MICROWAVE AND OPTICAL TECHNOLOGY LETTERS, Issue 3 2004
Dipanjan Gope
Abstract Integral-equation methodologies applied to extract parasitics for board, package, and on-chip structures involve solving a dense system of equations. In this paper, we present an improved matrix-compression technique for fast iterative solution of such dense systems, which applies QR decomposition on multilevel oct-tree-based interaction sub-matrices. The regular-tree structure of the fast-multipole method and the rank-revealing QR-based matrix-compression scheme are combined in order to achieve superior time and memory efficiency. As is demonstrated by the numerical-simulation results presented herein, the new algorithm is found to be faster and more memory efficient than both existing QR-based methods and FastCap. © 2004 Wiley Periodicals, Inc. Microwave Opt Technol Lett 41: 169,173, 2004; Published online in Wiley InterScience (www.interscience.wiley.com). DOI 10.1002/mop.20083 [source]

STRUCTURES OF PREVENTION: A SAFE-SEX/SAFE-INJECTING AUDIT OF MOUNT ALEXANDER SHIRE, A METHODOLOGICAL PILOT

AUSTRALIAN JOURNAL OF RURAL HEALTH, Issue 4 2000
Anton Mischewski
ABSTRACT: This paper reports the findings of a methodological pilot project that examined the availability of safe-sex and safe-injecting products in a rural shire in central Victoria. The study mapped the distribution and audited the availability of condoms, water-based lubricants, needles/syringes and needle disposal units to provide baseline data on access to and the availability of products that are directly related to the prevention of the human immunodeficiency virus, sexually transmissible infections and blood-borne viruses. Clear disparities were observed in the availability and pricing of safe sex/safe use materials between regional centres and outlying areas in the Shire. The findings make it clear that an emphasis on overcoming structural impediments to the adoption of safe sex/safe injecting practices is required. [source]

Does PTSD occur in sentenced prison populations?

CRIMINAL BEHAVIOUR AND MENTAL HEALTH, Issue 3 2007
A systematic literature review
Background,A systematic review of the literature on mental disorder in prisoners, published in 2002, made no mention of post-traumatic stress disorder (PTSD), but indicators from other studies suggest that a history of serious and chronic trauma is common among offenders. Aims,To conduct a systematic review of the literature with the specific questions: does any epidemiological study of sentenced prisoners include data on prevalence of PTSD while in prison? If so, what is the prevalence in this group? Method,Literature databases EMBASE, Medline, PsychInfo, PILOTS and SIGLE were searched. The Journal of Traumatic Stress was searched manually. Preliminary screening was conducted by reading abstracts of hundreds of papers. Ten exclusion criteria were then applied to the screened selection. Reference sections of all accessed papers were searched for any further studies. Results,One hundred and three potentially relevant papers were identified after preliminary screening. Four met all criteria for inclusion and suffered none of the exclusion criteria. PTSD rates ranged from 4% of the sample to 21%. Women were disproportionately affected. Conclusions and implications for practice,All four papers suggested that the prevalence of PTSD among sentenced prisoners is higher than that in the general population, as reported elsewhere. Overall the findings suggest a likely need for PTSD treatment services for sentenced prisoners. Copyright © 2007 John Wiley & Sons, Ltd. [source]

Institutionally based health care workers' exposure to traumatogenic events: Systematic review of PTSD presentation

JOURNAL OF TRAUMATIC STRESS, Issue 3 2010
Noelle Robertson
This review sought to identify published evidence for the presentation of posttraumatic stress disorder (PTSD) symptoms in institutionally based health care workers. The databases Medline, Psycinfo, PILOTS, CINAHL (R), EMBASE, and ISI Web of Science were searched in a systematic manner eliciting 9 quantitative studies. Presentation of PTSD among such workers appears comparable to data reported for emergency services staff. The authors discuss some of the theoretical debates underpinning the research as well as methodological weaknesses that temper the strength of conclusions drawn. [source]

Absorption of H2S in NaOCl caustic aqueous solution

ENVIRONMENTAL PROGRESS & SUSTAINABLE ENERGY, Issue 3 2001
Luke Chen
Pilot plant experimental data were collected to study the feasibility of H2S removal from air streams utilizing aqueous solutions. Solutions of NaOCl/NaOH were tested in a packed bed scrubber and found to be effective. An efficiency of 99.2% H2S removal was achieved at a gas flow rate of 790 lb/f2 -hr and liquid-gas ratio of 5.06. Sodium hydroxide was found to be the active ingredient in the absorption process. A minimum alkalinity of pH 11 in the scrubbing solution was required for the H2S to be efficiently absorbed in the packed bed scrubber. For gas flow rates up to 2,100 lb/f2 hr, the height of a transfer unit (HTU) varied from 1.8 ft to 2 ft with different proportions of NaOCl and NaOH in the solution. [source]

Pilot randomised controlled trial of community pharmacy administration of buprenorphine versus methadone

INTERNATIONAL JOURNAL OF PHARMACY PRACTICE, Issue 4 2006
Isobel M Cameron research fellow
Objectives The established regime for opiate substitute prescribing for drug misusers is daily methadone administered under supervision in community pharmacies. Buprenorphine has recently been introduced as an alternative. However there is a lack of evidence of the effectiveness of buprenorphine maintenance therapy (BMT) in the UK treatment setting. This study aimed to assess methods for a randomised controlled trial (RCT) and the feasibility of pharmacy-based supervised self-administration (SSA) of buprenorphine compared to methadone. Setting Specialist substance misuse service, general practices and community pharmacies in Aberdeen, Scotland. Method The design was a pilot RCT. Opiate-dependent drug misusers, newly referred for maintenance treatment were randomised to receive BMT or methadone maintenance therapy (MMT). Clients and pharmacists were interviewed at baseline and at the end of a 12-week intervention period. Clients completed the quality of life measure EQ-5D. Pharmacy activities were timed. Key findings Twenty-one opiate-dependent clients were recruited (BMT = 11, MMT = 10). Recruitment levels improved as the trial progressed. Clients' treatment preferences were evident. Withdrawals occurred early with BMT. Clients found SSA of buprenorphine acceptable, but found daily administration more manageable than three times weekly. Pharmacists found the dispensing of buprenorphine to be an acceptable role, but felt less certain of ensuring against diversion with buprenorphine than they were with methadone. Pharmacy activities associated with buprenorphine took longer than those associated with methadone (mean = 7 min 25 s versus mean = 3 min 27 s, respectively). Conclusion Recruitment to a trial comparing MMT to BMT for opiate-dependent clients within a UK treatment setting is feasible. Clients and pharmacists found buprenorphine acceptable. [source]

Stopping to Rest During a 400-Meter Walk and Incident Mobility Disability in Older Persons with Functional Limitations

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 2 2009
Sonja Vestergaard PhD
OBJECTIVES: To examine the association between stopping to rest during a 400-m usual-pace walk test (400-MWT) and incident mobility disability in older persons with functional limitations. DESIGN: Prospective cohort study. SETTING: Community based. PARTICIPANTS: Four hundred twenty-four participants in the Lifestyle Intervention and Independence for Elders Pilot (LIFE-P) Study aged 70 to 89 with functional limitations (summary score ,9 on the Short Physical Performance Battery (SPPB)) but able to complete the 400-MWT within 15 minutes. MEASUREMENTS: Rest stops during the 400-MWT were recorded. The onset of mobility disability, defined as being unable to complete the 400-MWT or taking more than 15 minutes to do so, was recorded at Months 6 and 12. RESULTS: Fifty-four (12.7%) participants rested during the 400-MWT at baseline, of whom 37.7% experienced mobility disability during follow-up, versus 8.6% of those not stopping to rest. Performing any rest stop was strongly associated with incident mobility disability at follow-up (odds ratio (OR)=5.4, 95% confidence interval (CI)=2.7,10.9) after adjustment for age, sex, and clinic site. This association was weaker, but remained statistically significant, after further adjusting for SPPB and time to complete the 400-MWT simultaneously (OR=2.6, 95% CI=1.2,5.9). CONCLUSION: Stopping to rest during the 400-MWT is strongly associated with incident mobility disability in nondisabled older persons with functional limitations. Given the prognostic value, rest stops should be recorded as part of the standard assessment protocol for the 400-MWT. [source]

Evaluating a Survivors Group Pilot for Women with Significant Intellectual Disabilities who have been Sexually Abused

JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES, Issue 4 2007
Nicholas Guy Peckham
Background, Sexual abuse has been associated with trauma, low self-esteem, anger, depression and challenging behaviours. This pilot study builds on a small published literature by evaluating a survivors group (SG) for women with an intellectual disability and an educational support group (ESG) for their carers. Method, The SG was delivered weekly over 5 months for 20 sessions and the ESG ran concurrently for their seven carers in a separate room within the same community-based building. Participants were helped to build trust and rapport, provided with education about sexual abuse designed for their level of ability, and helped to reprocess the trauma of their sexual abuse. Results, Both the SG and the ESG were evaluated using a repeated-measures design (double baseline, mid-treatment, post-treatment and follow up), to see whether there was any improvement in relevant clinical dependent variables associated with the consequences of sexual abuse (i.e. trauma, self-esteem, anger, depression and challenging behaviour). Improvements occurred in sexual knowledge, trauma and depression. Neither self-esteem nor anger improved for most of the SG and challenging behaviour worsened at first before improving. Conclusions, The SG seemed to be successful in improving sexual knowledge and in reducing trauma and depression, although challenging behaviours worsened at first before improving. There is a need for more sexual abuse/sexual education groups for men and women with intellectual disabilities. [source]

Feasibility and tolerability of probiotics for prevention of antibiotic-associated diarrhoea in hospitalized US military veterans

JOURNAL OF CLINICAL PHARMACY & THERAPEUTICS, Issue 6 2008
N. Safdar MD MS
Summary Background:, Probiotics may be efficacious for the prevention of antibiotic-associated diarrhoea. The tolerability and acceptability of probiotics in an elderly US veteran population has not been assessed. Purpose:, To undertake a randomized trial to determine the tolerability and acceptability of a probiotic, Florajen® in an elderly population with multiple comorbidities. Methods:, Pilot randomized double-blind trial comparing a probiotic, Florajen® to placebo for the prevention of antibiotic-associated diarrhoea in elderly hospitalized patients receiving antibiotics. Results:, Forty patients were enrolled and randomized. Antibiotic-associated diarrhoea occurred in 6/16 (37%) in the placebo group and 4/23 (17%) patients in the Florajen® group, (RR 1·63, 95% CI 0·73,3·65, P = 0·15). Florajen® was well tolerated in the study population with no major side effects that necessitated discontinuation. Conclusions:, In this pilot study, Florajen® was well tolerated in an elderly population, all of whom were taking several other medications. A larger study is needed to determine the effect of Florajen® on antibiotic-associated diarrhoea and Clostridium difficile infection. [source]

Initial experience with factor-Xa inhibition in percutaneous coronary intervention: the XaNADU-PCI Pilot

JOURNAL OF THROMBOSIS AND HAEMOSTASIS, Issue 2 2004
J. H. Alexander
Summary.,Background:,Direct factor (F)Xa inhibition is an attractive method to limit thrombotic complications during percutaneous coronary intervention (PCI). Objectives:,To investigate drug levels achieved, effect on coagulation markers, and preliminary efficacy and safety of several doses of DX-9065a, an intravenous, small molecule, direct, reversible FXa inhibitor during PCI. Patients and methods:,Patients undergoing elective, native-vessel PCI (n = 175) were randomized 4 : 1 to open-label DX-9065a or heparin in one of four sequential stages. DX-9065a regimens in stages I,III were designed to achieve concentrations of >,100 ng mL,1, >,75 ng mL,1, and >,150 ng mL,1. Stage IV used the stage III regimen but included patients recently given heparin. Results:,At 15 min median (minimum) DX-9065a plasma levels were 192 (176), 122 (117), 334 (221), and 429 (231) ng mL,1 in stages I,IV, respectively. Median whole-blood international normalized ratios (INRs) were 2.6 (interquartile range 2.5, 2.7), 1.9 (1.8, 2.0), 3.2 (3.0, 4.1), and 3.8 (3.4, 4.6), and anti-FXa levels were 0.36 (0.32, 0.38), 0.33 (0.26, 0.39), 0.45 (0.41, 0.51), and 0.62 (0.52, 0.65) U mL,1, respectively. Stage II enrollment was stopped (n = 7) after one serious thrombotic event. Ischemic and bleeding events were rare and, in this small population, showed no clear relation to DX-9065a dose. Conclusions:,Elective PCI is feasible using a direct FXa inhibitor for anticoagulation. Predictable plasma drug levels can be rapidly obtained with double-bolus and infusion DX-9065a dosing. Monitoring of DX-9065a may be possible using whole-blood INR. Direct FXa inhibition is a novel and potentially promising approach to anticoagulation during PCI that deserves further study. [source]

Randomised controlled trial of LigaSure versus conventional suture ligature for abdominal hysterectomy

BJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 7 2005
Bjørn Hagen
Objective To compare the use of LigaSure with conventional suture ligature in abdominal hysterectomy. Design Pilot randomised controlled unblinded trial with block randomisation according to three operating surgeons. Setting One Norwegian teaching hospital, Department of Gynaecology and Obstetrics. Sample Thirty women who underwent total or subtotal abdominal hysterectomy. Methods Data, with regard to operation time expenditure and the occurrence of peri- and post-operative complications, were collected and compared between the two techniques. Main outcome measures Operation time, peri- and post-operative complications. Results Mean operation duration was 61.7 minutes with LigaSure and 54.5 minutes with conventional suture ligature. The corresponding operative blood loss was 303 and 298 mL, respectively. Occurrence of complications was few and not significantly different between the two techniques. Mean hospital stay was longer following LigaSure operations (10 vs 6 days), probably due to a certain age imbalance between the study groups. Conclusions Within the limitation of this pilot study, we did not uncover a time sparing effect from the use of LigaSure or any difference in the occurrence of blood loss and complications. [source]

High incidence of myelodysplasia and secondary leukaemia in the UK Medical Research Council Pilot of autografting in chronic lymphocytic leukaemia

BRITISH JOURNAL OF HAEMATOLOGY, Issue 2 2006
Donald W. Milligan
Summary We report a high incidence of myelodysplastic syndrome (MDS)/acute myeloid leukaemia (AML) in patients entered into the Medical Research Council Chronic Lymphocytic Leukaemia-5 trial. Of 115 newly diagnosed patients treated with fludarabine, 65 patients proceeded to autologous transplant. Conditioning was cyclophosphamide and total body irradiation in 49 (75%) patients and chemotherapy in 12 (18%). Ten patients have developed MDS/AML; eight had undergone an autograft. Five-year actuarial risk of developing MDS/AML postautograft was 12·4% (95% confidence interval, 2·5,24%). No analysed potential risk factor was predictive for MDS/AML development. We hypothesise that potential causative factors are fludarabine, low cell dose and transplant conditioning. [source]

A Pilot, 15-month, randomised effectiveness trial of Risperidone long-acting injection (RLAI) versus oral atypical antipsychotic agents (AAP) in persons with bipolar disorder

ACTA NEUROPSYCHIATRICA, Issue 2 2010
K. N. Roy Chengappa
Chengappa KNR, Turkin SR, Schlicht PJ, Murphy SL, Brar JS, Fagiolini A, Houck PR, Garbutt RG, Fredrick N. A Pilot, 15-month, randomised effectiveness trial of Risperidone long acting injection (RLAI) versus oral atypical antipsychotic agents (AAP) in persons with bipolar disorder. Objective: Long-acting injectible antipsychotic agents are rarely considered in the treatment of bipolar patients [bipolar disorder (BPD)]. We posited that BPD patients receiving risperidone long-acting injections [Risperidone long-acting injections (RLAIs)] would experience fewer negative clinical events than those receiving oral atypical antipsychotic agents (AAP). Methods: Adult BPD patients in a hypomanic, manic or mixed episode were randomised to either oral risperdone followed by RLAI (n = 23) or an AAP (n = 25) for 15 months. Any mood stabilizers were continued. An independent clinician board declared any clinical events that occurred but the treatment assignment was concealed. Results: Nine of the 48 patients who participated in this study did not improve, leaving 39 patients in 1-year extension. RLAI patients received the following bi-weekly dosages: 25 mg (n = 9), 37.5 mg (n = 8), and 50 mg (n = 6). The AAP group included aripiprazole (n = 11, 15,30 mg/day), quetiapine (n = 8, 300,700 mg/day), olanzapine (n = 5, 15,25 mg/day), and ziprasidone, (n = 1, 160 mg/day). In total, 47 clinical events were declared. The RLAI-treated group experienced significantly fewer clinical events (mean: 0.86 ± 0.73) compared with the AAP group (1.61 ± 1.29), t = 2.29, d.f. = 37, p = 0.028 (95% CI = 0.087,1.421). Of all, 50% of the AAP subjects gained , 7% of their baseline body weight as did 38% of the RLAI-treated patients. Conclusions: RLAI-treated patients experienced significantly fewer negative clinical events. Further exploration should focus on which subtypes of BPD patients might benefit from RLAI treatment. Weight gain in BPD subjects requires clinical attention. Limitations include an open design, small sample size and the inability to conclude on whether this strategy is useful for depressive episodes. [source]

"I Am Not Alone": The Feasibility and Acceptability of Interactive Voice Response-Facilitated Telephone Peer Support Among Older Adults With Heart Failure

CONGESTIVE HEART FAILURE, Issue 3 2007
Michele Heisler MD
Patient self-management is a critical determinant of heart failure (HF) outcomes, yet patients with HF are often frail and socially isolated, factors that may limit their ability to manage self-care and access clinic-based services. Mobilizing peer support among HF patients is a promising strategy to improve self-management support. In this pilot, the authors evaluated the feasibility and acceptability of an interactive voice response (IVR)-based platform to facilitate telephone peer support among older adults with HF. Participants completed a baseline survey, were offered a 3-hour training session in peer communication skills, and were paired with another patient who had HF. Participants were asked to contact their partner weekly using a toll-free IVR phone system that protected their anonymity and provided automated reminders if contacts were not made. Times and duration of participants' telephone contacts were monitored and recorded. After the 7-week intervention, participants completed surveys and brief face-to-face interviews. The authors found high levels of use and satisfaction and improvements in depressive symptoms among the 20 pilot study participants. An IVR peer-support intervention is feasible, is acceptable to patients, and may have positive effects on patients' HF social support and health outcomes, in conjunction with structured health system support, that warrant more rigorous evaluation in a randomized trial. [source]

A case study of shell at Sakhalin: having a whale of a time?

CORPORATE SOCIAL RESPONSIBILITY AND ENVIRONMENTAL MANAGEMENT, Issue 3 2008
Subhasis Ray
Abstract This is a case study on the world's largest oil and gas project, at the Sakhalin Islands, Russia. Shell is the key promoter of this project. The case highlights the sustainability challenges that Shell faced when working on the mega-project. By their very nature, all such projects involve disruptions in the environmental and social fabric of the project site. NGOs often take up these issues and create international headlines, bringing pressure on the management team. The Russian government also changed its stand over a period of time. While many of these issues are valid in their own way, they often create managerial dilemmas. Traditional management approaches to community development and environmental conservation fell short of stakeholder expectations at Sakhalin. The issue of saving around 100 endangered whales put a cloud of doubt over this $20 billion project. The case highlights strategic issues involved in crafting sustainability strategies at mega-projects, possible pitfalls and the challenge of balancing project execution and stakeholder commitments against an unstable political backdrop. As Shell plans to start many exploration projects in bio-diversity rich parts of the world, the Sakhalin project acts as a pilot to and reminder of social responsibility challenges to big multi-nationals. Copyright © 2007 John Wiley & Sons, Ltd and ERP Environment. [source]

Evaluating social performance in the context of an ,audit culture': a pilot social review of a gold mine in Papua New Guinea

CORPORATE SOCIAL RESPONSIBILITY AND ENVIRONMENTAL MANAGEMENT, Issue 2 2008
Martha Macintyre
Abstract The growth of sustainable development frameworks that emphasize the social dimension has created a need for new approaches to evaluate social performance. The paper describes the design and pilot of a social review conducted at the Lihir Gold Mine in Papua New Guinea. The aim was to investigate more integrated measures , understood as combining qualitative and quantitative measures, and bridging international and local community standards , of social performance. The paper discusses the demands of time and resources placed on a range of stakeholders as part of a review. It then identifies impediments to developing integrated approaches, and analyses these with reference to Power's (1999, 2003) discussion of an emerging audit culture, which focuses on management systems rather than first-order questions of quality and performance. The authors conclude that, while an audit culture influenced this pilot study, an integrated approach on these two dimensions remains an achievable goal. Copyright © 2007 John Wiley & Sons, Ltd and ERP Environment. [source]

P-11 THE IMPACT OF INTRODUCING LIQUID BASED CYTOLOGY INTO A ROUTINE SCREENING LABORATORY

CYTOPATHOLOGY, Issue 2006
L. Gregory
With the exception of information from the liquid based cytology (LBC) pilot site there has been limited data to date on the impact of the introduction of SurePathÔ LBC in the NHSCSP. We will present data to show the impact on a medium sized laboratory (42 000 requests per annum) over the first phases of rollout. Data from before, during and post conversion, a period of 28 months, shows the following trends: (1) A significant fall in the inadequate rate (2) A slight decrease in the borderline / mild dyskaryosis rate (3) A small increase in the high-grade squamous dyskaryosis reporting rate (4) An increase in both the number and specificity of glandular lesions reported (5) A largely unchanged positive predictive value for high-grade abnormalities (6) A significant increase in laboratory productivity, unrelated to inadequate rate but through increased speed of screening. Although our experience is not directly comparable to the experience of the LBC pilot, our observations may well reflect that we were fortunate to be trained by staff from one of the LBC sites and thereby benefited directly from their experience. [source]

Diagnosis of Nonmelanoma Skin Cancer/Keratinocyte Carcinoma: A Review of Diagnostic Accuracy of Nonmelanoma Skin Cancer Diagnostic Tests and Technologies

DERMATOLOGIC SURGERY, Issue 10 2007
METTE MOGENSEN MD
BACKGROUND Nonmelanoma skin cancer (NMSC) is the most prevalent cancer in the light-skinned population. Noninvasive treatment is increasingly used for NMSC patients with superficial lesions, making the development of noninvasive diagnostic technologies highly relevant. OBJECTIVE The scope of this review is to present data on the current state-of-the-art diagnostic methods for keratinocyte carcinoma: basal cell carcinoma, squamous cell carcinoma, and actinic keratosis. METHODS AND MATERIALS MEDLINE, BIOSIS, and EMBASE searches on NMSC and physical and clinical examination, biopsy, molecular marker, ultrasonography, Doppler, optical coherence tomography, dermoscopy, spectroscopy, fluorescence imaging, confocal microscopy, positron emission tomography, computed tomography, magnetic resonance imaging, terahertz imaging, electrical impedance and sensitivity, specificity, and diagnostic accuracy. RESULTS State-of-the-art diagnostic research has been limited in this field, but encouraging results from the reviewed diagnostic trials have suggested a high diagnostic accuracy for many of the technologies. Most of the studies, however, were pilot or small studies and the results would need to be validated in larger trials. CONCLUSIONS Some of these new imaging technologies have the capability of providing new, three-dimensional in vivo, in situ understanding of NMSC development over time. Some of the new technologies described here have the potential to make it from the bench to the clinic. [source]

A pilot randomized trial in primary care to investigate and improve knowledge, awareness and self-management among South Asians with diabetes in Manchester

DIABETIC MEDICINE, Issue 12 2003
A. Vyas
Abstract Aims To investigate whether a secondary,primary care partnership education package could improve understanding of diabetes care among South Asians. Methods In a pilot randomized controlled trial, in the setting of eight general practices randomized to intervention or control, patients were invited to four or more rotating visits per year by one of a diabetes specialist nurse, dietician or chiropodist working with general practice staff. Participants were from lists of South Asian patients with known Type 2 diabetes in each (general) practice. Results Patients and practice scores at baseline and 1-year follow-up, from an interview using a questionnaire on knowledge, awareness and self-management of diabetes. Responses were developed into educational packages used during intervention. Of the 411 patients listed at baseline only 211 were traced for interview (refusal only 4%). Mean age was 55.4 years, age of diabetes onset 47.1 years. Fourteen percent were employed and 35% were able to communicate in English fluently. Only 118 could be traced and interviewed at 1 year, although there was no significant difference in demography between those who completed the study and those who did not. Despite a mean of four visits/patient, intervention had no impact on scores for diabetes knowledge, or awareness [score change 0.14, 95% confidence interval (CI) ,0.20, 0.49] or self-management (,0.05, 95% CI ,0.48, 0.39) between baseline and 1 year. Conclusions This form of secondary/primary care support did not transfer information effectively, and we suspect similar problems would arise in other similar communities. Different methods of clinician/patient information exchange need to be developed for diabetes in this South Asian group. [source]

Other people, other drugs: the policy response to petrol sniffing among Indigenous Australians

DRUG AND ALCOHOL REVIEW, Issue 3 2004
Dr PETER H. D'ABBS
Abstract This paper examines the policy response of Australian governments to petrol sniffing in Indigenous communities from the 1980s until the present. During this period, despite the formation of numerous inquiries, working parties and intergovernmental committees, there has been little accumulation of knowledge about the nature and causes of sniffing, or about the effectiveness of interventions. Policies are fragmentary; programmes are rarely evaluated, and most rely on short-term funding. The paper sets out to explain why this should be so. It draws upon a conceptual framework known as ,analytics of government' to examine the ways in which petrol sniffing comes to the attention of government agencies and is perceived as an issue; the mechanisms deployed by governments to address petrol sniffing; ways in which knowledge about sniffing is generated; and the underlying assumptions about people that inform policy-making. Drawing upon case studies of policy responses, the paper argues that a number of structural factors combine to marginalize petrol sniffing as an issue, and to encourage reliance on short-term, one-off interventions in place of a sustained policy commitment. Four recommendations are advanced to help overcome these factors: (1) agreements should be reached within and between levels of government on steps to be taken to reduce risk factors before the eruption of petrol-sniffing crises; (2) the evidence base relevant to petrol sniffing (and other inhalants) should be improved by funding and directing one or more existing national drug research centres to collate data on inhalant-caused mortality and morbidity, and to conduct or commission research into prevalence patterns, effectiveness of interventions and other gaps in knowledge; (3) the current pattern of short-term, pilot and project funding should be replaced with longer-term, evidence-based interventions that address the multiple risk and protective factors present in communities; and (4) insistence by governments that communities must take ,ownership' of the problem should be replaced by a commitment to genuine partnerships involving governments, non-government and community sectors. [source]

The impact of a supervised injecting facility on ambulance call-outs in Sydney, Australia

ADDICTION, Issue 4 2010
Allison M. Salmon
ABSTRACT Aims Supervised injecting facilities (SIFs) are effective in reducing the harms associated with injecting drug use among their clientele, but do SIFs ease the burden on ambulance services of attending to overdoses in the community? This study addresses this question, which is yet to be answered, in the growing body of international evidence supporting SIFs efficacy. Design Ecological study of patterns in ambulance attendances at opioid-related overdoses, before and after the opening of a SIF in Sydney, Australia. Setting A SIF opened as a pilot in Sydney's ,red light' district with the aim of accommodating a high throughput of injecting drug users (IDUs) for supervised injecting episodes, recovery and the management of overdoses. Measurements A total of 20 409 ambulance attendances at opioid-related overdoses before and after the opening of the Sydney SIF. Average monthly ambulance attendances at suspected opioid-related overdoses, before (36 months) and after (60 months) the opening of the Sydney Medically Supervised Injecting Centre (MSIC), in the vicinity of the centre and in the rest of New South Wales (NSW). Results The burden on ambulance services of attending to opioid-related overdoses declined significantly in the vicinity of the Sydney SIF after it opened, compared to the rest of NSW. This effect was greatest during operating hours and in the immediate MSIC area, suggesting that SIFs may be most effective in reducing the impact of opioid-related overdose in their immediate vicinity. Conclusions By providing environments in which IDUs receive supervised injection and overdose management and education SIF can reduce the demand for ambulance services, thereby freeing them to attend other medical emergencies within the community. [source]

A pilot study comparing a type 1 nurse-led diabetes clinic with a conventional doctor-led diabetes clinic

EUROPEAN DIABETES NURSING, Issue 1 2004
J Charlton Diabetes Nurse Specialist
Abstract A prospective comparative pilot study was designed to assess and compare care delivered by a diabetes specialist nurse (DSN) and standard doctor-led care for patients with type 1 diabetes. The philosophy was to provide an individualised, patient-centred, lifestyle-based approach. In all, 60 patients with type 1 diabetes were randomised to either the nurse-led clinic (NLC) or a conventional clinic. NLC patients received medical input during their annual screening appointment. In the nurse-led system patients prioritised relevant issues with the aid of a ,Waiting Area Menu'. The menu consisted of pertinent topics relevant to living with diabetes. Care interventions were then agreed and targets discussed. To date the results of DSN intervention include: 60% of patients changing to a more appropriate insulin regimen; 36% changing equipment following update from the DSN; 20% needing initiation of cardiovascular medication; and 26% being referred to other health care professionals. The mean HbA1c changed by -0.25% in the NLC group and by -0.06% in the control group (ns). During the pilot there were several barriers which we had not anticipated. These included staffing resources, and organisational and time management issues. However, feedback from patient questionnaires demonstrated that the majority of patients preferred the NLC. Copyright © 2004 FEND. [source]

Getting better byte by byte: a pilot randomised controlled trial of email therapy for bulimia nervosa and binge eating disorder,

EUROPEAN EATING DISORDERS REVIEW, Issue 2 2008
Paul Robinson
Abstract One hundred and ten people in an university population responded to emailed eating disorder questionnaires. Ninty-seven fulfilling criteria for eating disorders (bulimia nervosa (BN), binge eating disorder (BED), EDNOS) were randomised to therapist administered email bulimia therapy (eBT), unsupported Self directed writing (SDW) or Waiting list control (WLC). Measures were repeated at 3 months. Diagnosis, Beck depression inventory (BDI) and Bulimia investigatory test (BITE) scores were recorded. Follow-up rate was 63% and results must be interpreted cautiously. However significantly fewer participants who had received eBT or SDW fulfilled criteria for eating disorders at follow up compared to WLC. There was no significant difference between eBT and SDW in the analysis of variance (ANOVA), although in separate analyses, eBT was significantly superior to WLC (p,<,0.02) and the difference for SDW approached significance (p,=,0.06). BDI and BITE scores showed no significant change. For eBT participants there was a significant positive correlation between words written and improvement in BITE severity score. BN, BED and EDNOS can be treated via email. Copyright © 2007 John Wiley & Sons, Ltd and Eating Disorders Association. [source]

The impact of a motivational assessment interview on initial response to treatment in adolescent anorexia nervosa

EUROPEAN EATING DISORDERS REVIEW, Issue 2 2004
S. G. Gowers
Abstract This study was a pilot for a larger study to evaluate a time-limited outpatient programme for adolescent anorexia nervosa, to explore the ability of an assessment interview to change self-reported motivation and ascertain the extent to which this predicted engagement with treatment and early behavioural change. Forty-two adolescents with anorexia nervosa rated their motivation for change before and after attending a new-style assessment interview. Initial (6 week) effectiveness of the programme was evaluated by measuring engagement with treatment, weight change, clinician (HoNOSCA) and self-rated (EDI, MFQ, HoNOSCA-SR) outcome measures, overall and in relation to motivational status. The assessment interview significantly improved motivation. Motivational category after interview was unrelated to physical status, cognition or general functioning but predicted engagement with treatment. Whilst for the whole sample, treatment produced physical, cognitive and general improvements at 6 weeks, motivational status was a powerful predictor of weight gain. A client-centred assessment interview engaged 80% in an outpatient programme based on CBT. Motivational enhancement may improve engagement and specifically result in behavioural change and early weight gain. Copyright © 2004 John Wiley & Sons, Ltd and Eating Disorders Association. [source]

Rethinking the OSCE as a Tool for National Competency Evaluation

EUROPEAN JOURNAL OF DENTAL EDUCATION, Issue 2 2004
M. A. Boyd
The relatively recent curriculum change to Problem-Based Learning/Case-Based Education has stimulated the development of new evaluation tools for student assessment. The Objective Structured Clinical Examination (OSCE) has become a popular method for such assessment. The National Dental Examining Board of Canada (NDEB) began using an OSCE format as part of the national certification testing process for licensure of beginning dentists in Canada in 1996. The OSCE has been well received by provincial licensing authorities, dental schools and students. ,Hands on' clinical competency is trusted to the dental programs and verified through NDEB participation in the Accreditation process. The desire to refine the OCSE has resulted in the development of a new format. Previously OSCE stations consisted of case-based materials and related multiple-choice questions. The new format has case-based material with an extended match presentation. Candidates ,select one or more correct answers' from a group of up to15 options. The blueprint is referenced to the national competencies for beginning practitioners in Canada. This new format will be available to students on the NDEB website for information and study purposes. Question stems and options will remain constant. Case histories and case materials will change each year. This new OSCE will be easier to administer and be less expensive in terms of test development. Reliability and validity is enhanced by involving content experts from all faculties in test development, by having the OSCE verified by general practitioners and by making the format available to candidates. The new OSCE will be pilot tested in September 2004. Examples will be provided for information and discussion. [source]

Chronic high dose transdermal nicotine in Parkinson's disease: an open trial

EUROPEAN JOURNAL OF NEUROLOGY, Issue 12 2007
G. Villafane
Whether nicotine has therapeutic effects on Parkinson's disease (PD) symptoms is controversial, but high doses and chronic treatment have never been tested. We report the results of a pilot, open-label trial to assess the safety and possible efficacy of chronic high doses of nicotine. Six patients with advanced idiopathic PD received increasing daily doses of transdermal nicotine up to 105 mg/day over 17 weeks. All patients but one accepted the target dose. Nausea and vomiting were frequent but moderate, and occurred in most of the patients (four of six) who received over 90 mg/day and 14 weeks of nicotine treatment. During the plateau phase, patients improved their motor scores and dopaminergic treatment was reduced. These results confirm the feasibility of chronic high dose nicotinic treatment in PD but warrant validation of the beneficial effects by a randomized controlled trial. [source]

The piloted transition to flaming in smoldering fire retarded and non-fire retarded polyurethane foam

FIRE AND MATERIALS, Issue 8 2008
Olivier M. Putzeys
Abstract The piloted transition from smoldering to flaming, though a significant fire safety concern, has not been previously extensively studied. Experimental results are presented on the piloted transition from smoldering to flaming in non-fire retarded (NFR) polyurethane foam and the fire retarded polyurethane foam Pyrell®. The samples are small blocks, vertically placed in the wall of an upward wind tunnel. The free surface is exposed to an oxidizer flow and a radiant heat flux. The smolder product gases pass upwards through a pilot. The experiments on NFR foam show that the smolder velocity and peak smolder temperature, which increase with the oxygen concentration and heat flux, are strongly correlated to the transition to flaming event, in that there are minimum values of these parameters for transition to occur. The existence of a minimum smolder velocity for ignition supports the concept of a gaseous mixture reaching a lean flammability limit as the criterion for the transition to flaming. To compensate for the solid- and gas-phase effects of the fire retardants on the piloted transition in Pyrell, it was necessary to increase the oxygen concentration and the power supplied to the smolder igniter and the pilot. The piloted transition is observed in oxygen concentrations above 17% in NFR foam and above 23% in Pyrell. The results show that although Pyrell is less flammable than NFR foam, it is still susceptible to smoldering and the piloted transition to flaming in oxygen-enriched environments, which is of interest for special applications such as future space missions. Copyright © 2008 John Wiley & Sons, Ltd. [source]

A pilot randomised controlled trial comparing different frequencies of acupuncture for chronic low back pain

FOCUS ON ALTERNATIVE AND COMPLEMENTARY THERAPIES AN EVIDENCE-BASED APPROACH, Issue 2006
J Yuan
[source]

Choice of an outcome measure for a pilot randomised controlled trial into the treatment by herbal practitioners of symptoms associated with the menopause

FOCUS ON ALTERNATIVE AND COMPLEMENTARY THERAPIES AN EVIDENCE-BASED APPROACH, Issue 4 2003
A Denham
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Carrier testing in haemophilia A and B: adult carriers' and their partners' experiences and their views on the testing of young females

HAEMOPHILIA, Issue 3 2008
N. F. DUNN
Summary., This is a descriptive study, which aims to report adult carriers' and their husbands/partners' experiences of carrier diagnosis and their views as to how these issues should be handled for the next generation. Following an initial pilot, 105 carriers and husbands/partners responded to a postal questionnaire. Most of the adult carriers had been tested because either they or their parents wanted to know their carrier status or they had a son diagnosed with haemophilia. The respondents agreed that the main reasons for testing young potential carriers should be either a family history of severe haemophilia or that the young person or her parents wanted to know her status. Forty per cent (35/87) believed the earliest age for carrier testing should be 0,9 years, 44% (38/87) 10,15 years and 16% (14/87) ,16 years. Respondents aged 18,39 years were more likely to be in favour of testing <2 years. If parents and teenagers disagreed, the majority of parents thought that a test should not be forced, consent refused or results withheld. Genetic counselling provides an important opportunity for parents, who want a very early genetic test, to explore their motivations and balance their desire to prepare and protect their daughter with her right to decide as a teenager. [source]