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Selected AbstractsDrug-related problems in elderly general practice patients receiving pharmaceutical careINTERNATIONAL JOURNAL OF PHARMACY PRACTICE, Issue 3 2005Elaine Lau Research fellow Objective To describe the types of drug-related problems identified by pharmacists providing pharmaceutical care to elderly patients in the primary care or general medicine setting, and the impact of their recommendations on drug-related outcomes. Methods Searches of the MEDLINE, EMBASE, CINAHL, HealthSTAR, and International Pharmaceutical Abstracts electronic databases from 1990 to 2002 were conducted and a manual search of references from retrieved articles and references on file was performed. Large (n> 100) randomised, controlled studies comparing the provision of pharmaceutical care to usual care in seniors in primary care or general medicine settings were included. Two reviewers evaluated articles based on inclusion criteria and extracted data from the intervention arm of each study, resolving discrepancies by consensus. Nine original articles were included for analysis. Key findings The mean number of drug-related problems (DRPs) identified per patient was 3.2 and the mean number of recommendations made per patient was 3.3. The most common DRP identified was not taking/receiving a prescribed drug appropriately (35.2%, range 4.7,49.3%). The most common recommendations made involved patient education (37.2%, range 4.6,48.2%). Implementation rates were generally high for all types of recommendations, with the highest being for provision of patient education (81.6%). The small number of studies available examining measures of drug utilisation and costs, health services utilisation, and patient outcomes produced inconsistent results, making it difficult to draw conclusions. Conclusions Substantial numbers and a wide range of DRPs were identified by pharmacists who provided pharmaceutical care to seniors in the primary care and general medicine setting. Pharmacists' drug-therapy recommendations were well accepted; however, further study is needed to determine the impact of these recommendations on health-related outcomes. [source] Is Consent "Informed" When Patients Receive Care from Medical Trainees?ACADEMIC EMERGENCY MEDICINE, Issue 12 2008Daniel J. Pallin MD Abstract Objectives:, Medical care requires consent and consent requires information. Prior studies have shown that patients are poorly informed about the medical training hierarchy. The authors assessed the impact of "informed" on "consent," by assessing willingness to be seen by trainees before and after information about trainee's credentials. Methods:, A convenience sample of patients in an urban emergency department (ED) waiting room was surveyed, ascertaining willingness to be seen before and after information about trainees credentials, using Likert scales. McNemar's test, linear regression, and mixed models were used to assess statistical significance of information in changing preferences and patient characteristics predicting knowledge, willingness, and change in willingness to be seen with more information. Results:, The authors approached 397 patients, and 199 (50%) English speakers participated. Initially, 45% of subjects knew the meaning of "medical student," and 35%"intern" and "resident." In a controlled multivariate linear regression, educational attainment (p < 0.0001) predicted more knowledge, Hispanic ethnicity predicted less (p = 0.03). Subjects were less willing to be seen by lower-ranking trainees (p < 0.001). Information about trainees caused a significant increase in unwillingness to be seen by medical students (17% to 28%, p = 0.004) and interns (8% to 13%, p = 0.029). Conclusions:, Substantial numbers of ED patients would prefer not to be seen by trainees. When patients are informed about trainees' credentials, they become less willing to be seen by more junior trainees. Further research should clarify informed consent for care among non,English speakers and should address these issues in other medical settings. [source] The epidemiology of contact allergy in the general population , prevalence and main findingsCONTACT DERMATITIS, Issue 5 2007Jacob Pontoppidan Thyssen A substantial number of studies have investigated the prevalence of contact allergy in the general population and in unselected subgroups of the general population. The aim of this review was to determine a median prevalence and summarize the main findings from studies on contact allergy in the general population. Published research mainly originates from North America and Western Europe. The median prevalence of contact allergy to at least 1 allergen was 21.2% (range 12.5,40.6%), and the weighted average prevalence was 19.5%, based on data collected on all age groups and all countries between 1966 and 2007. The most prevalent contact allergens were nickel, thimerosal, and fragrance mix. The median nickel allergy prevalence was 8.6% (range 0.7,27.8%) and demonstrates that nickel was an important cause of contact allergy in the general population and that it was widespread in both men and women. Numerous studies demonstrated that pierced ears were a significant risk factor for nickel allergy. Nickel was a risk factor for hand eczema in women. Finally, heavy smoking was associated with contact allergy, mostly in women. Population-based epidemiological studies are considered a prerequisite in the surveillance of national and international contact allergy epidemics. [source] Bone replacement following dental trauma prior to implant surgery , present statusDENTAL TRAUMATOLOGY, Issue 1 2009Mats Hallman Although autogenous bone grafts is considered the ,gold standard', this may be associated with patient morbidity and graft resorption. Consequently, the use of bone substitutes has increased. Today, a substantial number of biomaterials are available on the market, but only a few are well documented. The user should be aware that these biomaterials have different properties: resorbable or non-resorbable, time of resorption and resorption mechanism. The purpose of this review is to describe the function of various bone substitutes and indications for their use in reconstructive implant surgery and to give an overview of the current situation. [source] Prevalence of autoimmune diseases in islet transplant candidates with severe hypoglycaemia and glycaemic lability: previously undiagnosed coeliac and autoimmune thyroid disease is identified by screeningDIABETIC MEDICINE, Issue 2 2007M. Walter Abstract Aims, Autoimmune diseases such as Addison's or coeliac disease can contribute to hypoglycaemia or malabsorption and are more common in Type 1 diabetes (T1DM). This brief report describes the prevalence of known and newly detected autoimmune disease in clinical islet transplant candidates with longstanding T1DM and severe hypoglycaemia and/or glycaemic lability who are routinely screened for coexisting autoimmune disease. Methods, One hundred and twenty-four C-peptide negative T1DM subjects [77 (62%) female, mean age 44 ± 9 years, diabetes duration 28 ± 11 years, body mass index 24.9 ± 3.5 kg/m2] with indications for clinical islet transplantation at the University of Alberta were screened for autoimmune disease by history and measurement of anti-transglutaminase antibodies (positive > 10 U/ml), 09.00 h cortisol (followed by adrenocorticotrophic hormone-stimulation if < 495 nmol/l) and thyroid-stimulating hormone to determine the prevalence of coeliac disease, Addison's disease and autoimmune thyroid disease, respectively. Results, Forty per cent of subjects had one or more coexisting autoimmune disease. The prevalence of autoimmune disease was 35%, coeliac disease 8% and Addison's disease 1.6%. In 11 individuals (9%), one or more autoimmune disease were newly detected (seven coeliac disease and five thyroid disease). Seven of 10 cases of coeliac disease were newly detected. A gluten-free diet in individuals with newly diagnosed coeliac disease reduced gastrointestinal symptoms, but indications for clinical islet cell transplantation persisted. Conclusions, Coexisting autoimmune disease is common in candidates for clinical islet cell transplantation. Screening in this group identified a substantial number of previously unrecognized cases. Clinicians should consider the presence of autoimmune disease even in the absence of classical symptoms. [source] Glycaemia and insulinaemia in elderly European subjects (70,75 years)DIABETIC MEDICINE, Issue 2 2001A. U. Teuscher SUMMARY Aims To determine glycaemia and insulinaemia in elderly subjects aged 70,75 years, living across Europe, who participated in the EURONUT-SENECA (Survey in Europe on Nutrition and the Elderly, a Concerted Action) study. Methods Fasting plasma glucose (FPG) and fasting insulin concentrations were measured in 1830 subjects aged 70,75 years living in 15 traditional towns in 11 European countries. For the diagnosis of diabetes, the recommendations of the 1997 report of the American Diabetes Association ,Expert Committee on the diagnosis and classification of diabetes mellitus' were used. Results A total of 31.6% of the study subjects had either diabetes (17.5%) or impaired fasting plasma glucose (FPG) (14.1%). Fifty-one per cent of the subjects with diabetes were unaware of the disease. No difference in diabetes prevalence was found for sex, but male subjects were more likely to have impaired FPG than female subjects (16.8 vs. 11.5%, P = 0.001). Hyperinsulinaemia (fasting insulin levels in the highest quartile) was associated with increased FPG, body mass index, and waist-to-hip ratio. Conclusions It was found that a substantial number of elderly Europeans have impaired glucose homeostasis, with diabetes and impaired FPG being present in almost a third of European subjects aged 70,75 years. [source] An ecological law and its macroecological consequences as revealed by studies of relationships between host densities and parasite prevalenceECOGRAPHY, Issue 3 2001Per ArnebergArticle first published online: 30 JUN 200 Epidemiological models predict a positive relationship between host population density and abundance of macroparasites. Here I test these by a comparative study. I used data on communities of four groups of parasites inhabiting the gastrointestinal tract of mammals, nematodes of the orders Oxyurida, Ascarida, Enoplida and Spirurida, respectively. The data came from 44 mammalian species and represent examination of 16 886 individual hosts. I studied average prevalence of all nematodes within an order in a host species, a measure of community level abundance, and considered the potential confounding effects of host body weight, fecundity, age at maturity and diet. Host population density was positively correlated with parasite prevalence within the order Oxyurida, where all species have direct life cycles. Considering the effects of other variables did not change this. This supports the assumption that parasite transmission rate generally is a positive function of host population density. It also strengthens the hypothesis that host densities generally act as important determinants of species richness among directly transmitted parasites and suggests that negative influence of such parasites on host population growth rate increase with increasing host population density among host species. Within the other three nematode orders, where a substantial number of the species have indirect life cycles, no relationships between prevalence and host population density were seen. Again, considering the effects of other variables did not affect this conclusion. This suggests that host population density is a poor predictor of species richness of indirectly transmitted parasites and that effects of such parasites on host population dynamics do not scale with host densities among species of hosts. [source] Is Privately-provided Electronic Money Next?ECONOMIC AFFAIRS, Issue 1 2000Catherine England To survive, any new electronic money will need to provide some advantage to its users, such as lower transaction costs, increased privacy, a greater ability to avoid taxes, or a more stable value than its government-provided competitors. Any successful new money will have to overcome substantial barriers to entry, however. These barriers to entry occur primarily in the form of the costs of switching to a different means of payment and require an understanding of the role played by ,network economics.' Unless a substantial number of the individuals and businesses with whom a person trades use the same money, any new means of payment will have little value. A temptation facing government regulators will be to extend and expand regulations to apply to new means of payment and forms of money. A more productive role of governments is to attempt to protect their own money-creation franchises by minimising the advantages offered by privately-provided alternatives. Governments should enforce contracts and punish fraud while remaining vigilant with respect to inflation, keep tax rates low and protect the privacy of their citizens. [source] Occupational exposures occurring in students in a UK dental school,EUROPEAN JOURNAL OF DENTAL EDUCATION, Issue 3 2002D. A. Stewardson Background:, Students whilst training may encounter a number of incidents where infection from patient body fluids may occur, especially as their manual skills are underdeveloped and their clinical experience is limited. Purpose of study:, (a) To assess the nature of the occupational exposures occurring to students in a UK dental school, (b) to assess the rate of reporting of incidents, and (c) to evaluate the association of various factors with these exposures. Students in the third, fourth and final years of the 5-year undergraduate dental course at the University of Birmingham were asked to complete a questionnaire that enquired into personal details, number and nature of incidents, their reporting and follow-up. A 100% response rate was achieved. Results:, Across the years, there was no significant correlation (p > 0.01) between sex, dominant hand, use of protective glasses or time of day. Slightly more exposures occurred in males, right-handed students, and in the afternoon. A significant decrease in exposures (p < 0.01) occurred within final year, and when an assistant was employed. Significantly more incidents occurred while a patient was being treated than during operational clean-up procedures. A substantial number of dental students had experienced one or more occupational exposures during training. Of these, percutaneous injuries predominated. Junior students appear to be more likely to experience exposures, and in these students, needlestick injuries are the most common source. Conclusions:, To reduce the incidence of these exposures, more instruction and training may be required in the earlier clinical years and more chairside assistance. Improvements are required in the monitoring of post-screening for seroconversion after HBV immunization, and in the reporting of test results in the event of an exposure incident. Under-reporting of incidents is common and ways to encourage and facilitate reporting should be sought. [source] Climate change and the future for coral reef fishesFISH AND FISHERIES, Issue 3 2008Philip L Munday Abstract Climate change will impact coral-reef fishes through effects on individual performance, trophic linkages, recruitment dynamics, population connectivity and other ecosystem processes. The most immediate impacts will be a loss of diversity and changes to fish community composition as a result of coral bleaching. Coral-dependent fishes suffer the most rapid population declines as coral is lost; however, many other species will exhibit long-term declines due to loss of settlement habitat and erosion of habitat structural complexity. Increased ocean temperature will affect the physiological performance and behaviour of coral reef fishes, especially during their early life history. Small temperature increases might favour larval development, but this could be counteracted by negative effects on adult reproduction. Already variable recruitment will become even more unpredictable. This will make optimal harvest strategies for coral reef fisheries more difficult to determine and populations more susceptible to overfishing. A substantial number of species could exhibit range shifts, with implications for extinction risk of small-range species near the margins of reef development. There are critical gaps in our knowledge of how climate change will affect tropical marine fishes. Predictions are often based on temperate examples, which may be inappropriate for tropical species. Improved projections of how ocean currents and primary productivity will change are needed to better predict how reef fish population dynamics and connectivity patterns will change. Finally, the potential for adaptation to climate change needs more attention. Many coral reef fishes have geographical ranges spanning a wide temperature gradient and some have short generation times. These characteristics are conducive to acclimation or local adaptation to climate change and provide hope that the more resilient species will persist if immediate action is taken to stabilize Earth's climate. [source] The future of stock enhancements: lessons for hatchery practice from conservation biologyFISH AND FISHERIES, Issue 2 2002Culum Brown Abstract The world's fish species are under threat from habitat degradation and over-exploitation. In many instances, attempts to bolster stocks have been made by rearing fish in hatcheries and releasing them into the wild. Fisheries restocking programmes have primarily headed these attempts. However, a substantial number of endangered species recovery programmes also rely on the release of hatchery-reared individuals to ensure long-term population viability. Fisheries scientists have known about the behavioural deficits displayed by hatchery-reared fish and the resultant poor survival rates in the wild for over a century. Whilst there remain considerable gaps in our knowledge about the exact causes of post-release mortality, or their relative contributions, it is clear that significant improvements could be made by rethinking the ways in which hatchery fish are reared, prepared for release and eventually liberated. We emphasize that the focus of fisheries research must now shift from husbandry to improving post-release behavioural performance. In this paper we take a leaf out of the conservation biology literature, paying particular attention to the recent developments in reintroduction biology. Conservation reintroduction techniques including environmental enrichment, life-skills training, and soft release protocols are reviewed and we reflect on their application to fisheries restocking programmes. It emerges that many of the methods examined could be implemented by hatcheries with relative ease and could potentially provide large increases in the probability of survival of hatchery-reared fish. Several of the necessary measures need not be time-consuming or expensive and many could be applied at the hatchery level without any further experimentation. [source] Analysis of single-locus tests to detect gene/disease associations,GENETIC EPIDEMIOLOGY, Issue 3 2005Kathryn Roeder Abstract A goal of association analysis is to determine whether variation in a particular candidate region or gene is associated with liability to complex disease. To evaluate such candidates, ubiquitous Single Nucleotide Polymorphisms (SNPs) are useful. It is critical, however, to select a set of SNPs that are in substantial linkage disequilibrium (LD) with all other polymorphisms in the region. Whether there is an ideal statistical framework to test such a set of ,tag SNPs' for association is unknown. Compared to tests for association based on frequencies of haplotypes, recent evidence suggests tests for association based on linear combinations of the tag SNPs (Hotelling T2 test) are more powerful. Following this logical progression, we wondered if single-locus tests would prove generally more powerful than the regression-based tests? We answer this question by investigating four inferential procedures: the maximum of a series of test statistics corrected for multiple testing by the Bonferroni procedure, TB, or by permutation of case-control status, TP; a procedure that tests the maximum of a smoothed curve fitted to the series of of test statistics, TS; and the Hotelling T2 procedure, which we call TR. These procedures are evaluated by simulating data like that from human populations, including realistic levels of LD and realistic effects of alleles conferring liability to disease. We find that power depends on the correlation structure of SNPs within a gene, the density of tag SNPs, and the placement of the liability allele. The clearest pattern emerges between power and the number of SNPs selected. When a large fraction of the SNPs within a gene are tested, and multiple SNPs are highly correlated with the liability allele, TS has better power. Using a SNP selection scheme that optimizes power but also requires a substantial number of SNPs to be genotyped (roughly 10,20 SNPs per gene), power of TP is generally superior to that for the other procedures, including TR. Finally, when a SNP selection procedure that targets a minimal number of SNPs per gene is applied, the average performances of TP and TR are indistinguishable. Genet. Epidemiol. © 2005 Wiley-Liss, Inc. [source] ,Zum Ruhme Englands': The ,Vorgeschichte' of the Nazi Film TitanicGERMAN LIFE AND LETTERS, Issue 2 2007Gerwin Strobl ABSTRACT This article examines the background to the Nazi film ,Titanic'. Commissioned by the Propaganda Ministry in 1940, at the height of war with Britain, the film was able to draw on extensive German engagement with the fate of the ,R.M.S. Titanic', stretching back to the original newspaper reports of April 1912. The sinking of the ,Titanic' had made a deeper impression in Germany than in other European countries, perhaps because a substantial number of the victims were in fact German or had ties with Germany. The extent of the emotional engagement showed not only in the tone of the newspaper reporting but in the sheer range of tributes that appeared in Germany: newspapers apart, there were films, paintings, poems, novels, lectures or even children's toys. The enduring interest in the ,Titanic' throughout the 1920s and 30s may explain the propagandists' decision to exploit the topic for Nazi purposes. Widespread German unease about the apparent preference given to first-class passengers during the rescue operation and rumours of financial improprieties surrounding the owners of the ,Titanic' made the topic especially attractive to the Nazis. Ultimately, however, the favourable German perceptions of ,heroic British seamanship' undermined the Nazi film and led Goebbels to restrict its release. [source] Business Models and the Transfer of Businesslike CentralGovernment AgenciesGOVERNANCE, Issue 2 2001Oliver James At the same time as many researchers in public administration are suggesting the emergence of similar New Public Management (NPM) forms in Organization for Economic Co-operation and Development (OECD) countries, a substantial number of those working in comparative political economy are rediscovering differences between countries. This paper explores a key component of NPM,business-like central government agencies,in four countries: the UK, the U.S., Germany, and Japan. So far, the private sector side of the NPM story has largely been neglected. However, the business-like agency model as developed in the UK was influenced by the Anglo-American system of corporate governance. In comparative political economy, the Anglo-American system is seen as different from that in Germany or Japan. These differences are important for understanding transfer through emulation of the UK agency model by policy-makers in other countries. An apparent inconsistency may be developing, with governments using an NPM form based on an Anglo-American model of business that is far from universal in business itself. [source] The molecular analysis of von Willebrand disease: a guideline from the UK Haemophilia Centre Doctors' Organisation Haemophilia Genetics Laboratory NetworkHAEMOPHILIA, Issue 5 2008S. KEENEY Summary., von Willebrand disease (VWD) is a common autosomally inherited bleeding disorder associated with mucosal or trauma-related bleeding in affected individuals. VWD results from a quantitative or qualitative deficiency of von Willebrand factor (VWF), a glycoprotein that is essential for primary haemostasis and that carries and protects coagulation factor VIII (FVIII) in the circulation. Through characterization of the phenotype and identification of mutations in the VWF gene in patients with VWD, understanding of the genetics and biochemistry of VWF and VWD has advanced considerably. The importance of specific regions of VWF for its interaction with other components of the vasculature has been revealed, and this has facilitated the formal classification of VWD into three subtypes based upon quantitative (types 1 and 3) and qualitative (type 2) deficiency of VWF. The underlying genetic lesions and associated molecular pathology have been identified in many cases of the qualitative type 2 VWD variants (2A, 2B, 2M, 2N) and in the severe quantitative deficiency, type 3 VWD. However in the partial quantitative deficiency, type 1 VWD, the picture is less clear: there is a variable relationship between plasma levels of VWF and bleeding, there is incomplete penetrance and variable expressivity within affected families, the causative molecular defect is unknown in a substantial number of cases, and even in those cases where the causative mutation is known, the associated molecular pathology is not necessarily understood. This guideline aims to provide a framework for best laboratory practice for the genetic diagnosis of VWD, based upon current knowledge and understanding. [source] Should Non-Invasive Helicobacter pylori Testing Replace Endoscopy in Investigation of Dyspepsia?HELICOBACTER, Issue S1 2000Kenneth McColl Our knowledge of Helicobacter pylori infection is now changing the way in which we investigate patients presenting with dyspepsia, with noninvasive H. pylori testing replacing endoscopy. Non-invasive H. pylori testing has been shown to be useful in predicting the underlying diagnosis in patients presenting with dyspepsia. Several studies have shown that 20,50% of dyspeptic patients with a positive H. pylori test will have evidence of underlying ulcer disease or duodenitis. In contrast, less than 5% of dyspeptic patients with a negative H. pylori test will have evidence of ulcer disease and in these subjects, the likeliest diagnosis is gastroesophageal reflux disease. This has led to many groups recommending that noninvasive H. pylori testing should be used in place of endoscopy, with all those testing positive being given anti- H. pylori therapy and those testing negative being treated symptomatically. One concern about nonendoscopic management of dyspeptic patients is the possibility of missing underlying malignancy but studies have shown that in western countries this is rare in patients less than 55 years of age presenting with dyspepsia in the absence of sinister symptoms. There is increasing evidence supporting eradication of H. pylori infection in dyspeptic patients without ulcer disease. Meta-analysis of four prospective randomized trials indicates that such treatment is superior to placebo in about 10% of subjects. H. pylori -positive dyspeptic patients are also recognized to have an increased risk of developing ulcer disease in the future which will be removed by treating the infection. Another justification for eradicating the infection in the absence of ulcer disease is the fact that H. pylori infection is now proven to be a risk factor for gastric cancer. Prospective randomized studies comparing endoscopy with noninvasive H. pylori testing in the management of dyspeptic patients indicate that managing dyspepsia by noninvasive H. pylori testing is at least as effective as endoscopic-based management in producing symptomatic resolution and saves a substantial number of endoscopic procedures. There is therefore now substantial evidence indicating that noninvasive H. pylori testing should be used in place of endoscopy to determine the management of younger dyspeptic patients without sinister symptoms and who are not taking nonsteroidal anti-inflammatory drugs. [source] Low dose 2-CdA schedule activity in splenic marginal zone lymphomasHEMATOLOGICAL ONCOLOGY, Issue 4 2003R. Riccioni Abstract Splenic Marginal Zone Lymphoma (SMZL) is a rare clinicopathological entity among marginal zone lymphomas. SMZL is an indolent lymphoma usually treated by splenectomy. A subset of patients is characterized by a more aggressive clinical course and poor prognosis. Treatment of these cases and second-line therapy for relapsed patients have not been yet identified. We report 10 cases treated with cladribrine (5,mg/m2/week) for six courses. Six patients (60%) achieved partial response, two patients (20%) achieved a complete response and the two remaining patients did not respond and died as a result of progression of the disease. The treatment was well tolerated. A total of 60% of the patients had an overall survival rate of 48 months and 24 months progression-free-survival was achieved by 37% with a median time of progression-free-survival of 17 months. Interestingly, in addition to a relevant percentage of hematological remission, some patients also experienced a molecular remission. We conclude that this treatment is safe and well tolerated and is able to induce a substantial number of responses. Our results suggest that this schedule is well tolerated and could be an useful alternative to splenectomy. Copyright © 2003 John Wiley & Sons, Ltd. [source] Unpaid Work at HomeINDUSTRIAL RELATIONS, Issue 4 2009YOUNGHWAN SONG A substantial number of people take work home without a formal payment arrangement. Using the Work Schedules and Work at Home Supplement to the May 2001 Current Population Survey, this paper investigates the determinants of unpaid work at home. Education, lack of overtime rates, being a team leader, efficiency wages, and larger earnings inequality in an occupation are positively related to the prevalence of unpaid work at home. Unpaid work at home appears to be a form of investment made in expectation of a return in the long run. [source] Development of Tactile Responses in Human Preterm and Full-Term Infants From 30 to 40 Weeks Postconceptional AgeINFANCY, Issue 1 2002Isabel Fearon Maturation of tactile sensitivity prior to term was examined in 36 preterm and 13 full-term infants using a fixed-trial, habituation procedure. Each infant was presented with a series of 8 habituation (arm stroke), 2 novel (arm lift), and 2 recovery (arm stroke) stimulus trials while heart rate and body movements were recorded. Maturation was observed with a gradual increase in the magnitude of the stimulus-elicited cardiac acceleration and cardiac-movement coupling from 30 to 40 weeks postconceptional age. The majority of infants displayed habituation,an excitatory response (heart rate acceleration and body movement),to the initial presentation of a tactile stimulus, response decline with repeated stimulations, and renewed response to a novel stimulus. A substantial number of infants (40%) failed to respond initially to the tactile stimulus, increased responding over several stimulus presentations, and failed to discriminate the presentation of a novel stimulus. We speculate that these differences in response patterns observed over all ages represent individual difference in the perception of stimulus intensity. [source] An open-label pilot study using thioguanine as a therapeutic alternative in Crohn's disease patients resistant to 6-mercaptopurine therapyINFLAMMATORY BOWEL DISEASES, Issue 3 2001Dr. Marla C. Dubinsky Abstract Background and Aims A substantial number of patients with inflammatory bowel disease (IBD) fail to achieve a complete clinical response with 6-mercaptopurine (6-MP) and azathioprine (AZA). Inability to achieve therapeutic 6-thioguanine nucleotide (6-TGN) levels due to the preferential overproduction of 6-methylmercaptopurine ribonucleotides (6-MMPR) upon dose escalation characterizes a newly described subgroup of IBD patients resistant to 6-MP/AZA therapy. Treatment with 6-thioguanine (6-TG), a related thiopurine, which forms 6-TGNs more directly may be beneficial in such patients. This pilot study evaluated the safety, tolerance, and efficacy of 6-TG in the subgroup of Crohn's disease (CD) patients failing to attain adequate disease control with traditional 6-MP/AZA therapy. Methods Ten CD patients with preferential 6-MMPR production upon 6-MP/AZA dose escalation were enrolled in an open-label pilot study. Seven of 10 patients had experienced dose-related 6-MP toxicities. Results Seventy percent of the patients (7 of 10) responded or were in remission at week 16. Clinical response was evident by week 4 in most. 6-TGN levels were nine-fold higher with 6-TG treatment than with 6-MP, whereas 6-MMPR levels were undetectable. No patient developed a recurrence of hepatic or hematological toxicity. Conclusions 6-TG was a safer and more efficacious thiopurine in this subgroup of IBD patients resistant to 6-MP therapy. Larger controlled trials are warranted to further evaluate both the short-and long-term safety and efficacy in this subgroup of patients as well as a broader spectrum of IBD patients. [source] The genetics of aspirin resistanceINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 5 2007Timothy Goodman Summary Aspirin is widely used for the prophylaxis of cardiovascular events in patients with cardiovascular risk factors or established atherosclerotic disease. However, despite aspirin treatment, a substantial number of patients experience recurrent events. Such ,aspirin resistance' is generally defined as failure of aspirin to produce an expected biological response, for example inhibition of platelet aggregation or of thromboxane A2 synthesis. Whilst its aetiology is multifactorial, genetic factors are also likely to play their part. Here we review the evidence for and against such a genetic contribution, as well as the data suggesting the involvement of specific genes. [source] Flavour retention during high temperature short time extrusion cooking process: a reviewINTERNATIONAL JOURNAL OF FOOD SCIENCE & TECHNOLOGY, Issue 5 2001Bhesh Bhandari Research on the stability of flavours during high temperature extrusion cooking is reviewed. The important factors that affect flavour and aroma retention during the process of extrusion are illustrated. A substantial number of flavour volatiles which are incorporated prior to extrusion are normally lost during expansion, this is because of steam distillation. Therefore, a general practice has been to introduce a flavour mix after the extrusion process. This extra operation requires a binding agent (normally oil), and may also result in a non-uniform distribution of the flavour and low oxidative stability of the flavours exposed on the surface. Therefore, the importance of encapsulated flavours, particularly the ,-cyclodextrin-flavour complex, is highlighted in this paper. [source] Roaming and service management in public wireless networks using an innovative policy management architectureINTERNATIONAL JOURNAL OF NETWORK MANAGEMENT, Issue 2 2005Idir Fodil Nowadays, public wireless local area networks (WLANs), commonly called hotspots, are being largely deployed by WISPs (Wireless Internet Service Providers) as a means of offering ubiquitous Internet access to their customers. Although a substantial number of solutions have been proposed to improve security, mobility and quality of service on the wireless area, access network management which is mandatory remains a very significant concern. This paper describes RSM-WISP, a new management architecture designed for WISPs to facilitate the implementation and management of the services they offer at the access side of the WLAN, and to manage roaming contracts between WISPs. Our architecture is based upon the policy-based management principles as introduced by the IETF, combined with more intelligence at the network edge. RSM-WISP adopts an architecture that is composed of two elements: a WISP management center (MC) that deploys policies and monitors all the WLANs, and a programmable access router (CPE) located in each WLAN. The CPE ensures service enforcement, service differentiation (access to different service levels) and guarantee, user access management, and dynamic WLAN adaptation according to the user's SLA (service level agreement). It also permits automatic service updates according to the user's requirements. Concerning roaming management, this is achieved on the CPE through multiple service provider support capabilities. This approach provides WISPs with a simple, flexible and scalable solution that allows easy service deployment and management at the access. This management architecture has been implemented, tested and validated on the 6WINDGate routers.,Copyright © 2005 John Wiley & Sons, Ltd. [source] How fundraising is carried out in US nonprofit organisationsINTERNATIONAL JOURNAL OF NONPROFIT & VOLUNTARY SECTOR MARKETING, Issue 4 2002Mark Hager A substantial number of nonprofit organisations in the USA report inflows of charitable contributions or grants without expenditures allocated to fundraising costs. This observation raises questions about how fundraising is carried out. Based on a survey of US charities, the paper observes that nonprofit organisations use a range of internal capacities and external relationships to conduct their fundraising. The use of staff members dedicated to fundraising is common, but much fundraising is still carried out by executive directors, volunteers and board members. Also, a substantial number of organisations engage external entities, including federated campaigns, support organisations and professional fundraising firms to generate contributions. Copyright © 2002 Henry Stewart Publications [source] Urban small vertebrate taphonomy: a case study from Anglo,Scandinavian YorkINTERNATIONAL JOURNAL OF OSTEOARCHAEOLOGY, Issue 5 2001P.J. Piper Abstract Sampling of deposits at the Queens Hotel site, York, produced a substantial number of small terrestrial vertebrate remains from the Anglo,Scandinavian features. By studying bone surface modification, fragmentation and skeletal completeness as taphonomic indicators, it was possible to demonstrate that the assemblage had resulted from two very different modes of accumulation and deposition. Refuse pits situated within the boundaries of the tenements had acted as accumulators of the fragmented and abraded small mammal and amphibian bones that existed as a sub-surface death assemblage within the local environment. In contrast, the excellent preservation and skeletal completeness of numerous frogs recovered from the basal fill of a wooden well could be accounted for by their direct entry into the burial environment as a result of pit-fall trapping. This paper also discusses the implications that the temporal and spatial variation in deposition demonstrated by the micro-faunal remains has for the reconstruction of local ecological and environmental conditions within this site, and for other such sites. Copyright © 2001 John Wiley & Sons, Ltd. [source] Synthetic morphology: prospects for engineered, self-constructing anatomiesJOURNAL OF ANATOMY, Issue 6 2008Jamie A. Davies Abstract This paper outlines prospects for applying the emerging techniques of synthetic biology to the field of anatomy, with the aim of programming cells to organize themselves into specific, novel arrangements, structures and tissues. There are two main reasons why developing this hybrid discipline , synthetic morphology , would be useful. The first is that having a way to engineer self-constructing assemblies of cells would provide a powerful means of tissue engineering for clinical use in surgery and regenerative medicine. The second is that construction of simple novel systems according to theories of morphogenesis gained from study of real embryos will provide a means of testing those theories rigorously, something that is very difficult to do by manipulation of complex embryos. This paper sets out the engineering requirements for synthetic morphology, which include the development of a library of sensor modules, regulatory modules and effector modules that can be connected functionally within cells. A substantial number of sensor and regulatory modules already exist and this paper argues that some potential effector modules have already been identified. The necessary library may therefore be within reach. The paper ends by suggesting a set of challenges, ranging from simple to complex, the achievement of which would provide valuable proofs of concept. [source] Use of serial pig body weights for genetic evaluation of daily gainJOURNAL OF ANIMAL BREEDING AND GENETICS, Issue 2 2010B. Zumbach Summary This study examined the utility of serial weights from FIRE (Feed Intake Recording Equipment, Osborne Industries, Inc., Osborne, KS, USA) stations for an analysis of daily gain. Data included 884 132 body weight records from 3888 purebred Duroc pigs. Pigs entered the feeder station at age 77,149 days and left at age 95,184 days. A substantial number of records were abnormal, showing body weight close to 0 or up to twice the average weight. Plots of body weights for some animals indicated two parallel growth curves. Initial editing used a robust regression, which was a two-step procedure. In the first step, a quadratic growth curve was estimated assuming small or 0 weights for points far away from the curve; the process is iterative. In the second step, weights more than 1.5 SD from the estimated growth curve were treated as outliers. The retained body weight records (607 597) were averaged to create average daily weight (170 443) and then used to calculate daily gains (152 636). Additional editing steps included retaining only animals with ,50 body weight records and SD of the daily gain ,2 kg, followed by removing records outside 3 SD from the mean for given age, across all the animals , the resulting data set included 69 068 records of daily gain from 1921 animals. Daily gain based on daily, weekly and bi-weekly intervals was analysed using repeatability models. Heritability estimates were 0.04, 6 and 9%, respectively. The last two estimates correspond to heritability of 28% for a 12 week interval. For daily gain averaged weekly, the estimate of heritability obtained with a random regression model varied from 0.07 to 0.10. After extensive editing, body weight records from automatic feeding stations are useful for genetic analyses of daily gain from weekly or bi-weekly but not daily intervals. [source] Chronic shedding of Campylobacter species in beef cattleJOURNAL OF APPLIED MICROBIOLOGY, Issue 2 2004G.D. Inglis Abstract Aims:, To determine the prevalence of chronic shedding of Campylobacter species by beef cattle, a longitudinal study of shedding patterns was conducted in a cohort of 60 beef steers over a 4-month period. Methods and Results:, Steers were maintained in a simulated feedlot setting but individually in pens to minimize transmission among animals. At each collection time, campylobacters in faeces were detected using conventional PCR. In addition, quantities of Campylobacter jejuni and C. lanienae in faeces were measured using real-time quantitative (RTQ) PCR. All of the steers tested shed Campylobacter species during the course of the study, and overall, 90% of the 299 samples tested were positive for Campylobacter DNA. The majority of the animals (86%) shed campylobacters at ,4 sample times. The most prevalent taxon detected in bovine faeces was C. lanienae (56% of samples) followed by C. jejuni (13%), C. hyointestinalis (8%), and C. fetus (2%). No C. coli was detected, and 13% of the faecal samples contained two or more of the above species. Seven (12%) and 34 (57%) animals shed C. jejuni and C. lanienae at ,3 sample times, respectively. For both C. lanienae and C. jejuni, a substantial number of cells were detected in faeces using RTQ-PCR; 27% of the samples positive for C. jejuni contained populations >104 cells g,1 (maximum of 5 × 105 cells g,1), and 44% of samples positive for C. lanienae possessed populations >106 cells g,1 (maximum of 4 × 108 cells g,1). A significant correlation was observed between shedding of C. lanienae and the severity of liver abscesses. In 27% of the samples, an amplicon was obtained for genus-specific but not for the species-specific primers. Sequencing of the partial 16S rRNA gene suggested the presence of at least two undescribed Campylobacter species but this has yet to be confirmed. Conclusions:, A high percentage of feedlot cattle shed large quantities of Campylobacter species in their faeces over a protracted period of time (ca 112 days). Significance and Impact of the Study:, This is the first study of longitudinal shedding patterns of campylobacters in beef cattle using PCR-detection methods. In addition, this is the first use of RTQ-PCR to directly quantify C. jejuni or C. lanienae in faeces. The results of the study show that a large number of cattle (>85%) chronically shed campylobacters in feedlots. [source] Non-apoptogenic killing of hela cervical carcinoma cells after short exposure to the alkylating agent N -methyl- N, -nitro- N -nitrosoguanidine (MNNG)JOURNAL OF CELLULAR BIOCHEMISTRY, Issue 6 2003Józefa W, sierska-G Abstract We examined the action of N -methyl- N, -nitro- N -nitrosoguanidine (MNNG) on HeLa cells and compared it with that of cisplatin (CP). MNNG directly killed a substantial number of cells within 1 hour and resulted in strong DNA-damage as evidenced by Comet measurements. Despite appearance of DNA lesions, p53 protein was not activated. Analysis of HeLa cells treated with MNNG for 1h, 3h and 6h by flow cytometry and by Hoechst staining did not reveal any sub-G1 cell population and chromatin condensation/fragmentation characteristic for apoptosis, respectively. Also, no biochemical changes typical for apoptosis such as activation of caspase-3 or release of cytochrome C from mitochondria were detected. Inactivation of PARP-1 reduced the direct cytotoxicity exerted by MNNG. Our results showing that despite appearance of severe DNA lesions after short exposure of HeLa cells to MNNG neither activation of p53 response nor induction of apoptosis occurred implicate that generation of strong DNA damage is not sufficient to stabilize p53 protein in HeLa cells. Our data unequivocally show that the conscientious determination of the type of cell death induced by genotoxic agents is necessary. The assessment of the changes based on at least a few independent criteria is required to discriminate between apoptosis and necrosis. Since the alkylating agents generate DNA strand breaks, the recruitment of methods based on determination of DNA cleavage such as DNA ladder or TUNEL assay for evaluation of apoptosis is not adequate. © 2003 Wiley-Liss, Inc. [source] Alterations of liver function test in patients treated with antipsychoticsJOURNAL OF CLINICAL LABORATORY ANALYSIS, Issue 6 2003M. Teresa Garcia-Unzueta Abstract The prevalence of alterations of liver function tests in patients treated with a wide range of antypsychotics is unknown. The aim of this study was to analyze the effects of antipsychotics on liver function tests in a population of schizophrenic outpatients. Concentrations of AST, ALT, GGT, alkaline phosphatase, albumin, and bilirubin were determined in 54 patients fitting DSM-IV criteria of schizophrenia, and the same number of sex- and age-matched healthy subjects. Assessments included the Clinical Global Impression (CGI) and the Positive and Negative Syndrome Scale (PANSS) in addition to treatment related variables. Transaminases concentrations were slightly elevated in study patients compared to healthy controls, but without statistical significance. Alkaline phosphatase showed higher values in schizophrenic patients. Albumin and bilirubin were lower in study patients. Liver function tests abnormalities were found in about 10% of schizophrenic patients treated with antipsychotics. Treatment with depot phenotiazines induces alteration in these tests more frequently than treatment with other antipsychotics. PANSS negative subscale scores directly correlated with alkaline phosphatase and inversely correlated with albumin. A substantial number of patients in treatment with antipsychotic drugs present alterations of liver function tests. Both pharmacological and clinical factors could be related with these alterations. J. Clin. Lab. Anal. 17:216,218, 2003. © 2003 Wiley-Liss, Inc. [source] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||