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Terms modified by Treating Selected AbstractsTreating and preventing adolescent mental health disorders.ACTA PSYCHIATRICA SCANDINAVICA, Issue 6 2006What we know, what we don't know No abstract is available for this article. [source] Treating [K4(H2O)0.5][SnTe4] with PPh4+ or AsPh4+: Formation of a Highly Air-Stable Tellurostannate Salt, a Tellurolate with One-Coordinate Te Atoms, and a Polytelluride Salt with ,1[Te4(H2O)2]2, Chains,EUROPEAN JOURNAL OF INORGANIC CHEMISTRY, Issue 28 2007Eugen Ruzin Abstract In reactions of potassium orthotellurostannates with EPh4Cl (E = P, As), different single-crystalline products are obtained. An air-stable dimeric tellurostannate forms by partial replacement of strongly interacting K+ cations by weakly interacting or noninteracting [PPh4]+ ions. For E = As, an equally air-stable tellurophenolate, in which Te has the rare coordination number 1, results upon As,C bond cleavage at a tetraphenylarsonium cation. Oxidation of the air-sensitive [Sn2Te6]4, anion and Te2, by O2 (air) affords a tetratelluride salt with strands of H2O-bridged [Te4]2, anions. (© Wiley-VCH Verlag GmbH & Co. KGaA, 69451 Weinheim, Germany, 2007) [source] Long-Term, Open-Label Safety Study of Oral Almotriptan 12.5 mg for the Acute Treatment of Migraine in AdolescentsHEADACHE, Issue 5 2010Frank Berenson MD (Headache 2010;50:795-807) Objectives., This study evaluated the long-term safety of oral almotriptan 12.5 mg for the treatment of multiple migraine episodes in adolescents over a 12-month period. Efficacy outcomes were assessed as a secondary objective. Methods., Adolescent migraineurs aged 12-17 years were enrolled in this 12-month, open-label study (Study ID CR002827). Patients were instructed to record their assessments on paper headache records whenever they experienced a migraine headache that they treated with study medication. Safety was assessed descriptively and assessments included adverse event (AE) recording, change in laboratory values, vital signs, and electrocardiogram parameters. Efficacy outcomes were assessed descriptively and outcomes included rates for 2- and 24-hour pain relief and sustained pain relief, 2- and 24-hour pain-free and sustained pain-free, and presence of migraine-associated symptoms of photophobia, phonophobia, nausea and vomiting. Results., Overall, 67.1% of patients reported ,1 AE over the course of the trial, 7.6% had an AE judged by the study investigator to be related to treatment with almotriptan, 2.4% discontinued because of an AE, and 1.9% reported serious AEs. The most commonly reported treatment-related AEs (occurring in ,1% of patients) were nausea (1.4%) and somnolence (1.4%). Pain relief responses for treated migraines of moderate or severe intensity at baseline were 61.7% and 68.6%, at 2 and 24 hours, respectively; the sustained pain relief rate was 55.5%. Pain-free responses were reported for 40.5% of all treated migraines at 2 hours and 65.9% of treated migraines at 24 hours; the sustained pain-free rate was 38.4%. The proportion of migraines that achieved the pain relief, sustained pain relief, pain-free and sustained pain-free endpoints were similar in the 12- to 14-year and 15- to 17-year age groups. Treating with almotriptan 12.5 mg when headache pain was mild was associated with higher rates of pain relief and pain-free at 2 and 24 hours, and sustained pain relief and sustained pain-free, compared with treatment initiated when pain was severe. Conclusions., Almotriptan 12.5 mg was well tolerated in this adolescent population over a 12-month period. No unexpected safety or tolerability concerns were revealed over the course of this study. The results are consistent with almotriptan 12.5 mg being effective for the acute treatment of pain and symptoms associated with migraine in both younger and older adolescents. [source] Treating to Success in Type 2 Diabetes: What to Do When Oral Therapies FailJOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 2008Article first published online: 6 JAN 200 First page of article [source] Treating missing values in INAR(1) models: An application to syndromic surveillance dataJOURNAL OF TIME SERIES ANALYSIS, Issue 1 2010Jonas Andersson Time-series models for count data have found increased interest in recent years. The existing literature refers to the case of data that have been fully observed. In this article, methods for estimating the parameters of the first-order integer-valued autoregressive model in the presence of missing data are proposed. The first method maximizes a conditional likelihood constructed via the observed data based on the k -step-ahead conditional distributions to account for the gaps in the data. The second approach is based on an iterative scheme where missing values are imputed so as to update the estimated parameters. The first method is useful when the predictive distributions have simple forms. We derive in full details this approach when the innovations are assumed to follow a finite mixture of Poisson distributions. The second method is applicable when there are no closed form expression for the conditional likelihood or they are hard to derive. The proposed methods are applied to a dataset concerning syndromic surveillance during the Athens 2004 Olympic Games. [source] New Presentation Package for Treating, Assisting Battered WomenNURSING FOR WOMENS HEALTH, Issue 6 2003Article first published online: 9 MAR 200 No abstract is available for this article. [source] Cyclosporin versus Tacrolimus as Primary Immunosuppressant After Liver Transplantation: A Meta-AnalysisAMERICAN JOURNAL OF TRANSPLANTATION, Issue 7 2006V. C. McAlister A systematic review of randomized clinical trials (RCT) was undertaken to evaluate the beneficial and harmful effects of immunosuppression with cyclosporin versus tacrolimus for liver transplanted patients. MEDLINE, EMBASE, Cochrane Central and Hepato-Biliary Group Controlled Trials Registers were searched. Using fixed and random effects model, relative risk (RR), values <1 favoring tacrolimus, with 95% confidence intervals (CI) were calculated. Of 717 potentially relevant references, 16 RCTs were eligible for inclusion. Mortality and graft loss at 1 year were significantly reduced in tacrolimus-treated recipients (Death: RR 0.85, 95% CI 0.73,0.99; graft loss: RR 0.73, 95% CI 0.61,0.86). Tacrolimus reduced the number of recipients with acute rejection (RR 0.81, 95% CI 0.75,0.88) and steroid-resistant rejection (RR 0.54, 95% CI 0.47,0.74) in the first year. Lymphoproliferative disorder or dialysis rates were not different but more de novo diabetes (RR 1.38, 95% CI 1.01,1.86) occurred with tacrolimus. More patients stopped cyclosporin than tacrolimus (RR 0.57, 95% CI 0.49,0.66). Treating 100 recipients with tacrolimus instead of cyclosporin would avoid rejection and steroid-resistant rejection in nine and seven patients respectively, graft loss and death in five and two patients respectively, but four additional patients would develop diabetes after liver transplantation. [source] Synthesis of 5-Substituted 2-Methylbenzimidazoles with Anticancer ActivityARCHIV DER PHARMAZIE, Issue 1 2003Sh. I. El-Naem Abstract A series of compounds comprising the thiocarboximidopyrazolyl 5, the phenylpyrazolyl 6, the dimethylpyrazolyl 7, the nitrophenylpyrazolyl 8, the dimethyloxazolyl 9, the benzoxazepinyl 10, and pyrimidyl 11 a,c derivatives of 3-(2-methyl-1H -benzimidazol-5-ylazo)pentane-2, 4-dione was synthesized. Moreover, 5-amino-2-methylbenzimidazole (3) was reacted with phthalic anhydride or maleic anhydride in acetic acid or in toluene to produce 12,15. Treating 5, 6-diamino-2-methylbenzimidazole (16) with ethyl cyanoacetate or diethyl malonate or acetyl acetone leads to the formation of the benzodiazepine derivatives 17,20. The cytotoxic activity of the compounds 2, 7, 9, 10, and 11 was tested against 60 types of human cancer cell lines. Compounds 7 and 9 were found to be the most potent. [source] Treating Traumatized Children: Risk, Resilience and RecoveryCHILD AND ADOLESCENT MENTAL HEALTH, Issue 1 2010Paul Abeles No abstract is available for this article. [source] Understanding and Treating Complicated Grief: What Can We Learn from Posttraumatic Stress Disorder?CLINICAL PSYCHOLOGY: SCIENCE AND PRACTICE, Issue 2 2006Anke Ehlers The article outlines possible parallels between the phenomenology and treatment of complicated grief (CG) and posttraumatic stress disorder (PTSD). In particular, it explores how treatment procedures used in Cognitive Therapy for PTSD (Ehlers & Clark, 2000) may be adapted for the treatment of CG. Stimulus Discrimination may be helpful in breaking the link between everyday triggers and "felt presence" memories of the deceased. Memory Updating procedures may help the patient accept that the deceased is no longer alive and no longer suffering. Reclaiming your Life procedures may help the patient access autobiographical memories that are not linked to the deceased and counteract beliefs about the value of life without the deceased. The article further addresses the necessity of specifying the idiosyncratic beliefs that prevent coming to terms with the death, of understanding the relationship between beliefs and coping strategies, and of distinguishing memories from rumination. [source] A programming environment for behavioural animationCOMPUTER ANIMATION AND VIRTUAL WORLDS (PREV: JNL OF VISUALISATION & COMPUTER ANIMATION), Issue 5 2002Frédéric Devillers Abstract Behavioural models offer the ability to simulate autonomous agents like organisms and living beings. Psychological studies have shown that human behaviour can be described by a perception,decision,action loop, in which the decisional process should integrate several programming paradigms such as real time, concurrency and hierarchy. Building such systems for interactive simulation requires the design of a reactive system treating flows of data to and from the environment, and involving task control and preemption. Since a complete mental model based on vision and image processing cannot be constructed in real time using purely geometrical information, higher levels of information are needed in a model of the virtual environment. For example, the autonomous actors of a virtual world would exploit the knowledge of the environment topology to navigate through it. Accordingly, in this paper we present our programming environment for real-time behavioural animation which is compounded of a general animation and simulation platform, a behavioural modelling language and a scenario-authoring tool. Those tools has been used for different applications such as pedestrian and car driver interaction in urban environments, or a virtual museum populated by a group of visitors. Copyright © 2002 John Wiley & Sons, Ltd. [source] Results of a Survey of 5,700 Patient Monopolar Radiofrequency Facial Skin Tightening Treatments: Assessment of a Low-Energy Multiple-Pass Technique Leading to a Clinical End Point AlgorithmDERMATOLOGIC SURGERY, Issue 8 2007FRCP, FRCPC, JEFFREY S. DOVER MD INTRODUCTION Monopolar radiofrequency is an effective means of nonsurgical facial skin tightening. OBJECTIVE The objective of this study was to determine whether using larger tips at lower energy and multiple passes, using patient feedback on heat sensation and treating to a clinical end point of visible tightening, would yield better results than single passes with small tips at high energy, as measured by patient and physician satisfaction. METHODS Fourteen physicians from four specialties were surveyed to determine the answers to the following three questions. (1) Is patient's feedback on heat sensation a valid and preferred method for optimal energy selection? (2) Do multiple passes at moderate energy settings yield substantial and consistent efficacy? (3) Is treating to a clinical end point of visible tightening predictable of results? RESULTS A total of 5,700 patient treatments were surveyed. Comparisons were made using the original algorithm of high-energy, single pass to the new algorithm of lower energy and multiple passes with visible tightening as the end point of treatment. Using the original treatment algorithm, 26% of patients demonstrated immediate tightening, 54% observed skin tightening 6 months after treatment, 45% found the procedure too painful, and 68% of patients found the treatment results met their expectations. With the new multiple-pass algorithm, 87% observed immediate tightening, 92% had the tightening six months after treatment, 5% found the procedure too painful, while 94% found the treatment results met their expectations. CONCLUSIONS Patient feedback on heat sensation is a valid, preferable method for optimal energy selection in monopolar radiofrequency skin-tightening treatments. [source] Factors influencing the challenges of modelling and treating fecal indicator bacteria in surface watersECOHYDROLOGY, Issue 4 2009Cristiane Q. Surbeck Abstract In the United States, thousands of creeks, rivers, and coastal zones are listed as impaired in the Clean Water Act's 303(d) list. The number one general cause of impairments is denoted as ,pathogens', which can include known pathogenic organisms or, more commonly, fecal indicator bacteria (FIB), such as fecal coliform bacteria, Escherichia coli, and enterococci bacteria. Despite efforts by water quality managers to reduce FIB in surface waters via treatment, successful and significant reduction of FIB has been difficult to achieve to meet water quality standards. In addition, current efforts to numerically model FIB concentrations in surface waters do not consider many complexities associated with FIB as a pollutant. Reasons for the challenge of treating and modelling FIB are their varied sources and mechanisms of survival and decay in the environment. This technical note addresses this challenge by discussing the nature of FIB, their sources, and their fate and transport mechanisms. Sources of FIB to surface waters include wastewater, stormwater and dry-weather runoff, and animals. Mechanisms of pathogen indicator occurrence in surface waters are transport in stormwater, ecological proliferation, and interaction with sediments. Copyright © 2009 John Wiley & Sons, Ltd. [source] Molecular analysis of mutations at the HPRT and TK loci of human lymphoblastoid cells after combined treatments with 3,-azido-3,-deoxythymidine and 2,,3,-dideoxyinosine,ENVIRONMENTAL AND MOLECULAR MUTAGENESIS, Issue 4 2002Quanxin Meng Abstract Combinations of antiretroviral drugs that include nucleoside reverse transcriptase inhibitors (NRTIs) are superior to single-agent regimens in treating or preventing HIV infection, but the potential long-term health hazards of these treatments in humans are uncertain. In earlier studies, our group found that coexposure of TK6 human lymphoblastoid cells to 3,-azido-2,,3,-dideoxythymidine (AZT) and 2,,3,-dideoxyinosine (ddI), the first two NRTIs approved by the FDA as antiretroviral drugs, produced multiplicative synergistic enhancement of DNA incorporation of AZT and mutagenic responses in both the HPRT and TK reporter genes, as compared with single-drug exposures (Meng Q et al. [2000a]: Proc Natl Acad Sci USA 97:12667,12671). The purpose of the current study was to characterize the mutational specificity of equimolar mixtures of 100 ,M or 300 ,M AZT + ddI at the HPRT and TK loci of exposed cells vs. unexposed control cells, and to compare the resulting mutational spectra data to those previously found in cells exposed to AZT alone (Sussman H et al. [1999]: Mutat Res 429:249,259; Meng Q et al. [2000b]: Toxicol Sci 54:322,329). Molecular analyses of HPRT mutant clones were performed by reverse transcription,mediated production of cDNA, PCR amplification, and cDNA sequencing to define small DNA alterations, followed by multiplex PCR amplification of genomic DNA to define the fractions of deletion events. TK mutants with complete gene deletions were distinguished by Southern blot analysis. The observed HPRT mutational categories included point mutations, microinsertions/microdeletions, splicing-error mutations, and macrodeletions including partial and complete gene deletions. The only significant difference or shift in the mutational spectra for NRTI-treated cells vs. control cells was the increase in the frequency of complete TK gene deletions following exposures (for 3 days) to 300 ,M AZT,ddI (P = 0.034, chi-square test of homogeneity); however, statistical analyses comparing the observed mutant fraction values (measured mutant frequency × percent of a class of mutation) between control and NRTI-treated cells for each class of mutation showed that the occurrences of complete gene deletions of both HPRT and TK were significantly elevated over background values (0.34 × 10,6 in HPRT and 6.0 × 10,6 in TK) at exposure levels of 100 ,M AZT,ddI (i.e., 1.94 × 10,6 in HPRT and 18.6 × 10,6 in TK) and 300 ,M AZT,ddI (i.e., 5.6 × 10,6 in HPRT and 34.6 × 10,6 in TK) (P < 0.05, Mann,Whitney U -statistic). These treatment-related increases in complete gene deletions were consistent with the spectra data for AZT alone (ibid.) and with the known mode of action of AZT and ddI as DNA chain terminators. In addition, cotreatments of ddI with AZT led to substantial absolute increases in the mutant fraction of other classes of mutations, unlike cells exposed solely to AZT [e.g., the frequency of point mutations among HPRT mutants was significantly increased by 130 and 323% over the background value (4.25 × 10,6) in cells exposed to 100 and 300 ,M AZT,ddI, respectively]. These results indicate that, at the same time that AZT,ddI potentiates therapeutic or prophylactic efficacy, the use of a second NRTI with AZT may confer a greater cancer risk, characterized by a spectrum of mutations that deviates from that produced solely by AZT. Environ. Mol. Mutagen. 39:282,295, 2002. Published 2002 Wiley-Liss, Inc. [source] Perchlorate reduction by a novel chemolithoautotrophic, hydrogen-oxidizing bacteriumENVIRONMENTAL MICROBIOLOGY, Issue 10 2002Husen Zhang Summary Water treatment technologies are needed that can remove perchlorate from drinking water without introducing organic chemicals that stimulate bacterial growth in water distribution systems. Hydrogen is an ideal energy source for bacterial degradation of perchlorate as it leaves no organic residue and is sparingly soluble. We describe here the isolation of a perchlorate-respiring, hydrogen-oxidizing bacterium (Dechloromonas sp. strain HZ) that grows with carbon dioxide as sole carbon source. Strain HZ is a Gram-negative, rod-shaped facultative anaerobe that was isolated from a gas-phase anaerobic packed-bed biofilm reactor treating perchlorate-contaminated groundwater. The ability of strain HZ to grow autotrophically with carbon dioxide as the sole carbon source was confirmed by demonstrating that biomass carbon (100.9%) was derived from CO2. Chemolithotrophic growth with hydrogen was coupled with complete reduction of perchlorate (10 mM) to chloride with a maximum doubling time of 8.9 h. Strain HZ also grew using acetate as the electron donor and chlorate, nitrate, or oxygen (but not sulphate) as an electron acceptor. Phylogenetic analysis of the 16S rRNA sequence placed strain HZ in the genus Dechloromonas within the , subgroup of the Proteobacteria. The study of this and other novel perchlorate-reducing bacteria may lead to new, safe technologies for removing perchlorate and other chemical pollutants from drinking water. [source] Performance of a full-scale biotrickling filter treating H2S at a gas contact time of 1.6 to 2.2 secondsENVIRONMENTAL PROGRESS & SUSTAINABLE ENERGY, Issue 2 2003David Gabriel Emission of objectionable odors is a major problem for wastewater treatment and other processing facilities. Biological treatment is a promising alternative to conventional control methods, such as chemical scrubbing, but historically, biotreatment has always required significantly larger reactor volumes than chemical scrubbers. In this paper, we present several aspects of the operation and performance of a chemical scrubber, retrofitted to operate as a biotrickling filter treating 16,000 m3 h,1 of foul air with the original gas contact time of 1.6 to 2.2 seconds. In continuous operation for more than a year, the biotrickling filter has shown stable performance and robust behavior for H2S treatment, with pollutant removal performance comparable to using a chemical scrubber. Reclaimed water was used as a nutrient source for the process, and to maintain the pH in the biotrickling filter between 1.5 and 2.2. At a gas contact time of 1.6 seconds, H2S removal was in excess of 95% for sustained inlet H2S concentrations as high as 30 ppmv. This corresponds to volumetric elimination rates of 95 to 105 g H2S m,3 h,1. Efficiencies of about 90% were observed under transient conditions at 2.2 seconds gas contact time for inlet concentration peaks up to 60 ppmv. The biotrickling filter also removed significant amounts of reduced sulfur compounds, ammonia, and volatile organic compounds present in traces in the air, which is important in practical applications. Selected experiments, such as intermittent trickling operation and a one-month operation period at neutral pH, are also presented. Results indicate that the intermittent trickling operation does not have a significant effect on H2S removal. However, when operated at neutral pH, biotrickling filter performance clearly decreased, probably due to an excessive chlorine supply to the reactor through the make-up water. The study demonstrates that biotrickling filters can replace chemical scrubbers as a safer, more economical technique for odor control. [source] Nitrate- and Nitrite-Assisted Conversion of an Acetonitrile Ligand Into an Amidato Bridge at an {Mo2(Cp)2(,-SMe)3} Core: Electrochemistry of the Amidato Complex [Mo2(Cp)2(,-SMe)3{,-,1,,1 -OC(Me)NH}]+EUROPEAN JOURNAL OF INORGANIC CHEMISTRY, Issue 19 2005Marc Le Hénanf Abstract Treatment of [Mo2(Cp)2(,-SMe)3(MeCN)2]+ (1+) with NO3, or NO2, results in the conversion of one terminally bound acetonitrile ligand into an amidato bridge. The reaction produces [Mo2(Cp)2(,-SMe)3{,-,1,,1 -OC(Me)NH}]0/+ (20/+) and involves the formation of an intermediate, which was detected by cyclic voltammetry but which could not be isolated, and which likely arises from the substitution of the NOx anion for one MeCN ligand. The electrochemical behaviour of 2+ was studied by cyclic voltammetry in THF and MeCN. The reduction of 2+ in the presence of acid (HBF4/H2O or HBF4/Et2O) in these solvents leads to the release of the amidate bridge. Controlled-potential electrolysis of 2+ in MeCN in the presence of acid produces 1+ quantitatively; the charge consumed (>1 F,mol,1 of 1+) indicates that electrons are also used to reduce protons. This was confirmed by the formation of 2+ (in variable amounts depending on the conditions) on treating 2 with acid. (© Wiley-VCH Verlag GmbH & Co. KGaA, 69451 Weinheim, Germany, 2005) [source] Hydrologic versus geomorphic limitation on CPOM storage in stream ecosystemsFRESHWATER BIOLOGY, Issue 8 2008MELANIE J. SMALL Summary 1. Stream ecosystems are the products of interactions between hydrology, geomorphology and ecology, but examining all three components simultaneously is difficult and rarely attempted. Frequently, either geomorphology or hydrology is treated as invariable or static. 2. To examine the validity of treating either hydrology or geomorphology as static, we studied the individual and combined effects of hydrology and channel geomorphology on coarse particulate organic matter (CPOM) storage. Using data from an experimental leaf release in a hydrologically regulated stream we created a simple numerical model. This allowed us to quantify the relative influence of CPOM trapping and CPOM retention on total long-term CPOM storage under variable regimes of flood frequency and geomorphic structure. 3. CPOM storage is a function of supply, flood frequency and the type and frequency of in-stream structures. In-stream structures perform two distinct functions, trapping and retention, whose relative importance in leaf storage changes with stream hydrology. Trapping is more important for CPOM storage in streams with few floods, while retention is more important in streams with frequent floods. Different structures (e.g. boulders, large wood, small wood) perform these functions at different efficiencies. We found that large wood trapped two to three times more leaves than the bank, but that the bank retained leaves two to three times more efficiently. 4. A modelled channel with five times the amount of large wood as the study channel (a ,wood restoration') initially stored 14% more leaves than the modelled ,natural' channel. After six floods, however, the modelled wood restoration channel stored 50% less CPOM than the natural channel as the large wood had high trapping but poor retention. The modelled natural channel contained structures that could both trap and retain. Thus, as different structures performed different functions, the structural complexity buffered the stream allochthonous energy base against changes in hydrology through its balance of trapping and retention. 5. As the frequency of floods increased, the spatial distribution of CPOM became increasingly patchy as storage was driven entirely by structures with high retention. Thus, the coupling of flood frequency and geomorphic structure influenced CPOM availability, which in turn has ramifications for the entire stream food web. [source] Long-Term Tolerability of Sumatriptan Nasal Spray in Adolescent Patients With MigraineHEADACHE, Issue 10 2004Shankar Natarajan MD Objective.,This 1-year, open-label, multicenter study was designed to assess the long-term tolerability and efficacy of sumatriptan nasal spray 20 mg in adolescent patients with migraine. Methods.,A prospective, multicenter, open-label study was conducted in patients aged 12 to 17 years who were allowed to treat an unlimited number of migraines at severe, moderate, or mild pain intensity with sumatriptan nasal spray for up to 1 year. All patients started the study at the 20-mg dose of sumatriptan nasal spray. Dose could be adjusted downward to 5 mg at the discretion of the investigator to optimize therapy. Results.,A total of 484 adolescent migraineurs treated 4676 migraines with sumatriptan nasal spray 20 mg (3593 during the first 6 months and 1083 during the second 6 months). A total of 3940 migraines and 699 migraines were treated with one and two 20-mg doses of sumatriptan nasal spray, respectively. Only 10 patients (treating 42 migraines) took the 5-mg dose of sumatriptan nasal spray. The overall percentage of migraines treated with either one 20-mg dose or one, two, or three 20-mg doses with at least 1 drug-related adverse event was 19%. The most common specific drug-related adverse event was unpleasant taste, reported in 17% of migraines. No other single drug-related adverse event was reported in more than 1% of migraines over the 1-year treatment period. When unpleasant taste was excluded from the adverse-event tabulations, the percentages of migraines with at least 1 drug-related adverse event after one or one, two, or three 20-mg doses declined to 4% and 3%, respectively. No patient experienced any drug-related changes in 12-lead ECGs, vital signs, or nasal assessments; and no clinically meaningful changes in clinical laboratory values were observed. Across all migraines with evaluable efficacy data (n = 4334), headache relief was reported in 43% of migraines at 1 hour and in 59% at 2 hours after dosing with sumatriptan nasal spray 20 mg. Of the 2561 migraines with headache relief 2 hours postdose, headache recurrence was reported within 24 hours of initial dosing in 7% of migraines. None of the efficacy or tolerability results varied as a function of time in the study (ie, first 6 months vs. second 6 months). Conclusion.,Sumatriptan nasal spray 20 mg is generally well tolerated and may be beneficial during long-term use by adolescent migraineurs ages 12 to 17 years. [source] Historians and Moral EvaluationsHISTORY AND THEORY, Issue 4 2004RICHARD T. VANN In dem Gebiet der Geschichte liegt die ganze moralische Welt. ,Schiller ABSTRACT The reappearance of the question of moral judgments by historians makes a reappraisal of the issues timely. Almost all that has been written on the subject addresses only the propriety of moral judgments (or morally charged language) in the written texts historians produce. However, historians have to make moral choices when selecting a subject upon which to write; and they make a tacit moral commitment to write and teach honestly. Historians usually dislike making explicit moral evaluations, and have little or no training in how to do so. They can argue it's not their job; they are only finders of fact. Historians holding a determinist view of actions do not think it appropriate to blame people for doing what they couldn't help doing; for those believing there is an overall pattern to history, individual morality is beside the point. Finally, since earlier cultures had values different from ours, it seems unjust to hold them to contemporary standards. This essay modifies or rejects these arguments. Some historians have manifested ambivalence, acknowledging it is difficult or impossible to avoid making moral evaluations (and sometimes appropriate to make them). Ordinary-language philosophers, noting that historiography has no specialized vocabulary, see it as saturated by the values inherent in everyday speech and thought. I argue that the historicist argument about the inevitably time-bound limitation of all values is exaggerated. Historians who believe in the religious grounding of values (like Lord Acton) obviously disagree with it; but even on a secular level, morals are often confused with mores. If historians inevitably make moral evaluations, they should examine what philosophical ethicists,virtue ethicists, deontologists, and consequentialists,have said about how to make them; and even if they find no satisfactory grounding for their own moral attitudes, it is a brute fact that they have them. I end with an argument for "strong evaluations",neither treating them as a troublesome residue in historiography nor, having despaired of finding a solid philosophical ground for moral evaluations, concluding that they are merely matters of taste. I believe historians should embrace the role of moral commentators, but that they should be aware that their evaluations are, like all historical judgments, subject to the criticisms of their colleagues and readers. Historians run little risk of being censorious and self-righteous; the far greater danger is acquiescing in or contributing to moral confusion and timidity. [source] HORMONAL CONTROL OF THE VITELLOGENESIS IN THE JAPANESE OAK SILKWORM, ANTHERAEA YAMAMAZ (LEPIDOPTERA: SATURNIIDAE)INSECT SCIENCE, Issue 1 2002YE Gong-yin Abstract Effects of ecdysteroid and juvenile hormone (JH) on vitellogenesis of the Japanese oak silkworm, Antheraea yamami are reported in this article. After topical treatment with 20-hydroxyecdysone alone or JH analog (i.e. methoprene) alone and combined treatment with these two chemicals, vitellogenin (Vg) titers in the fat body and haemolymph at the pupal stage were mostly higher than those of the control, indicating that both ecdysteroid and JH exerted a promoting effect on the synthesis of Vg. In contrast, the Vg uptake was markedly inhibited by JH while stimulating effect of the ecdysteroid could be shown that vitellin (Vt) titer in the ovary was lower after methoprene treatments, but higher after 20-hydroxyecdyson treatments. Meanwhile, effects of these two hormones on Vg synthesis in the fat body were also tested with the incubation in vitro with Grace medium containing H-leucine and the hormones. The results demonstrated that Vg synthesis was stimulated after treating with methoprene alone or 20-hydroxyecdysone alone and combined treating with these two chemicals, and particularly ecdysteroid had more marked positive effect. To comprehensively concluded our results, it could be regarded that ecdysteroid play the main role in the regulation of vitellogenesis for the Japanese oak silkworm. [source] Short-term dietary administration of celecoxib enhances the efficacy of tumor lysate-pulsed dendritic cell vaccines in treating murine breast cancerINTERNATIONAL JOURNAL OF CANCER, Issue 9 2006Tobias Hahn Abstract Cyclooxygenase-2 (COX-2) is a rate-limiting enzyme in the synthesis of prostaglandins. It is over-expressed in multiple cancers and has been associated with diminished tumor immunity. Dendritic cells (DCs) are considered candidates for cancer immunotherapy due to their ability to process and present antigens to T cells and stimulate immune responses. However, DC-based vaccines have exhibited minimal effectiveness against established tumors. In this study, we evaluated the effect of short-term administration of the selective COX-2 inhibitor celecoxib on the efficacy of DC-based vaccines in preventing and treating established 4T1 murine mammary tumors. We show that dietary celecoxib alone significantly suppresses the growth of primary tumors and the incidence of lung metastases in the prophylactic setting but is less effective against pre-established tumors. However, we demonstrate that celecoxib administered after primary tumor establishment synergizes with tumor lysate-pulsed DC and the adjuvant, GM-CSF, to improve the antitumor immune response by suppressing primary tumor growth and markedly reducing the occurrence of lung metastases. This triple combination therapy elicits a tumor-specific immune response evidenced by elevated IFN-, and IL-4 secretion by CD4+ T cells and results in increased infiltration of CD4+ and CD8+ T cells to the tumor site. In addition, dietary celecoxib inhibits angiogenesis evidenced by decreased vascular proliferation within the tumor and serum vascular endothelial growth factor levels. These studies suggest that short-term celecoxib therapy in combination with DC vaccines may be safely used for treating metastatic breast cancer. © 2005 Wiley-Liss, Inc. [source] A practical guide to the evaluation and treatment of male lower urinary tract symptoms in the primary care settingINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 9 2007M. T. Rosenberg Summary Aims:, Lower urinary tract symptoms (LUTS) are common in both men and women, and are among the most prevalent patient complaints heard by primary care physicians (PCPs). This article aims to provide PCPs with a logical algorithm for the assessment and initiation of treatment for LUTS in the male patient. Results:, Management of LUTS involves a focused history and physical, as well as the assessment of bother. In patients for whom treatment is warranted, a series of decisions regarding therapy should be considered. Male patients commonly suffer from storage and/or voiding symptoms. Treatment of male LUTS is commonly begun with agents that are aimed at remedying the outlet symptoms of benign prostatic hyperplasia (BPH). When this intervention is ineffective or when refractory symptoms persist, consideration should be given to treating the storage symptoms characteristic of overactive bladder (OAB). Discussion:, This article is intended to provide the PCP with a logical guide to the treatment of male LUTS. Benign prostatic hyperplasia and OAB predominate among the causes of these symptoms, and the PCP should be comfortable treating each. Recent data detailing the safety of the use of these treatments in the male patient are reviewed and incorporated into the algorithm. Conclusion:, Primary care physicians are in a unique position to successfully identify and treat male patients with LUTS. With this paper, they now have a tool to approach treatment logically and practically. [source] Improvement in behavioural symptoms in patients with moderate to severe Alzheimer's disease by memantine: a pooled data analysisINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 5 2008S. Gauthier Abstract Introduction Behavioural disturbances are a common and distressing aspect of Alzheimer's disease (AD). This pooled analysis evaluated the specific benefits of memantine on behavioural disturbances in patients with moderate to severe AD. Methods Data were pooled from six 24/28-week, randomised, placebo-controlled, double-blind studies. Of the 2,311 patients included in these studies, 1,826 patients with moderate to severe AD (MMSE <20) were included in this analysis, corresponding to the extended indication for memantine in Europe. In this subgroup, 959 patients received memantine 20,mg/day and 867 received placebo. Behavioural symptoms were rated using the Neuropsychiatric Inventory (NPI) total and single-item scores at weeks 12 and 24/28. Results At weeks 12 and 24/28, ITT analysis demonstrated that memantine treatment produced statistically significant benefits over placebo treatment in NPI total score (p,=,0.001 and p,=,0.008), and in NPI single items: delusions (p,=,0.007,week 12, p,=,0.001,week 24/28), hallucinations (p,=,0.037,week 12), agitation/aggression (p,=,0.001,week 12, p,=,0.001,week 24/28), and irritability/lability (p,=,0.005,week 24/28), LOCF population. Analysis of the patients without symptoms at baseline indicated reduced emergence of agitation/aggression (p,=,0.002), delusions (p,=,0.047), and disinhibition (p,=,0.011), at week 12, and of agitation/aggression (p,=,0.002), irritability/lability (p,=,0.004), and night-time behaviour (p,=,0.050) at week 24/28 in those receiving memantine. OC analyses yielded similar results. Conclusions The data suggest that memantine is effective in treating and preventing the behavioural symptoms of moderate to severe AD. Specific persistent benefits were observed on the symptoms of delusions and agitation/aggression, which are known to be associated with rapid disease progression, increased caregiver burden, early institutionalisation, and increased costs of care. Copyright © 2007 John Wiley & Sons, Ltd. [source] Danish dentists' knowledge, attitudes and management of procedural dental pain in children: association with demographic characteristics, structural factors, perceived stress during the administration of local analgesia and their tolerance towards painINTERNATIONAL JOURNAL OF PAEDIATRIC DENTISTRY, Issue 3 2005J. K. RASMUSSEN Summary., Objective., The aim of the present study was to describe Danish dentists' knowledge of, attitudes towards and management of procedural pain during paediatric dental care, and to assess the importance of demographic characteristics, structural factors, perceived stress during administration of local analgesia and the dentists' own tolerance towards procedural dental pain. Design., A cross-sectional questionnaire study was conducted in Denmark in May 2001. Subjects and methods., The subjects were a random sample of 30% of Danish dentists treating children. Usable information was obtained from 327 (80·3%) of the dentists in the sample. Results., One-quarter of the respondents answered that a 3,5-year-old child could report pain only with uncertainty. More than 80% of the dentists stated that they never compromised on painlessness. Very few agreed to the statement that children forget pain faster than adults. One-third agreed to, or were neutral to, the statement that all restorative care in primary teeth could be performed painlessly using N2O-O2 sedation alone. The majority of the respondents reported using three or more methods to assess the effect of their pain control methods. Almost 90% reported using local analgesia for restorative work ,always' or ,often'. A similar proportion reported using topical analgesia before injection ,always' or ,often'. Administering a mandibular block to preschool children was the procedure perceived as the most stressful (33·6%) pain control method. Demographic factors (gender), structural factors (always working alone and treating 3,5-year-old children daily), perceived stress during the administration of a mandibular block in preschool children and the dentists' own willingness to accept potentially painful dental treatment without local analgesia were associated with knowledge of, attitudes towards and management of procedural dental pain in children. Conclusions., Danish dentists treating children demonstrate concern about procedural dental pain in children. Factors amenable to change via training and reorganization into larger clinical units seem to determine their knowledge of, attitudes towards and management of procedural dental pain in children. [source] Influence of nitrogen on the degradation of toluene in a compost-based biofilterJOURNAL OF CHEMICAL TECHNOLOGY & BIOTECHNOLOGY, Issue 9 2001Marie-Caroline Delhoménie Abstract Two identical laboratory-scale bioreactors were operated simultaneously, each treating an input air flow rate of 1,m3,h,1. The biofilters consisted of multi-stage columns, each stage packed with a compost-based filtering material, which was not previously inoculated. The toluene inlet concentration was fixed at 1.5,g,m,3 of air. Apart from the necessary carbon, the elements nitrogen, phosphorus, sulfur, potassium and other micro-elements are also essential for microbial metabolism. These were distributed throughout the filter bed material by periodic ,irrigations' with various test nutrient solutions. The performance of each biofilter was quantified by determining its toluene removal efficiency, and elimination capacity. Nutrient solution nitrogen levels were varied from 0 to 6.0,g,dm,3, which led to elimination capacities of up to 50,g,m,3,h,1 being obtained for a toluene inlet load of 80,g,m,3,h,1. A theoretical analysis also confirmed that the optimum nitrogen solution concentration lays in the range 4.0,6.0,g,dm,3. Validation of the irrigation mode was achieved by watering each biofilter stage individually. Vertical stage-by-stage stratification of the biofilter performance was not detected, ie each filter bed section removed the same amount of pollutant, the elimination capacity per stage being about 16,g,m,3,h,1 per section of column. © 2001 Society of Chemical Industry [source] Evidence-based algorithms for diagnosing and treating ventilator-associated pneumonia,JOURNAL OF HOSPITAL MEDICINE, Issue 5 2008Richard J. Wall MD Abstract BACKGROUND: Ventilator-associated pneumonia (VAP) is widely recognized as a serious and common complication associated with high morbidity and high costs. Given the complexity of caring for heterogeneous populations in the intensive care unit (ICU), however, there is still uncertainty regarding how to diagnose and manage VAP. OBJECTIVE: We recently conducted a national collaborative aimed at reducing health care,associated infections in ICUs of hospitals operated by the Hospital Corporation of America (HCA). As part of this collaborative, we developed algorithms for diagnosing and treating VAP in mechanically ventilated patients. In the current article, we (1) review the current evidence for diagnosing VAP, (2) describe our approach for developing these algorithms, and (3) illustrate the utility of the diagnostic algorithms using clinical teaching cases. DESIGN: This was a descriptive study, using data from a national collaborative focused on reducing VAP and catheter-related bloodstream infections. SETTING: The setting of the study was 110 ICUs at 61 HCA hospitals. INTERVENTION: None. MEASUREMENTS AND RESULTS: We assembled an interdisciplinary team that included infectious disease specialists, intensivists, hospitalists, statisticians, critical care nurses, and pharmacists. After reviewing published studies and the Centers for Disease Control and Prevention VAP guidelines, the team iteratively discussed the evidence, achieved consensus, and ultimately developed these practical algorithms. The diagnostic algorithms address infant, pediatric, immunocompromised, and adult ICU patients. CONCLUSIONS: We present practical algorithms for diagnosing and managing VAP in mechanically ventilated patients. These algorithms may provide evidence-based real-time guidance to clinicians seeking a standardized approach to diagnosing and managing this challenging problem. Journal of Hospital Medicine 2008;3:409,422. © 2008 Society of Hospital Medicine. [source] Palliative management of cancer of the oesophagus , opportunities for dietetic interventionJOURNAL OF HUMAN NUTRITION & DIETETICS, Issue 5 2003A. Holdoway Introduction: Cancer of the oesophagus develops insidiously and when patients present with symptoms such as dysphagia to solids/semi-solids and in some cases liquids, the disease is often advanced and patients are frequently poorly nourished and cachectic (Angorn, 1981; Larrea, 1992). In our own unit we were aware that patients were only referred to the dietitian once an oesophageal stent was inserted or radiotherapy commenced, thereby possibly missing opportunities to treat or prevent malnutrition earlier. We therefore evaluated the nutritional status and care pathways of patients diagnosed with cancer of the oesophagus in whom palliative treatment was the only option, with the aim of assessing the extent of malnutrition and identifying opportunities for earlier dietetic intervention to prevent or slow the development of malnutrition. Method: Data were collated on all patients referred to the hospital's dysphagia clinic and diagnosed with inoperable cancer of the oesophagus. Height, weight, body mass index, degree of dysphagia, period of dysphagia, percentage weight loss (data collected as standard practice in the dysphagia clinic) and time to stent insertion/radiotherapy and survival time was collected from the medical notes. Results: Data were available on 58 patients, 33 male, 25 female, mean age 75 years (range 49,92 years). The mean length of survival was 10.2 months (0,24 months). At diagnosis, 47% experienced dysphagia with solids, 33% with semi-solids and 16% experienced a degree of dysphagia with liquids. The period of dysphagia was 1 month to 2 years. Eighty-three per cent of patients had lost weight at diagnosis. Mean percentage weight loss per individual was 13% (range 0,45%). Thirty-five per cent had a BMI <20 kg/m2. Median time from diagnosis to radiotherapy (n = 8) was 2 months with range, 1,6 months. Median time from diagnosis to the placement of the oesophageal stent (n = 12) was 1 month with range, 0,7 months. Discussion: These data illustrate that malnutrition remains a significant problem in this patient group. These results demonstrate that dysphagia and malnutrition, as indicated by weight loss, is developing in the community before diagnosis. Opportunities for earlier dietetic intervention exist between diagnosis and date at which other treatments commence, i.e. stent insertion. Further opportunities exist to educate community health professionals on treating and preventing malnutrition when dysphagia presents. Survival times support the need for dietetic follow-up. In our unit the results of this audit helped to improve care pathways for patients with cancer of the oesophagus. In response to the above findings, a nutritional screening tool is now completed by a nurse specialist at the first clinic attended. This has enabled appropriate and timely advice to be given on modified texture and fortification of food to optimize nutritional intake at diagnosis. [source] Self-Compassion Versus Global Self-Esteem: Two Different Ways of Relating to OneselfJOURNAL OF PERSONALITY, Issue 1 2009Kristin D. Neff ABSTRACT This research examined self-compassion and self-esteem as they relate to various aspects of psychological functioning. Self-compassion entails treating oneself with kindness, recognizing one's shared humanity, and being mindful when considering negative aspects of oneself. Study 1 (N=2,187) compared self-compassion and global self-esteem as they relate to ego-focused reactivity. It was found that self-compassion predicted more stable feelings of self-worth than self-esteem and was less contingent on particular outcomes. Self-compassion also had a stronger negative association with social comparison, public self-consciousness, self-rumination, anger, and need for cognitive closure. Self-esteem (but not self-compassion) was positively associated with narcissism. Study 2 (N=165) compared global self-esteem and self-compassion with regard to positive mood states. It was found that the two constructs were statistically equivalent predictors of happiness, optimism, and positive affect. Results from these two studies suggest that self-compassion may be a useful alternative to global self-esteem when considering what constitutes a healthy self-stance. [source] The effects of high-dose esomeprazole on gastric and oesophageal acid exposure and molecular markers in Barrett's oesophagusALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 8 2010A. Abu-Sneineh Aliment Pharmacol Ther 2010; 32: 1023,1030 Summary Background, Acid reflux is often difficult to control medically. Aim, To assess the effect of 40 mg twice daily esomeprazole (high-dose) on gastric and oesophageal pH and symptoms, and biomarkers relevant to adenocarcinoma, in patients with Barrett's oesophagus (BO). Methods, Eighteen patients, treated with proton pump inhibitors as prescribed by their treating doctor, had their therapy increased to high-dose esomeprazole for 6 months. Results, At entry into the study, 9/18 patients had excessive 24-h oesophageal acid exposure, and gastric pH remained <4 for >16 h in 8/18. With high-dose esomeprazole, excessive acid exposure occurred in 2/18 patients, and gastric pH <4 was decreased from 38% of overall recording time and 53% of the nocturnal period to 15% and 17%, respectively (P < 0.001). There was a reduction in self-assessed symptoms of heartburn (P = 0.0005) and regurgitation (P < 0.0001), and inflammation and proliferation in the Barrett's mucosa. There was no significant change in p53, MGMT or COX-2 expression, or in aberrant DNA methylation. Conclusions, High-dose esomeprazole achieved higher levels of gastric acid suppression and control of oesophageal acid reflux and symptoms, with significant decreases in inflammation and epithelial proliferation. There was no reversal of aberrant DNA methylation. [source] | |||||||||||||||||||||||||||||||||||||