both the potential water quality impact of perpetuating current trends and potential benefits of major changes in agricultural practices in the U.S. Corn Belt. The Soil Water Assessment Tool (SWAT) was applied to evaluate the effect of management practices on surface water discharge and annual loads of sediment and nitrate in these watersheds. The agricultural practices comprising Scenario 1, which assumes perpetuation of current trends (conversion to conservation tillage, increase in farm size and land in production, use of currently-employed Best Management Practices (BMPs)) result in simulated increased export of nitrate and decreased export of sediment relative to the present. However, simulations indicate that the substantial changes in agricultural practices envisioned in Scenarios 2 and 3 (conversion to conservation tillage, strip intercropping, rotational grazing, conservation set-asides and greatly extended use of best management practices (BMPs) such as riparian buffers, engineered wetlands, grassed waterways, filter strips and field borders) could potentially reduce current loadings of sediment by 37 to 67 percent and nutrients by 54 to 75 percent. Results from the study indicate that major improvements in water quality in these agricultural watersheds could be achieved if such environmentally-targeted agricultural practices were employed. Traditional approaches to water quality improvement through application of traditional BMPs will result in little or no change in nutrient export and minor decreases in sediment export from Corn Belt watersheds. [source]

Japan's Power Shift and Its DPRK Policy

PACIFIC FOCUS, Issue 2 2010
Yoshinori Kaseda
Many serious issues exist between Japan and North Korea (DPRK), such as nuclear, missile, abduction, and colonial issues. Progress on their resolution has been limited. Consequently, the two countries have remained unfriendly neighbors. Their relations recently deteriorated as a result of the DPRK's satellite launch and its second nuclear test in the first half of 2009, and Japan's strong response to them. In the middle of this period of significant tension, in August 2009, the Democratic Party of Japan (DPJ) won a landslide victory in the lower house elections, ending the dominance of the Liberal Democratic Party (LDP) over the last half a century. This political sea change in Japan has not resulted in major improvements in the Japan,DPRK relations. Yet, the DPJ's stance toward the DPRK's military threat and the Japan,US alliance is different from that of the LDP. So far, the DPJ has opted to avoid following in the LDP's footsteps of strengthening the alliance and expanding Japan's military operations in response to the DPRK's military threat. Instead, it intends to increase Japan's independence from the USA, and reduce US military presence in Japan. Given such intentions, the DPJ seems willing to improve Japan's relations with the DPRK. The question is whether its willingness will be translated into real actions to bring about major improvements. [source]

Inflammation and Sleep Disordered Breathing in Children: A State-of-the-Art Review,

Aviv D. Goldbart MD
Abstract Sleep disordered breathing (SDB) represents a spectrum of breathing disorders, ranging from snoring to obstructive sleep apnea syndrome (OSAS), that disrupt nocturnal respiration and sleep architecture. OSAS is a common disorder in children, with a prevalence of 2,3%. It is associated with neurobehavioral, cognitive, and cardiovascular morbidities. In children, adenotonsillectomy is the first choice for treatment and is reserved for moderate to severe OSAS, as defined by an overnight polysomnography. In adults, OSAS is the result of mechanical dysfunction of the upper airway, manifesting as severity-dependent nasal, oropharyngeal, and systemic inflammation that decrease after continuous positive airway pressure therapy. Inflammatory changes have been reported in upper airway samples from children with OSAS, and systemic inflammation, as indicated by high-sensitivity C-reactive protein (hsCRP) levels, has been shown to decrease in children with OSAS after adenotonsillectomy. Anti-inflammatory treatments for children with mild OSAS are associated with major improvements in symptoms, polysomnographic respiratory values, and radiologic measures of adenoid size. Inflammation is correlated to some extent with OSAS-related neurocognitive morbidity, but the role of inflammatory markers in the diagnosis and management of OSAS, and the role of anti-inflammatory treatments, remains to be clarified. This review examines the role of inflammation in the pathophysiology of sleep-disordered breathing in pediatric patients and the potential therapeutic implications. Pediatr. Pulmonol. 2008; 43:1151,1160. © 2008 Wiley-Liss, Inc. [source]

Gleaning signals about the past from cemetery data

Lisa Sattenspiel
Abstract Cemetery headstones provide an easily accessible source of demographic data in human populations. In common with other sources of demographic data, such as skeletal samples, cemetery data may not be representative of the populations from which they were derived. In some circumstances they can be reasonably representative, however, and in such cases they may provide signals about demographic changes in the population that contributed to the cemetery. We present here analyses of burials occurring between 1900 and 1990 at the Columbia Cemetery in Columbia, Missouri. Our analyses, in combination with archival materials relating to infrastructure improvements in Columbia and data on infectious disease mortality in the state of Missouri, show that patterns of death observed in the cemetery data provide evidence for the timing of changes in the health of Columbia's residents. At the time that major improvements in sanitation and hygiene were implemented, burials of individuals dying under age 45 decreased significantly while burials of individuals older than 45 remained relatively high. Furthermore, data on infectious disease mortality indicate significant declines in deaths from water- and milk-borne infections, but no change in mortality from respiratory illnesses. These data also indicate that observed changes occurred about a decade later in Columbia than in large cities and more densely populated states elsewhere in the United States. Thus, this study illustrates the value of cemetery data in helping to fill gaps about how and when different events known to affect patterns of birth and death may have played out across time and space. Am J Phys Anthropol, 2010. © 2009 Wiley-Liss, Inc. [source]

Capacity development for education service delivery in Pakistan: Top-down devolution

David Watson
Abstract The historical, political, socio-cultural and institutional context in the public service of Pakistan is not auspicious for the delivery of social services such as education. The then military regime introduced radical devolution reforms in 2001 that promised improvements in service delivery by enhancing accountabilities and capacities for change in local government. However the political economy of this top-down devolution has proved contentious. It established new power structures and authorities over resources at local levels but without concurrent efforts to enhance service delivery capacities. This article examines capacity issues in two cases of capacity development in education service delivery in Pakistan's largest province. The Punjab Education Sector Reform Programme (PESRP) was managed by a provincial-level implementation unit; the Strategic Policy Unit (SPU) of City District Government Faisalabad was a local government project supported by technical co-operation. Both delivered major improvements in education delivery capacity in just 4 years, after decades of delivery stagnation and worsening education indicators. The sustainability of these initiatives is in doubt, as political economy factors remain a major impediment to devolved service delivery in Pakistan. Copyright © 2009 John Wiley & Sons, Ltd. [source]

First experience with The IRIS retinal implant system

Purpose To report on the first 4 months experience of a patient with the active IRIS- Implant. Methods 4 weeks after implantation the training with the active implant started. Thresholds were measured at each training day. Light perception, light localisation, point to point discrimination and motion detection were measured with special test procedures. Visual function training was performed. Results Visual perception was achieved, when the stimuli were generated by the computer and with the camera mode. All tests were successful. Conclusion Successful stimulation and major improvements during the training demonstrates that with the Iris Implant System a visual perception can be achieved, which is relevant for daily life. [source]