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Adequate Control (adequate + control)
Selected AbstractsAge-Varying Association Between Blood Pressure and Risk of Dementia in Those Aged 65 and Older: A Community-Based Prospective Cohort StudyJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 8 2007Ge Li MD OBJECTIVES: To assess variation in the association between blood pressure (BP) and risk for dementia across a spectrum of older ages and to examine BP changes before dementia onset. DESIGN: Prospective cohort study. SETTING: A large health maintenance organization in Seattle, Washington. PARTICIPANTS: A cohort of 2,356 members of a large health maintenance organization aged 65 and older who were initially without dementia. MEASUREMENTS: Dementia diagnosis was assessed biennially, and systolic (SBP) and diastolic BP (DBP) were measured at baseline and at four follow-up assessments. Cox proportional hazards models were used to estimate hazard ratios (HRs) for dementia and Alzheimer's disease (AD) associated with baseline BP in different age groups. RESULTS: Within the youngest age group (65,74 at enrollment) a greater risk for dementia was found in participants with high SBP (,160 mmHg) (hazard ratio (HR)=1.60, 95% confidence interval (CI)=1.01,2.55) or borderline-high DBP (80,89 mmHg) (HR=1.59, 95% CI=1.07,2.35) than for those with normal BP (SBP <140 mmHg and DBP <80 mmHg). The dementia risk associated with SBP declined with increasing age (SBP-by-age interaction, P=.01). SBP declined similarly with aging in subjects who developed dementia and those who did not. Thus, in this sample, the association between SBP and dementia risk was not dependent on when BP was measured in relation to onset of dementia. CONCLUSION: High SBP was associated with greater risk of dementia in the young elderly (<75) but not in older subjects. Adequate control of hypertension in early old age may reduce the risk for dementia. [source] Quantitative effects produced by modifications of neuronal activity on the size of GABAA receptor clusters in hippocampal slice culturesEUROPEAN JOURNAL OF NEUROSCIENCE, Issue 2 2004Serge Marty Abstract The number and strength of GABAergic synapses needs to be precisely adjusted for adequate control of excitatory activity. We investigated to what extent the size of GABAA receptor clusters at inhibitory synapses is under the regulation of neuronal activity. Slices from P7 rat hippocampus were cultured for 13 days in the presence of bicuculline or 4-aminopyridine (4-AP) to increase neuronal activity, or DNQX to decrease activity. The changes provoked by these treatments on clusters immunoreactive for the ,1 and ,2 subunits of the GABAA receptor or gephyrin were quantitatively evaluated. While an increase in activity augmented the density of these clusters, a decrease in activity provoked, in contrast, a decrease in their density. An inverse regulation was observed for the size of individual clusters. Bicuculline and 4-AP decreased whilst DNQX increased the mean size of the clusters. When the pharmacological treatments were applied for 2 days instead of 2 weeks, no effects on the size of the clusters were observed. The variations in the mean size of individual clusters were mainly due to changes in the number of small clusters. Finally, a regulation of the size of GABAA receptor clusters occurred during development in vivo, with a decrease of the mean size of the clusters between P7 and P21. This physiological change was also the result of an increase in the number of small clusters. These results indicate that neuronal activity regulates the mean size of GABAA receptor- and gephyrin-immunoreactive clusters by modifying specifically the number of synapses with small clusters of receptors. [source] Clinical insights from the Fenofibrate Intervention and Event Lowering in Diabetes study: a community practice perspectiveINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 6 2009P. P. Toth Summary Achieving adequate control of cardiovascular risk in type 2 diabetes mellitus (DM) is crucially important; however, the atherogenic dyslipidaemia (including low high-density lipoprotein cholesterol and hypertriglyceridaemia) typically encountered in type 2 DM is often managed inadequately. Evidence from the Fenofibrate Intervention and Event Lowering in Diabetes study suggests that fenofibrate reduces the risk of long-term macrovascular and microvascular type 2 diabetic complications, especially in patients demonstrating features of the metabolic syndrome. Fenofibrate represents a useful treatment option for controlling cardiovascular risk in type 2 diabetes patients in the community setting. [source] Qualitative similarities in cognitive impairment associated with 24 h of sustained wakefulness and a blood alcohol concentration of 0.05%JOURNAL OF SLEEP RESEARCH, Issue 4 2003Marina G. Falleti Summary Previous studies that have quantified fatigue-related cognitive impairment as blood alcohol concentration (BAC) equivalents have been limited by two issues: the effect of practice on tests of cognition and, more importantly, the statistic used to quantify change in cognitive performance. The current study addressed these issues by adopting an ABACA design, which allowed for the adequate control of practice effects, and by using effect size metrics, which enabled direct comparisons to be made in performance impairments as a result of fatigue (i.e. sustained wakefulness of 24 h) and alcohol (i.e. BAC of 0.05%). Cognitive performance under the fatigue and alcohol conditions required the use of the CogStateTM battery. It was demonstrated that fatigue caused greater impairment than alcohol on the speed of continuous attention and memory and learning, and on the accuracy of complex matching. Alcohol was more detrimental than fatigue only on the accuracy of memory and learning. Performances on the remaining tasks were the same for both the fatigue and alcohol conditions. These differences and similarities in performance impairment are discussed emphasizing the deleterious cognitive effects of relatively short periods of sustained wakefulness. [source] Extended-stay hospitalization for childhood asthma in JapanPEDIATRICS INTERNATIONAL, Issue 4 2009Hidekazu Tani Abstract Background:, While recent advances in asthma management have enabled adequate control to be frequently achieved in outpatient settings, children whose asthma remains poorly controlled despite outpatient treatment are often referred to extended-stay hospitals. The aim of the present study was to examine trends concerning extended-stay hospitalization and to evaluate the present status of this approach. Methods:, A retrospective study was conducted to assess changes in the number of admissions among 408 children with extended stays at Kamiamakusa General Hospital between 1989 and 2005. Medical and laboratory data of 236 patients admitted since 1994 were obtained from clinical records. Results:, The number of children with extended-stay hospitalizations since 2000 declined dramatically compared with the early 1990s, while the percentage of patients with complications of childhood asthma, such as severe atopic dermatitis, school absenteeism, and obesity, have increased significantly in the recent past. Practical benefits of extended-stay hospitalization were demonstrated by significant improvement of exercise performance and measurement of pulmonary function parameters and serum IgE concentrations by time of discharge. In addition to improvement in asthmatic symptoms, maintenance drug requirements and frequency of school absenteeism were reduced. Conclusions:, The medical mission of extended-stay hospitalizations is currently limited due to the availability of improved pharmacotherapy. Some patients, however, with exceptionally severe asthma or psychological problems that interact with their medical condition still fare poorly under outpatient care and could benefit from group care. Further study is needed to identify the components of long-term programs essential to produce change. [source] Late follow-up of a randomized trial of surgery plus tamoxifen versus tamoxifen alone in women aged over 70 years with operable breast cancerBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 6 2004M. Fennessy Background: Breast cancer has been considered a more indolent disease in the elderly, who are less tolerant of aggressive therapy. This trial tested the hypothesis that tamoxifen without surgery would provide adequate control of breast cancer for the remainder of life in elderly women, thereby sparing them surgery. Method: Women aged over 70 years with operable, invasive breast cancer were randomized to receive either tamoxifen alone or surgery plus tamoxifen. Time to treatment failure (TTF), indicating initial primary treatment failure, was the primary endpoint. Overall mortality, and death from breast cancer were also compared between the two groups. Results: Between 1984 and 1991, 455 patients were included in the trial. The analysis was based on a median follow-up of 12·7 years. The TTF was significantly shorter in the tamoxifen alone group: hazard ratio (HR) 4·41 (95 per cent confidence interval (c.i.) 3·31 to 5·88). Ninety-three (40·4 per cent) of 230 patients randomized to tamoxifen alone underwent surgery for the management of their disease. Both overall mortality and mortality from breast cancer were significantly increased in the tamoxifen alone group, although the survival curves did not diverge for the first 3 three years: HR 1·29 (95 per cent c.i. 1·04 to 1·59) and 1·68 (95 per cent c.i. 1·15 to 2·47) respectively. Conclusion: Omission of primary surgery in unselected elderly women with operable breast cancer who were fit for the procedure resulted in an increased rate of progression, therapeutic intervention and mortality. Copyright © 2004 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source] 1365: Immunosuppressors and biologic agentsACTA OPHTHALMOLOGICA, Issue 2010AD DICK Purpose To overview the contemporary therapeutic approaches to treatment of non-infectious non-infective ocular inflammatory disease. Treatment of non-infectious uveitis has over past 15 years expanded from the use of traditional therapies including corticosteroids and immunosuppressants to the deployment of targetting the immune response with biologic therapies with monoclonal antibodies and immunoadhesins. Methods The talk will overview the evidence of effect of immunosuppressants in the treatment of uveitis, the role of predicting steroid responsiveness, the use of monotherapy with immunosuppression and finally the pathways and evidence of success of biologic therapy. Results The concommitant use of immunosuppression is an important aspect to the adequate treatment of uveitis. This ensures adequate control of inflammation whilst reducing the need for comcomitant steroids thereapy. Moreover, monotherapy is equally efficacious in the control of some forms of uveitis. Neverthless there are patients who remain refractory to therapy, and in particular treatment of sight threatening Cystoid macular oedema. The use of targetted biologic therapy has gained increasing evidence to now lead to clinical trials in the use of anti-TNF and anti-IL17 agents. Conclusion There is now a recognised algorithm to treat aggressively and early patients with sight threatening disease. The appropriately timed use of immunosuppression and moreover increasingly earlier intervention with biologics has the promise to alter prognosis and outcome of such blinding disorders. [source] Aorta protein networks in marginal and acute zinc deficiencyPROTEINS: STRUCTURE, FUNCTION AND BIOINFORMATICS, Issue 10 2008John H. Beattie Dr. Abstract Human zinc deficiency is a global problem and may influence the development of cardiovascular disease. Our objective was to determine Zn deficiency affected pathways and protein interactions in rat aorta and their likely influence on stress-induced atherogenesis. In two separate studies, rats were given diets acutely (<1,mg Zn/kg) or marginally (6,mg Zn/kg) deficient in Zn. Both studies included Zn adequate controls (35,mg Zn/kg) and the acute deficiency study included a pair-fed group. After 6,wk, proteins from thoracic aorta were separated by 2-DE. Proteins affected by zinc deficiency were identified by principal component analysis. Multiple correlations of identified proteins indicated protein networks of related function. Proteins clusters decreased in zinc deficiency were related to fatty acid and carbohydrate metabolism. Structurally related proteins, including zyxin and over nine transgelin 1 proteins, were either increased or decreased by acute and marginal deficiencies. PKC, was significantly decreased in Zn deficiency suggesting that Zn may regulate the phosphorylation of target proteins. Zn deficiency-related changes in structural, carbohydrate and fatty acid-related proteins may be disadvantageous for maintaining vascular health and are consistent with a protective role for zinc in the development of atherosclerosis. [source] Atypical antipsychotics in the treatment of deliriumPSYCHIATRY AND CLINICAL NEUROSCIENCES, Issue 5 2009Vaios Peritogiannis md Delirium is common in all medical settings. Atypical antipsychotics are increasingly used for the management of delirium symptomatology but their effectiveness has not been systematically studied. The aim of the present study was therefore to provide an up-to-date review on the use of atypical antipsychotics in the treatment of delirium. A search was conducted of the databases of MEDLINE, PsycINFO and EMBASE from 1997 to 2008 for English-language articles using the key words ,delirium' and the names of all the atypical antipsychotics. A total of 23 studies were used for this review. Fifteen of the studies were single-agent trials. Four studies were comparison trials, including one double-blind trial, and four studies were retrospective, including three comparison studies. All studies reported improvement of delirium symptomatology after the administration of atypical antipsychotics. No study included a placebo group. Other limitations included sample heterogeneity, small sample size, different rating scales for delirium, and lack of adequate controls. The improvement in delirium was observed within a few days after treatment initiation and the doses given were relatively low. Atypical antipsychotics were well tolerated, but safety was not evaluated systematically. Atypical antipsychotics appear to be effective and safe in symptomatic treatment of delirium but the evidence is limited and inconclusive. There are no double-blind, placebo-controlled studies assessing the efficacy and safety of these agents in delirium. Further research is needed with well-designed studies. [source] Mapping the motivations and intentions of technology orientated entrepreneursR & D MANAGEMENT, Issue 2 2003Elizabeth Chell The role of entrepreneurs in stimulating growth in the small business economy has received significant interest in the last three decades. This growing interest is prompted, in part, by the government's assumption that the establishment and expansion of existing small firms could be greatly enhanced by the promotion of entrepreneurial education programmes in colleges and universities. Whilst there has been significant interest in the role, type and effect of entrepreneurs in the economy, few studies have examined the effect of entrepreneurial programmes on the progression of an idea through to commercialisation. This is because such research, whilst seemingly desirable, is problematic. Evidence can be gleaned through the development of suitable conceptual frameworks and methods, to assess the role and impact of entrepreneurial programmes on the commercialisation of products or processes, and the enhancement of entrepreneurial capabilities. To address this problem, the research will examine different approaches and frameworks that have been developed and applied hitherto. The objective of this will be to highlight the difficulties in assessing the motivations, cognitive and behavioural changes of entrepreneurs. Also, the research will demonstrate the need to undertake adequate controls, which illustrate possible improvement in entrepreneurial capabilities, networks, and credibility in comparison to students that embarked on courses without entrepreneurial elements. The process will confine itself to business development within the higher education (HEI) context. The MSEC has as its remit to provide opportunity, education, awareness and training to foster entrepreneurship within science and engineering departments across four universities in Greater Manchester. This setting will provide a unique situation in which to investigate the development of germinal technology businesses from the inception of an idea to the point of incubation, prototype development and investment. There is a requirement to understand the needs of the virgin entrepreneur, possible obstacles to commercialisation and the process of new venture creation. The methodology to be adopted has been identified, and forges new ground on combining positivist and phenomenological paradigms. The multi,paradigm approach supports the use of critical incident technique to reveal greater insights in to the personal and cognitive development of virginal entrepreneurs, the suitability of enterprise programmes to act as catalysts for venture creation, and their role in supporting technology transfer. The research will not only confine itself to examining undergraduate and postgraduate projects within MSEC's business creation unit, but will also continue to assess the experience of entrepreneurs' when they leave the programme. The research also documents the economic contribution of the programme, in terms of generation of new technology,based firms and the impact of entrepreneurs joining established small firms. Ultimately the aim is to build a long,term picture of the role of enterprise programmes in HEIs that will inform policy and practice. [source] | ||||||||||