Distribution by Scientific Domains
Distribution within Medical Sciences

Selected Abstracts

African Americans Unaware of High Kidney Disease Risk

Carolyn Davis Cockey MLS executive editor
No abstract is available for this article. [source]

Emergency Medicine Practitioner Knowledge and Use of Decision Rules for the Evaluation of Patients with Suspected Pulmonary Embolism: Variations by Practice Setting and Training Level

Michael S. Runyon MD
Abstract Background Several clinical decision rules (CDRs) have been validated for pretest probability assessment of pulmonary embolism (PE), but the authors are unaware of any data quantifying and characterizing their use in emergency departments. Objectives To characterize clinicians' knowledge of and attitudes toward two commonly used CDRs for PE. Methods By using a modified Delphi approach, the authors developed a two-page paper survey including 15 multiple-choice questions. The questions were designed to determine the respondents' familiarity, frequency of use, and comprehension of the Canadian and Charlotte rules. The survey also queried the frequency of use of unstructured (gestalt) pretest probability assessment and reasons why physicians choose not to use decision rules. The surveys were sent to physicians, physician assistants, and medical students at 32 academic and community hospitals in the United States and the United Kingdom. Results Respondents included 555 clinicians; 443 (80%) work in academic practice, and 112 (20%) are community based. Significantly more academic practitioners (73%) than community practitioners (49%) indicated familiarity with at least one of the two decision rules. Among all respondents familiar with a rule, 50% reported using it in more than half of applicable cases. A significant number of these respondents could not correctly identify a key component of the rule (23% for the Charlotte rule and 43% for the Canadian rule). Fifty-seven percent of all respondents indicated use of gestalt rather than a decision rule in more than half of cases. Conclusions Academic clinicians were more likely to report familiarity with either of these two specific decision rules. Only one half of all clinicians reporting familiarity with the rules use them in more than 50% of applicable cases. Spontaneous recall of the specific elements of the rules was low to moderate. Future work should consider clinical gestalt in the evaluation of patients with possible PE. [source]

Scene-Graph-As-Bus: Collaboration between Heterogeneous Stand-alone 3-D Graphical Applications

Bob Zeleznik
We describe the Scene-Graph-As-Bus technique (SGAB), the first step in a staircase of solutions for sharing software components for virtual environments. The goals of SGAB are to allow, with minimal effort, independently-designed applications to share component functionality; and for multiple users to share applications designed for single users. This paper reports on the SGAB design for transparently conjoining different applications by unifying the state information contained in their scene graphs. SGAB monitors and maps changes in the local scene graph of one application to a neutral scene graph representation (NSG), distributes the NSG changes over the network to remote peer applications, and then maps the NSG changes to the local scene graph of the remote application. The fundamental contribution of SGAB is that both the local and remote applications can be completely unaware of each other; that is, both applications can interoperate without code or binary modification despite each having no knowledge of networking or interoperability. [source]

A spot test for detection of cobalt release , early experience and findings

Jacob P. Thyssen
Background: It is often difficult to establish clinical relevance of metal exposure in cobalt-allergic patients. Dermatologists and patients may incorrectly assume that many metallic items release cobalt at levels that may cause cobalt dermatitis. Cobalt-allergic patients may be unaware that they are exposed to cobalt from handling work items, causing hand dermatitis. Objectives: To present early findings with a newly developed cobalt spot test. Methods and Results: A cobalt spot test based on disodium-1-nitroso-2-naphthol-3,6-disulfonate was able to identify cobalt release at 8.3 ppm. The test may also be used as a gel test if combined with an agar preparation. We found no false-positive reactions when testing metals and alloys known not to contain cobalt. However, one cobalt-containing alloy, which elicited cobalt dermatitis in cobalt-allergic patients, was negative upon cobalt gel testing. Conclusions: The cobalt test detects amounts of cobalt release that approximate the elicitation concentration seen in cobalt-allergic patients. It may serve as a useful tool in dermatology offices and workplaces. [source]

CPA assessment , the regional assessors' experience

E. Welsh
Many individuals within Laboratory Medicine will be unaware that CPA conducts assessments to two different sets of CPA Standards. There are the Standards for the Medical Laboratory and the Standards for EQA Schemes in Laboratory Medicine. The style and format of both sets of standards is very similar with each being presented in eight sections A , H. The EQA standards are almost identical to the laboratory standards with the exception of the E.F and G standards which are specific to EQA schemes. There are approximately 40 EQA Schemes registered with CPA compared with almost 2 500 laboratories. These EQA schemes vary from very large national/international schemes with numerous analytes to small interpretive schemes run by one individual with a personal interest in that specific subject. The large schemes usually come under the UKNEQAS consortia banner and due to their size and configuration do not present undue problems in the assessment process. Smaller interpretive EQA schemes present a challenge both for the scheme and CPA in gaining accreditation. These schemes are usually within the discipline of Histopathology and are regarded as educational rather than proficiency testing schemes. Very frequently, the scheme is organized by a single individual with a collection of microscope slides, storage facilities for the slides and a computer. This presents the Scheme Organizer with great difficulty in complying with the Quality Management System requirements of the CPA Standards. There are a number of models which can be applied in order to satisfy the requirement of the Quality Management System, but ultimately it must be recognized that in some circumstances it is not possible to accredit these small schemes. The NHSCSP Gynae Cytology EQA Scheme is probably the largest EQA scheme within the UK, in respect of the number of participants and the number of staff supporting the scheme. Scheme Management decided that all nine regions of England would apply for accreditation under one CPA Reference Number. This process meant that the scheme would be assessed as a Managed Pathology Network. This is unique in terms of EQA schemes and presented a number of problems not previously encountered in EQA scheme accreditation. This decision meant that all nine regions must comply with a single Quality Management System and other CPA standards whilst allowing flexibility within the system for each region to facilitate the assessment process specific to their user's requirements. The process worked in a satisfactory manner and the overall outcome was not dissimilar to that of other large EQA schemes. The assessment to the current EQA Standards only commenced in April 2006 whilst the Standards for Medical Laboratories commenced in 2003, and it is perhaps not surprising to find that the principal non-conformities are related to the Quality Management System. This parallels the findings encountered in laboratory accreditation. There is an ongoing educational process for Scheme Management and the Facilitators in each region in how to comply fully with the standards and a commitment to quality improvement which ultimately is beneficial to the participant's of the scheme and to patient safety. [source]

Bilateral Auricular Squamous Cell Carcinomas with Perineural Invasion

Stacy Russell Beaty BA
Background. Bilateral squamous cell carcinoma (SCC) of the external ears is a rare phenomenon, and we are unaware of instances of bilateral perineural involvement. Objective. To describe bilateral auricular SCCs, each with perineural invasion. Methods. Case report and literature review. Results. Histopathologic examination revealed perineural invasion in both tumors. Conclusion. This appears to be an unusual presentation of bilateral auricular SCCs with perineural invasion in an elderly immunocompromised patient. [source]

Ramadan Education and Awareness in Diabetes (READ) programme for Muslims with Type 2 diabetes who fast during Ramadan

V. Bravis
Diabet. Med. 27, 327,331 (2010) Abstract Background and Aims, During Ramadan, Muslims fast from dawn to dusk for one lunar month. The majority of Muslim diabetic patients are unaware of complications such as hypoglycaemia during fasting. The safety of fasting has not been assessed in the UK Muslim population with diabetes. The aim of this study was to determine the impact of Ramadan-focused education on weight and hypoglycaemic episodes during Ramadan in a Type 2 diabetic Muslim population taking oral glucose-lowering agents. Methods, We retrospectively analysed two groups. Group A attended a structured education programme about physical activity, meal planning, glucose monitoring, hypoglycaemia, dosage and timing of medications. Group B did not. Hypoglycaemia was defined as home blood glucose < 3.5 mmol/l. Results, There was a mean weight loss of 0.7 kg after Ramadan in group A, compared with a 0.6-kg mean weight gain in group B (P < 0.001). The weight changes observed were independent of the class of glucose-lowering agents used. There was a significant decrease in the total number of hypoglycaemic events in group A, from nine to five, compared with an increase in group B from nine to 36 (P < 0.001). The majority were in patients treated with short-acting sulphonylureas (group A,100%, group B,94%). At 12 months after attending the programme, glycated haemoglobin (HbA1c) reduction were sustained in group A. Conclusions, Ramadan-focused education in diabetes can empower patients to change their lifestyle during Ramadan. It minimizes the risk of hypoglycaemic events and prevents weight gain during this festive period for Muslims, which potentially benefits metabolic control. [source]

Living with Type 2 diabetes: a family perspective

P. White
Abstract Aim To explore the beliefs, attitudes and perceptions of adults with Type 2 diabetes and their family members. Methods Focus groups were conducted with: (i) people with good diabetes control (HbA1c < 7.0%); (ii) their family members; (iii) people with poor diabetes control (HbA1c > 8.5%); and (iv) their family members. Results There were no discernible differences between those with good and poor diabetes control or between the family members of each group. Overall, family members perceived diabetes to be more serious and as having a greater impact on daily life than those with the illness. Those with diabetes were unaware of this heightened concern and had a more relaxed approach to living with diabetes. The lack of information and perceived knowledge about diabetes impacted upon participants' causal attributions about the illness and its perceived severity. Conclusions Diabetes is an illness that affects both individuals and families. There is a need for further investigation into the impact that family members have on the management of diabetes. [source]

Glycaemia and insulinaemia in elderly European subjects (70,75 years)

A. 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]

Aspiration biopsy cytomorphology of primary pulmonary germ cell tumor metastatic to the brain

Haitham Arabi M.D.
Abstract Extragonadal germ cell tumors are uncommon and such tumors originating from the lung parenchyma are extremely rare. This is a case of 68-year-old female who was admitted with complaints of right-sided weakness, inability to maintain her balance, right-sided headache, and bloody sputum. Her workup revealed two enhancing brain lesions and large lung mass involving the left lower lobe. Fine-needle aspiration (FNA) of the lung followed by craniotomy was performed and the patient was initially diagnosed with lung adenocarcinoma metastatic to the brain based on the cytomorphology of the lung FNA and histology of the brain mass. However, retrospective investigation revealed markedly elevated alpha fetoprotein (AFP) of which the cytopathologist was unaware at the time of diagnosis. A review of the cytology and surgical specimen slides, as well as immunohistochemistry (IHC) on the brain tumor and FNA cell block were preformed. On the basis of the slides review, clinical findings, and immunostaining results, a diagnosis of primary pulmonary mixed germ cell tumor, containing choriocarcinoma and yolk sac elements, with brain metastases, was retrospectively made. Diagn. Cytopathol. 2009. © 2009 Wiley-Liss, Inc. [source]

Melanoma with cartilaginous differentiation: Diagnostic challenge on fine-needle aspiration with emphasis on differential diagnosis

Krisztina Z. Hanley M.D.
Abstract Fine-needle aspiration (FNA) is a minimally invasive, fast, and accurate diagnostic method for the evaluation of patients with locally recurrent or distant metastases of malignant melanoma. In the vast majority of cases, the diagnosis is straightforward with the characteristic cytologic features well documented in the literature. Divergent differentiation (chondroid, neural, myofibroblastic, and osteocartilagenous) in a melanoma is rare and can potentially create diagnostic challenges if the evaluator is unaware of the same. We report a case of a 46-year-old female with a history of primary anal melanoma who presented with a groin mass. The FNA of the groin mass showed a neoplasm rich in chondroid matrix and raised the possibility of a second primary mesenchymal neoplasm rather than metastasis from the patient's known primary anal melanoma. A review of the histologic features of the anal melanoma showed divergent chondroid differentiation in the anal melanoma with the metastatic deposit in the groin exhibiting extensive chondroid differentiation. The differential diagnostic considerations are discussed. Diagn. Cytopathol. 2009. © 2008 Wiley-Liss, Inc. [source]

Libertarian Free Will and CNC Manipulation

DIALECTICA, Issue 3 2001
Ishtiyaque Haji
An agent who is the victim of covert and nonconstraining control (CNC) is unaware of being controlled and controllers get their way by manipulating the victims so that they willingly do what the controllers desire. Our primary objective is to argue that if cases of CNC manipulation undermine compatibilist accounts of the sort of control required for moral responsibility, they also undermine various agent-causal and non-agent-causal libertarian accounts as well. [source]

Interventions with injection drug users in Ukraine

ADDICTION, Issue 11 2009
Robert E. Booth
ABSTRACT Aims To assess the effectiveness of a brief human immunodeficiency virus (HIV) testing and counseling intervention compared to a more time-consuming and expensive street-based intervention with injection drug users (IDUs). Design Cross-over experimental design in which 900 IDUs were recruited, followed by a ,wash-out' period with no recruitment, a reversal of intervention assignment areas and an additional recruitment of 900 IDUs with baseline and 6-month follow-up assessments. Setting Kiev, Odessa and Makeevka/Donesk Ukraine. Participants A total of 1798 IDUs. Measurements HIV testing and audio computer-assisted self-interview (ACASI) data on socio-demographics, drug use and injection and sex-related risk behaviors. Findings Participants in both conditions reduced their injection and sex risks significantly; however, there was little difference in outcomes between conditions. IDUs who knew they were HIV-infected at baseline were significantly more likely to practice safe sex than those unaware or HIV-negative; those who first learned that they were infected at baseline changed their safe sex practices significantly more than those who already knew that they were infected at baseline and those who were HIV-negative. Younger IDUs and those injecting for a shorter period of time reported higher injection and sex risk behaviors following interventions. Conclusions Awareness of HIV infection by street-recruited drug injectors is associated with reduced sex risks. Additional interventions are required for younger IDUs and those injecting for shorter periods of time. [source]

Prevalence of HIV, hepatitis C and syphilis among injecting drug users in Russia: a multi-city study

ADDICTION, Issue 2 2006
Tim Rhodes
ABSTRACT Objectives To estimate the prevalence of HIV, hepatitis C virus (HCV) and syphilis in injecting drug users (IDUs) in Russia. Methods Unlinked anonymous cross-sectional survey of 1473 IDUs recruited from non-treatment settings in Moscow, Volgograd and Barnaul (Siberia), with oral fluid sample collection for HIV, HCV antibody (anti-HIV, anti-HCV) and syphilis testing. Results Prevalence of antibody to HIV was 14% in Moscow, 3% in Volgograd and 9% in Barnaul. HCV prevalence was 67% in Moscow, 70% in Volgograd and 54% in Barnaul. Prevalence of positive syphilis serology was 8% in Moscow, 20% in Volgograd and 6% in Barnaul. Half of those HIV positive and a third of those HCV positive were unaware of their positive status. Common risk factors associated with HIV and HCV infection across the cities included both direct and indirect sharing of injecting equipment and injection of home-produced drugs. Among environmental risk factors, we found increased odds of anti-HIV associated with being in prison in Moscow, and some association between official registration as a drug user and anti-HIV and anti-HCV. No associations were found between sexual risk behaviours and anti-HIV in any city. Conclusions HIV prevalence among IDUs was markedly higher than city routine surveillance data suggests and at potentially critical levels in terms of HIV prevention in two cities. HCV prevalence was high in all cities. Syphilis prevalence highlights the potential for sexual risk and sexual HIV transmission. Despite large-scale testing programmes, knowledge of positive status was poor. The scaling-up of harm reduction for IDUs in Russia, including sexual risk reduction, is an urgent priority. [source]

One-year changes in glucose and heart disease risk factors among participants in the WISEWOMAN programme

JC Will PhD
Abstract Background: WISEWOMAN provides chronic disease risk factor screening, referrals and lifestyle interventions to low-income, uninsured women, to reduce their heart disease and stroke risk. Participants learn behaviour-changing skills tailored to low-income populations, such as collaborative goal setting, the need to take small steps and other empowerment techniques. Aim: To quantify the baseline prevalence of pre-diabetes (fasting blood glucose 5.5,6.9 mmol/l) and diabetes among WISEWOMAN participants and assess one-year changes in glucose levels and other diabetes risk factors. Methods: We used 1998,2005 baseline and one-year follow-up data from WISEWOMAN participants. Using a multilevel regression model, we assessed one-year changes in glucose, blood pressure (BP), total cholesterol and 10-year risk of coronary heart disease (CHD) among participants with baseline pre-diabetes (n=688) or diabetes (n=338). Results: At baseline, 15% of participants had pre-diabetes and 10% had diabetes. Of those with diabetes, 26% were unaware of their condition before baseline screening. During the one-year follow-up period, participants with pre-diabetes experienced statistically significant improvements in glucose (2.9%) and cholesterol (2.1%) levels and 10-year CHD risk (4.3%). Participants with newly diagnosed diabetes experienced statistically significant improvements in glucose (11.5%), BP (3.1%,3.5%) and cholesterol (6.4%) levels. Participants with previously diagnosed diabetes experienced significant improvements in BP (1.9%,3.4%), cholesterol level (3.8%), and 10-year CHD risk (8.5%). Conclusions: Implementing patient-centered, comprehensive and multilevel interventions and demonstrating their effectiveness will likely lead to the adoption of this approach on a much broader scale. [source]

Acute cardiorespiratory collapse from heparin: a consequence of heparin-induced thrombocytopenia

Martha P. Mims
Abstract: Background:, Heparin has rarely been reported to cause acute cardiorespiratory reactions or collapse. Some reports relate this to underlying heparin-induced thrombocytopenia. Objective:, To confirm and increase awareness of acute life-threatening cardiopulmonary events when patients with heparin-induced thrombocytopenia are re-exposed to heparin. Design:, Retrospective observational case series. Patients/setting:, Four cardiovascular surgery patients were identified in two adjacent large urban hospitals over a 2-yr-period who experienced eight episodes of cardiorespiratory collapse immediately following heparin administration. All had underlying heparin-induced thrombocytopenia. Results:, Intravenous boluses of unfractionated heparin were given to four patients with known or previously unrecognized heparin-induced thrombocytopenia. Two patients experienced severe respiratory distress within 15 min for which they required endotracheal intubation. Two other patients experienced cardiac arrest or a lethal arrhythmia within minutes of receiving intravenous heparin. Serologic tests for heparin-induced antibodies were positive in all patients. In three cases, the platelet count was normal or near normal but fell dramatically (71%) immediately following the heparin bolus. Three cases had prior diagnoses of heparin-induced thrombocytopenia, but health care workers administered heparin either unaware of the diagnosis or ignorant of its significance. No patients died, but all required some form of cardiopulmonary resuscitation and subsequent intensive care. Conclusions:, Heparin administration to patients with heparin-induced antibodies can result in life-threatening pulmonary or cardiac events. Appreciation of this phenomenon can unmask cases of heparin-induced thrombocytopenia and strengthens the mandate to avoid any heparin exposure in affected patients. Recognition is crucial to avoiding disastrous outcomes. [source]

A Randomized Controlled Trial of Mist in the Acute Treatment of Moderate Croup

Gina M. Neto MD
Abstract Objective: To determine whether the use of mist improves clinical symptoms in children presenting to the emergency department (ED) with moderate croup. Methods: Children 3 months to 6 years of age were eligible for the study if they presented to the ED with moderate croup. Moderate croup was defined as a croup score of 2-7. The patients were randomly assigned to receive either mist (humidified oxygen) via mist stick or no mist. The patients had croup scores measured at baseline and every 30 minutes for up to two hours. At these intervals the following parameters were also measured: heart rate, respiratory rate, oxygen saturation, and patient comfort score. The patients were treated until the croup score was less than 2 or until two hours had elapsed. All patients initially received a dose of oral dexamethasone (0.6 mg/kg). Other treatments, such as racemic epinephrine or inhaled budesonide, were given at the discretion of the treating physician. The research assistants were unaware of the assigned treatments. Results: There were 71 patients enrolled in the study; 35 received mist and 36 received no mist. The two treatment groups had similar characteristics at baseline. The median baseline croup score was 4 in both groups. The outcomes were measured as the change from baseline at 30, 60, 90, and 120 minutes. The change in the croup score from baseline in the mist group was not statistically different from the croup score change in the group that did not receive mist (p = 0.39). There was also no significant difference in improvement of oxygen saturation, heart rate, or respiratory rate at any of the assessment times. There was no adverse effect from the mist therapy. Conclusions: Mist therapy is not effective in improving clinical symptoms in children presenting to the ED with moderate croup. [source]

HUMAN STUDY: Preconscious attentional bias in cigarette smokers: a probe into awareness modulation on attentional bias

Xiaodan Yan
ABSTRACT It has been frequently reported that smokers showed attentional bias toward smoking-related stimuli. The current study aimed to examine whether such bias was also present when subjects were unaware of the presented stimuli and the possible role of awareness modulation on attentional bias. With a psychophysical approach (interocular suppression), we suppressed subjects' awareness to the cigarette pictures presented to one of their eyes. The visual dot probe task was modified to increase the perceptual load and to control the physical features between two rivaling images. Twenty-eight male smokers and 25 male non-smokers participated in the experiment. We found a significant interaction between experiment conditions and subject groups, with only the smoker group showed attentional bias toward cigarette pictures in unaware condition. Moreover, smokers' attentional bias in unaware condition was negatively correlated with their scores on Cigarette Dependence Scale while their attentional bias in aware condition was positively correlated with scores on Questionnaires of Smoking Urges. Such dissociation indicates the possibility of awareness modulation on attentional bias: it is possible that in aware condition, the attentional bias was modulated by smoking urge in awareness, thus concealed the effect of dependence degree. Further studies indicated that awareness modulated attentional bias through many factors, such as craving, quit attempt, attitude and disgust. Interestingly, non-smokers also showed attentional bias in aware condition, which further suggested that due to awareness modulation, attentional bias could even be addiction-unrelated. [source]

Implementation and evaluation of existing guidelines on the use of neurophysiological tests in non-acute migraine patients: a questionnaire survey of neurologists and primary care physicians

P. Rossi
Background and purpose:, The main aims of this study were to evaluate: the diffusion, use and perception of the usefulness of the 2004 EFNS guidelines on neurophysiological testing in non-acute headache patients; the frequency with which the different neurophysiological tests were recommended in non-acute migraine patients by physicians aware or unaware of the guidelines; and the appropriateness of the reasons given for recommending neurophysiological tests. Methods:, One hundred and fifty physicians selected amongst the members of the Italian societies of general practitioner (GPs), neurologists and headache specialists were contacted via e-mail and invited to fill in a questionnaire specially created for the study. Results:, Ninety-two percent of the headache specialists, 8.6% of the neurologists and 0% of the GPs were already aware of the EFNS guidelines. A significantly higher proportion of headache specialists had not recommended any neurophysiological tests to the migraine patients they had seen in the previous 3 months, whereas these tests had frequently been prescribed by the GPs and neurologists. Overall, 80%, 42% and 42.6% of the reasons given by headache specialists, neurologists and GPs, respectively, for recommending neurophysiological testing in their migraine patients were appropriate (P < 0.01). Conclusions:, The diffusion of the EFNS guidelines on neurophysiological tests and neuroimaging procedures was found to be very limited amongst neurologists and GPs. The physicians aware of the EFNS guidelines recommended neurophysiological tests to migraine patients less frequently and more appropriately than physicians who were not aware of them. The most frequent misconceptions regarding neurophysiological tests concerned their perceived capacity to discriminate between migraine and secondary headaches or between migraine and other primary headaches. [source]

On the positive side of error processing: error-awareness positivity revisited

Shani Shalgi
Abstract Performance errors are indexed in the brain even if they are not consciously registered, as demonstrated by the error-related negativity (ERN or Ne) event-related potential. It has recently been shown that another response-locked potential, the error positivity (Pe), follows the Ne, but only in those trials in which the participants consciously detect making the error (,Aware Errors'). In the present study we generalize these findings to an auditory task and investigate possible caveats in the interpretation of the Pe as an index of error awareness. In an auditory Go/No-Go error-awareness task (auditory EAT) participants pressed an additional ,fix error' button after noticing that they had made an error. As in visual tasks, the Ne was similar for aware (,fixed') and unaware (,unfixed') errors, while the Pe was enhanced only for Aware Errors. Within subjects, the Ne and Pe behaved in similar fashions for auditory and visual errors. A control condition confirmed that the awareness effect was not due to the requirement to report error awareness. These results reinforce the evidence in favor of the Pe as a correlate of conscious error processing, and imply that this process is not modality-specific. Nevertheless, single-trial analysis suggested that the Pe may be a delayed P3b related to stimulus processing rather than to response monitoring. [source]

The effect of arm crossing on persistence and performance

Ron Friedman
Two experiments investigated the hypothesis that arm crossing serves as a proprioceptive cue for perseverance within achievement settings. Experiment 1 found that inducing participants to cross their arms led to greater persistence on an unsolvable anagram. Experiment 2 revealed that arm crossing led to better performance on solvable anagrams, and that this effect was mediated by greater persistence. No differences in comfort, instruction adherence, or mood were observed between the arms crossed and control conditions, and participants appeared to be unaware of the effect of arm crossing on their behavior. Implications of the findings are discussed in terms of the interplay between proprioceptive cues and contextual meaning. Copyright © 2007 John Wiley & Sons, Ltd. [source]

Regulation of Injected Ground Water Tracers

GROUND WATER, Issue 4 2000
Skelly A. Holmbeck-Pelham
Ground water tracer tests are routinely performed to estimate aquifer flow and transport properties, including the determination of well capture zones, hydrogeologic parameters, and contaminant travel times. Investigators may be unaware of tracer test reporting requirements and may fail to notify their regulatory agency prior to conducting tracer tests. The injection of tracers falls under the jurisdiction of the federal Underground Injection Control (UIC) program, which regulates the introduction of substances into underground sources of drinking water as part of the Safe Drinking Water Act. The UIC program is administered by the U.S. Environmental Protection Agency (EPA) and by states with EPA-approved programs. The federal UIC program requires that tracer tests must not endanger underground sources of drinking water, and all tracer tests must be reported prior to injection. We contacted the UIC program administrator for every state in early 1997. Some states report having more stringent requirements, while some states do not meet minimum federal requirements. Although the primary responsibility for ground water tracer selection and use rests on the investigator, national guidance is required to assure compliance with the UIC program. To assist investigators, we present acceptable tracers that have been identified by two states, Nevada and South Carolina, that require no further regulatory review. [source]

Nurses' use of computer databases to identify evidence for practice ,a cross-sectional questionnaire survey in a UK hospital

Peter Griffiths
The objectives of this study were to determine nurses' use of electronic databases to inform practice. A questionnaire survey of 114 nurses working on five acute wards in a large inner city teaching hospital investigated their general use of computers and the three databases, cinahl, medline and the Cochrane Library. Eighty-two qualified nurses responded (response rate 72%). The results show limited confidence and low frequency in using the databases. Thirty-four per cent expressed low confidence using cinahl. Twenty-seven per cent used cinahl on a regular basis. Twenty-two per cent never used it. Eighteen per cent were unaware that it was available locally. Knowledge and use of medline was even lower with only 18% using it regularly. Knowledge of the Cochrane Library was extremely limited, with 75% unaware of its existence. Use of a home computer and higher education were associated with higher frequency of use of cinahl and medline. If nurses are to make use of electronic resources to contribute to evidence-based practice, effort needs to be put into ensuring that already qualified nurses have basic computer skills and specific knowledge of available resources. More emphasis should be placed on ,evidence-based' resources, such as the Cochrane library, as sources of information for practice. [source]

Prevalence of hepatitis C in an ethnically diverse HIV-1-infected cohort in south London

HIV MEDICINE, Issue 3 2005
AH Mohsen
Objectives There is limited information on the prevalence of and risk factors for hepatitis C virus (HCV) infection among HIV-1-infected patients in the UK. Our objective was to determine the prevalence of HCV infection among an ethnically diverse cohort of HIV-infected patients in south London, and to extrapolate from these data the number of co-infected patients in the UK. Methods A total of 1017 HIV-1-infected patients who had attended King's College Hospital HIV clinic between September 2000 and August 2002 were screened for HCV antibody using a commercial enzyme-linked immunosorbent assay (ELISA). Positive results were confirmed by polymerase chain reaction (PCR) or recombinant immunoblot assay. Demographic, clinical and laboratory data were obtained from the local computerized database and medical records. We applied our HCV prevalence rates in the different HIV transmission groups to the estimated number of HIV-infected persons in these groups in the UK, to obtain a national estimate of the level of HIV-HCV co-infection. Results Of the 1017 HIV-1-infected patients, 407 (40%) were white men, 158 (15.5%) were black African men, 268 (26.3%) were black African women, and 61 (6%) and 26 (2.6%) were black Caribbean men and women, respectively. Heterosexual exposure was the most common route of HIV acquisition (53.5%), followed by men having sex with men (36.9%), and current or previous injecting drug use (IDU) (7.2%). The overall prevalence of HCV co-infection was 90/1017 (8.9%), but this varied substantially according to route of transmission, from 82.2% among those with a history of IDU (which accounted for 67% of all HCV infections), to 31.8% in those who had received blood products, to 3.5% and 1.8% in those with homosexually and heterosexually acquired infection, respectively. Multivariate logistic regression analysis identified several independent risk factors for HCV infection: a history of IDU [odds ratio (OR)=107.2; 95% confidence interval (CI)=38.5,298.4], having received blood products (OR=16.5; 95% CI=5.1,53.7), and either being from a white ethnic group (OR=4.3; 95% CI=1.5,12.0) or being born in Southern Europe (OR=6.7; 95% CI=1.5,30.7). Based on the 35 473 known HIV-1-infected persons in the UK and the 10 997 estimated to be unaware of their status, we projected that there are at least 4136 HIV-HCV co-infected individuals in the UK and 979 who are unaware of their status. Conclusions Overall, 9% of our cohort was HIV-HCV co-infected. The prevalence was highest among intravenous drug users (82%), who accounted for most of our HCV cases, and lowest among heterosexual men and women from sub-Saharan Africa and the Caribbean [< 2%]. Our estimate that a significant number of co-infected persons may be unaware of their HIV and HCV status, highlights an urgent need to increase the uptake of HCV and HIV testing, particularly among injecting drug users, to reduce the risk of onward transmission. [source]

Everybody Talks About Organizational Justice, But Nobody Does Anything About It

Most organizational justice studies focus primarily on theoretical issues and identify implications for practice only in passing. I advocate moving to the next step by testing such implications in theory-based studies that implement and assess the impact of interventions designed to promote organizational justice. Research that promotes organizational justice promises to benefit both organizations and their employees, and may be considered morally appropriate. Although usually not considered in this connection, theory-based application studies also promise to shed light on the theories from which they are derived. Despite these benefits, there are several reasons why such investigations are conducted only rarely. First, because managers tend to be unaware of justice-related problems, they are unlikely to accede to researchers' requests to address them in research. Second, many researchers erroneously believe that studies assessing ways of improving conditions in organizations lack scientific objectivity. Third, scholarly values favor research that addresses theoretical issues and that eschew practical applications. Finally, the challenges of conducting intervention studies are inclined to be formidable, and these may deter researchers from undertaking such efforts. [source]

Virtual colonoscopy compared with conventional colonoscopy for stricturing postoperative recurrence in Crohn's disease

Dr. Livia Biancone
Abstract Background The place of virtual colonoscopy (VC) in patients with Crohn's disease (CD) requiring endoscopic follow-up after surgery is unknown. The authors compared findings from VC versus conventional colonoscopy (CC) for assessing the postoperative recurrence of CD. Methods Sixteen patients with ileocolonic anastomosis for CD were prospectively enrolled from January 2001 to January 2002. Recurrence was assessed by CC according to Rutgeerts et al. VC was performed with a computed tomography scanner, with images examined by three radiologists who were unaware of the endoscopic findings. Results CC showed perianastomotic recurrence in 15 of 16 patients. Perianastomotic narrowing or stenosis was detected by VC in 11 of these 15 patients. There were 11 true positive, 1 true negative, 0 false-positive, and 4 false-negative findings (73% sensitivity, 100% specificity, 100% positive predictive value, 20% negative predictive value, 75% accuracy). Among the eight patients showing a rigid stenosis of the anastomosis not allowing passage of the colonoscope, VC detected narrowing or stenosis in seven patients. Conclusions The current findings suggest that although the widespread use of VC in CD is currently not indicated because of possible false-negative findings, this technique may represent an alternative to CC in noncompliant postsurgical patients with a rigid stenosis not allowing passage of the endoscope. [source]

Scorpion stings in Australia: five definite stings and a review

G. K. Isbister
Abstract Despite scorpions being locally abundant in many parts of Australia, scorpion sting is a poorly defined clinical condition in Australia. Many health-care workers are unaware of the effects of their stings and scorpions are often feared based on their international reputation. Five scorpion stings that occurred in different parts of Australia where the scorpion was caught at the time of the sting and identified by a professional arachnologist are reported in the present paper. The spectrum of clinical effects of scorpion stings in Australia and the potential for significant effects are discussed. These cases and recent prospective case series demonstrate that in ­Australia scorpion stings cause only minor effects. The main effect is localized pain lasting for several hours, associated less commonly with systemic effects, local numbness and paraesthesia. Most stings are from smaller scorpions from the family Buthidae and often occur indoors at night. The stings from Australian buthid scorpions cause more severe effects than from the larger species in the families Urodacidae (genus Urodacus) and Liochelidae (genus Liocheles). (Intern Med J 2004; 34: 427,430) [source]

Regional audit: Perioperative management of MRSA orthopaedic patients in the Oxford region

N. Aslam
Summary Aim:, Methicillin resistant staphylococcus aureus (MRSA) colonisation or infection is of particular importance in patients undergoing operations involving implanteable materials, such as in orthopaedic surgery. An audit of the perioperative management of orthopaedic patients in the Oxford region was carried out to assess the level of clinician awareness and the uniformity of current guidelines between hospitals. Methods:, A postal questionnaire was designed for asking information on various aspects of perioperative management of MRSA patients and was sent to each hospital. Results:, Responses were obtained from nine of 10 hospitals in the region. The average response rate for each hospital was 75%, and the overall individual response rate was 67.5% (27/40). Seventy-eight per cent of respondents knew that there was a pre-admission screening policy. Fifteen per cent were unaware of any MRSA policy. Forty-four per cent indicated that teicoplanin was used for prophylaxis in implant surgery whilst 44% used vancomycin. Eighteen per cent believed that cefuroxime was used for prophylaxis. Forty-eight per cent of hospitals had an MRSA-free zone for orthopaedic patients. Conclusion:, This study indicates a lack of uniformity in the perioperative management of MRSA-positive patients in the region and a lack of awareness of both MRSA guidelines and their implementation. Uniformity of MRSA guidelines is necessary to allow better clinician awareness and compliance, especially in surgical trainees who are travelling between different training hospitals in the region. Implementation of such a policy with re-audit of subsequent awareness and compliance is proposed. [source]

Intertriginous lymphomatoid drug eruption

Ronni Wolf MD
A 76-year-old man developed a maculopapular purpuric eruption confined to the intertriginous areas (i.e. the inguinal, gluteal, and axillary folds). Two days before the eruption appeared, he had received a second course of chemotherapy consisting of cisplatinum 40 mg and gemcitabine (Gemzar) 1700 mg for the treatment of squamous cell carcinoma of the lung stage III B. The histologic picture was of either lymphomatoid drug eruption or lymphomatoid papulosis. The antineoplastic therapy was changed to once-weekly intravenous vinorelbine (Navelbine) 50 mg, a Vinca alkaloid, and the eruption resolved completely within two weeks without any further therapy. These circumstantial evidences support the diagnosis of intertriginous drug eruption. Our case is interesting and unusual in that it demonstrated a rare clinical presentation of drug eruption, namely, intertriginous drug eruption or baboon syndrome, with a histologic picture of a lymphomatoid drug eruption that can mimic lymphoma. We are unaware of any earlier reported case of baboon syndrome with a histologic picture of lymphomatoid drug eruption. The pathomechanisms of both types of drug eruption, i.e. baboon syndrome and lymphomatoid drug eruption, are not fully understood. [source]

Isolated limb infusion with cytotoxic agent for treatment of localized refractory cutaneous T-cell lymphoma

Summary We described a 57-yr-old male diagnosed with cutaneous T-cell lymphoma that had failed multiple treatment options, as his disease was mainly confined to one limb. We attempted a novel approach in this condition using a technique of intra-arterial limb infusion with cytotoxic agent Melphalan (ILI) which has been proven beneficial in management of localised malignant melanoma. This treatment approach was well tolerated with mild myelosuppression and moderate limb toxicity. However, a significant improvement has been noted in the affected limb. This case demonstrated the successful use of isolated limb infusion with Melphalan in the management of localised cutaneous T-cell lymphoma. However, this result needs to be confirmed and further study is recommended. We are unaware there have been similar cases reported in the literature. [source]