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Selected AbstractsEcohydrological controls on snowmelt partitioning in mixed-conifer sub-alpine forestsECOHYDROLOGY, Issue 2 2009Noah P. Molotch Abstract We used co-located observations of snow depth, soil temperature, and moisture and energy fluxes to monitor variability in snowmelt infiltration and vegetation water use at mixed-conifer sub-alpine forest sites in the Valles Caldera, New Mexico (3020 m) and on Niwot Ridge, Colorado (3050 m). At both sites, vegetation structure largely controlled the distribution of snow accumulation with 29% greater accumulation in open versus under-canopy locations. Snow ablation rates were diminished by 39% in under-canopy locations, indicating increases in vegetation density act to extend the duration of the snowmelt season. Similarly, differences in climate altered snow-season duration, snowmelt infiltration and evapotranspiration. Commencement of the growing season was coincident with melt-water input to the soil and lagged behind springtime increases in air temperature by 12 days on average, ranging from 2 to 33 days under warmer and colder conditions, respectively. Similarly, the timing of peak soil moisture was highly variable, lagging behind springtime increases in air temperature by 42 and 31 days on average at the Colorado and New Mexico sites, respectively. Latent heat flux and associated evaporative loss to the atmosphere was 28% greater for the year with earlier onset of snowmelt infiltration. Given the large and variable fraction of precipitation that was partitioned into water vapour loss, the combined effects of changes in vegetation structure, climate and associated changes to the timing and magnitude of snowmelt may have large effects on the partitioning of snowmelt into evapotranspiration, surface runoff and ground water recharge. Copyright © 2009 John Wiley & Sons, Ltd. [source] Maternal employment and the initiation of breastfeedingACTA PAEDIATRICA, Issue 4 2001S Noble This study examines whether planning to be employed postpartum has an effect on initiation of breastfeeding. Data were collected from questionnaires completed by mothers who were subjects in the prospective, population-based, Avon Longitudinal Study of Pregnancy and Childhood. The mothers of 10 530 full-term singleton infants gave information during pregnancy on their postpartum employment plans and their initial infant feeding methods. Information was also given by 7642 of these mothers on the timing of their postpartum employment plans. Adjusted logistic regression was performed to identify associations between (a) "any" plans to work postpartum and the initiation of breastfeeding, and (b) the timing of the commencement of work postpartum, and the initiation of breastfeeding. A total of 8316 (79%) of the women initiated breastfeeding. The decision to breastfeed was not associated with "any" plans to work postpartum. However, women who planned to commence work prior to 6 wk postpartum were significantly less likely to initiate breastfeeding compared with those not intending to work postpartum. Older, more highly educated women, women who had or were planning to attend childbirth classes, women who were breastfed as infants, women who did not smoke and women who were giving birth to their first child were significantly more likely to initiate breastfeeding. Conclusion: Planning to return to employment prior to 6 wk postpartum reduces the likelihood of initiating breastfeeding. As increasing numbers of mothers are returning to work shortly after the birth of their child, this finding could have implications for maintaining the current level of breastfeeding. [source] Potential impacts on the incidence of fatal heroin-related overdose in Western Australia: a time-series analysisDRUG AND ALCOHOL REVIEW, Issue 4 2002KIM HARGREAVES Abstract In response to the rising concerns about the rate of heroin-related fatalities, overdose prevention campaigns, run by both users' organizations and government agencies, have been implemented in a number of states across Australia. In Western Australia (WA) in mid-1997, various overdose prevention initiatives were implemented. These included the implementation of a protocol limiting police presence at overdose events; the commencement of naloxone administration by ambulance staff; and the establishment of the Opiate Overdose Prevention Strategy (OOPS) which provided follow-up for individuals treated for overdose in emergency departments. This paper reports the results of a multiple linear regression analysis of 60 months of time-series data, both prior to and following the implementation of these interventions, to determine their impact on the number of fatal heroin overdoses in WA. The model employed in the analysis controlled for changes over time in proxy indicators of use and community concerns about heroin, as well as market indicators. The results suggest that, although the interventions implemented have managed to reduce the expected number of fatalities, they have become less successful in doing so as time passes. This has implications for both existing and potential interventions to reduce fatal heroin-related overdose. [source] Preventing growth in amphetamine use: long-term effects of the Midwestern Prevention Project (MPP) from early adolescence to early adulthoodADDICTION, Issue 10 2009Nathaniel R. Riggs ABSTRACT Aim The aim of the current study was to examine the long-term effect of an early adolescent substance abuse prevention program on trajectories and initiation of amphetamine use into early adulthood. Design Eight middle schools were assigned randomly to a program or control condition. The randomized controlled trial followed participants through 15 waves of data, from ages 11,28 years. This longitudinal study design includes four separate periods of development from early adolescence to early adulthood. Setting The intervention took place in middle schools. Participants A total of 1002 adolescents from one large mid-western US city were the participants in the study. Intervention The intervention was a multi-component community-based program delivered in early adolescence with a primary emphasis on tobacco, alcohol and marijuana use. Measures At each wave of data collection participants completed a self-report survey that included questions about life-time amphetamine use. Findings Compared to a control group, participants in the Midwestern Prevention Project (MPP) intervention condition had reduced growth (slope) in amphetamine use in emerging adulthood, a lower amphetamine use intercept at the commencement of the early adulthood and delayed amphetamine use initiation. Conclusions The pattern of results suggests that the program worked first to prevent amphetamine use, and then to maintain the preventive effect into adulthood. Study findings suggest that early adolescent substance use prevention programs that focus initially on the ,gateway' drugs have utility for long-term prevention of amphetamine use. [source] Gene therapy in epilepsyEPILEPSIA, Issue 1 2009Véronique Riban Summary Results from animal models suggest gene therapy is a promising new approach for the treatment of epilepsy. Several candidate genes such as neuropeptide Y and galanin have been demonstrated in preclinical studies to have a positive effect on seizure activity. For a successful gene therapy-based treatment, efficient delivery of a transgene to target neurons is also essential. To this end, advances have been made in the areas of cell transplantation and in the development of recombinant viral vectors for gene delivery. Recombinant adeno-associated viral (rAAV) vectors in particular show promise for gene therapy of neurological disorders due to their neuronal tropism, lack of toxicity, and stable persistence in neurons, which results in robust, long-term expression of the transgene. rAAV vectors have been recently used in phase I clinical trials of Parkinson's disease with an excellent safety profile. Prior to commencement of phase I trials for gene therapy of epilepsy, further preclinical studies are ongoing including evaluation of the therapeutic benefit in chronic models of epileptogenesis, as well as assessment of safety in toxicological studies. [source] Drug use patterns and mental health of regular amphetamine users during a reported ,heroin drought'ADDICTION, Issue 7 2004Amanda Baker ABSTRACT Aims The present study extends the findings of a pilot study conducted among regular amphetamine users in Newcastle, NSW, in 1998. It compares key features between current participants in a state capital city (Brisbane) and a regional city (Newcastle) and between the 1998 and current Newcastle sample. Design Cross-sectional survey. Setting Brisbane and Newcastle, Australia. Participants The survey was conducted among 214 regular amphetamine users within the context of a randomized controlled trial of brief interventions for amphetamine use. Measurements Demographic characteristics, past and present alcohol and other drug use and mental health, treatment, amphetamine-related harms and severity of dependence. Findings The main findings were as follows: (i) the rate of mental health problems was high among regular amphetamine users and these problems commonly emerged after commencement of regular amphetamine use; (ii) there were regional differences in drug use with greater accessibility to a wider range of drugs in a state capital city and greater levels of injecting risk-taking behaviour outside the capital city environment; and (iii) there was a significant increase in level of amphetamine use and percentage of alcohol users, a trend for a higher level of amphetamine dependence and a significant reduction in the percentage of people using heroin and benzodiazepines among the 2002 Newcastle cohort compared to the 1998 cohort. Conclusions Further longitudinal research is needed to elucidate transitions from one drug type to another and from recreational to injecting and regular use and the relationship between drug use and mental health in prospective studies among users. Implications Intervention research should evaluate the effectiveness of interventions aimed at: preventing transition to injecting and regular use of amphetamines; toward reducing levels of depression among amphetamine users and interventions among people with severe psychopathology and personality disorders; and toward reducing the prevalence of tobacco dependence among amphetamine users. [source] An echocardiographic and auscultation study of right heart responses to training in young National Hunt Thoroughbred horsesEQUINE VETERINARY JOURNAL, Issue S36 2006G. LIGHTFOOT Summary Reasons for performing study: There are few data available to determine the effect of training on cardiac valve function. Objectives: To investigate the effect of commercial race training on right ventricular (RV) and tricuspid valve function in an untrained group of National Hunt Thoroughbreds (TB). Material and methods: Cardiac auscultation, guided M-mode echocardiography of the RV, and colour flow Doppler (CFD) tricuspid valve and right atrium were performed in 90 TB horses (age 2,7 years) 1998,2003. Forty horses were examined at least once and 48 horses were examined on at least 2 occasions. Examinations were then classified as: i) before commencement of race training, ii) after cantering exercise had been sustained for a period of 8,12 weeks and iii) at full race fitness. Tricuspid valve regurgitation (TR) murmurs were graded on a 1,6 scale and CFD echocardiography TR signals were graded on a 1,9 scale. Right ventricular internal diameter (RVID) in diastole and systole (RVIDd and RVIDs) was measured by guided M-mode. Associations between continuous RVID and TR measures and explanatory covariates of weight, age, heart rate, yard and stage of training were examined using general linear mixed models with horse-level random effects. Results: On average, RVIDd and RVIDs increased by 0.08 and 0.1 cm, respectively, per year increase in age (P=0.1 and 0.02) and by 0.3 and 0.4 cm, respectively between pre-training and race fitness (P = 0.07 and 0.005). Tricuspid regurgitation score by colour flow Doppler increased by 0.6/year with age (P<0.0001) and by 1.8 between pre-training and race fitness (P< 0.0001). No significant associations were found between any outcomes and weight, heart rate and training yard. Due to the high level of co-linearity between age and training, multivariable models including both terms were not interpretable. Conclusions and clinical relevance: Athletic training of horses exerts independent effects on both severity and prevalence of tricuspid valve incompetence. This effect should therefore be taken into account when examinations are performed. Dimensions of RV increase with age and training in TB horses in a manner that appears to be similar to that of the LV. [source] Sprinklered office fire testsFIRE AND MATERIALS, Issue 3 2008I. D. Bennetts Abstract This paper presents data relating to the performance of sprinklers and detectors in real office fire situations. For sprinklers, these data are additional to that associated with the standardized testing used to determine the design delivery density and pressure requirements for various occupancy situations, and provide a useful insight into the effect of sprinklers on developing fires with various office situations. The data given in this paper include the times for activation of various types of sprinkler heads (normal and fast response), the efficacy of the systems as far as extinguishment is concerned, estimates of the maximum size of the fires prior to commencement of extinguishment and associated air temperatures at various locations within the office enclosures. Copyright © 2008 John Wiley & Sons, Ltd. [source] Effects of fire on surface carbon, energy and water vapour fluxes over campo sujo savanna in central BrazilFUNCTIONAL ECOLOGY, Issue 6 2003A. J. B. Santos Summary 1Tower-based eddy covariance measurements were used to quantify the effect of fire on subsequent carbon dioxide fluxes and water and surface energy balance characteristics for campo sujo savanna located near Brasília in Central Brazil (15°56, S, 47°51, W). Campo sujo is a xeromorphic, open shrub savanna with very scattered but definitely visible shrubs and tree-like shrub elements. We studied two areas, one exposed to a prescribed fire late in the dry season, and a second that had not been burned for the previous 4 years. 2The fire on 22 September 1998 consumed an estimated 26 mol C m,2. Immediately after the fire, evapotranspiration rates decreased and the savanna became a stronger net source of CO2 to the atmosphere. This was attributed to the removal of the still slightly physiologically active grass layer and higher soil CO2 efflux rates as a consequence of elevated surface soil temperatures post-burning. 3On the commencement of the first rains in early October 1998, this situation was reversed, with the burned area rapidly becoming a stronger sink for CO2 and with higher evapotranspiration rates than a nearby unburned (control) area. This difference persisted throughout the wet season (until at least June 1999) and was attributable to greater physiological activity of the regrowing vegetation in the burned area. Early in the growing season, higher soil evaporation rates may also have contributed to faster water use by the previously burned area. 4Overall, we estimate an annual gross primary productivity for the burned area of 135 mol C m,2 year,1, with that for the unburned area being 106 mol C m,2 year,1. Estimated ecosystem respiration rates were more similar on an annual basis (96 and 82 mol C m,2 year,1 for the burned and unburned areas, respectively), giving rise to a substantially higher net ecosystem productivity for the previously burned area (38 vs 24 mol C m,2 year,1). 5Stimulation of photosynthetic activity in the rapid post-fire growth phase means that the negative effects of fire on the ecosystem carbon balance were more or less neutralized after only 12 months. [source] Insights into biaxial extensional tectonics: an examplefrom the Sand,kl, Graben, West Anatolia, TurkeyGEOLOGICAL JOURNAL, Issue 1 2003Mustafa Cihan Abstract West Anatolia, together with the Aegean Sea and the easternmost part of Europe, is one of the best examples of continental extensional tectonics. It is a complex area bounded by the Aegean,Cyprus Arc to the south and the North Anatolian Fault Zone (NAFZ) to the north. Within this complex and enigmatic framework, the Sand,kl, Graben (10,km wide, 30,km long) has formed at the eastern continuation of the Western Anatolian extensional province at the north-northwestward edge of the Isparta Angle. Recent studies have suggested that the horst,graben structures in West Anatolia formed in two distinct extensional phases. According to this model the first phase of extension commenced in the Early,Middle Miocene and the last, which is accepted as the onset of neotectonic regime, in Early Pliocene. However, it is controversial whether two-phase extension was separated by a short period of erosion or compression during Late Miocene,Early Pliocene. Both field observations and kinematic analysis imply that the Sand,kl, Graben has existed since the Late Pliocene, with biaxial extension on its margins which does not necessarily indicate rotation of regional stress distribution in time. Although the graben formed later in the neotectonic period, the commencement of extension in the area could be Early Pliocene (c. 5,Ma) following a severe but short time of erosion at the end of Late Miocene. The onset of the extensional regime might be due to the initiation of westward motion of Anatolian Platelet along the NAFZ that could be triggered by the higher rate of subduction at the east Aegean,Cyprus Arc in the south of the Aegean Sea. Copyright © 2003 John Wiley & Sons, Ltd. [source] Successful treatment using cyclosporine A plus corticosteroid therapy in an elderly patient with severe idiopathic interstitial pneumoniaGERIATRICS & GERONTOLOGY INTERNATIONAL, Issue 2 2006Masayuki Kikawada An 81-year-old woman was referred to our hospital due to acute progressive respiratory failure. Her chest X-ray film showed bilateral interstitial changes and computed tomography revealed a diffuse ground-glass appearance. Histological examination of transbronchial lung biopsy specimens did not provide a final diagnosis. The patient was diagnosed as having idiopathic interstitial pneumonia (IIP) and was treated with corticosteroid therapy. The chest X-ray appearance improved temporarily after corticosteroid therapy, but the interstitial changes did not resolve and subsequently became worse again, so administration of cyclosporine A was added. After commencement of cyclosporine A, corticosteroid therapy could be gradually tapered over 10 months. This case suggests that a combination of steroid therapy with cyclosporine A is effective for severe IIP of unknown pathological diagnosis. [source] The ,New War' on Terror, Cosmopolitanism and the ,Just War' RevivalGOVERNMENT AND OPPOSITION, Issue 1 2008Helen Dexter The post-Cold War era has seen the return of the ,good war' and a move away from legal pacifism , the control of war through international law , to ,just war' theorizing. This article is concerned with the re-legitimization of warfare witnessed within the post-Cold War security paradigm that is being justified via humanitarian claims. It aims to highlight the difficult relationship that has developed since the commencement of the Bush administration's ,war on terror' between the cosmopolitan beliefs of those who have long argued for legal and legitimate humanitarian intervention, and the cosmopolitanism being espoused by the neo-conservatives of the Bush administration and the Project for the New American Century. [source] The effect of accumulation period and harvest date in spring on dry-matter yield and forage quality in mixed swards containing Lolium spp. and Trifolium subterraneum in Western AustraliaGRASS & FORAGE SCIENCE, Issue 1 2001M. N. Callow The object of this study was to determine the effect of closing date and date of harvest for conservation (accumulation period), on dry-matter (DM) yield and forage quality of annual pasture in Western Australia. The field study comprised 48 plots, 2 m × 2 m, sown with either annual ryegrass (Lolium rigidum Gaud.) or Italian ryegrass (L. multiflorum Lam.), and mixed with subterranean clover (Trifolium subterraneum L.). Defoliation of swards until the end of winter was at the three leaves tiller,1 stage. In spring, once stem nodal development had commenced, swards were defoliated every 3,4 weeks. Swards were defoliated either twice with three leaves tiller,1 (accumulation period 1 commenced on 15 August); twice with three leaves tiller,1 and then once after 4 weeks (accumulation period 2 commenced on 11 September); twice with three leaves tiller,1 and then twice after 4-week intervals (accumulation period 3 commenced on 9 October) or; twice with 3 leaves tiller,1 and then twice after 4-week intervals and then once after 3 weeks (accumulation period 4 commenced on 30 October). From the commencement of the accumulation period, tiller density, DM yield and forage quality were determined weekly for up to 10 weeks. There was a positive quadratic association between DM yield and days after the commencement of the accumulation period. Yields were maximized from accumulation period 1 with 5·3, 6·6 and 9·5 t DM ha,1, and growth rates were 140, 128 and 145 kg DM ha,1 d,1, for Wimmera annual ryegrass and Richmond and Concord cultivars of Italian ryegrass respectively. In contrast, in vitro dry-matter digestibility (IVDMD) and crude protein (CP) content were negatively associated with days after the commencement of the accumulation period, and initial values were greater than 0·80 and 180 g kg DM,1 for IVDMD and CP content respectively. The rate of decline in IVDMD d,1 for Wimmera annual ryegrass was 0·005, 0·019 and 0·012 d,1 for accumulation periods 1, 2 and 3, respectively, while for Italian ryegrass cultivars Richmond was 0·015, 0·011, 0·02 and 0·012 d,1 and Concord was 0·014, 0·009, 0·013 and 0·01 d,1, for the 4 accumulation periods respectively. It is recommended that annual and Italian ryegrass pastures be harvested between 10% and 20% inflorescence emergence when IVDMD will exceed 0·70 regardless of cultivar and/or defoliation practice prior to the commencement of the accumulation period. [source] Institutional Review Boards and Multisite Studies in Health Services Research: Is There a Better Way?HEALTH SERVICES RESEARCH, Issue 1 2005Jennifer L. Gold Objective. The following paper examines the issue of whether the current system for ethics review of multisite health services research protocols is adequate, or whether there exist alternative methods that should be considered. Principal Findings. (1) Investigators at different sites in a multisite project often have very different experiences with respect to the requirements and requests of the review board. Other problems include the waste of time and resources spent on document preparation for review boards, and delays in the commencement of research activities. (2) There are several possible reasons why there is variability in ethics review. These include the absence of standardized forms, differences in the background and experiences of board members, the influence of institutional or professional culture, and regional thinking. (3) Given the limited benefits derived from the variability in recommendations of multiple boards and the numerous problems encountered in seeking ethics approval from multiple boards suggest that some sort of reform is in order. Conclusions. The increasing number of multisite, health services research studies calls for a centralized system of ethics review. The local review model is simply not conducive to multisite studies, and jeopardizes the integrity of the research process. Centralized multisite review boards, together with standardized documents and procedure, electronic access to documentation, and training for board members are all possible solutions. Changes to the current system are necessary not only to facilitate the conduct of multisite research, but also to preserve the integrity of the ethics approval process in general. [source] Guidelines for the treatment of chronic hepatitis and cirrhosis due to hepatitis C virus infection for the fiscal year 2008 in JapanHEPATOLOGY RESEARCH, Issue 1 2010Hiromitsu Kumada In the 2008 guidelines for the treatment of patients with chronic hepatitis C, pegylated interferon (Peg-IFN) combined with ribavirin for 48 weeks are indicated for treatment-naive patients infected with hepatitis C virus (HCV) of genotype 1. Treatment is continued for an additional 24 weeks (72 weeks total) in the patients who have remained positive for HCV RNA detectable by the real-time polymerase chain reaction at 12 weeks after the start of treatment, but who turn negative for HCV RNA during 13,36 weeks on treatment. Re-treatment is aimed to either eradicate HCV or normalize transaminase levels for preventing the development of hepatocellular carcinoma (HCC). For patients with compensated cirrhosis, the clearance of HCV RNA is aimed toward improving histological damages and decreasing the development of HCC. The recommended therapeutic regimen is the initial daily dose of 6 million international units (MIU) IFN continued for 2,8 weeks that is extended to longer than 48 weeks, if possible. IFN dose is reduced to 3 MIU daily in patients who fail to clear HCV RNA by 12 weeks for preventing the development of HCC. Splenectomy or embolization of the splenic artery is recommended to patients with platelet counts of less than 50 × 103/mm3 prior to the commencement of IFN treatment. When the prevention of HCC is at issue, not only IFN, but also liver supportive therapy such as stronger neo-minophagen C, ursodeoxycholic acid, phlebotomy, branched chain amino acids (BCAA), either alone or in combination, are given. In patients with decompensated cirrhosis, by contrast, reversal to compensation is attempted. [source] Results of decompression surgery for pain in chronic pancreatitisHPB, Issue 4 2007J.D. Terrace Abstract Introduction. A vast majority of patients with chronic pancreatitis require regular opiate/opioid analgesia and recurrent hospital admission for pain. However, the role and timing of operative strategies for pain in chronic pancreatitis is controversial. This study hypothesized that pancreatic decompression surgery reduces analgesia requirement and hospital readmission for pain in selected patients. Patients and methods. This was a retrospective review of patients undergoing longitudinal pancreatico-jejunostomy (LPJ), with or without coring of the pancreatic head (Frey's procedure), between 1995 and 2007 in a single UK centre. Surgery was performed for chronic pain with clinical/radiological evidence of chronic pancreatitis amenable to decompression/head coring. Results. Fifty patients were identified. Thirty-six were male with a median age of 46 years and median follow-up of 30 months. Twenty-eight underwent LPJ and 22underwent Frey's procedure. No significant difference in reduction of analgesia requirement (71% vs 64%, p=0.761) or hospital readmission for pain (21% vs 23%, p=1.000) was observed when comparing LPJ and Frey's procedure. Patients were significantly more likely to be pain-free following surgery if they required non-opiate rather than opiate analgesia preoperatively (75% vs 19%, p=0.0002). Fewer patients required subsequent hospital readmission for pain if taking non-opiate rather than opiate analgesia preoperatively (12.5% vs 31%, p=0.175). Conclusions. In selected patients, LPJ and Frey's procedure have equivalent benefit in short-term pain reduction. Patients should be selected for surgery before the commencement of opiate analgesia. [source] Carbimazole-induced agranulocytosis: does antineutrophil cytoplasmic antibody have a role?INTERNAL MEDICINE JOURNAL, Issue 4 2010G. Yip Abstract Carbimazole is a drug that is widely used for hyperthyroid disorders, such as Graves' disease. Agranulocytosis is a rare idiosyncratic adverse reaction to the drug which is potentially fatal. This report describes a patient with a history of successfully treated pyoderma gangrenosum, who developed agranulocytosis 3 weeks after commencement of carbimazole for Graves' disease. It may give credence to the theory that implicates antineutrophil cytoplasmic antibodies in the pathogenesis of agranulocytosis induced by antithyroid drugs. [source] Effect of long-term nebulized colistin on lung function and quality of life in patients with chronic bronchial sepsisINTERNAL MEDICINE JOURNAL, Issue 7 2007D. P. Steinfort Abstract Recurrent Gram-negative bacterial infection is a significant cause of death in patients with bronchiectasis and severe chronic obstructive pulmonary disease (COPD). Nebulized colistin in cystic fibrosis has shown maintenance of pulmonary function and improved symptom scores. We prospectively followed 18 patients with chronic bronchial sepsis treated with nebulized colistin 30 mg daily. Mean decline in forced expiratory volume in 1 s was significantly slower following commencement of inhaled colistin (44 mL/year vs 104 mL/year, P = 0.035). Mean decline in forced vital capacity was also significantly slower following commencement of colistin (48 mL/year vs 110 mL/year, P = 0.033). Patient-reported quality of life improved following commencement of colistin (3.6 vs 6.2, P = 0.001). No patient had isolates resistant to colistin. No side-effects were reported by patients in the cohort. Use of inhaled colistin in the treatment of bronchiectasis and severe (COPD) in patients with recurrent Gram-negative infections is safe. Inhaled colistin may improve quality of life and slow decline in forced expiratory volume in 1 s and forced vital capacity. [source] Smoking and the risk of breast cancer among carriers of BRCA mutationsINTERNATIONAL JOURNAL OF CANCER, Issue 3 2004Parviz Ghadirian Abstract The effect of cigarette smoking on the risk of breast cancer is controversial, although most studies show little or no effect. It has been suggested that smoking may reduce the risk of developing hereditary breast cancer. We completed a case-control study on 1,097 women with breast cancer who were BRCA1 or BRCA2 mutation carriers and 1,097 age-matched controls with a mutation in the same gene but without breast cancer. There were no statistically significant differences between the cases and controls in terms of the number of current and ex-smokers (41.2% and 40.4%, respectively) or the age at smoking commencement (18.2 years and 18.5 years, respectively). There were no statistically significant differences between cases and controls regarding beginning smoking within 5 years of menarche (OR = 1.03; 95% CI 0.83 to l.28) or before the first pregnancy (OR = 1.09; 95% CI = 0.90 to 1.33). In conclusion, contrary to our previous report, smoking does not appear to be a risk factor for breast cancer among carriers of BRCA mutations. © 2004 Wiley-Liss, Inc. [source] The natural history of asthma from childhood to adulthoodINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 8 2007M. S. Koh Summary Medical Practitioners are often questioned regarding the prognosis of a child with asthma. We have performed a literature review of the natural history of childhood asthmatics. Factors which affect the natural history and prognosis of childhood asthma are discussed. Current evidence suggests that evolution of asthma severity is fairly predictable. Features of childhood asthma such as severity, duration, atopy, bronchial hyperresponsiveness and exposure to smoking can predict the course of asthma into adulthood. Most children with mild intermittent asthma will outgrow their asthma, or have mild episodic asthma. Early commencement of anti-inflammatory therapy, such as inhaled corticosteroids may prevent the progression of the disease. Most patients with mild asthma have good functional outcome and low healthcare utilisation. [source] Leflunomide in subacute cutaneous lupus erythematosus , two sides of a coinINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 1 2008Anke Suess MD Background, Subacute cutaneous lupus erythematosus (SCLE), a distinct clinical subset of lupus erythematosus, remains a therapeutic challenge, especially in cases resistant to topical and standard systemic therapy. Leflunomide, a novel antirheumatic drug, has shown efficacy in the treatment of systemic lupus erythematosus in pilot studies. Methods, We report two patients with SCLE who demonstrated the spectrum of possible clinical responses to leflunomide therapy. Results, One patient experienced a complete clinical remission of symptoms, whereas the other developed a massive skin reaction which was distinctly related to the commencement of leflunomide therapy. Conclusion, To our knowledge, this is the first time that remission and deterioration of SCLE by leflunomide therapy have been described. [source] An interplay of alleviating mutations in the clinical phenotype of ,-thalassaemia intermediaINTERNATIONAL JOURNAL OF LABORATORY HEMATOLOGY, Issue 6 2004A. NADKARNI Summary Prediction of a , -thalassaemia major phenotype from the , -genotype is generally relatively straightforward. However, despite the ability to accurately define the , -thalassaemia mutations, prediction of a , -thalassaemia intermedia phenotype from the genotype sometimes remains problematic and this has important implications in genetic counselling and prenatal diagnosis. We report a 11-year-old Indian male child with a thalassaemia intermedia phenotype. , -Globin gene analysis of the family showed that he was a compound heterozygote with the ,88 (C,T) ,+ -mutation and the IVS1 nt 130 (G,C) ,0 -mutation. Both these mutations are rare among Indians. The propositus was also found to be heterozygous for the XmnI polymorphism and had a normal , -genotype. In this family interplay of two alleviating mutations (a milder promoter mutation along with a gene for raised HbF) might have synergistically compensated for lack of globin chains in the patient. Hence, the nature of the , -genotype as well as the knowledge of the presence or absence of alleviating factors will help the clinician to decide whether early commencement of a regular transfusion regime is necessary. [source] Profile of opportunistic infections among patients on immunosuppressive medicationINTERNATIONAL JOURNAL OF RHEUMATIC DISEASES, Issue 3 2006Srinivas REDDY Abstract Background:, The widespread use of immunosuppressives in treating systemic autoimmune disorders has resulted in opportunistic infections (OIs) following such therapy. Current data regarding the possibility of infection due to these drugs or from the primary disease, per se, is conflicting. Objectives:, We aimed to analyse the profile of patients requiring hospitalization for OIs among those being treated with glucocorticoids and other immunosuppressive agents as part of management of systemic autoimmune disorders and to analyse the host factors in relation to OIs. Method:, In this descriptive analysis, all patients hospitalized the Postgraduate Institute of Medical Education and Research, Chandigarh, India, under medicinal units for OIs that occurred following and during treatment with corticosteroids and other immunosuppressive agents for treatment of systemic autoimmune disorders from February 2002 to January 2003, were studied. All hospitalized patients received antibiotics according to the nature of infection and sensitivity reports. All relevant clinical details were recorded in a standard pro forma. Descriptive statistics were used. The Institute Ethics Committee's permission was secured prior to study commencement. Results:, Nineteen patients (16 female) were admitted because of OIs. Their mean age (± SD) was 37.32 (± 19.9) years. Ten patients had systemic lupus erythematosus (SLE), two had SLE with overlap, five had rheumatoid arthritis, and one each had vasculitis and scleroderma with polymyositis. There were 28 infections. One (5.3%) patient had four infections, one (5.3%) had three, six (31.6%) had two, nine (47.4%) had one, and in two (10.5%) patients the infection was not localized. Of the 19 cases, 10 (52.6%) received > 10 mg of prednisolone each day (median = 1130 mg). The remaining nine (47.4%) were on < 10 mg prednisolone each day (median = 880 mg). Methylprednisolone was given to two (6.3%) patients. Bacteria accounted for most of the infections. There were two fungal infections and one patient each with tuberculosis and peritonitis. Infections occurred predominantly in the chest, urine and skin. Septicemia was diagnosed in three patients. There were two deaths, one each with SLE and rheumatoid arthritis. Conclusion:, Since infections can occur at low doses of corticosteroids, we suggest that these disorders may be, per se, responsible for an increased risk of infection. [source] Spatial planning, mobilities and culture,Chinese and New Zealand student preferences for Californian travelINTERNATIONAL JOURNAL OF TOURISM RESEARCH, Issue 3 2007Chris Ryan Abstract Itineraries are under-researched within tourism, which is arguably strange given their potential importance as determinants of visitor expenditure distribution, and how itinerary planning may become a tool of destination management in determining which areas are most affected by visitor flows, whether positively or negatively. This exploratory study required students in New Zealand and the Peoples' Republic of China to draw maps of potential trips to the south-west of the USA in order to assess to what degree differences might exist as to (i) preferred places to visit; (ii) durations of stay; (iii) speeds of dispersion and concentration at the points of embarkation and disembarkation (in this instance Los Angeles); and (iv) total distances travelled. Differences were indeed found, and ethnicity appeared to be the main explanatory variable for the differences. Chinese students were found to travel slightly less, not to become so dispersed overall, but were also found to have higher rates of dispersion and slower rates of concentration at the commencement and at the end of the trip. The itineraries also suggest a further triangular pattern of travel that can be added to the categories identified by Oppermann. Copyright © 2007 John Wiley & Sons, Ltd. [source] Capsaicin Troche for Swallowing Dysfunction in Older PeopleJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 5 2005Takae Ebihara MD Objectives: To determine whether oral capsaicin troche supplementation with every meal upregulates the impairment of upper respiratory protective reflexes such as the swallowing reflex and the cough reflex. Design: Randomized, controlled study with recruitment through nursing homes. Setting: Sendai, Japan, from September 2002 through December 2003. Participants: Sixty-four participants in nursing homes with a mean age±standard deviation of 81.9±1.0 with stable physical status. Intervention: Participants were randomly assigned to the program for the supplementation of capsaicin trochisci or placebo trochisci before every meal for 4 weeks. Measurements: Assessment of individual latency time of the swallowing reflex (LTSR) and cough reflex sensitivity. Results: Before the commencement of this study, there were no significant baseline differences in multiple parameters between the intervention group and control group. LTSR in participants in the intervention group was significantly shorter than in the control group (P<.05). The odds ratio (OR) of the shortening of the LTSR of more than 1 minute in the intervention group was 3.4 (95% confidence interval (CI)=1.1,10.4), compared with the control group (P=.03). In particular, daily capsaicin supplementation significantly increased the ratio of LTSR reduction at 4 weeks after the study to baseline LTSR in the high-risk group (baseline LTSR >6.0 seconds) compared with the low-risk group (baseline LTSR <3.0 seconds) and the intermediate group (3.0 seconds Investigation of the effect of delayed reflux on PVC grain properties produced by suspension polymerizationJOURNAL OF APPLIED POLYMER SCIENCE, Issue 5 2010N. Etesami Abstract The effects of the condenser operation on properties of polyvinyl chloride (PVC) particles produced by suspension polymerization process were investigated in a pilot scale reactor. It was observed that delaying reflux operation increased the cold plasticizer absorption of the final resin. Both bulk density and K-value of the PVC powder decreased by increasing time delay in the reflux operation. It was also found that commencement of refluxing before 20% conversion resulted in bimodal particle size distribution (PSD), while monomodal PSD was obtained for longer delays in refluxing. SEM micrographs showed that surface of produced particles were rough and smooth when reflux started before and after 20% conversion, respectively. © 2010 Wiley Periodicals, Inc. J Appl Polym Sci, 2010 [source] Rheological properties of acrylic bone cement during curing and the role of the size of the powder particlesJOURNAL OF BIOMEDICAL MATERIALS RESEARCH, Issue 2 2002Gladius Lewis Abstract A dynamic compressive rheometric technique was used to determine the true or complex viscosity (,*) of three poly (methyl methacrylate), PMMA-based bone cement formulations (one commercially available and two experimental), as a function of the time that elapsed from commencement of hand mixing of the cement constituents (t). For each cement, two rheological parameters [namely, the time of onset of cure (tons) and the critical cure rate (CCR), which is herein defined as the complex viscosity rate computed at tons] were determined from the ,*,t data. For each cement, particle analysis was used to obtain the powder particle size distribution, from which the following parameters were obtained: (a) the overall mean particle diameter Dm, and (b) the relative amounts of small-sized PMMA beads (mean diameter d between 0 and 40 ,m) (,) and large-sized PMMA beads (d > 75 ,m) (,). It is seen that the key particle parameter is not Dmper se but , and ,. Thus, the highest values of tons and CCR were obtained from a cement with the highest values of , and ,. An explanation for these trends is given, and two areas for further research work in this field are outlined. © 2002 John Wiley & Sons, Inc. J Biomed Mater Res (Appl Biomater) 63: 191,199, 2002; DOI 10.1002/jbm.10127 [source] Transient Global Amnesia as the Presenting Feature of Heparin-Induced ThrombocytopeniaJOURNAL OF CARDIAC SURGERY, Issue 3 2010Chun Huat Teh M.B.Ch.B. Both immunoglobulin G-specific enzyme-linked immunosorbent assay and serotonin release assay were strongly positive for the antibodies that cause heparin-induced thrombocytopenia. The patient's cognitive functions returned to normal following discontinuation of unfractionated heparin and warfarin and commencement of lepirudin infusion.,(J Card Surg 2010;25:300-302) [source] The essentials of Advance Care Planning for end-of-life care for older peopleJOURNAL OF CLINICAL NURSING, Issue 3-4 2010Sarah Yeun-Sim Jeong Aims and objectives., The aim of the study was to investigate the phenomenon of Advance Care Planning and the use of Advance Care Directives in residential aged care facilities in Australia. The objectives were to: ,,investigate the implementation process of Advance Care Planning and the use of Advance Care Directives; ,,investigate the outcomes of Advance Care Planning and experiences of people involved in Advance Care Planning and Advance Care Directives, including residents, families and nursing staff. Background., Benefits of Advance Care Planning for older residents are considerable given their degenerative health-breakdown and minimal chance of recovery. To date, the use of Advance Care Planning and Advance Care Directives is limited and models of service delivery and processes are needed to enhance best practice with Advance Care Planning and positive outcomes for older Australians. Design., Case study. Methods., The study conducted using multiple sources of evidence to enrich understanding of the phenomenon of Advance Care Planning. The researcher engaged in data collection over six months involving participant observation, field notes, semi-structured interviews and document analysis. The findings contribute to the limited knowledge of options currently available to older adults and their families in their decision-making about end-of-life care options. Permission to conduct the study., Prior to commencement of the data collection, ethics clearances from the University of Newcastle and the regional Area Health Service were achieved. Permission to access the residential aged care facilities to undertake the study was obtained from the relevant residential aged care facility ethics committees or designated authorities. The researcher undertook several strategies to ensure all the ethical principles were considered and adhered to while conducting the project. Results., The research identified the components and factors involved in the Advance Care Planning process and in attaining desired outcomes. The conceptual framework developed elaborates how Advance Care Planning should be implemented and what may constitute successful implementation of Advance Care Planning in residential aged care facilities. The four main elements (input, throughput, output, feedback), and 20 sub-elements were requisites for nurses to initiate and implement the Advance Care Planning. Conclusion., The essential components for end-of-life care are identified in the implementation processes of Advance Care Planning in residential aged care facilities. The study contributes to greater awareness of the processes needed for ,dying well' and highlights the need to explore experiences of ,successful dying' and the way nurses contribute to these events. Relevance to clinical practice., The case study identified four determinative requisites for successful implementation of Advance Care Planning in aged care facilities: the expert nurse, discussion, education and involvement of a multidisciplinary team. Nurses should take these factors into account and use person-centred approach in formalised processes to encourage participation in plans for end-of-life care. [source] Lower urinary tract symptoms: a hermeneutic phenomenological study into men's lived experienceJOURNAL OF CLINICAL NURSING, Issue 2 2005BSc (Hons), Mark Wareing MSc Aim., This was an investigation to discover the lived experience of men with lower urinary tract symptoms arising from benign prostatic hyperplasic. Design., A hermeneutic phenomenological study. Methods., Approval was granted by the local Applied and Qualitative Research Ethics Committee (AQREC) prior to the commencement of the study. Data were gathered via semi-structured interviews that were audio taped, and subsequently transcribed. Each transcripted interview was analysed by the investigator and a team of ,expert readers'. The team agreed on a total of 57 sub-themes divided into seven categories with unanimity, therefore obviating the need for participant validation. Findings., The major findings of the study suggest that men experience a broad and dramatic spectrum of phenomena while living with a benign prostate condition. This includes profound embarrassment, fear, revulsion as well as humour that require a range of methods and life adjustments to manage and contain their symptoms. Conclusions., The participant's narratives provide a thick, rich and meaningful insight into how men understand their bodies, and make sense of prostate disease; a significant men's health issue. Relevance to clinical practice., Several studies have already been published describing men's lived experience of prostate surgery for benign prostatic hyperplasia. This research has captured men's lived experience of lower urinary tract symptoms ahead of surgical intervention. Men experience a broad scope of phenomena resulting from life with a benign prostate condition that encompasses fear and embarrassment and the development of coping mechanisms and changes in life style. Recent media awareness campaigns to raise public awareness of prostate disease as a men's health issue appear to be changing how men perceive their bodies, how they converse with one another, and their help seeking behaviour. [source]
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