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Substantial Improvement (substantial + improvement)
Selected AbstractsA (Re)Conceived Feminist Paradigm for Public Relations: A Case for Substantial ImprovementJOURNAL OF COMMUNICATION, Issue 4 2005Linda Aldoory This article advances a feminist paradigm for public relations scholarship by (re)conceptualizing the concepts of gender, power, and diversity as discursive practices that construct the meaning of public relations. These three concepts are then applied to the body of work on organization-public relationships. The article posits that the current feminist paradigm retains androcentric bias. By transforming the way that the paradigm is practiced, general theory and knowledge are enriched. The reconceptualizations put forth in this article are useful for communication scholarship in general and can be used as a model for feminist research in other domains of communication. [source] Flammability and mechanical properties of Al(OH)3 and BaSO4 filled polypropyleneJOURNAL OF APPLIED POLYMER SCIENCE, Issue 5 2010S. Tan Abstract The flammability and mechanical properties of Al(OH)3/BaSO4/polypropylene (PP) composites were investigated. The flow, morphological, and thermal properties were also analyzed by melt flow index (MFI), Scanning electron microscopy (SEM), and Differential scanning calorimeter (DSC) studies, respectively. Total filler amount was fixed at 30 wt % to optimize physical characteristics of the composites. In addition to the flame retardant filler Al(OH)3, BaSO4 was used to balance the reduction in impact strength at high filler loadings. Substantial improvement in mechanical properties was achieved for 20 wt % Al(OH)3 (i.e., 10 wt % BaSO4) composition while maximum flammability resistance was obtained for 30 wt % Al(OH)3 composite. SEM studies showed that the presence of aggregated Al(OH)3 particles led to low interfacial adhesion between them and PP matrix ending up with decreased mechanical strength. © 2010 Wiley Periodicals, Inc. J Appl Polym Sci, 2010 [source] Synthesis and characterization of styrene butadiene rubber,Bentonite clay nanocompositesPOLYMER ENGINEERING & SCIENCE, Issue 7 2009Sugata Chakraborty In the present study, naturally occurring unfractionated bentonite clay was used to prepare styrene butadiene rubber/bentonite clay nanocomposite by latex stage blending. The bentonite clay was organo-modified by in situ resol formation by the reaction of resorcinol and formaldehyde. The latex clay mixture was co-coagulated with acid. The resulting clay masterbatch was compounded and evaluated by Fourier Transform Infrared spectroscopy, X-ray diffraction (XRD), Transmission Electron Microscopy (TEM), Energy Dispersive X-ray spectroscopy (EDS), Scanning Electron Microscopy, Thermogravimetric analysis, and Differential Scanning Calorimetry. XRD showed that the interplanar distance of the in situ resol-modified bentonite clay increased from 1.23 to 1.41 nm for the unmodified bentonite. TEM analysis indicated partial exfoliation and/or intercalation. EDS (Si and Al mapping) of the clay revealed the nature of the dispersion in the nanocomposites vis-à-vis the conventional styrene-butadiene rubber (SBR)/bentonite clay composite. Thermogravimetric analysis was used to compare the decomposition trends of the SBR/clay nanocomposites with the SBR/clay composite. The glass transition temperature of SBR/clay nanocomposites increased as compared with that of neat SBR. Substantial improvement in most of the other mechanical properties was also observed in case of the nanocomposites. POLYM. ENG. SCI., 2009. © 2009 Society of Plastics Engineers [source] Qualifications Recognition Reform for Skilled Migrants in Australia: Applying Competency-based Assessment to Overseas-qualified NursesINTERNATIONAL MIGRATION, Issue 6 2002Lesleyanne Hawthorne The past two decades have coincided with unprecedented Australian selection of skilled migrants, in particular professionals from non-English speaking background (NESB) source countries. By 1991, the overseas-born constituted 43 to 49 per cent of Australia's engineers, 43 per cent of computer professionals, 40 per cent of doctors, 26 per cent of nurses, and rising proportions in other key professions. Within one to five years of arrival, just 30 per cent of degree-qualified migrants were employed. However, few diploma holders had found work in any profession, and select NESB groups were characterized by acute labour market disadvantage. Throughout the 1980s and 1990s, barriers to credential recognition were identified as a major contributing factor to these inferior employment outcomes. This paper describes the evolution of Australia's qualifications recognition reform agenda for NESB migrants, including progressive growth in support of a shift from paper to competency-based assessment (CBA). Within this context, the paper examines the degree to which improvements were achieved in the 1990s in the field of nursing , the first major Australian profession to embrace CBA, and one promoted by the National Office of Overseas Skills Recognition as an exemplar of the reform process. Assessment protocols and outcomes are analysed within two contrasting contexts: pre-migration at Australian overseas posts, and within Australia following overseas-qualified nurses' (OQNs) arrival. Based on empirical data from a wide range of sources, the paper identifies the development of a major paradox. Substantial improvements in qualifications recognition were indeed achieved for NESB nurses through CBA in Australia, in particular in the dominant immigrant-receiving states of Victoria and New South Wales. At the same time, it is argued, a significant tightening of recognition procedures was occurring at Australian overseas posts where CBA was unavailable. The Immigration Department placed pre-migration assessment more, rather than less, exclusively in the hands of the professional nursing bodies, in a period coinciding with their harsher, rather than more lenient, treatment of NESB migrants' qualifications. Minimal improvement in recognition of overseas qualifications was achieved in other professions. [source] Estimating the Intensity of a Spatial Point Process from Locations Coarsened by Incomplete GeocodingBIOMETRICS, Issue 1 2008Dale L. Zimmerman Summary The estimation of spatial intensity is an important inference problem in spatial epidemiologic studies. A standard data assimilation component of these studies is the assignment of a geocode, that is, point-level spatial coordinates, to the address of each subject in the study population. Unfortunately, when geocoding is performed by the standard automated method of street-segment matching to a georeferenced road file and subsequent interpolation, it is rarely completely successful. Typically, 10,30% of the addresses in the study population, and even higher percentages in particular subgroups, fail to geocode, potentially leading to a selection bias, called geographic bias, and an inefficient analysis. Missing-data methods could be considered for analyzing such data; however, because there is almost always some geographic information coarser than a point (e.g., a Zip code) observed for the addresses that fail to geocode, a coarsened-data analysis is more appropriate. This article develops methodology for estimating spatial intensity from coarsened geocoded data. Both nonparametric (kernel smoothing) and likelihood-based estimation procedures are considered. Substantial improvements in the estimation quality of coarsened-data analyses relative to analyses of only the observations that geocode are demonstrated via simulation and an example from a rural health study in Iowa. [source] Regioselective Enzymatic Diol Esterification in Batch and Fixed-Bed Adsorptive Reactors: Experiments and ModelingBIOTECHNOLOGY PROGRESS, Issue 4 2000Cristiano Migliorini The dynamic behavior of batch and fixed-bed adsorptive reactors is studied for the enzyme-catalyzed regioselective esterification of propionic acid and 2-ethyl-1,3-hexanediol in hexane. The reaction is equilibrium-limited with an apparent equilibrium constant of 0.6 ± 0.1 at 22 °C. Moreover, accumulation of water produced in the reaction onto the biocatalyst causes a decrease in the catalytic activity. As a result, improvements in both reaction rate and final conversion can be achieved by operating in an adsorptive-reactor mode. Control of water in the reactor is achieved with a catalytically inert ion-exchange resin in Na-form. The resin prevents an excessive accumulation of water on the biocatalyst and reduces equilibrium limitations. The thermodynamic activity of water is identified as a key parameter for the design of such reactors. A mathematical model capable of predicting the water activity as a function of the varying concentrations of reactants and products is thus developed and found to successfully predict the experimental behavior observed in laboratory reactors. Substantial improvements in performance predicted by the model are seen experimentally in batch reactions and during the transient operation of continuous-flow fixed-bed reactors combining adsorptive and catalytic functions. [source] Enhancing Neural Network Traffic Incident-Detection Algorithms Using WaveletsCOMPUTER-AIDED CIVIL AND INFRASTRUCTURE ENGINEERING, Issue 4 2001A. Samant Researchers have presented freeway traffic incident-detection algorithms by combining the adaptive learning capability of neural networks with imprecision modeling capability of fuzzy logic. In this article it is shown that the performance of a fuzzy neural network algorithm can be improved through preprocessing of data using a wavelet-based feature-extraction model. In particular, the discrete wavelet transform (DWT) denoising and feature-extraction model proposed by Samant and Adeli (2000) is combined with the fuzzy neural network approach presented by Hsiao et al. (1994). It is shown that substantial improvement can be achieved using the data filtered by DWT. Use of the wavelet theory to denoise the traffic data increases the incident-detection rate, reduces the false-alarm rate and the incident-detection time, and improves the convergence of the neural network training algorithm substantially. [source] Forks in the Road: Choices in Procedures for Designing Wildland LinkagesCONSERVATION BIOLOGY, Issue 4 2008PAUL BEIER análisis de sensibilidad; conectividad; corredor de vida silvestre; enlace; diseño de reservas Abstract:,Models are commonly used to identify lands that will best maintain the ability of wildlife to move between wildland blocks through matrix lands after the remaining matrix has become incompatible with wildlife movement. We offer a roadmap of 16 choices and assumptions that arise in designing linkages to facilitate movement or gene flow of focal species between 2 or more predefined wildland blocks. We recommend designing linkages to serve multiple (rather than one) focal species likely to serve as a collective umbrella for all native species and ecological processes, explicitly acknowledging untested assumptions, and using uncertainty analysis to illustrate potential effects of model uncertainty. Such uncertainty is best displayed to stakeholders as maps of modeled linkages under different assumptions. We also recommend modeling corridor dwellers (species that require more than one generation to move their genes between wildland blocks) differently from passage species (for which an individual can move between wildland blocks within a few weeks). We identify a problem, which we call the subjective translation problem, that arises because the analyst must subjectively decide how to translate measurements of resource selection into resistance. This problem can be overcome by estimating resistance from observations of animal movement, genetic distances, or interpatch movements. There is room for substantial improvement in the procedures used to design linkages robust to climate change and in tools that allow stakeholders to compare an optimal linkage design to alternative designs that minimize costs or achieve other conservation goals. Resumen:,Los modelos son utilizados comúnmente para identificar tierras que mantengan la habilidad de la vida silvestre para moverse entre bloques de tierras silvestres a través de una matriz de tierras que habían sido incompatibles con el movimiento de vida silvestre. Ofrecemos 16 opciones y supuestos que se originan en el diseño de enlaces para facilitar el movimiento o el flujo de genes de especies focales entre 2 o más bloques de tierras silvestres predefinidos. Recomendamos el diseño de enlaces que sirvan a múltiples (y solo a una) especies focales que funjan como una sombrilla colectiva para todas las especies nativas y los procesos ecológicos, que explícitamente admitan supuestos no comprobados y que utilicen análisis de incertidumbre para ilustrar efectos potenciales de la incertidumbre del modelo. La mejor forma de mostrar tal incertidumbre a los interesados es mediante mapas de los enlaces modelados bajo diferentes suposiciones. También recomendamos modelar a habitantes de corredores (especies que requieren más de una generación para mover sus genes entre bloques de tierra silvestre) de manera diferente que las especies pasajeras (un individuo se puede mover entre bloques de tierras silvestres en unas cuantas semanas). Identificamos un problema, que denominamos el problema de traducción subjetiva, que surge porque un analista debe decidir subjetivamente cómo traducir medidas de selección de recursos a resistencia. Este problema puede ser sobrepuesto mediante la estimación de la resistencia a partir de observaciones de movimientos de animales, distancias genéticas o movimientos entre fragmentos. Hay espacio para la mejora sustancial de los procedimientos utilizados para diseñar enlaces robustos ante el cambio climático y en herramientas que permiten que los interesados comparen un diseño óptimo con diseños alternativos que minimicen costos o alcancen otras metas de conservación. [source] Antipsychotic-induced weight gainDIABETES OBESITY & METABOLISM, Issue 5 2005A. J. Goudie Abstract:, Novel ,atypical' antipsychotic drugs represent a substantial improvement on older ,typical' drugs. However, clinical experience has shown that some, but not all, of these drugs can induce substantial weight gain. This interferes with compliance with drug taking and has expected effects on morbidity and mortality. In this review, we summarize current thinking on: (i) the extent to which different ,atypical' drugs induce weight gain; (ii) the possible roles of various neurotransmitters and neuropeptides in this adverse drug reaction; and (iii) the state of development of animal models in this area. We also outline major areas for future research. [source] Cost-effectiveness of interventions to prevent alcohol-related disease and injury in AustraliaADDICTION, Issue 10 2009Linda Cobiac ABSTRACT Aims To evaluate cost-effectiveness of eight interventions for reducing alcohol-attributable harm and determine the optimal intervention mix. Methods Interventions include volumetric taxation, advertising bans, an increase in minimum legal drinking age, licensing controls on operating hours, brief intervention (with and without general practitioner telemarketing and support), drink driving campaigns, random breath testing and residential treatment for alcohol dependence (with and without naltrexone). Cost-effectiveness is modelled over the life-time of the Australian population in 2003, with all costs and health outcomes evaluated from an Australian health sector perspective. Each intervention is compared with current practice, and the most cost-effective options are then combined to determine the optimal intervention mix. Measurements Cost-effectiveness is measured in 2003 Australian dollars per disability adjusted life year averted. Findings Although current alcohol intervention in Australia (random breath testing) is cost-effective, if the current spending of $71 million could be invested in a more cost-effective combination of interventions, more than 10 times the amount of health gain could be achieved. Taken as a package of interventions, all seven preventive interventions would be a cost-effective investment that could lead to substantial improvement in population health; only residential treatment is not cost-effective. Conclusions Based on current evidence, interventions to reduce harm from alcohol are highly recommended. The potential reduction in costs of treating alcohol-related diseases and injuries mean that substantial improvements in population health can be achieved at a relatively low cost to the health sector. [source] Age, period and cohort influences on beer, wine and spirits consumption trends in the US National Alcohol SurveysADDICTION, Issue 9 2004William C. Kerr ABSTRACT Aims To estimate the separate influences of age, period and cohort on the consumption of beer wine and spirits in the United States. Design Linear age,period,cohort models controlling for demographic change with extensive specification testing. Setting US general population 1979,2000. Measurements Monthly average of past-year consumption of beer, wine and spirits in five National Alcohol Surveys. Findings The strongest cohort effects are found for spirits; cohorts born before 1940 are found to have significantly higher consumption than those born after 1946, with especially high spirits consumption for men in the pre-1930s cohorts. Significant cohort effects are also found for beer with elevated consumption in the 1946,65 cohorts for men but in the pre-1940 cohorts for women. Significant negative effects of age are found for beer and spirits consumption, although not for wine. Significant period effects are found for men's beer and wine consumption and for women's spirits consumption. Increased educational attainment in the population over time is associated with reduced beer consumption and increased wine consumption. Conclusions Changing cohort demographics are found to have significant effects on beverage-specific consumption, indicating the importance of controlling for these effects in the evaluation of alcohol policy effectiveness and the potential for substantial improvement in the forecasting of future beverage-specific consumption trends, alcohol dependence treatment demand and morbidity and mortality outcomes. [source] Passive Hedge Fund Replication , Beyond the Linear CaseEUROPEAN FINANCIAL MANAGEMENT, Issue 2 2010Noël Amenc G10 Abstract In this paper we extend,Hasanhodzic and Lo (2007),by assessing the out-of-sample performance of various non-linear and conditional hedge fund replication models. We find that going beyond the linear case does not necessarily enhance the replication power. On the other hand, we find that selecting factors on the basis on an economic analysis allows for a substantial improvement in out-of-sample replication quality, whatever the underlying form of the factor model. Overall, we confirm the findings in,Hasanhodzic and Lo (2007)that the performance of the replicating strategies is systematically inferior to that of the actual hedge funds. [source] Serially concatenated continuous phase modulation with symbol interleavers: performance, properties and design principlesEUROPEAN TRANSACTIONS ON TELECOMMUNICATIONS, Issue 4 2006Ming Xiao Serially concatenated continuous phase modulation (SCCPM) systems with symbol interleavers are investigated. The transmitted signals are disturbed by additive white Gaussian noise (AWGN). Compared to bit interleaved SCCPM systems, this scheme shows a substantial improvement in the convergence threshold at the price of a higher error floor. In addition to showing this property, we also investigate the underlying reason by error event analysis. In order to estimate bit error rate (BER) performance, we generalise traditional union bounds for a bit interleaver to this non-binary interleaver. For the latter, both the order and the position of permuted non-zero symbols have to be considered. From the analysis, some principal properties are identified. Finally, some design principles are proposed. Our paper concentrates on SCCPM, but the proposed analysis methods and conclusions can be widely used in many other systems such as serially concatenated trellis coded modulation (SCTCM) et cetera. Copyright © 2006 AEIT [source] Estimation of allele frequencies with data on sibshipsGENETIC EPIDEMIOLOGY, Issue 3 2001Karl W. Broman Abstract Allele frequencies are generally estimated with data on a set of unrelated individuals. In genetic studies of late-onset diseases, the founding individuals in pedigrees are often not available, and so one is confronted with the problem of estimating allele frequencies with data on related individuals. We focus on sibpairs and sibships, and compare the efficiency of four methods for estimating allele frequencies in this situation: (1) use the data for one individual from each sibship; (2) use the data for all individuals, ignoring their relationships; (3) use the data for all individuals, taking proper account of their relationships, considering a single marker at a time; and (4) use the data for all individuals, taking proper account of their relationships, considering a set of linked markers simultaneously. We derived the variance of estimator 2, and showed that the estimator is unbiased and provides substantial improvement over method 1. We used computer simulation to study the performance of methods 3 and 4, and showed that method 3 provides some improvement over method 2, while method 4 improves little on method 3. Genet. Epidemiol. 20:307,315, 2001. © 2001 Wiley-Liss, Inc. [source] Forum on: the role of recombinant factor VIII in children with severe haemophilia AHAEMOPHILIA, Issue 2 2009M. FRANCHINI Summary., The development of recombinant FVIII (rFVIII) products, fuelled by the need for improved safety of treatment arising from the dramatic widespread blood-borne virus transmission in the 1970,1980s revolutionized the care of children with haemophilia A over the last two decades. The larger availability of perceived safer replacement therapy associated with the introduction of rFVIII products reassured the haemophilia community and there was a strong push in some Western countries to treat haemophilic children only with rFVIII. Moreover, this significantly contributed in the 1990s to the diffusion outside Northern Europe of prophylactic regimens implemented at an early age to prevent bleeding and the resultant joint damage (i.e. primary prophylaxis), together with the possibility of home treatment. These changes led to a substantial improvement of the quality of life of haemophilic children and of their families. The general agreement that primary prophylaxis represents the first-choice treatment for haemophilic children has been recently supported by two randomized controlled trials carried out with rFVIII products, providing evidence on the efficacy of early prophylaxis over on-demand treatment in preserving joint health in haemophilic children. However, the intensity and optimal modalities of implementation of prophylaxis in children, in particular with respect to the issue of the venous access, are still debated. A number of studies also supports the role of secondary prophylaxis in children, frequently used in countries in which primary prophylaxis was introduced more recently. With viral safety now less than an issue and with the more widespread use of prophylaxis able to prevent arthropathy, the most challenging complication of replacement therapy for children with haemophilia remains the risk of inhibitor development. Despite conflicting data, there is no evidence that the type of FVIII concentrate significantly influences the complex multifactorial process leading to anti-FVIII alloantibodies, whereas other treatment-related factors are likely to increase (early intensive treatments due to surgery or severe bleeds) or reduce (prophylaxis) the risk. Although the optimal regimen is still uncertain, eradication of anti-FVIII antibodies by immune tolerance induction (ITI), usually with the same product administered at inhibitor detection, should be the first-choice treatment for all patients with recent onset inhibitors. This issue applies particularly to children, as most patients undergo ITI at an early age, when inhibitors usually appear. The availability of a stable and long-lasting venous access represents a leading problem also in this setting. These and other topics concerning rFVIII treatment of haemophilic children were discussed in a meeting held in Rome on 27 February 2008 and are summarized in this report. [source] Latent class models for use of primary care: evidence from a British panelHEALTH ECONOMICS, Issue 9 2005Teresa Bago d'Uva Abstract This paper models access to and utilisation of primary care using data from the British Household Panel Survey for the period 1991,2001. A latent class panel data framework is adopted to model individual unobserved heterogeneity in a flexible way. Accounting for the panel structure of the data leads to a substantial improvement in fit, and permits the identification of latent classes of users of health care. Analysis by gender shows that men and women respond differently to some factors, in particular, to age and income. There is evidence of a positive impact of income on the probability of seeking primary care. This effect is especially significant in the case of women. For both genders, the marginal effect of income on the propensity to visit a GP is greater for individuals who are less likely to seek primary care. A latent class aggregated count data model for the number of GP visits classifies individuals in three latent classes and shows a positive income effect particularly amongst those with lower levels of utilisation. Copyright © 2005 John Wiley & Sons, Ltd. [source] Micro-mechanical simulation of geotechnical problems using massively parallel computersINTERNATIONAL JOURNAL FOR NUMERICAL AND ANALYTICAL METHODS IN GEOMECHANICS, Issue 14 2003David W. Washington Abstract This paper demonstrates that the architecture of a massively parallel computer can be adapted for micro-mechanical simulations of a Geotechnical problem. The Discrete Element Method was used on a massively parallel supercomputer to simulate Geotechnical boundary value problems. For the demonstration, a triaxial test was simulated using an algorithm titled ,TRUBAL for Parallel Machines (TPM)' based on the discrete element method (DEM). In this trial demonstration, the inherent parallelism within DEM algorithm is shown. Then a comparison is made between the parallel algorithm (TPM) and the serial algorithm (TRUBAL) to show the benefits of this research. TPM showed substantial improvement in performance with increasing number of processors when compared with TRUBAL using single processor. Copyright © 2003 John Wiley & Sons, Ltd. [source] Linking global circulation model synoptics and precipitation for western North AmericaINTERNATIONAL JOURNAL OF CLIMATOLOGY, Issue 15 2002Suzan Lapp Abstract Synoptic downscaling from global circulation models (GCMs) has been widely used to develop local and regional-scale future precipitation scenarios under global warming. This paper presents an analysis of the linkages between the Canadian Centre for Climate Modelling and Analysis first version of the Canadian Global Coupled Model (CCCma CGCM1) 2000 model output and local/regional precipitation time series. The GCM 500 hPa geopotential heights were visually classified for synoptic patterns using a geographical information system. The pattern frequencies were statistically compared with historical data from Changnon et al. (1993. Monthly Weather Review121: 633,647) for the winter period 1961,85. The CGCM1 synoptic frequencies compare favourably with the historical data, and they represent a substantial improvement over the 1992 Canadian Climate Centre Global Circulation Model synoptic climatology output. The CGCM1 output was used to forecast future winter precipitation scenarios for five geographically diverse climate stations in western North America. Copyright © 2002 Royal Meteorological Society. [source] Pulmonary involvement in Sweet's syndrome: a case report and review of the literatureINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 6 2006Leonardo Astudillo MD Pulmonary involvement in Sweet's syndrome (SS) is rare. We report a case of SS with severe respiratory involvement responding to corticosteroid therapy. A 82-year-old man presented fever of 39 °C associated with cough and dyspnea, and crackles in the left lung. The infection work-up was negative. Chest X-ray showed cardiomegaly and left lower lobe pulmonary infiltrates. Pulmonary signs did not improve on treatment with antibiotics, and after 1 week maculopapular lesions appeared, localized on the knees, the periombilical area and the back. The antibiotics were changed without improvement. A skin biopsy revealed infiltration by neutrophilic granulocytes and marked edema in the dermis, consistent with SS. The patient's condition progressively worsened, requiring high oxygenotherapy, and he was transferred to an intensive care unit. Chest X-ray revealed an important alveolar and interstitial syndrome. Bronchoalveolar lavage found 170 leukocytes with 30% neutrophils (N < 5%), 7% lymphocytes and 63% macrophages. A search for bacteria, viruses or parasites in bronchoalveolar lavage was negative. The patient was treated with antibiotics, a high dose of furosemide and steroids for 4 days. Because the patient improved dramatically within 5 days, with a negative infection work-up and a dramatic decrease of C-reactive protein, the antibiotics were stopped. Steroids were secondarily tapered very slowly. A chest computed tomography (CT) scan showed a substantial improvement of pulmonary lesions. We also review the 22 cases of pulmonary involvement of SS reported in the literature. [source] Lichenoid nail changes as sole external manifestation of graft vs. host diseaseINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 1 2002Sara Isabel Palencia MD A 56-year-old-man who had refractory anemia with an excess of blasts underwent an allogeneic peripheral blood stem cell transplantation (PBSCT) from his brother after preparation with melphalan and fludarabin. He received GvHD (graft-vs.-host disease) prophylaxis with cyclosporine from day ,1 at a daily dose of 5 mg/kg of body weight. The daily dosage was tapered gradually from day +20. On post-PBSCT day 68 he developed acute cutaneous GvHD grade 3 and acute gastrointestinal GvHD grade 2,3, which was resolved with a daily dose of 1 mg/kg of body weight of prednisone. The patient was discharged in good clinical condition and without signs of GvHD, and he started tapering his immunosuppressive treatment. By day 160 he developed oral lichen planus-like changes, with several reticulate white lesions on the oral mucosa. A biopsy specimen was microscopically consistent with lichenoid GvHD (Fig. 1). By day 150 after PBSCT, when he was being treated with CsA 100 mg once daily and prednisone 10 mg once daily, his fingernails started to grow abnormally and gradually became dystrophic and painful. Two months later his toenails became similarly affected. Although affecting all finger and toe nails, the lesions were especially important in both thumbs. Physical examination revealed multiple findings on his nails (Fig. 2): thickening, fragility, onycholysis, longitudinal striations, and even pterygium. The micological cultures were negative. A biopsy specimen showed an sparse papillary dermis lymphoid infiltrate with focal exocytosis and presence of isolated multiple necrotic keratinocytes (Fig. 3). These findings were interpreted as a lichenoid GvHD with oral and nail involvement. The patient did not have other associated cutaneous lesions. He did not develop signs or symptoms consistent with hepatic GvHD. In May 2000 thalidomide was added to the immunosuppressive therapy, at a daily dose from 100 to 300 mg according to tolerance (constipation, sedation, ,). The lesions on the oral mucous showed a substantial improvement, but the nail changes remained more or less stable. Thalidomide was discontinued after 7 months because the patient displayed numbness and tingling in the hands and feet consistent with a peripheral neuropathy. Twenty days later he stopped taking thalidomide and the oral lichenoid lesions worsened, resulting in difficulty in eating. He also developed periungueal erythema, swelling and intense pain after minimal trauma. The daily dose of prednisone increased to 20,30 mg with moderate improvement. However, the dose could not be increased because of the secondary immunosuppressive effects. Twenty-three months post-PBSCT the patient remains with intense oral and nail lichenoid lesions. Figure Figure 1 . Oral mucosa with a lichenoid hiperplasia and a band-like lymphoid infiltrate. Note the basal lymphocytosis with isolated necrotic keratinocytes Figure 2. Lichenoid graft-vs.-host disease showing marked nail involvement with a ridge in the midline Figure 3. Panoramic view of the nail epithelium. Dermal lymphocytes with basal exocytosis and apoptotic keratinocytes (arrow) are evident [source] Twelve-year course and outcome predictors of anorexia nervosaINTERNATIONAL JOURNAL OF EATING DISORDERS, Issue 2 2006Dipl-Psych, Manfred M. Fichter MD Abstract Objective The current study presents the long-term course of anorexia nervosa (AN) over 12 years in a large sample of 103 patients diagnosed according to criteria in the 4th ed. of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Method Assessments were made at the beginning of therapy, at the end of therapy, at the 2-year follow-up, at the 6-year follow-up, and at the 12-year follow-up. Self-rating and an expert-rating interview data were obtained. Results The participation rate at the 12-year follow-up was 88% of those alive. There was substantial improvement during therapy, a moderate (in many instances nonsignificant) decline during the first 2 years posttreatment, and further improvement from 3 to 12 years posttreatment. Based on a global 12-year outcome score, 27.5% had a good outcome, 25.3% an intermediate outcome, 39.6% had a poor outcome, and 7 (7.7%) were deceased. At the 12-year follow-up 19.0% had AN, 9.5% had bulimia nervosa-purging type (BN-P), 19.0% were classified as eating disorder not otherwise specified (EDNOS). A total of 52.4% showed no major DSM-IV eating disorder and 0% had binge eating disorder (BED). Systematic,strictly empirically based,model building resulted in a parsimonious model including four predictors of unfavorable 12-year outcome explaining 45% of the variance, that is, sexual problems, impulsivity, long duration of inpatient treatment, and long duration of an eating disorder. Conclusion Mortality was high and symptomatic recovery protracted. Impulsivity, symptom severity, and chronicity were the important factors for predicting the 12-year outcome. © 2005 by Wiley Periodicals, Inc. [source] Collaborative Clinical Quality Improvement for Pressure Ulcers in Nursing HomesJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 10 2007(See editorial comments by Dr. George Taler on pp 167, 1675) The National Nursing Home Improvement Collaborative aimed to reduce pressure ulcer (PU) incidence and prevalence. Guided by subject matter and process experts, 29 quality improvement organizations and six multistate long-term care corporations recruited 52 nursing homes in 39 states to implement recommended practices using quality improvement methods. Facilities monitored monthly PU incidence and prevalence, healing, and adoption of key care processes. In residents at 35 regularly reporting facilities, the total number of new nosocomial Stage III to IV PUs declined 69%. The facility median incidence of Stage III to IV lesions declined from 0.3 per 100 occupied beds per month to 0.0 (P<.001) and the incidence of Stage II to IV lesions declined from 3.2 to 2.3 per 100 occupied beds per month (P=.03). Prevalence of Stage III to IV lesions trended down (from 1.3 to 1.1 residents affected per 100 occupied beds (P=.12). The incidence and prevalence of Stage II lesions and the healing time of Stage II to IV lesions remained unchanged. Improvement teams reported that Stage II lesions usually healed quickly and that new PUs corresponded with hospital transfer, admission, scars, obesity, and immobility and with noncompliant, younger, or newly declining residents. The publicly reported quality measure, prevalence of Stage I to IV lesions, did not improve. Participants documented disseminating methods and tools to more than 5,359 contacts in other facilities. Results suggest that facilities can reduce incidence of Stage III to IV lesions, that the incidence of Stage II lesions may not correlate with the incidence of Stage III to IV lesions, and that the publicly reported quality measure is insensitive to substantial improvement. The project demonstrated multiple opportunities in collaborative quality improvement, including improving the measurement of quality and identifying research priorities, as well as improving care. [source] Withdrawal of Fall-Risk-Increasing Drugs in Older Persons: Effect on Tilt-Table Test OutcomesJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 5 2007Nathalie Van Der Velde MD OBJECTIVES: To determine whether outcomes of tilt-table tests improved after withdrawal of fall-risk-increasing drugs (FRIDs). DESIGN: Prospective cohort study. SETTING: Geriatric outpatient clinic. PARTICIPANTS: Two hundred eleven new, consecutive outpatients, recruited from April 2003 until December 2004. MEASUREMENTS: Tilt-table testing was performed on all participants at baseline. Subsequently, FRIDs were withdrawn in all fallers in whom it was safely possible. At a mean follow-up of 6.7 months, tilt-table testing was repeated in 137 participants. Tilt-table testing addressed carotid sinus hypersensitivity (CSH), orthostatic hypotension (OH), and vasovagal collapse (VVC). Odds ratios (ORs) of tilt-table-test normalization according to withdrawal (discontinuation or dose reduction) of FRIDs were calculated using multivariate logistic regression analysis. RESULTS: After adjustment for confounders, the reduction of abnormal test outcomes (ORs) according to overall FRID withdrawal was 0.34 (95% confidence interval (CI)=0.06,1.86) for CSH, 0.35 (95% CI=0.13,0.99) for OH, and 0.27 (95% CI=0.02,3.31) for VVC. For the subgroup of cardiovascular FRIDs, the adjusted OR was 0.13 (95% CI=0.03,0.59) for CSH, 0.44 (95% CI=0.18,1.0) for OH, and 0.21 (95% CI=0.03,1.51) for VVC. CONCLUSION: OH improved significantly after withdrawal of FRIDs. Subgroup analysis of cardiovascular FRID withdrawal showed a significant reduction in OH and CSH. These results imply that FRID withdrawal can cause substantial improvement in cardiovascular homeostasis. Derangement of cardiovascular homeostasis may be an important mechanism by which FRID use results in falls. [source] Polypropylene nanocomposite film: A critical evaluation on the effect of nanoclay on the mechanical, thermal, and morphological behaviorJOURNAL OF APPLIED POLYMER SCIENCE, Issue 6 2010S. K. Sharma Abstract Polypropylene (PP)/clay nanocomposites prepared by melt blending technique using different percentages of clay with and without maleic anhydride grafted PP (MA-PP) were studied. The intercalated and exfoliated structure of nanocomposites was characterized by X-Ray Diffraction (XRD) and transmission electron microscopy (TEM). Because of the typical intercalated and exfoliated structure, the tensile modulus of the nanocomposites were improved significantly as compared to virgin PP. The viscoelastic behavior of the nanocomposites was studied by dynamical mechanical analysis (DMA) and the results showed that with the addition of treated clay to PP there was substantial improvement in storage modulus increases. The thermal stability and crystallization of the PP nanocomposites as studied by differential scanning calorimeter (DSC) and thermo gravimetric analysis (TGA) were also improved significantly compared to PP. © 2009 Wiley Periodicals, Inc. J Appl Polym Sci, 2010 [source] Periodontal therapy alters gene expression of peripheral blood monocytesJOURNAL OF CLINICAL PERIODONTOLOGY, Issue 9 2007Panos N. Papapanou Abstract Aims: We investigated the effects of periodontal therapy on gene expression of peripheral blood monocytes. Methods: Fifteen patients with periodontitis gave blood samples at four time points: 1 week before periodontal treatment (#1), at treatment initiation (baseline, #2), 6-week (#3) and 10-week post-baseline (#4). At baseline and 10 weeks, periodontal status was recorded and subgingival plaque samples were obtained. Periodontal therapy (periodontal surgery and extractions without adjunctive antibiotics) was completed within 6 weeks. At each time point, serum concentrations of 19 biomarkers were determined. Peripheral blood monocytes were purified, RNA was extracted, reverse-transcribed, labelled and hybridized with AffymetrixU133Plus2.0 chips. Expression profiles were analysed using linear random-effects models. Further analysis of gene ontology terms summarized the expression patterns into biologically relevant categories. Differential expression of selected genes was confirmed by real-time reverse transcriptase-polymerase chain reaction in a subset of patients. Results: Treatment resulted in a substantial improvement in clinical periodontal status and reduction in the levels of several periodontal pathogens. Expression profiling over time revealed more than 11,000 probe sets differentially expressed at a false discovery rate of <0.05. Approximately 1/3 of the patients showed substantial changes in expression in genes relevant to innate immunity, apoptosis and cell signalling. Conclusions: The data suggest that periodontal therapy may alter monocytic gene expression in a manner consistent with a systemic anti-inflammatory effect. [source] One Approach to Formulating and Evaluating Student Work Groups in Legal Environment of Business CoursesJOURNAL OF LEGAL STUDIES EDUCATION, Issue 1 2007Joan E. Camara The principal focus of this study is an investigation of whether students' grade point average (GPA) is a viable criterion for forming student work groups in the undergraduate Legal Environment of Business course. More specifically, the research focuses on the impact of: (1) GPA-homogeneous (HO) and GPA-heterogeneous (HE) groups upon student satisfaction with group processes and (2) the impact on individual student performance in both group and nongroup assignments. Data obtained from fourteen HE and fourteen HO student groups, in four separate Legal Environment of Business classes consisting of a mix of Management, Marketing, Computer Information Systems, International Business, Financial Services, and Accounting majors, generated a number of significant results. The most surprising observations dealt with the behavior of low achievers whose individual grades showed substantial improvement after working in HO groups. Researchers who are assessing pedagogical methods which serve to engage a student's active learning and motivation should find these results to be of interest. In addition, the beneficial impact on task and relationship behaviors observed in this study should provide solace or a sense of reward to the larger set of academicians, across disciplines, who attempt to impart realistic organizational skills to their classes. [source] Multivariable real-time optimal control of a cooling and antisolvent semibatch crystallization processAICHE JOURNAL, Issue 10 2009Milana Trifkovic Abstract This article presents an experimental study of simultaneous optimization with respect to two variables (cooling rate and flow-rate of antisolvent) in an offline and online (real-time) manner on a semibatch crystallizer. The nucleation and growth kinetic parameters of paracetamol in an isopropanol-water cooling, antisolvent batch crystallizer were estimated by nonlinear regression in terms of the moments of the crystal population density. Moments of crystal population were estimated from the measured chord length distribution, generated by the FBRM®, and the supersaturation was calculated from the measured concentration by attenuated total reflectance-fourier transform infrared spectroscopy. The results of real-time optimization showed a substantial improvement of the end of batch properties (the volume-weighted mean size and yield). For the same objective function, the real-time optimization method resulted in an increase in the volume-weighted mean size by ,100 ,m and 15% of theoretical yield compared with the best result obtained in an offline optimization manner. © 2009 American Institute of Chemical Engineers AIChE J, 2009 [source] Correlations between synthetic peptide-based enzyme immunoassays and immunofluorescence assay for detection of human herpesvirus 8 antibodies in different Argentine populationsJOURNAL OF MEDICAL VIROLOGY, Issue 6 2006Celeste Pérez Abstract Human herpesvirus 8 (HHV-8) antibody tests vary in sensitivity and specificity, depending on the population tested and on the type of assay. In this study, we evaluated the sensitivity and specificity of two peptide enzyme immunoassays using a multiple antigenic peptide (PK8.1-MAP) or a chimeric peptide (PK8.1-orf65) as the antigens and determined the HHV-8 seroprevalence in different Argentine polulations using an immunofluorescence assay (IFA) as reference. For analysis, when either or both of the peptide EIAs were positive, the specimen was considered positive (PEIA). We estimated the sensitivity and specificity of PEIA to be 97% using Kaposi's sarcoma (KS) patients and healthy individuals as positive and negative controls respectively. Then, we expanded the control groups to include IFA positive men who have sex with men (MSM) and IFA negative blood donors. The sensitivity decreased to 83% but specificity remained high at 98%. Concordance between PEIA and IFA was 77% for 1/40 IFA titers and increased to 90% for titers ,1/160. Seroprevalences for HHV-8 performed in the HIV positive MSM were (IFA 73.1%; PEIA55.2%); heterosexuals (52.5%, 22.2%), which includes injecting drug users (IDU) (54.0%, 32.4%) and non-IDU (51.6%, 16.1%). The inclusion of non-KS HHV-8 IFA positive individuals to the positive controls may be a substantial improvement towards the realistic assessment of assay sensitivity. These peptide EIAs can be used for trends in populations with high probablity of being HHV-8 infected and negative results should be confirmed by IFA. IFA test is still the most suitable test for populations with low probabilities of being infected. J. Med. Virol. 78:806,813, 2006. © 2006 Wiley-Liss, Inc. [source] Atlas-Based Anatomic Labeling in Neurodegenerative Disease via Structure-Driven Atlas WarpingJOURNAL OF NEUROIMAGING, Issue 1 2005Dominik S. Meier PhD ABSTRACT A new method is presented for the automated anatomic labeling and comparative morphometric analysis of brain magnetic reso nance imaging, warping a prelabeled atlas into congruence with the subject anatomy. The strategy emphasizes anatomically meaningful atlas deformations in the presence of strong degen eration and substantial morphologic differences, for example, cases with high levels of atrophy. The atlas deformation is not driven by image intensity similarities but by continuous anatomic correspondence maps, derived from individual presegmented brain structures. Automatically generated correspondence maps provide large sets of fiducials, driving a warp with many thousand degrees of freedom. Validation included a scan-rescan study and anatomically relevant self-validation in multiple sclerosis patients with substantial cortical and subcortical degeneration. The mean coefficient of variation in the scan-rescan study was 1.4%, with no significant difference in preci sion between normal and neurodegenerative anatomies. The self-validation demonstrated good structural overlap, with substantial improvement over established methods, such as Talairach spatial normalization. [source] Trancranial Doppler Monitoring of Response to Therapy for Meningovascular SyphilisJOURNAL OF NEUROIMAGING, Issue 1 2003Roger E. Kelley MD ABSTRACT Meningovascular syphilis is now quite uncommon, but there have been increasing reports in patients immunocompromised with human immunodeficiency virus. The response of syphilis affecting the central nervous system to antibiotic therapy remains a challenge. This is an even greater challenge in patients who have underlying compromise of the immune system. The authors present a 46-year-old male with recurrent stroke who was found to have cerebrospinal fluid compatible with syphilitic involvement of the central nervous system and a cerebral arteriogram, which revealed focal narrowing of the right middle cerebral artery. The baseline transcranial Doppler study demonstrated increased mean and peak flow velocity within the right middle cerebral artery. Despite a 10-day course of intravenous penicillin, with substantial improvement in the cerebrospinal fluid results, this flow velocity elevation persisted, in a remarkably consistent pattern, over a 4-month follow-up period. Thus, the involved vessel remained patent following treatment, but no clear resolution of the stenotic lesion was observed. [source] | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||