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Selected AbstractsPaediatric emergency guidelines: Could one size fit all?EMERGENCY MEDICINE AUSTRALASIA, Issue 1 2009Sarah Dalton Abstract Objectives: The development of clinical practice guidelines (CPG) is a core task in EDs and CPGs are widely used. The process of CPGs development in Australian and New Zealand ED is unknown. We aim to describe this process in paediatric EDs and examine the feasibility of developing collaborative guidelines. Methods: A piloted questionnaire regarding CPG development, dissemination, implementation and evaluation was circulated to all 13 Paediatric Research in Emergency Departments International Collaborative (PREDICT) sites. Specific questions regarding feasibility of combined guidelines were included. Results: All PREDICT EDs participated in the survey. All used CPGs in EDs and 12/13 had ED-specific guidelines. EDs had an average of 77 guidelines with approximately 5 new guidelines generated annually. Staff at most sites (10/13) also accessed guidelines from external sources. Most hospitals (10/13) had a guideline committee, generally comprising of senior ED and general paediatric staff. Guidelines were usually written by committee members and 10/13 hospitals adopted modified external guidelines. An average committee met six times a year for 90 min and involved seven clinicians. Most sites did not have a project manager or dedicated secretarial support. Few hospitals included literature references (3/13) or levels of evidence (1/13) in their guidelines. Most did not consider implementation, evaluation or teaching packages. Most sites (10/13) supported the development of collaborative guidelines. Conclusions: Paediatric EDs expend significant resources to develop CPGs. Collaborative guidelines would likely decrease duplication of effort and increase the number of available, current and evidence-based CPGs. [source] Level of Concern and Precaution Taking Among Australians Regarding Travel During Pandemic (H1N1) 2009: Results From the 2009 Queensland Social SurveyJOURNAL OF TRAVEL MEDICINE, Issue 5 2010FACTM, FAFPHM, FFTM ACTM, FFTM RCPSG, Peter A. Leggat MD Background. Global disease outbreaks, such as the recent Pandemic (H1N1) 2009 (the so-called Swine flu), may have an impact on travel, including raising the concerns of travelers. The objective of this study was to examine the level of concern of Australians regarding travel during Pandemic (H1N1) 2009 and how this impacted on their travel. Methods. Data were collected by interviews as part of the Queensland Social Survey (QSS) 2009. Specific questions were incorporated regarding travel and Pandemic (H1N1) 2009. Multivariate logistic regression was used to analyze associations between demographic variables and concern and likelihood of cancelling travel. Results. There were 1,292 respondents (41.5% response rate). The sample was nearly equally divided between males and females (50.2% vs 49.8%). Younger people (18,34 y) were under-represented in the sample; older people (>55y) were over-represented in the sample. About half (53.2%) of respondents indicated some level of concern about Pandemic (H1N1) 2009 when traveling and just over one-third (35.5%) indicated they would likely cancel their air travel if they had a cough and fever that lasted more than one day. When cross-tabulating these responses, people who expressed concern regarding Pandemic (H1N1) 2009 when they traveled were more likely than those without concern to cancel their air travel if they had a cough and fever lasting more than one day (44.7% vs 27.7%, ,2 = 33.53, p < 0.001). People with higher levels of education [adjusted odds ratio (AOR): 0.651], people with higher incomes (AOR: 0.528) and people living outside of metropolitan Southeast Queensland (AOR: 0.589) were less likely to be concerned about Pandemic (H1N1) 2009 when traveling, and younger people (AOR: 0.469) were less likely than others to cancel travel if they had a cough and fever. Conclusions. Pandemic (H1N1) 2009 was of some concern to more than half of Queensland travelers. None-the-less, the majority of Queenslanders would not have postponed their own travel, even if they exhibited symptoms consistent with Pandemic (H1N1) 2009. [source] The gestational timing of pregnancy loss: Adaptive strategy?,AMERICAN JOURNAL OF HUMAN BIOLOGY, Issue 6 2009Donna Day Baird This commentary links early pregnancy milestones (rescue of the corpus luteum, the luteal-placental shift, and blocking of the spiral arteries) with the pattern of gestation-specific pregnancy loss in humans. The objective is to describe the pattern and present an adaptive hypothesis: that high first trimester pregnancy loss results from selection to reduce the risk of maternal morbidity and mortality associated with human delivery. Specific questions within the broad framework of this hypothesis can be addressed with research in comparative physiology and endocrinology. Am. J. Hum. Biol., 2009. Published 2009 Wiley-Liss, Inc. [source] The Mechanism of Hearing Loss in Paget's Disease of Bone,THE LARYNGOSCOPE, Issue 4 2004Edwin M. Monsell MD Abstract Objectives/Hypothesis The mechanism of hearing loss (HL) in Paget's disease of bone was investigated. The present study was a systematic, prospective, controlled set of clinical investigations to test the hypothesis that there is a general underlying mechanism of HL in Paget's disease of bone and to gain additional insights into the auditory and otologic dynamics of this disease. Specific questions were 1) whether the mechanism is cochlear or retrocochlear and 2) whether the bone mineral density of the cochlear capsule is related to hearing levels. Study Design Several double-blinded, cross-sectional, prospective, correlational studies were conducted in a population of elderly human subjects with skull involvement with Paget's disease versus a control population of elderly subjects free of Paget's disease. Demographic and clinical data were recorded. Longitudinal observations were made in subjects under treatment. Methods Subjects were recruited from a Paget's disease clinic. Pure-tone auditory thresholds, word recognition, and auditory brainstem responses (ABRs) were recorded. The dimensions of the internal auditory canals were measured using computed tomographic (CT) images and digital image analysis. The precision, accuracy, and temporal stability of methods to measure the bone mineral density of the cochlear capsule and an adjacent area of nonotic capsule bone were validated and applied. Correlations were sought between hearing levels and cochlear capsule bone mineral density. Results ABRs were recorded in 64 ears with radiographically confirmed Paget's disease involving the skull. Responses were absent in eight ears, all of which had elevated high pure-tone thresholds. ABRs were interpreted as normal in 56 ears; none were abnormal. The mid-length diameter and minimum diameter of the internal auditory canal of 68 temporal bones from subjects with Paget's disease were found to have no statistically significant relationship to hearing thresholds. The Pearson product-moment correlation coefficients (age- and sex-adjusted) in the group with Paget's disease involving the temporal bone were ,0.63 for left ears and ,0.73 for right ears for high-frequency air conduction pure-tone thresholds (mean of 1, 2, and 4 kHz) versus cochlear capsule density. Correlation coefficients (age- and sex-adjusted) between cochlear capsule density and air-bone gap (mean at 0.5 and 1 kHz) for the affected group were ,0.67 for left ears and ,0.63 for right ears. All correlations between hearing thresholds and cochlear capsule density in pagetic subjects were significant at P < .001. The regressions were consistent throughout the ranges of hearing level. There were no significant correlations between cochlear capsule mean density and hearing level in the volunteer subjects. Conclusions The evidence supports the existence of a general, underlying, cochlear mechanism of pagetic HL that is closely related to loss of bone mineral density in the cochlear capsule. This mechanism accounts well for both the high-frequency sensorineural HL and the air-bone gap. Early identification, radiographic diagnosis of temporal bone involvement, and vigorous treatment with third-generation bisphosponates are important to limit the development and progression of pagetic HL. [source] An Empirical Study of the Effect of Knowledge Management Processes at Individual, Group, and Organizational Levels,DECISION SCIENCES, Issue 2 2003Rajiv Sabherwal ABSTRACT To enhance our understanding of knowledge management, this paper focuses on a specific question: How do knowledge management processes influence perceived knowledge management effectiveness? Prior literature is used to develop the research model, including hypotheses about the effects of four knowledge management processes (internalization, externalization, socialization, and combination) on perceived individual-level, group-level, and organizational-level knowledge management effectiveness. The study was conducted at the John F. Kennedy Space Center of the National Aeronautics and Space Administration using a survey of 159 individuals and two rounds of personal interviews. Structural equation modeling was performed to test measurement and structural models using the survey data. The emergent model suggests that internalization and externalization impact perceived effectiveness of individual-level knowledge management. Socialization and combination influence perceived effectiveness of knowledge management at group and organizational levels, respectively. The results also support the expected upward impact in perceived effectiveness of knowledge management, from individual to group level, as well as from group level to organizational level. The study's limitations and implications for practice and future research are described. [source] A Delphi survey of evidence-based nursing priorities in Hong KongJOURNAL OF NURSING MANAGEMENT, Issue 5 2002C PSYCHOL, Peter French PhD The purpose of this study was to inform an evidence-based nursing development project within the Hospital Authority, Hong Kong. It considered the specific question of: what are the nursing practice issues which need to be addressed as a matter of priority in order to improve nursing practice, the quality of care or develop some aspect of nursing practice. A three round Delphi survey was adopted. The methodological problems associated with the use of the Delphi method are addressed. An expert panel consisting of 190 Department Operations Managers (nurses) was identified. The data collection focused on issues related to nursing skills and client care and excluded management or educational issues. Agreed categories were prioritized in the final round by utilizing a 11-point rating scale. The group mean score for each category was calculated and rank ordered. The results provided 45 categories that reflected the nursing practice priorities that required more research evidence to guide practice. The top five ranked items were: nurse patient communication, resuscitation, administration of medicines, counselling and nursing documentation. The top 10 items were used to inform the advisory and selection processes for the evidence-based practice development project. [source] End-of-life care in Italy: personal experience of family caregivers.PSYCHO-ONCOLOGY, Issue 11 2008A content analysis of open questions from the Italian Survey of the Dying of Cancer (ISDOC) Abstract Objective: This study aims at describing the emotional and practical experience of a representative sample of Italian non-professional caregivers when caring for a terminally ill family member and is part of the ,Italian Survey of the Dying of Cancer', which involved 2000 adult cancer deaths representative of the whole country. Methods: Information on patients' experience was gathered from non-professional caregivers by an interview. A specific question was asked about the caregivers' emotional and practical experiences while assisting a terminally ill relative. A content analysis of the open question on caregivers' perceptions was performed on transcribed answers. Three researchers independently generated categories. Subsequently, areas where they differed were reconsidered and an interpretation was agreed upon. Results: Valid interviews were obtained from 1231 non-professional caregivers. Answers were classified according to the perception of the experience as positive (33.1%), negative (65.1%) or neutral (1.8%). Conclusion: Assisting a family member with cancer in his/her last three months of life is a very strong physical and mental stress for the caregiver. In some cases, this experience is nevertheless perceived as an evolution chance. Health-care providers should need to develop programs to ensure that family caregivers' needs for information and support are given great importance. Copyright © 2008 John Wiley & Sons, Ltd. [source] Quantifying the condition of Hawaiian coral reefsAQUATIC CONSERVATION: MARINE AND FRESHWATER ECOSYSTEMS, Issue 1 2010Ku'ulei S. Rodgers Abstract (1)This investigation developed and tested descriptive models designed to evaluate coral reef ecological condition based on data developed using the basic techniques most often used in coral reef surveys. (2)Forty-three variables at 184 stations were analysed in order to identify specific factors that are useful metrics for describing reef condition. (3)The common practice of using ,reference sites' for paired site comparisons was evaluated by developing a reference site model (RSM). This use of reference sites proved to be subjective and unreliable, especially when multiple factors and multiple sites are involved. However, in some cases the RSM is appropriate in demonstrating severe degradation based on factors such as sediment, coral cover and fish abundance. (4)An objective ecological gradient model (EGM) was developed based on a wide range of metrics at numerous sites. A computer program was developed that allows a quantitative ranking of reef condition along a continuum and can be used to compare reefs across a wide range of conditions. Further, this approach permits the operator to alter and define criteria appropriate to a specific question. (5)Results of this investigation provide ecological insights into the importance of natural and anthropogenic ecological factors in determining coral reef condition. Copyright © 2009 John Wiley & Sons, Ltd. [source] Optimization of an enrichment process for circulating tumor cells from the blood of head and neck cancer patients through depletion of normal cellsBIOTECHNOLOGY & BIOENGINEERING, Issue 2 2009Liying Yang Abstract The optimization of a purely negative depletion, enrichment process for circulating tumor cells (CTCs) in the peripheral blood of head and neck cancer patients is presented. The enrichment process uses a red cell lysis step followed by immunomagnetic labeling, and subsequent depletion, of CD45 positive cells. A number of relevant variables are quantified, or attempted to be quantified, which control the performance of the enrichment process. Six different immunomagnetic labeling combinations were evaluated as well as the significant difference in performance with respect to the blood source: buffy coats purchased from the Red Cross, fresh, peripheral blood from normal donors, and fresh peripheral blood from human cancer patients. After optimization, the process is able to reduce the number of normal blood cells in a cancer patient's blood from 4.05,×,109 to 8.04,×,103 cells/mL and still recover, on average, 2.32 CTC per mL of blood. For all of the cancer patient blood samples tested in which CTC were detected (20 out of 26 patients) the average recovery of CTCs was 21.7 per mL of blood, with a range of 282 to 0.53 CTC. Since the initial number of CTC in a patient's blood is unknown, and most probably varies from patient to patient, the recovery of the CTC is unknown. However, spiking studies of a cancer cell line into normal blood, and subsequent enrichment using the optimized protocol indicated an average recovery of approximately 83%. Unlike a majority of other published studies, this study focused on quantifying as many factors as possible to facilitate both the optimization of the process as well as provide information for current and future performance comparisons. The authors are not aware any other reported study which has achieved the performance reported here (a 5.66 log10) in a purely negative enrichment mode of operation. Such a mode of operation of an enrichment process provides significant flexibility in that it has no bias with respect to what attributes define a CTC; thereby allowing the researcher or clinician to use any maker they choose to define whether the final, enrich product contains CTCs or other cell type relevant to the specific question (i.e., does the CTC have predominately epithelial or mesenchymal characteristics?). Biotechnol. Bioeng. 2009;102: 521,534. © 2008 Wiley Periodicals, Inc. [source] What do they know?: a content analysis of women's perceptions of trial informationBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 12 2004Sara Kenyon Objective To examine interpretations of study information by women participating in ORACLE, a trial of antibiotics in preterm labour. Design Questionnaire survey sent to women recruited to the ORACLE trial. Setting United Kingdom. Population A questionnaire was sent to 3074 ORACLE participants in a purposively selected sample of 55 collaborating maternity units, chosen to reflect a range of regions and of district general and teaching hospitals. Methods Content analysis was applied to verbatim text provided in response to an open question. Responses were also compared with a framework based on key points about the purpose of ORACLE. Closed questions were analysed using descriptive statistics. Main outcome measures Participants' interpretations of the purpose of the study. Results A response rate of 61% was achieved, and 1462 participants provided written answers to a specific question on why the study was being carried out. Content analysis suggested that the information leaflet was highly valued as a source of information about the trial. There was evidence that women's interpretations of the purpose of the trial were not identical to those that the investigators intended. Of the five key points about the trial described in the information leaflet, 400 (27%) participants reported one key point, 550 (38%) two key points, 229 (16%) three key points and 23 (1.5%) four key points. None reported five key points and it was not possible to classify 46 responses (3%). Vague, confused understanding or poor recall were evident in 204 (14%) of responses. Conclusion Although the ORACLE trial was run as a model of good practice at the time, this study suggests that it may not be possible to demonstrate full understanding of trial purpose and design by all participants. Emphasis should be on the provision of full information that involves consumers in its design and evaluation. [source] Facets on the psychopathy checklist screening version and instrumental violence in forensic psychiatric patientsCRIMINAL BEHAVIOUR AND MENTAL HEALTH, Issue 4 2010Jenny Laurell Background,There is a recognised relationship between psychopathy and instrumental violence, but not all violence by people who meet the criteria for psychopathy is instrumental. Aims,Our aims were to compare offence types among forensic psychiatric patients with and without the Psychopathy Checklist: Screening Version (PCL: SV) criteria for psychopathy. Our specific questions were whether factor 1 , the interpersonal affective dimension , was related to instrumentality and on severity of the violent crime. Our hypothesis was that the relationship between psychopathy and instrumental violence would be dependent on the severity of the violent crime. Methods,Sixty-five male patients at the forensic psychiatric hospital in Sundsvall, all with a violent criminal history, were assessed for psychopathy through interview and records using the PCL: SV. Severity and the instrumentality of their previous violence were coded using the Cornell coding guide for violent incidents. Results,The interpersonal features of psychopathy (the interpersonal facet), and only the interpersonal features were significantly associated with instrumentality and severity of violence. Instrumentality was also significantly related to the severity of the violence, independent of psychopathy score. Conclusions,The results indicated that, at least among forensic psychiatric patients, planning is more likely than not with respect to serious crimes. The specific link between interpersonal features of psychopathy and instrumental and severe violence suggests potential clinical value in recognising subtypes of psychopathy. Copyright © 2010 John Wiley & Sons, Ltd. [source] Does PTSD occur in sentenced prison populations?CRIMINAL BEHAVIOUR AND MENTAL HEALTH, Issue 3 2007A 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] Numerical evaluation of the damping-solvent extraction method in the frequency domainEARTHQUAKE ENGINEERING AND STRUCTURAL DYNAMICS, Issue 6 2002Ushnish Basu Abstract The damping-solvent extraction method for the analysis of unbounded visco-elastic media is evaluated numerically in the frequency domain in order to investigate the influence of the computational parameters,domain size, amount of artificial damping, and mesh density,on the accuracy of results. An analytical estimate of this influence is presented, and specific questions regarding the influence of the parameters on the results are answered using the analytical estimate and numerical results for two classical problems: the rigid strip and rigid disc footings on a visco-elastic half-space with constant hysteretic material damping. As the domain size is increased, the results become more accurate only at lower frequencies, but are essentially unaffected at higher frequencies. Choosing the domain size to ensure that the static stiffness is computed accurately leads to an unnecessarily large domain for analysis at higher frequencies. The results improve by increasing artificial damping but at a slower rate as the total (material plus artificial) damping ratio ,t gets closer to 0.866. However, the results do not deteriorate significantly for the larger amounts of artificial damping, suggesting that ,t,0.6 is appropriate; a larger value is not likely to influence the accuracy of results. Presented results do not support the earlier suggestion that similar accuracy can be achieved by a large bounded domain with small damping or by a small domain with larger damping. Copyright © 2002 John Wiley & Sons, Ltd. [source] Identification of an osteopontin-like protein in fish associated with mineral formationFEBS JOURNAL, Issue 17 2007Vera G. Fonseca Fish has been recently recognized as a suitable vertebrate model and represents a promising alternative to mammals for studying mechanisms of tissue mineralization and unravelling specific questions related to vertebrate bone formation. The recently developed Sparus aurata (gilthead seabream) osteoblast-like cell line VSa16 was used to construct a cDNA subtractive library aimed at the identification of genes associated with fish tissue mineralization. Suppression subtractive hybridization, combined with mirror orientation selection, identified 194 cDNA clones representing 20 different genes up-regulated during the mineralization of the VSa16 extracellular matrix. One of these genes accounted for 69% of the total number of clones obtained and was later identified as theS. aurata osteopontin-like gene. The 2138-bp full-length S. aurata osteopontin-like cDNA was shown to encode a 374 amino-acid protein containing domains and motifs characteristic of osteopontins, such as an integrin receptor-binding RGD motif, a negatively charged domain and numerous post-translational modifications (e.g. phosphorylations and glycosylations). The common origin of mammalian osteopontin and fish osteopontin-like proteins was indicated through an in silico analysis of available sequences showing similar gene and protein structures and was further demonstrated by their specific expression in mineralized tissues and cell cultures. Accordingly, and given its proven association with mineral formation and its characteristic protein domains, we propose that the fish osteopontin-like protein may play a role in hard tissue mineralization, in a manner similar to osteopontin in higher vertebrates. [source] Does contact dermatitis to fragrances influence the quality of life?FLAVOUR AND FRAGRANCE JOURNAL, Issue 4 2009A descriptive study measuring, comparing the quality of life, skin involvement in patients with contact dermatitis to fragrances Abstract The study of the impact of diseases on individuals' quality of life is an important and useful tool for clinicians, particularly for an efficient follow-up and for the good management of patients suffering from chronic diseases. Contact dermatitis is a common condition in dermatological patients. However, despite efficient screening, the understanding and acceptance of contact allergy remain difficult and avoidance of these allergens is not always possible. The aim of this study was to determine whether contact dermatitis to fragrances affects quality of life and to define whether there is a relationship between the severity of skin involvement and quality of life. To measure the quality of life, we chose the VQ-Dermato (VQ-d) questionnaire, the only valid and reliable questionnaire in French, to which we added 10 non-validated specific questions regarding fragrances. We included patients with pertinent positive patch test reactions to fragrances attending the contact clinic between 1 January 1998 and 30 September 2004. During this time, 2814 patients were patch tested and 310 had positive reactions to the fragrance mix 8% (FM) of the standard series. We recruited non-atopic individuals, exclusively allergic to fragrance mix, with patch test reactions scored ++ and +++; the only additional positive reactions accepted were to balsam of Peru and the patient's own perfumes; 52 patients met these criteria, but only 33 participated. To evaluate the severity of skin involvement, we used the severity scoring of atopic dermatitis (SCORAD index). The quality of life of individuals allergic to fragrances was mostly moderately affected. Patients were more affected psychologically during the first year after the diagnosis of fragrance allergy. Skin reaction during the acute stage of contact allergy to fragrances can be severe. No correlation between VQ-d and SCORAD could be established. It was concluded that there was no severe impact on quality of life because of fragrance contact allergy, but that psychological issues and depression may play an important role in determining the way skin disease affects people. Patch testing improves the quality of life. Lack of correlation between VQ-d and SCORAD demonstrates that an objective measure such as SCORAD may not fully capture the impact of the disease. These results cannot be generalized because of the low response rate and limited sample size. Copyright © 2009 John Wiley & Sons, Ltd. [source] Validity and reliability of the Structured Clinical Interview for Obsessive-Compulsive Spectrum (SCI-OBS) and of the Structured Clinical Interview for Social Phobia Spectrum (SCI-SHY)INTERNATIONAL JOURNAL OF METHODS IN PSYCHIATRIC RESEARCH, Issue 1 2000Liliana Dell'osso Associate Professor of Psychiatry Abstract This paper reports on the psychometric properties of the Structured Clinical Interview for Obsessive-Compulsive Spectrum (SCI-OBS) and the Structured Clinical Interview for Social Phobia Spectrum (SCI-SHY). Interviews were administered to 135 patients with psychiatric disorders and 119 controls. During the same session, subjects were given the Mini International Neuropsychiatric Interview (MINI), the Liebowitz Social Anxiety Scale (LSAS), the Checklist for Obsessions and Compulsions and the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). Patients and raters also answered specific questions on acceptability and usefulness of the interviews. Inter-rater reliability was assessed by administering the interviews to 36 patients with psychiatric disorders and 12 controls. The internal consistency of all domains of the interviews was from moderate to substantial (Kuder-Richardson coefficient >0.60). Discriminant validity was excellent. The concurrent validity of the SCI-SHY versus the LSAS and of the SCI-OBS versus the Checklist for Obsessions and Compulsions was satisfactory. However, no association was found between Y-BOCS and the SCI-OBS domains. Inter-rater reliability was substantial. Both interviews were rated as meaningful and clear by most subjects. Raters' attitudes toward the utility of these interviews for understanding patients and their foreseeable use in their practice varied, but most were in favour of administering them as self-report instruments. Copyright © 2000 Whurr Publishers Ltd. [source] Health Status of Temporary Migrants in Urban Areas in Vietnam1INTERNATIONAL MIGRATION, Issue 4 2007Liem T. Nguyen ABSTRACT The rapid economic growth after economic reform, known in Viet Nam as "Doi Moi", and the growing scope of urban migration raise specific questions for social policy, including migration and health policies. This paper compares issues of health status and its determinants as they affect temporary urban migrants versus permanent urban migrants and non-migrants. The analyses utilize multivariate logistic regression and data from the 1997 Vietnam Migration and Health Survey. The results show that temporary migrants staying in guest houses are most vulnerable to health problems. Though most of them are initially healthier, their reported health deteriorates faster than other groups of urban residents. The findings also present important implications for the current migration and health policies in Vietnam: 1) A special attention should be given to temporary migrants in guest houses; 2) Different priorities in health policy should be applied to different groups of migrants and non-migrants; 3) The current population management policy by registration system needs to be reviewed; 4) Providing clean water is one of the most important ways to improve health of temporary migrants; 5) Targeting educational investments and reducing unemployment would likely to improve overall health; 6) A higher priority on health policies targeting women would likely pay dividends, and; 7) Improving management and collaboration between government offices and interested partners is important to improving health status and reducing inequity. [source] Good Deaths, Bad Deaths, and Preferences for the End of Life: A Qualitative Study of Geriatric OutpatientsJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 9 2002Elizabeth K. Vig MD OBJECTIVES: Patient involvement in decision-making has been advocated to improve the quality of life at the end of life. Although the size of the oldest segment of the population is growing, with greater numbers of older adults facing the end of life, little is known about their preferences for the end of life. This study aimed to explore the attitudes of older adults with medical illness about the end of life, and to investigate whether current values could be extended to end-of-life preferences. DESIGN: Descriptive study with interviews using open- and closed-ended questions. SETTING: Patients attending two university-affiliated geriatric clinics were interviewed in a private conference room near the clinic they attended or in their homes. PARTICIPANTS: Sixteen older men and women identified by their physicians as having nonterminal heart disease or cancer. MEASUREMENTS: The interview contained open-ended questions such as: "What are the most important things in your life right now?" and "What would you consider a good/bad death?" The interview also contained closed-ended questions about symptoms, quality of life, and health status. Additional questions elicited preferences for the end of life, such as location of death and the presence of others. The open-ended questions were tape-recorded, transcribed, and analyzed using qualitative methods. The closed-ended questions were analyzed using descriptive statistics. RESULTS: Patients with heart disease and cancer provided similar responses. Participants' views about good deaths, bad deaths, and end-of-life scenarios were heterogeneous. Each participant voiced a unique combination of themes in describing good and bad deaths. Because each participant described a multifaceted view of a good death, for instance, no theme was mentioned by even half of the participants. Participants provided differing explanations for why given themes contributed to good deaths. Currently valued aspects of life were not easily translated into end-of-life preferences. For example, although the majority of participants identified their family as being important, many gave reasons why they did not want their family members present when they died. CONCLUSIONS: Because of the heterogeneity of views and the difficulty in inferring end-of-life preferences from current values, older adults should be asked not only questions about general values, but also specific questions about their end-of-life choices and the reasons for these choices. A thorough understanding of an individual's end-of-life preferences may help health professionals working with older adults develop patient-centered care plans for the end of life. [source] In Silico Modeling and Simulation of Bone Biology: A ProposalJOURNAL OF BONE AND MINERAL RESEARCH, Issue 7 2005Nadine A Defranoux Abstract Contemporary, computer-based mathematical modeling techniques make it possible to represent complex biological mechanisms in a manner that permits hypothesis testing in silico. This perspective shows how such approaches might be applied to bone remodeling and therapeutic research. Currently, the dominant conceptual model applied in bone research involves the dynamic balance between the continual build-up and breakdown of bone matrix by two cell types, the osteoblasts and osteoclasts, acting together as a coordinated, remodeling unit. This conceptualization has served extraordinarily well as a focal point for understanding how mutations, chemical mediators, and mechanical force, as well as external influences (e.g., drugs, diet) affect bone structure and function. However, the need remains to better understand and predict the consequences of manipulating any single factor, or combination of factors, within the context of this complex system's multiple interacting pathways. Mathematical models are a natural extension of conceptual models, providing dynamic, quantitative descriptions of the relationships among interacting components. This formalization creates the ability to simulate the natural behavior of a system, as well as its modulation by therapeutic or dietetic interventions. A number of mathematical models have been developed to study complex bone functions, but most include only a limited set of biological components needed to address a few specific questions. However, it is possible to develop larger, multiscale models that capture the dynamic interactions of many biological components and relate them to important physiological or pathological outcomes that allow broader study. Examples of such models include Entelos' PhysioLab platforms. These models simulate the dynamic, quantitative interactions among a biological system's biochemicals, cells, tissues, and organs and how they give rise to key physiologic and pathophysiologic outcomes. We propose that a similar predictive, dynamical, multiscale mathematical model of bone remodeling and metabolism would provide a better understanding of the mechanisms governing these phenomena as well as serve as an in silico platform for testing pharmaceutical and clinical interventions on metabolic bone disease. [source] Ecological speciation in marine v. freshwater fishesJOURNAL OF FISH BIOLOGY, Issue 5 2009O. Puebla Absolute barriers to dispersal are not common in marine systems, and the prevalence of planktonic larvae in marine taxa provides potential for gene flow across large geographic distances. These observations raise the fundamental question in marine evolutionary biology as to whether geographic and oceanographic barriers alone can account for the high levels of species diversity observed in marine environments such as coral reefs, or whether marine speciation also operates in the presence of gene flow between diverging populations. In this respect, the ecological hypothesis of speciation, in which reproductive isolation results from divergent or disruptive natural selection, is of particular interest because it may operate in the presence of gene flow. Although important insights into the process of ecological speciation in aquatic environments have been provided by the study of freshwater fishes, comparatively little is known about the possibility of ecological speciation in marine teleosts. In this study, the evidence consistent with different aspects of the ecological hypothesis of speciation is evaluated in marine fishes. Molecular approaches have played a critical role in the development of speciation hypotheses in marine fishes, with a role of ecology suggested by the occurrence of sister clades separated by ecological factors, rapid cladogenesis or the persistence of genetically and ecologically differentiated species in the presence of gene flow. Yet, ecological speciation research in marine fishes is still largely at an exploratory stage. Cases where the major ingredients of ecological speciation, namely a source of natural divergent or disruptive selection, a mechanism of reproductive isolation and a link between the two have been explicitly documented are few. Even in these cases, specific predictions of the ecological hypothesis of speciation remain largely untested. Recent developments in the study of freshwater fishes illustrate the potential for molecular approaches to address specific questions related to the ecological hypothesis of speciation such as the nature of the genes underlying key ecological traits, the magnitude of their effect on phenotype and the mechanisms underlying their differential expression in different ecological contexts. The potential provided by molecular studies is fully realized when they are complemented with alternative (e.g. ecological, theoretical) approaches. [source] Impacts of global change on plant diversity and vice versa: Old and new challenges for vegetation scientistsJOURNAL OF VEGETATION SCIENCE, Issue 6 2005Frank Berendse Abstract. The desire to stop the current dramatic loss of biodiversity has been a major stimulus for many vegetation ecologists to unravel the mechanisms responsible for the coexistence of species. After the Rio Janeiro Convention many ecologists were convinced that nature conservation would gain strong societal support if they could prove that the loss of species would have important negative effects on the ecosystem functions that are relevant to society. I conclude that in order to understand such possible effects, it is necessary to analyse the effects of individual species on those ecosystem processes that we consider to be relevant in the context of specific questions. The great challenge for the near future is to scale the effects of plant species on their local environment up to the level of the whole planet, so that we learn about possible feedbacks that might regulate or destabilize those characteristics of the globe that are essential to our society. [source] Conserving the evolutionary potential of California valley oak (Quercus lobata Née): a multivariate genetic approach to conservation planningMOLECULAR ECOLOGY, Issue 1 2008DELPHINE GRIVET Abstract California valley oak (Quercus lobata Née) is a seriously threatened endemic oak species in California and a keystone species for foothill oak ecosystems. Urban and agricultural development affects a significant fraction of the species' range and predicted climate change is likely to dislocate many current populations. Here, we explore spatial patterns of multivariate genotypes and genetic diversity throughout the range of valley oak to determine whether ongoing and future patterns of habitat loss could threaten the evolutionary potential of the species by eradicating populations of distinctive genetic composition. This manuscript will address three specific questions: (i) What is the spatial genetic structure of the chloroplast and nuclear genetic markers? (ii) What are the geographical trends in the distribution of chloroplast and nuclear genotypes? (iii) Is there any part of the species' range where allelic diversity in either the chloroplast or nuclear genomes is particularly high? We analysed six chloroplast and seven nuclear microsatellite genetic markers of individuals widespread across the valley oak range. We then used a multivariate approach correlating genetic markers and geographical variables through a canonical trend surface analysis, followed by GIS mapping of the significant axes. We visualized population allelic richness spatially with GIS tools to identify regions of high diversity. Our findings, based on the distribution of multivariate genotypes and allelic richness, identify areas with distinctive histories and genetic composition that should be given priority in reserve network design, especially because these areas also overlap with landscape change and little degree of protection. Thus, without a careful preservation plan, valuable evolutionary information will be lost for valley oak. [source] Textual analysis of retired nurses' oral historiesNURSING INQUIRY, Issue 4 2007Barbra Mann Wall This paper considers the use of textual analysis of oral histories as a method for historians of nursing. Fifty-three oral histories of retired nurses in midwestern USA were analyzed for the purpose of historical reconstruction of past education experiences in nursing. Textual analysis was used to determine how nurses made sense of their educational experiences, and it involved gathering data, analyzing the information, and using a different method of interpreting the data. Although the participants responded to specific questions, the oral histories in this study are more than mere answers to the researchers' queries. The participants' memories are narratives that are the joint product of both the historian and the participant. As such, the oral history becomes a text to be stored along with other primary sources for future historians' use. The research also suggests decentering oral histories from an exclusively academic agenda and focusing more on what the participants choose to remember and why they make those choices. [source] Latest news and product developmentsPRESCRIBER, Issue 20 2007Article first published online: 26 NOV 200 GPs and pharmacists to work more closely Closer working between GPs and community and primary-care pharmacists ,could further improve prescribing quality and therapeutic outcomes for patients', according to a report by the London School of Pharmacy and Alliance Boots. The report suggests that the expansion of primary-care centres and the increasing complexity of care they offer mean that community pharmacists will increasingly need to take on some GP roles. It foresees an increase in shared premises and calls for closer interdisciplinary working between GPs, pharmacists and nurses. Variation in PCT commissioning of enhanced services from pharmacies has resulted in ,a fragmented system of postcode pharmaceutical care rationing'. Full read-write access to patients' records will be essential if the benefits of electronic prescribing are to be realised. How pharmacists can support commissioners The NHS Alliance and Primary Care Pharmacists' Association have published a guide for practice-based commissioners on making the most of primary-care pharmacists. Prescribing Support and Prescribing Advice for Practice Based Commissioners , A Guide for Commissioning Groups and GPs illustrates how pharmacists can support commissioners at all levels of medicines use. Copies are free to NHS Alliance members and cost £10 for others. Directory website aids diabetes management The National Diabetes Support Team is developing a website that brings together different datasets and tools for diabetes management. The Diabetes Data Directory (www.yhpho.org.uk/diabetesdatadirectory/introddd.asp) summarises what other online databases can provide and lists the tools that can be used to answer specific questions. The first edition is now online, providing direct links to the appropriate sites. Flu vaccine efficacy in older people challenged US reviewers have questioned the effectiveness of flu vaccine in older people (Lancet Infect Dis online: 24 September; doi: 10.1016/ S1473-3099(07)70236-0). They were unable to confirm a reduction in flu mortality since 1980, concluding that biased patient selection and nonspecific end-points such as all-cause mortality may have exaggerated the benefits of vaccination in clinical trials. The Department of Health is encouraging younger people in at-risk groups to be vaccinated against flu this winter; last year, 58 per cent of under-65s at risk were not vaccinated. OC cervical cancer risk probably overestimated Recent evidence that oral contraceptives may be associated with a small increase in the incidence of cervical cancer probably overestimates the risk, says the Clinical Effectiveness Unit of the Faculty of Family Planning and Reproductive Health Care (www.ffprhc.org.uk). A recent study in the BMJ reported a 12 per cent reduced overall risk of cancer associated with oral contraceptives but an increased risk of cervical cancer of 38 per 100 000 woman-years after at least eight years' use. The FFPRHC says this study was conducted before the UK cervical screening programme was established, and at a time when the average Inhaled insulin ,unlikely to be cost effective' Inhaled insulin (Exubera) is safe and effective but costs so much more than injected insulin that it is unlikely to be cost effective, according to a new Health Technology Assessment (2007;11:No.33.www.hta.nhsweb.nhs.uk). The review included nine trials (seven of Exubera), in which the only significant difference between inhaled and injected soluble insulin was in patient preference. However, most of the trials used syringes for insulin injection rather than pens. The extra cost of inhaled insulin is put at between £600 and £1000 per year. New topics for NICE The Secretary of State for Health has referred the novel antihypertensive aliskiren (Rasilez) for appraisal by NICE; aliskiren is the first direct renin inhibitor to be introduced. Other referrals to NICE include five clinical guidelines (multiple pregnancy, transient loss of consciousness, lower UTI in men, post-ITU rehabilitation and colorectal and anal cancer). Topics for technology appraisals include cetuximab (Erbitux) for colorectal and head and neck cancers. QOF statistics for 06/07 GPs in England averaged 96.3 per cent of the maximum points available for the clinical domain of the Quality and Outcomes Framework in 2006/07 compared with 97.1 per cent previously, official statistics show. Mean practice scores for most clinical areas were in the mid-90 per cent range, but highest for obesity (100 per cent) and lowest for depression (81 per cent), palliative care (90 per cent), mental health and epilepsy (<95 per cent). NICE consulting on type 2 diabetes guideline NICE is consulting on its draft clinical guideline for the management of type 2 diabetes. Comments should be submitted online by 22 November; publication is scheduled for April 2008. The drug of first choice for glycaemic control is metformin, which should be considered even for patients who are not overweight; a sulphonylurea is an alternative or adjunctive agent if glycaemic control is not achieved with metformin alone. If these regimens fail, a glitazone may be added. Exenatide (Byetta) is recommended only for obese patients for whom other oral treatments have failed. The guidance will update and replace clinical guidelines E, F, G and H, and technology appraisals 53, 60 and 63. Glitazones increase risk of HF but not CV death A new meta-analysis , this time of seven trials involving a total of 20 191 patients with type 2 diabetes or impaired glucose tolerance treated with a glitazone , has concluded that these agents are associated with an increased risk of heart failure but not cardiovascular death (Lancet 2007;370:1129,36). Compared with comparator drugs, glitazones were associated with an increased risk of congestive heart failure (2.3 vs 1.4 per cent; relative risk, RR, 1.72; number needed to harm over 30 months, 107). There was no heterogeneity between studies, showing that this is a class effect. However, the risk of cardiovascular death was not increased for either rosiglitazone (Avandia) or pioglitazone (Actos). Copyright © 2007 Wiley Interface Ltd [source] On the Relation between Form and Substance in LawRATIO JURIS, Issue 1 2007PHILIP SOPER In particular, he concentrates on the hazy relationship between form and substance in Summers' theory. In order to analyze some major difficulties entailed in the thesis that form and substance are different and independent things, the author discusses three specific questions: (1) the difference between form and substance; (2) the possibility of a form meant to be value-neutral; (3) how to distinguish a form-centered approach from a formalistic approach when one has to interpret a statute. This last question is dealt with through examples taken from two legal decisions.* [source] Choosing remediation and waste management options at hazardous and radioactive waste sitesREMEDIATION, Issue 1 2002Michael Greenberg This article discusses a process for finding insights that will allow federal agencies and environmental professionals to more effectively manage contaminated sites. The process is built around what Etzioni (1968) called mixed-scanning, that is, perpetually doing both comprehensive and detailed analyses and periodically re-scanning for new circumstances that change the decision-making environment. The article offers a checklist of 127 items, which is one part of the multiple-stage scanning process. The checklist includes questions about technology; public, worker, and ecological health; economic cost and benefits; social impacts; and legal issues. While developed for a DOE high-level radioactive waste application, the decision-making framework and specific questions can be used for other large-scale remediation and management projects. © 2002 Wiley Periodicals, Inc. [source] The emerging role of the distal Fallopian tube and p53 in pelvic serous carcinogenesis,THE JOURNAL OF PATHOLOGY, Issue 1 2010C Simon Herrington Abstract In their paper in this issue of the Journal, Xian et al have analysed in detail the Fallopian tubes from two patients with Li,Fraumeni syndrome (germline TP53 mutation) in order to investigate further the possible role of p53 signatures in the development of high-grade pelvic serous carcinoma. They find an increased frequency of p53 signatures, with associated evidence of DNA damage and loss of heterozygosity at the wild-type TP53 allele, but postulate, as Li,Fraumeni syndrome is not associated with an increased risk of pelvic serous carcinoma, that these events are not sufficient for the development of carcinoma. Rather, they put forward a model postulating that further events, particularly loss of BRCA1/2 function, are required for lesion progression. This paper exemplifies how the hypothesis-driven study of a rare syndrome can be highly effective at answering specific questions about disease processes. It is of note that recent evidence from the same group provides convincing evidence that the distal Fallopian tube may, in fact, be the commonest site of origin for high-grade pelvic serous carcinomas, most of which may originate at this site rather than from the ovary. In addition to its biological significance, this, if proven, has clear clinical implications. Copyright © 2009 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd. [source] Sexual Function in F-111 Maintenance Workers: The Study of Health Outcomes in Aircraft Maintenance PersonnelTHE JOURNAL OF SEXUAL MEDICINE, Issue 6 2009Anthony Brown MPH ABSTRACT Introduction., In Australia, four formal F-111 fuel tank deseal/reseal (DSRS) repair programs were implemented over more than two decades, each involving different processes and using a range of hazardous substances. However, health concerns were raised by a number of workers. The "Study of Health Outcomes in Aircraft Maintenance Personnel" was commissioned by the Australian Department of Defence to investigate potential adverse health outcomes as a result of being involved in the deseal/reseal processes. Aim., To compare measures of sexual function in F-111 aircraft fuel tank DSRS maintenance workers, against two appropriate comparison groups. Methods., Exposed and comparison participants completed a postal questionnaire which included general questions of health and health behavior, and two specific questions on sexual functioning. They also completed the International Index of Erectile Function (IIEF) questionnaire. Logistic regression was used to explore exposure status and outcome while adjusting for potential confounders. Main Outcome Measures., The three outcomes of interest for this study were the proportion of participants with erectile dysfunction (ED) according to the IIEF, the proportion with self-reported loss of interest in sex, and the proportion with self-reported problems with sexual functioning. Results., Compared with each of the comparison groups, a larger proportion of the exposed group reported sexual problems and were classified as having ED according to the IIEF. In logistic regression, the odds of all three outcomes were higher for exposed participants relative to each comparison group and after adjustment for potentially confounding variables including anxiety and depression. Conclusions., There was a consistent problem with sexual functioning in the exposed group that is not explained by anxiety and depression, and it appears related to DSRS activities. Brown A, Gibson R, Tavener M, Guest M, D'Este C, Byles J, Attia J, Horsley K, Harrex W, and Ross J. Sexual function in F-111 maintenance workers: The study of health outcomes in aircraft maintenance personnel. J Sex Med 2009;6:1569,1578. [source] Validation of the quality of The National Pain Database for pain management services in the United KingdomANAESTHESIA, Issue 11 2008G. C. Hall Summary Data on specialist pain management is scarce. We evaluated PainDB, a database which aggregates this information from UK pain clinics. PainDB entries for 1120 patients (2648 consultations) were compared to records at 30 pain clinics. Staff were surveyed about normal practice at 28 sites. First consultations (17 135) on the aggregated PainDB were analysed for 2003 for omissions. Those consultations included on PainDB (54.6%) showed good concurrence with written notes (88.1%), with no pattern for the missing visits. Questionnaire responses were often absent from notes (56%) and diagnosis was most frequently omitted from PainDB (12.4,18.4%). Clinic staff overestimated completeness. Despite commitment, PainDB is currently unsuitable for research or audit. As routine hospital data should provide information on activity, specific questions on severity and outcome could be answered by short-term recording of predefined variables. [source] Do early interviews affect children's long-term event recall?APPLIED COGNITIVE PSYCHOLOGY, Issue 7 2004Margaret-Ellen Pipe The present study examined the effects of the timing of an initial interview on children's recall of an event over delays of 1 and 2 years. Fifty-five children who had originally participated in a novel event when they were between 5- and 6-years old and had been interviewed about it following either short (1 week or less) or long (1 or 6 month) delays were re-interviewed 1 and 2 years after the original experience. An additional 20 children not interviewed prior to the 1-year interview were included as a no-prior-interview control group. Long delays to the initial interview led to better open-ended recall at the 1-year delay than short delays to initial interview or no prior interview. However, initial interviews that followed short delays had a greater impact on children's responses to specific questions. The results suggest that prior interview history is an important consideration when examining the effects of long delays on children's event reports, and that the effects of the timing of an initial interview depend on the nature of the information recalled. Copyright © 2004 John Wiley & Sons, Ltd. [source] | |||||||||||||||||||||||||