Numerous Advantages (numerous + advantage)

Distribution by Scientific Domains

Selected Abstracts

Longitudinal Diminution of Tumor Size for Basal Cell Carcinoma Suggests Shifting Referral Patterns for Mohs Surgery

BACKGROUND The Mohs technique for removal of cutaneous malignancies offers tissue-sparing benefits compared with other treatment methods. With wider acceptance and availability of Mohs surgery, referral patterns may be shifting toward the treatment of smaller, lower-risk tumors. OBJECTIVE The objective was to examine whether referral patterns for basal cell carcinoma (BCC) at an academic Mohs surgery practice have shifted over recent years toward referral for smaller, lower risk tumors. METHODS A retrospective longitudinal comparison of tumor characteristics was performed for BCCs treated at our institution from a recent year (2004) and a past year (1996). Statistical analyses were used to identify differences in tumor size, distribution by anatomic site, and primary versus recurrent status. RESULTS Complete data were available for 603 BCCs treated in 1996 and 1,514 BCCs treated in 2004. A 24% decrease in preoperative tumor surface area was observed from 1996 (1.25 cm2) to 2004 (0.95 cm2). Tumors were twice as likely to be recurrent in 1996 (15.1%) than in 2004 (7.4%). There were no significant differences in the anatomic distribution of lesions in the years compared. CONCLUSIONS Findings at our institution suggest that in recent years, referral patterns have shifted toward a preference for Mohs surgery for the treatment of smaller, primary BCCs. This may be a result of increased awareness by the dermatologic and medical community of the numerous advantages of Mohs surgery and a greater appreciation of its tissue-sparing properties, which may result in less complex and more successful aesthetic reconstructions. [source]

Medical journals and effective dissemination of health research

Aravinthan Coomarasamy
Clinical medical journals have not been effective in meeting the information needs of practitioners and bridging the gap between clinical research and practice. The slow adoption of results of clinical research is at least partly due to the failure of clinical journals to disseminate information in a way that would motivate practitioners to change practice. Although implementation is primarily a local process, medical journals are in a unique position to advance implementation by modifying their focus and adjusting their contents. Strategies that may be useful include publication of pre-appraised evidence summaries and ,clinical bottom-lines' and giving importance to systematic reviews and large evaluative research articles as they represent higher levels of evidence and have greater potential to change practice. Clinical journals should encourage researchers to consider how and by whom the findings will be used and provide information on implications for implementation such as possible strategies that may work, cost-effectiveness, side-effects and potential barriers to implementation. Medical journal publishers should explore ways to cooperate so that findings of landmark clinical trials could be shared thus reducing the ,scatter' of medical information. Electronic media offers numerous advantages such as quick accessibility and linking of information, and medical journals should capitalize on such innovations. There is a paradigm shift in health care practice as evidence is consciously and explicitly incorporated into individual patient care. Medical journals need to change to reflect this change in practice and provide practitioners with valid and relevant information. [source]

Utilizing endocrine secretory pathways in salivary glands for systemic gene therapeutics,

Antonis Voutetakis
Mammalian salivary glands are commonly used models of exocrine secretion. However, there is substantial experimental evidence showing the physiological existence of endocrine secretory pathways in these tissues. The use of gene transfer technology in vivo has allowed the unambiguous demonstration of these endocrine pathways. We and others have exploited such findings and evaluated salivary glands as possible target tissues for systemic applications of gene therapeutics. Salivary glands present numerous advantages for this purpose, including being well encapsulated, which limits extra-glandular vector dissemination, and having the luminal membranes of almost all parenchymal cells accessible via intraoral delivery of vectors through the main excretory ducts. Existing studies suggest that clinical benefits will result from salivary gland targeted systemic gene therapeutics. J. Cell. Physiol. 199: 1,7, 2004. Published 2003 Wiley-Liss, Inc. [source]

Methadone Reincarnated: Novel Clinical Applications with Related Concerns

PAIN MEDICINE, Issue 4 2002
Scott M. Fishman MD
Methadone has numerous advantages as an analgesic, which have supported its recent increase in use. However, methadone also has a pharmacological profile as an opioid that differentiates it from other, better known or more widely used opioids. It also has unusual pharmacodynamics, pharmacokinetics, and metabolism that must be considered for safe use of methadone as an analgesic. This review looks at the history of methadone use as an analgesic and its properties that distinguish it as an unusual, and potentially, unstable opioid. [source]

Flow modeling and simulation for vacuum assisted resin transfer molding process with the equivalent permeability method

Renliang Chen
Vacuum assisted resin transfer molding (VARTM) offers numerous advantages over traditional resin transfer molding, such as lower tooling costs, shorter mold filling time and better scalability for large structures. In the VARTM process, complete filling of the mold with adequate wet-out of the fibrous preform has a critical impact on the process efficiency and product quality. Simulation is a powerful tool for understanding the resin flow in the VARTM process. However, conventional three-dimensional Control Volume/Finite Element Method (CV/FEM) based simulation models often require extensive computations, and their application to process modeling of large part fabrication is limited. This paper introduces a new approach to model the flow in the VARTM process based on the concept of equivalent permeability to significantly reduce computation time for VARTM flow simulation of large parts. The equivalent permeability model of high permeable medium (HPM) proposed in the study can significantly increase convergence efficiency of simulation by properly adjusting the aspect ratio of HPM elements. The equivalent permeability model of flow channel can simplify the computational model of the CV/FEM simulation for VARTM processes. This new modeling technique was validated by the results from conventional 3D computational methods and experiments. The model was further validated with a case study of an automobile hood component fabrication. The flow simulation results of the equivalent permeability models were in agreement with those from experiments. The results indicate that the computational time required by this new approach was greatly reduced compared to that by the conventional 3D CV/FEM simulation model, while maintaining the accuracy, of filling time and flow pattern. This approach makes the flow simulation of large VARTM parts with 3D CV/FEM method computationally feasible and may help broaden the application base of the process simulation. Polym. Compos. 25:146,164, 2004. 2004 Society of Plastics Engineers. [source]

Pediatric Laryngotracheal Obstruction: Current Perspectives on Stridor

John Bent MD
Abstract Objectives/Hypothesis: To assess how medical advances have impacted the diagnosis, management, and outcomes of pediatric laryngotracheal obstruction, and to describe the advantages of audio-video documentation of stridorous children. Study Design and Methods: Retrospective. Methods and Materials: 268 patients were referred for suspected laryngotracheal obstruction during the 30 months between September 1, 1995 and March 1, 1998: 173 had 206 flexible fiberoptic laryngoscopies, and 160 had 273 direct laryngoscopies. One hundred and forty-one children were identified with laryngotracheal obstruction, yielding 40 different diagnoses that could be classified into 9 major categories. Thirty-six children (25.5%) had multiple sites of upper airway obstruction. Results: 138 children had follow-up >1 month. Twelve children died (8.7%), leaving 126 survivors (mean follow-up = 21.1 months). Outcomes were classified as resolved (44.2%), improved (37.0%), stable (9.4%), failed (0.7%), or death (8.7%). Better outcomes were seen in more readily treated diagnostic categories, such as tracheobronchial foreign body, chronic laryngitis, and suprastomal granulation tissue; laryngeal stenosis, tracheomalacia, and recurrent respiratory papillomatosis, had less favorable outcomes (P <.001). The former group also showed superior outcome compared to laryngomalacia (P <.001) and vocal cord mobility disorders (P = .004). Ninety-four patients (68.1%) had comorbidities complicating their management. Comorbid conditions were universal among deceased patients and least common in the resolved outcomes category (56.7%), supporting the premise that patients with poor outcomes are more likely to have comorbidities than patients with resolution of laryngotracheal symptoms (P = .034). Conclusions: Audio-video recording of pediatric laryngotracheal obstruction offers numerous advantages. Children classified into an array of diagnostic categories usually have favorable outcomes, but opportunities for continued advances exist, particularly regarding management of comorbidity and chronic obstruction. [source]

Novel application of oxygen-transferring membranes to improve anaerobic wastewater treatment

Anthony S. Kappell
Abstract Anaerobic biological wastewater treatment has numerous advantages over conventional aerobic processes; anaerobic biotechnologies, however, still have a reputation for low-quality effluents and operational instabilities. In this study, anaerobic bioreactors were augmented with an oxygen-transferring membrane to improve treatment performance. Two anaerobic bioreactors were fed a synthetic high-strength wastewater (chemical oxygen demand, or COD, of 11,000 mg l,1) and concurrently operated until biomass concentrations and effluent quality stabilized. Membrane aeration was then initiated in one of these bioreactors, leading to substantially improved COD removal efficiency (>95%) compared to the unaerated control bioreactor (,65%). The membrane-augmented anaerobic bioreactor required substantially less base addition to maintain circumneutral pH and exhibited 75% lower volatile fatty acid concentrations compared to the unaerated control bioreactor. The membrane-aerated bioreactor, however, failed to improve nitrogenous removal efficiency and produced 80% less biogas than the control bioreactor. A third membrane-augmented anaerobic bioreactor was operated to investigate the impact of start-up procedure on nitrogenous pollutant removal. In this bioreactor, excellent COD (>90%) and nitrogenous (>95%) pollutant removal efficiencies were observed at an intermediate COD concentration (5,500 mg l,1). Once the organic content of the influent wastewater was increased to full strength (COD = 11,000 mg l,1), however, nitrogenous pollutant removal stopped. This research demonstrates that partial aeration of anaerobic bioreactors using oxygen-transferring membranes is a novel approach to improve treatment performance. Additional research, however, is needed to optimize membrane surface area versus the organic loading rate to achieve the desired effluent quality. 2005 Wiley Periodicals, Inc. [source]