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Selected AbstractsImproving communication between health and infant mental health professionals utilizing ongoing Collaborative Peer Supervision GroupsINFANT MENTAL HEALTH JOURNAL, Issue 3 2004Michael Thomasgard This article discusses the use of Collaborative Peer Supervision Groups (CPSG) to promote ongoing professional development for those who work with infants, toddlers, and their families. Our model's strength and clinical utility result from its three major components: (a) a relationship-based perspective that acknowledges the important role that feelings and emotions play across the life span, (b) a peer supervision model that helps to ensure that no individual or discipline is "the expert," and (c) a collaborative case-based continuing-education experience. Salient features of forming and maintaining a CPSG group are discussed including access to a Web site containing many key start-up and evaluation materials. Existing barriers to effective communication between disciplines are discussed as are specific methods to structure case data. Additional tools to help anchor a CPSG are considered as are methods of evaluation. Two case presentations are considered to illustrate group process. Lessons learned from such groups are highlighted. Our intent is to provide sufficient background material so that others with a similar interest will be comfortable starting and maintaining a CPSG group on their own. ©2004 Michigan Association for Infant Mental Health. [source] P38 mitogen-activated protein kinase signal transduction in the diagnosis and follow up of immunotherapy of wasp venom allergy,CYTOMETRY, Issue 5 2010Marjoke M. Verweij Abstract Background: P38 mitogen-activated protein kinase (MAPK) is known to govern IgE-mediated basophil activation. Intracellular phosphorylated p38 MAPK (Pp38 MAPK) in IgE-activated basophils can be quantified flow cytometrically. Objectives: To study whether Pp38 MAPK constitutes a potential novel read-out for flow-assisted diagnosis of hymenoptera venom allergy and to investigate whether this marker allows follow-up of successful venom immunotherapy (VIT). Methods: Fifty-two patients with documented wasp venom allergy and seven wasp-stung asymptomatic control individuals were enrolled. Wasp venom-induced basophil activation was analyzed flow cytometrically with anti-IgE, anti-CD63, and anti-Pp38 MAPK to assess their activation status before starting immunotherapy. To assess whether p38 MAPK constitutes a candidate marker for monitoring VIT, we repeated the basophil activation test (BAT) in 25 patients on the fifth day of a build-up immunotherapy. In addition, we investigated whether the Pp38 MAPK-based BAT could contribute in the decision of discontinuing VIT in a cross-sectional analysis in 13 patients receiving treatment for 3 years and 14 patients receiving treatment for 5 years. Results: Patients exhibited a dose-dependent basophil activation with phosphorylation of p38 MAPK and upregulation of downstream CD63. In contrast, stung controls demonstrated a dose-dependent but "abrogated" signal transduction in basophils with less and shorter duration of the phosphorylation of p38 MAPK and without subsequent upregulation of CD63. When repeated after 5 days of VIT and when investigated cross-sectionally after 3 years or 5 years of maintenance therapy, no effect of VIT on the phosphorylation of p38 MAPK was demonstrable. Conclusions: This study discloses that not only basophils from patients, but also from the stung control individuals, respond to wasp venom stimulation with phosphorylation of p38 MAPK, although to a lesser extend. No clear effect of VIT on the phosphorylation of p38 MAPK was shown. Thus, although p38 MAPK provides an additional tool in the diagnosis of wasp venom allergy, it does not contribute to the decision whether to stop successful VIT. © 2010 International Clinical Cytometry Society [source] Flow cytometric evaluation of CD38 expression assists in distinguishing follicular hyperplasia from follicular lymphoma,CYTOMETRY, Issue 5 2009Kristin Mantei Abstract The distinction of follicular lymphoma (FL) from reactive follicular hyperplasia (FH) can be a diagnostic challenge in flow cytometry. In this study, the median fluorescent intensity (MFI) of CD38 as assessed by flow cytometry on B and T cell subpopulations in 102 lymph nodes specimens with histopathologically confirmed FL was compared with 55 cases of FH. The MFI of CD38 was highly significantly reduced in the neoplastic B cells in FL when compared with the reactive germinal center B cells in FH (P < 1.0E-16). The MFI of CD38 did not differ between the non-neoplastic B-cells in FL and nongerminal center B-cells in FH (P = 0.14) or between T-cells and non-neoplastic B-cells in FL (P = 0.63). A marginal increase in the MFI of CD38 was seen for T cells in FL compared with FH (P = 0.04). An increased difference in the MFI of CD38 was identified for T-cells compared with nongerminal center B-cells in FH (P = 0.005). No difference in CD38 expression was seen between Grades 1, 2, or 3 FL. The study also confirmed increased expression of CD10 (P < 1.0E-9), decreased CD19 (P < 1.0E-22), and CD20 (P < 1.0E-16) in FL in comparison with FH, as has been previously reported. This study identified decreased CD38 as a common finding in FL in comparison with FH and provides an additional tool to help differentiate FL from FH by flow cytometry. © 2009 Clinical Cytometry Society [source] A Case of Aptos Thread Migration and Partial ExpulsionDERMATOLOGIC SURGERY, Issue 3 2005José G. Silva-Siwady MD Background In our practice, the use of dented polypropylene suture has become a very simple, conservative, and effective procedure for lifting flabby ptosed facial tissue, improving it without surgery. As with some cosmetic procedures, we have seen complications with this technique. Objective To present a case report of migration and partial expulsion of Aptos thread (TOTAL Charm, Moscow, Russia). Methods After successful fixation of facial tissue with 10 Aptos threads (5 on each side, 3 in the upper and central cheek, and 2 in the mandibular area), the patient returned 28 days later owing to migration and partial expulsion of one of the Aptos threads. Results The expulsed thread was easily removed, and the patient was treated with antibiotic therapy without further complications. Conclusion After this experience, we can conclude that Aptos threads are an additional tool in our arsenal for the treatment of facial aging. We must be especially cautious and aware that our patients can present with previously unknown complications secondary to newly described procedures, as with this recent technique. JOSé G. SILVA-SIWADY, MD, CELINA DÍAZ-GARZA, AND JORGE OCAMPO-CANDIANI, MD, HAVE INDICATED NO SIGNIFICANT INTEREST WITH COMMERCIAL SUPPORTERS. [source] Online CIEF-ESI-MS in glycerol,water media with a view to hydrophobic protein applicationsELECTROPHORESIS, Issue 23 2009Meriem Mokaddem Abstract A new online coupling of CIEF with ESI-MS has been developed in glycerol,water media. This improved protocol provides: (i) the electric continuity during the whole analysis by a discontinuous filling of the capillary with 60:40 (cm/cm) catholyte/proteins,ampholyte mixture; (ii) the use of an anticonvective medium, i.e. 30:70 glycerol/water, v/v, compatible with MS detection and as an aid to hydrophobic protein solubilization and (iii) the use of unmodified bare fused-silica capillaries, as the glycerol/water medium strongly reduces EOF. Focusing was performed in positive polarity and cathodic mobilization was achieved by both voltage and pressure application. The setup was optimized with respect to analysis time, sensitivity and precision on pI determination. The optimized anolyte and catholyte were composed of 50,mM formic acid/1,mM glutamic acid (pH 2.35) and 100,mM NH3/1,mM lysine (pH 10.6), respectively. The effects of ampholyte concentration, focusing time and ESI parameters were presented for model proteins and discussed. This new integrated protocol should be an easy and effective additional tool in the field of proteome analysis, providing a means for the characterization of a large number of hydrophilic and hydrophobic proteins. [source] Induction of neutralizing antibodies in mice immunized with an amino-terminal polypeptide of Streptococcus mutans P1 protein produced by a recombinant Bacillus subtilis strainFEMS IMMUNOLOGY & MEDICAL MICROBIOLOGY, Issue 2 2010Milene B. Tavares Abstract The oral pathogen Streptococcus mutans expresses a surface protein, P1, which interacts with the salivary pellicle on the tooth surface or with fluid-phase saliva, resulting in bacterial adhesion or aggregation, respectively. P1 is a target of protective immunity. Its N-terminal region has been associated with adhesion and aggregation functions and contains epitopes recognized by efficacious antibodies. In this study, we used Bacillus subtilis, a gram-positive expression host, to produce a recombinant N-terminal polypeptide of P1 (P139,512) derived from the S. mutans strain UA159. Purified P139,512 reacted with an anti-full-length P1 antiserum as well as one raised against intact S. mutans cells, indicating preserved antigenicity. Immunization of mice with soluble and heat-denatured P139,512 induced antibodies that reacted specifically with native P1 on the surface of S. mutans cells. The anti-P139,512 antiserum was as effective at blocking saliva-mediated aggregation of S. mutans cells and better at blocking bacterial adhesion to saliva-coated plastic surfaces compared with the anti-full-length P1 antiserum. In addition, adsorption of the anti-P1 antiserum with P139,512 eliminated its ability to block the adhesion of S. mutans cells to abiotic surfaces. The present results indicate that P139,512, expressed and purified from a recombinant B. subtilis strain, maintains important immunological features of the native protein and represents an additional tool for the development of anticaries vaccines. [source] The influence of poorly interconnected fault zone flow paths on spring geochemistryGEOFLUIDS (ELECTRONIC), Issue 2 2008J. C. ROWLAND Abstract Thermal springs commonly occur along faults because of the enhanced vertical permeability afforded by fracture zones. Field and laboratory studies of fault zone materials document substantial heterogeneities in fracture permeabilities. Modeling and field studies of springs suggest that spatial variations in permeability strongly influence spring locations, discharge rates and temperatures. The impact of heterogeneous permeability on spring geochemistry, however, is poorly documented. We present stable isotope and water chemistry data from a series of closely spaced thermal springs associated with the Hayward Fault, California. We suggest that substantial spatial variations observed in ,18O and chloride values reflect subsurface fluid transport through a poorly connected fracture network in which mixing of subsurface waters remains limited. Our measurements provide insight into the effect of fracture zone heterogeneities on spring geochemistry, offer an additional tool to intuit the nature of tectonically induced changes in fault zone plumbing, and highlight the need to consider local variations when characterizing fracture zone fluid geochemistry from spring systems with multiple discharge sites. [source] Ovipositional discrimination by Microplitis rufiventris females between healthy and granulosis virus-infected Spodoptera littoralis larvaeJOURNAL OF APPLIED ENTOMOLOGY, Issue 1 2004E. M. Hegazi Abstract: Ovipositional choice tests by Microplitis rufiventris females (Hym., Braconidae) between granulosis virus-infected (GVI) and non-infected (NI) Spodoptera littoralis larvae (Lep., Noctuidae), were assessed using discriminatory methods for re-isolating the NI and virus-infected hosts after removing the female parasitoid. When M. rufiventris females were given a choice between NI and GVI S. littoralis hosts, the adult females exhibited marked preference (P < 0.01) for the NI (i.e. higher quality) hosts. In this case, M. rufiventris females and S. littoralis GV (SlGV) did not significantly compete for the same type of host larvae and are, generally, compatible. However, when the choice was given between two low qualities of S. littoralis hosts, i.e. virus-free previously parasitized hosts and viral-infected hosts a significant preference (P < 0.01) of the parasitoid females for the GVI larvae was observed. In this case, the parasitoid would be at a disadvantage when competing with GV for the same host. However, the parasitoid could be used as an additional tool for the dissemination of biocontrol viruses within different pest populations, i.e. hosts other than S. littoralis. Importantly, the results showed different strategies of parasitoid female in egg-laying management. When M. rufiventris female was given a choice between healthy and SlGVI hosts, the female deposited more eggs than when she was given a choice between two low qualities of host larvae. The results of the study may have implications in pest management strategies using M. rufiventris and SlGV against S. littoralis larvae. [source] Comparison of the efficiency and sensitivity of virus isolation and molecular methods for routine diagnosis of infectious haematopoietic necrosis virus and infectious pancreatic necrosis virusJOURNAL OF FISH DISEASES, Issue 2 2002-Maganja, D Barli Infectious haematopoietic necrosis virus (IHNV) and infectious pancreatic necrosis virus (IPNV) are widely distributed fish pathogens in Europe. A reverse transcriptase,polymerase chain reaction (RT,PCR) assay was developed for the detection of both viruses as an alternative method to virus assay in cell culture. Oligonucleotide primers corresponding to highly conserved regions of glycoprotein G-gene sequences were used for IHNV. For the detection of IPNV the VP2-coding region was selected for RT,PCR amplification. Products of the expected size were amplified from total ribonucleic acid (RNA) extracts of infected cells. The optimized RT,PCR methods successfully detected viral RNA from ovarian and seminal fluids and other organs. To enhance the sensitivity and specificity of RT,PCR, a semi-nested PCR assay was tested using additional specific inner primers for reamplification of products obtained by RT,PCR. Because of the possibility of template carry-over contamination, a closed one step RT,PCR method was tested. This technically simplified approach was then combined with the PCR,enzyme linked immunosorbent assay (ELISA) method for the detection of amplification products and verification using specific biotinylated probes. The test provides an additional tool for the detection of IHNV and IPNV which is rapidly and easily performed and is highly sensitive, especially for the detection of IHNV in fish samples coinfected with IPNV. The PCR,ELISA method for the detection of RT,PCR products enables the screening of large numbers of samples and offers the possibility for automatisation of diagnostic work. [source] Limbic Encephalitis Investigated by 18FDG-PET and 3D MRIJOURNAL OF NEUROIMAGING, Issue 1 2001Jan Kassubek MD ABSTRACT Two patients with clinically probable or possible limbic encephalitis (LE) are reported, both cases with typical findings in clinical symptoms (severe neuropsychological deficits and complex partial seizures) and in routine magnetic resonance imaging (MRI) (hyperintense mesiotemporal lesions). Underlying malignancy was identified (rectal carcinoma) in one case but could not be detected in the other patient. The 2 patients were investigated by cerebral 18F-fluoro-2-deoxy-D-glucose,positron emission tomography (FDG-PET) and 3-dimensional (3D) MRI, and abnormalities in metabolic activity were mapped using coregistration of spatially normalized PET and MRI. Highly significant focal hypermetabolism in bilateral hippocampal areas was found in both cases. The authors' findings support FDG-PET coregistered to 3D MRI as a potentially valuable additional tool in the imaging diagnostics of LE. Results are discussed with respect to the clinical symptoms and previously reported imaging findings in the disease. [source] Comprehend and analyze knowledge networks to improve software evolutionJOURNAL OF SOFTWARE MAINTENANCE AND EVOLUTION: RESEARCH AND PRACTICE, Issue 3 2009Christian Del Rosso Abstract When a set of people are connected by a set of meaningful social relationships we talk of a social network. A social network represents a social structure and the underlying structural patterns can be used to analyze and comprehend how people relate to each other and their emergent behavior as a group. Developing software is fundamentally a human activity. Developers cooperate and exchange knowledge and information, creating in fact, a particular type of social network that we call knowledge network. In this paper we investigate knowledge networks in software development teams by applying social network analysis and we use the Apache web server as a case study. By analyzing the structural communication and coordination patterns in Apache we have been able to identify the Apache knowledge network, highlight potential communication bottlenecks, and find brokers and important coordination points in the software development team. Furthermore, our work enables a software architect to analyze and maintain the organization and the software architecture aligned during software evolution. An important lesson that we have is that the analysis of knowledge networks constitutes an additional tool to be added to the traditional software architecture assessment methods. Copyright © 2009 John Wiley & Sons, Ltd. [source] Non-empirical calculations of NMR indirect carbon,carbon coupling constants.MAGNETIC RESONANCE IN CHEMISTRY, Issue 6 2005Aliphatic, Part 1, alicyclic oximes Abstract One-bond carbon,carbon coupling constants were calculated in a series of nine aliphatic and alicyclic oximes at the SOPPA (second-order polarization propagator approach) level in good agreement with the available experimental data, and several unknown couplings were predicted with high reliability. The experimental difference between J(C,C) of the corresponding carbon,carbon bonds in cis and trans orientations to the nitrogen lone pair is very well reproduced at the SOPPA level, and this provides an additional tool in the configurational assignment at the CN bond in oximes and related systems. Copyright © 2005 John Wiley & Sons, Ltd. [source] Predictive value of transcranial sonography in the diagnosis of Parkinson's diseaseMOVEMENT DISORDERS, Issue 10 2006Jürgen Prestel MD Abstract Transcanial sonography (TCS) is increasingly applied in the diagnosis of Parkinson's disease (PD), but investigator bias may influence the results of examination. Blinding the sonographer to the clinical diagnosis of 42 PD patients and 35 controls, we obtained a positive predictive value of 85.7% and a negative predictive value of 82.9% in the diagnosis of PD solely by interpreting the results of TCS, indicating that TCS is a valuable additional tool in the diagnosis of PD. © 2006 Movement Disorder Society [source] Reversal theory states and cigarette availability predict lapses during smoking cessation among adolescents,RESEARCH IN NURSING & HEALTH, Issue 4 2003Rebecca F. Burris Abstract Although 67% of adolescent smokers say they want to quit, only 7% are able to do so. The purpose of this study was to use metamotivational states as described in reversal theory to predict whether adolescents who are trying to quit smoking will lapse (smoke a cigarette) or will resist smoking in highly tempting situations. Reversal theory holds that individuals switch between telic (serious-minded) and paratelic (playful) metamotivational states. Questionnaires and semistructured interviews were administered to 62 adolescents ages 14,19 who had participated in a smoking cessation program. Interviews were coded according to the Metamotivational State Interview and Coding Schedule, and the resulting data were analyzed using logistic regression analysis. Adolescents in the paratelic metamotivational state (OR,=,15.34; 95% CI: 5.3, 43.6) or with cigarettes readily available (OR,=,4.6; 95% CI: 1.6, 13.2) were more likely to lapse than were adolescents in the telic state or who required effort to obtain cigarettes. The variables telic/paratelic state and cigarette availability accurately predicted the outcome of highly tempting situations 80% of the time. Using reversal theory constructs to develop state-specific strategies shows promise as an additional tool for those in this age group coping with the temptation to smoke. © 2003 Wiley Periodicals, Inc. Res Nurs Health 26:263,272, 2003 [source] Chimpanzees prey on army ants with specialized tool setAMERICAN JOURNAL OF PRIMATOLOGY, Issue 1 2010Crickette M. Sanz Abstract Several populations of chimpanzees have been reported to prey upon Dorylus army ants. The most common tool-using technique to gather these ants is with "dipping" probes, which vary in length with regard to aggressiveness and lifestyle of the prey species. We report the use of a tool set in army ant predation by chimpanzees in the Goualougo Triangle, Republic of Congo. We recovered 1,060 tools used in this context and collected 25 video recordings of chimpanzee tool-using behavior at ant nests. Two different types of tools were distinguished based on their form and function. The chimpanzees use a woody sapling to perforate the ant nest, and then a herb stem as a dipping tool to harvest the ants. All of the species of ants preyed upon in Goualougo are present and consumed by chimpanzees at other sites, but there are no other reports of such a regular or widespread use of more than one type of tool to prey upon Dorylus ants. Furthermore, this tool set differs from other types of tool combinations used by chimpanzees at this site for preying upon termites or gathering honey. Therefore, we conclude that these chimpanzees have developed a specialized method for preying upon army ants, which involves the use of an additional tool for opening nests. Further research is needed to determine which specific ecological and social factors may have shaped the emergence and maintenance of this technology. Am. J. Primatol. 72:17,24, 2010. © 2009 Wiley-Liss, Inc. [source] Monitoring population productivity in the saiga antelopeANIMAL CONSERVATION, Issue 4 2009A. Kühl Abstract Effective conservation requires a good understanding of factors causing variation in population growth rate. We here analyse the relationship between female age and fecundity in the saiga antelope Saiga tatarica tatarica, a critically endangered ungulate of the Eurasian steppes and semideserts, at both individual and population levels. Annual variation in age structure and twinning rates was investigated using long-term datasets, sampling a total of 3308 females in four populations over more than 40 years. Further, a new non-invasive method is presented, estimating twinning rates from both calves and placentas encountered during calving aggregation transects. At an individual level, the most parsimonious model for twinning rates included three age classes (1, 2 and ,3 years); however, the model with only two classes (1 and ,2 years) was competitive and particularly useful for monitoring because these two age classes can reliably be determined by direct observation in the field. Among yearlings, 77.4% were fecund and 11.7% twinned, whereas among older females 94.6% were fecund and 72.6% twinned. At a population level, annual variation in age structure (proportion ,2 years) correlated well with annual variation in twinning rate except in the north-west Pre-Caspian population. Our results suggest that the recent poaching-driven collapse in saiga numbers has potentially resulted in reductions in fecundity, which will have an impact on population growth rate. Our results highlight the potential for monitoring of twinning rate using non-invasive calving aggregation transects as a cost-effective additional tool to population counts for monitoring the status of this critically endangered species. These monitoring methods are also potentially transferable to other ungulate species. [source] Muscle magnetic resonance imaging involvement in muscular dystrophies with rigidity of the spineANNALS OF NEUROLOGY, Issue 2 2010Eugenio Mercuri MD Objective The aim of the study was to evaluate whether the visual analysis of muscle magnetic resonance imaging scans can identify specific patterns of muscle involvement. Methods We assessed scans from 83 patients with muscle disorders characterized by rigidity of the spine secondary to mutations in 4 different genes. The conditions studied were rigid spine syndrome (SEPN1 defects), Bethlem myopathy, and Ullrich congenital muscular dystrophy, allelic disorders caused by Col6A1, Col6A2, and Col6A3 mutations, the autosomal dominant form of Emery,Dreifuss muscular dystrophy (LMNA defects) and calpain-deficient limb girdle muscular dystrophy (CAPN3 defects). The scans of 25 patients affected by other myopathies were also reviewed as a control group. The scans were compared with the previously described patterns. Results In 82% of the scans in the study group (68/83) the patterns were classified as "typical" of 1 of the 5 forms studied, and in 7 (8%) were consistent with 1 of the reported patterns but not entirely typical. With one exception, the patterns identified were always consistent with the appropriate genetic diagnosis. The remaining scans (9%) had only minimal changes and were uninformative. None of the scans of the 25 patients in the control group had patterns that could be classified as typical of the 5 forms examined. The sensitivity to detect selective patterns in relation to the genetic diagnosis was 0.9. Interpretation These findings suggest that muscle magnetic resonance imaging could be used in clinical practice as an additional tool in the differential diagnosis of muscle disorders with prominent spinal rigidity. ANN NEUROL 2010;67:201,208 [source] Know your dose: RADDOSEACTA CRYSTALLOGRAPHICA SECTION D, Issue 4 2010Karthik S. Paithankar The program RADDOSE is widely used to compute the dose absorbed by a macromolecular crystal during an X-ray diffraction experiment. A number of factors affect the absorbed dose, including the incident X-ray flux density, the photon energy and the composition of the macromolecule and of the buffer in the crystal. An experimental dose limit for macromolecular crystallography (MX) of 30,MGy at 100,K has been reported, beyond which the biological information obtained may be compromised. Thus, for the planning of an optimized diffraction experiment the estimation of dose has become an additional tool. A number of approximations were made in the original version of RADDOSE. Recently, the code has been modified in order to take into account fluorescent X-ray escape from the crystal (version 2) and the inclusion of incoherent (Compton) scattering into the dose calculation is now reported (version 3). The Compton cross-section, although negligible at the energies currently commonly used in MX, should be considered in dose calculations for incident energies above 20,keV. Calculations using version 3 of RADDOSE reinforce previous studies that predict a reduction in the absorbed dose when data are collected at higher energies compared with data collected at 12.4,keV. Hence, a longer irradiation lifetime for the sample can be achieved at these higher energies but this is at the cost of lower diffraction intensities. The parameter `diffraction-dose efficiency', which is the diffracted intensity per absorbed dose, is revisited in an attempt to investigate the benefits and pitfalls of data collection using higher and lower energy radiation, particularly for thin crystals. [source] Left Ventricle Afterload Impedance Control by an Axial Flow Ventricular Assist Device: A Potential Tool for Ventricular RecoveryARTIFICIAL ORGANS, Issue 9 2010Francesco Moscato Abstract Ventricular assist devices (VADs) are increasingly used for supporting blood circulation in heart failure patients. To protect or even to restore the myocardial function, a defined loading of the ventricle for training would be important. Therefore, a VAD control strategy was developed that provides an explicitly definable loading condition for the failing ventricle. A mathematical model of the cardiovascular system with an axial flow VAD was used to test the control strategy in the presence of a failing left ventricle, slight physical activity, and a recovering scenario. Furthermore, the proposed control strategy was compared to a conventional constant speed mode during hemodynamic changes (reduced venous return and arterial vasoconstriction). The physiological benefit of the control strategy was manifested by a large increase in the ventricular Frank,Starling reserve and by restoration of normal hemodynamics (5.1 L/min cardiac output at a left atrial pressure of 10 mm Hg vs. 4.2 L/min at 21 mm Hg in the unassisted case). The control strategy automatically reduced the pump speed in response to reduced venous return and kept the pump flow independent of the vasoconstriction condition. Most importantly, the ventricular load was kept stable within 1%, compared to a change of 75% for the constant speed. As a key feature, the proposed control strategy provides a defined and adjustable load to the failing ventricle by an automatic regulation of the VAD speed and allows a controlled training of the myocardium. This, in turn, may represent a potential additional tool to increase the number of patients showing recovery. [source] Treatment of Thyrotoxic Crisis With Plasmapheresis and Single Pass Albumin Dialysis: A Case ReportARTIFICIAL ORGANS, Issue 2 2010Sebastian Koball Abstract Thyrotoxic crisis (thyroid storm) is a life-threatening condition. Standard therapy is based on thiamazole, prednisolone, and nonselective beta-blockers. Extracorporeal plasmapheresis is an additional tool for removing circulating thyroxine in patients who do not respond quickly to conventional standard therapy. As thyroxine can be bound by albumin, the aims of the present therapy report were to investigate the potential of extracorporeal single-pass albumin dialysis (SPAD) to remove thyroid hormones and to compare it with plasmapheresis. A 68-year-old female with thyrotoxic crisis refractory to conventional therapy underwent two sessions of plasmapheresis without clinical response. For the treatment dose to be increased, the patient was then treated with a modified continuous veno-venous hemodialysis with a dialysate containing 4% of human serum albumin (SPAD) intended to bind and remove thyroxines continuously. In total, the patient received three sessions of plasmapheresis and four SPAD treatments. Thyroxine levels were detected in the patient and in exchanged plasma or albumin dialysate, respectively, to calculate the amount removed. The main finding was that SPAD treatments were tolerated well by the patient. Due to continuous approach, SPAD sessions removed more thyroid hormone than plasmapheresis did, resulting in the improvement of the clinical status of the patient (reduction of heart rate and catecholamine dosage), which enabled bridging the patient to thyroidectomy as the ultimate surgical treatment. This is the first clinical report of the use of albumin dialysis in thyroid storm. SPAD represents a safe and efficient alternative to plasmapheresis as it can be performed continuously in this critical condition. [source] Three-dimensional and quantitative analysis of atherosclerotic plaque composition by automated differential echogenicityCATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 7 2007Nico Bruining PhD Abstract Objective: To validate automated and quantitative three-dimensional analysis of coronary plaque composition using intracoronary ultrasound (ICUS). Background: ICUS displays different tissue components based on their acoustic properties in 256 grey-levels. We hypothesised that computer-assisted image analysis (differential echogenicity) would permit automated quantification of several tissue components in atherosclerotic plaques. Methods and Results: Ten 40-mm-long left anterior descending specimens were excised during autopsy of which eight could be successfully imaged by ICUS. Histological sections were taken at 5 mm intervals and analyzed. Since most of the plaques were calcified and having a homogeneous appearance, one specimen with a more heterogeneous composition was further examined: at each interval of 5 mm, 15 additional sections (every 100 ,m) were evaluated. Plaques were scored for echogenicity against the adventitia: brighter (hyperechogenic) or less bright (hypoechogenic). Areas of hypoechogenicity correlated with the presence of smooth muscle cells. Areas of hyperechogenicity correlated with presence of collagen, and areas of hyperechogenicity with acoustic shadowing correlated with calcium. None of these comparisons showed statistical significant differences. Conclusion: This ex vivo feasibility study shows that automated three-dimensional differential echogenicity analysis of ICUS images allows identification of different tissue types within atherosclerotic plaques. This technology may play a role as an additional tool in longitudinal studies to trace possible changes in plaque composition. © 2007 Wiley-Liss, Inc. [source] Using computer-assisted self-interviewing (CASI) questionnaires to facilitate consultation and participation with vulnerable young peopleCHILD ABUSE REVIEW, Issue 6 2005Murray Davies Abstract This paper explores computer-assisted self-interviewing (CASI) as a methodology for consulting with vulnerable children. The authors provide a brief review of the literature in this area, indicating that computer-mediated environments for self-administered questionnaires can be particularly helpful in enabling data to be obtained about sensitive subjects. A case example is provided of Viewpoint Interactive, a CASI application in use in the UK in local authority children's services, education, and in learning disability child care practice. The paper concludes that CASI as a methodology can assist with consultation, and that it may provide a useful additional tool in the complex process of moving beyond consultation alone to the development of increased and more effective participation for vulnerable children in the provision of their care. Copyright © 2005 John Wiley & Sons, Ltd. [source] Noninvasive peripheral perfusion index as a possible tool for screening for critical left heart obstructionACTA PAEDIATRICA, Issue 10 2007A de-Wahl Granelli Abstract Aim: Peripheral perfusion index (PPI) has been suggested as a possible method to detect illness causing circulatory embarrassment. We aimed to establish the normal range of this index in healthy newborns, and compare it with newborns with duct-dependent systemic circulation. Design: We conducted a case,control study. Setting: Our study population comprised 10 000 prospectively recruited newborns from Västra Götaland, Sweden. Patients: A total of 10 000 normal newborns and 9 infants with duct-dependent systemic circulation (left heart obstructive disease [LHOD] group) participated in the study. Methods: We conducted single pre- and postductal measurements of PPI with a new generation pulse oximeter (Masimo Radical SET) before discharge from hospital. Results: PPI values between 1 and 120 h of age show an asymmetrical, non-normal distribution with median PPI value of 1.70 and interquartile range of 1.18,2.50. The 5th percentile = 0.70 and 95th percentile = 4.50. All infants in the LHOD group had either pre- or postductal PPI below the interquartile range, and 5 of 9 (56%) were below the 5th percentile cut-off of 0.70 (p < 0.0001, Fisher's exact test). A PPI value <0.70 gave an odds ratio for LHOD of 23.75 (95% CI 6.36,88.74). Conclusion: PPI values lower than 0.70 may indicate illness and a value <0.50 (1st percentile) indicates definite underperfusion. PPI values might be a useful additional tool for early detection of LHOD. [source] The adult sense of coherence scale is applicable to 12-year-old schoolchildren,an additional tool in health promotionACTA PAEDIATRICA, Issue 8 2006Päivi-Leena Honkinen Abstract Background: Two principal operationalizations of sense of coherence (SOC) for the study of adults have been developed, one consisting of 29 and another consisting of 13 items. According to these studies, SOC is associated with various aspects of perceived health. Also, a 16-item scale for determining SOC in young children (,10 y) is available. It is unclear from which age on SOC can be studied by using any of the scales for adults. Aim: To determine whether the 13-item SOC scale for adults is applicable to children 12 y of age. Methods: Comparable data of SOC had been collected by a mail survey directed to adults (mean age 36 y, n=706) in 1985. Twelve-year-old children filled in questionnaires in school class in 1997 (n=994). Results: SOC score range, mean, median and standard deviation (SD), and Cronbach alpha coefficients of the total SOC scale were almost identical in children and adults. Conclusion: The 13-item SOC scale aimed at adults is applicable to children of 12 y of age or older. The SOC scale could be a useful additional tool for identifying children with perceived health deficits potentially in need of supportive interventions. [source] Molecular analysis of tetracycline resistance in Salmonella enterica subsp. enterica serovars Typhimurium, Enteritidis, Dublin, Choleraesuis, Hadar and Saintpaul: construction and application of specific gene probesJOURNAL OF APPLIED MICROBIOLOGY, Issue 4 2000G. Frech A total of 65 epidemiologically unrelated tetracycline-resistant isolates of the six Salmonella enterica subsp. enterica (Salm.) serovars Dublin, Choleraesuis, Typhimurium, Enteritidis, Hadar and Saintpaul were investigated for the presence of tetracycline resistance genes. For this, specific gene probes of the tetracycline resistance genes (tet) of the hybridization classes A, B, C, D, E and G were constructed by cloning PCR-amplified internal segments of the respective tet structural genes. These gene probes were sequenced and used in hybridization experiments with plasmid DNA or endonuclease digested whole cell DNA as targets. Only tet(A) genes were detected on plasmids in all Salm. Dublin isolates as well as in single isolates of Salm. Choleraesuis and Salm. Typhimurium. Genes of the hybridization classes B, C, D and G, but also in some cases those of class A, were located in the chromosomal DNA of the corresponding Salmonella isolates. Restriction fragment length polymorphisms (RFLPs) of tet gene carrying fragments were detected in chromosomally tetracycline-resistant isolates. These RFLPs might represent valuable additional tools for the identification and characterization of tetracycline-resistant Salmonella isolates. [source] Controlled and localized genetic manipulation in the brainJOURNAL OF CELLULAR AND MOLECULAR MEDICINE, Issue 2 2006Rachel Aronoff Abstract Brain structure and function are determined in part through experience and in part through our inherited genes. A powerful approach for unravelling the balance between activity-dependent neuronal plasticity and genetic programs is to directly manipulate the genome. Such molecular genetic studies have been greatly aided by the remarkable progress of large-scale genome sequencing efforts. Sophisticated mouse genetic manipulations allow targeted point-mutations, deletions and additions to the mouse genome. These can be regulated through inducible promoters expressing in genetically specified neuronal cell types. However, despite significant progress it remains difficult to target specific brain regions through transgenesis alone. Recent work suggests that transduction vectors, like lentiviruses and adeno-associated viruses, may provide suitable additional tools for localized and controlled genetic manipulation. Furthermore, studies with such vectors may aid the development of human genetic therapies for brain diseases. [source] Ancillary Tools in Pacemaker and Defibrillator Lead Extraction Using a Novel Lead Removal SystemPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 3 2001ANTONIS S. MANOLIS MANOLIS, A.S., et al.: Ancillary Tools in Pacemaker and Defibrillator Lead Extraction Using a Novel Lead Removal System. A previous report described our preliminary experience with a highly successful pacing lead removal system (VascoExtor). Extending this experience, we found it necessary to use additional tools to enhance the success of percutaneous lead extraction with this system. In the present series, we used the standard locking stylets (S and K), and recently, one newer type of stylet (Magic) over the last 3 years in 34 patients to extract 48 pacemaker leads in 31 patients and 3 defibrillator (ICD) leads in 3 patients. Lead extraction was carried out in 23 men and 11 women (aged 64 ± 17 years) because of pacemaker infection (n = 21), pacemaker (n = 8) or ICD (n = 3) lead malfunction, or prior to ICD implant (n = 2). Leads were in place for 3.5 ± 3.7 years. Infections, involving pocket and lead(s), were due to S. epidermidis (n = 13), S. aureus (n = 6), S. aureus plus E. coli (n = 1), or fungi (n = 1). Of the 48 pacing leads, 31 were ventricular, 15 atrial, and 2 were VDD leads. The ICD leads were two double-coil leads (CPI) and one single-coil lead (Telectronics). Using the S (n = 12), K (n = 8), or Magic (n = 3) stylets, all pacing leads in 23 patients and the ICD leads in 2 patients were successfully removed from a subclavian approach using the locking stylets. However, in nine (26.5%) patients ancillary tools were required. In four patients, lead fragments were captured with use of a noose catheter, a pigtail catheter, and a bioptome from a right femoral approach. In two patients, locking could not be effected and a noose catheter from the right femoral vein was used, aided by a pigtail and an Amplatz catheter and a bioptome to remove three leads. In a patient with an ICD lead, a combined subclavian (stylet S) and right femoral approach (noose catheter) was required. In a patient with a dysfunctional ventricular lead 12 years old, a motor drive unit was used to facilitate the exchange of locking stylets, but extraction failed. In another patient, a fragment of a dysfunctional ventricular lead remained intravascularly despite resorting to a femoral approach. Finally, lead removal was completely (32/34, 94%) or partially (1/34, 3%) successful in 33 (97%) of 34 patients for 50 (98%) of 51 leads without complications. In conclusion, to enhance the success of pacing or ICD lead extraction with use of the VascoExtor locking stylets, an array of ancillary tools were required in more than one fourth of patients. [source] Latest news and product developmentsPRESCRIBER, Issue 8 2007Article first published online: 23 JUL 200 Lamotrigine for partial, valproate for generalised A large UK trial has shown that lamotrigine is the most effective choice in the treatment of partial epilepsy (Lancet 2007;369: 1000-15). The SANAD trial, commissioned by the National Institute for Health Research's Health Technology Assessment programme, randomised 1721 patients (for whom carbamazepine monotherapy would have been the treatment of choice) to treatment with carbamazepine, gabapentin, lamotrigine, oxcarbazepine (Trileptal) or topiramate (Topamax). Lamotrigine was associated with a longer time to treatment failure, though time to 12-month remission favoured carbamazepine. Over four years' follow-up, lamotrigine was numerically but not significantly superior. The authors concluded lamotrigine is clinically superior to carbamazepine for partial epilepsy A second arm of the trial, yet to be published, evaluated the treatment of generalised epilepsy and found valproate to be clinically most effective, though topiramate was cost effective for some patients. Chronic pain common in nursing homes Most residents in nursing homes say they have long- term pain but only one in seven say a health professional has ever discussed its treatment with them, according to a report by the Patients' Association (www.patients-association.org.uk). Pain in Older People ,A Hidden Problem was a qualitative study of 77 older residents in care homes in England. Most were frail and suffered long-term illness. The study found that 85 per cent of residents said they were often troubled by aches or pains and these lasted over a year in 74 per cent. Most described their pain as moderate (33 per cent) or severe (38 per cent) but 8 per cent said it was excruciating. Many reported limitations on mobility and social activities despite a high level of stoicism. All but one were taking medication to relive pain; one-third experienced adverse effects but 78 per cent believed drugs offered the most effective treatment. One-quarter said a doctor or nurse had discussed how to stop their pain worsening, and 15 per cent said they had discussed how to treat their pain. Visits from GPs appeared to be uncommon. Atherothrombotic events despite treatment Between one in five and one in seven of high-risk patients experience atherothrombotic events despite evidence-based treatment, the REACH study has shown (J Am Med Assoc 2007;297:1197-1206). REACH (REduction of Atherothrombosis for Continued Health) is an international observational study involving 68 236 patients with atherothrombotic disease or at least three risk factors. Most were taking conventional evidence-based medication. After one year, the incidence of the combined endpoint of cardiovascular death, myocardial infarction, stroke or hospitalisation for atherothrombotic events was approximately 15 per cent for patients with coronary artery disease or cardiovascular disease, and 21 per cent in patients with peripheral artery disease and established coronary disease. Event rates increased with the number of vascular beds affected, rising to 26 per cent in patients with three symptomatic arterial disease locations. Extended CD prescribing by nurses and pharmacists The Medicines and Healthcare products Regulatory Agency (MHRA) is consulting on expanding the prescribing of controlled drugs (CDs) by nonmedical prescribers. Currently, nurse independent prescribers can prescribe 12 CDs, including diamorphine and morphine, but pharmacist independent prescribers may not prescribe any CDs. The proposal is to allow both professions to prescribe any CDs within their competence, with the exception of cocaine, diamorphine or dipipanone for the management of addiction. The closing date for consultation is 15 June. Consultation is also underway on expanding the range of CDs nurses and pharmacists can prescribe under a patient group direction (PGD), and their use for pain relief. The closing date for consultation is 20 April. Intrinsa: transdermal testosterone for women A transdermal formulation of testosterone has been introduced for the treatment of low sexual desire associated with distress in women who have experienced an early menopause following hysterectomy involving a bilateral oophorectomy and are receiving concomitant oestrogen therapy. Manufacturer Procter & Gamble says that Intrinsa, a twice-weekly patch, delivers testosterone 300µg every 24 hours, achieving premenopausal serum testosterone levels. Clinical trials showed that Intrinsa reduced distress in 65-68 per cent and increased satisfying sexual activity in 51-74 per cent of women. A month's treatment (eight patches) costs £28.00. Fish oil for secondary ,not primary ,prevention of CHD Supplementing statin therapy with eicosapentaenoic acid (EPA) reduces the risk of major coronary events in patients with coronary heart disease (CHD) ,but not in patients with no history of CHD Lancet 2007;369:1090-8). The five-year study in 18 645 patients with total cholesterol levels of 6.5mmol per litre or greater found that the incidence of sudden cardiac death, fatal and nonfatal myocardial infarction in CHD patients treated with EPA plus a statin was 8.7 per cent compared with 10.7 per cent with a statin alone (relative risk reduction 19 per cent). A similar relative risk reduction in patients with no CHD was not statistically significant. There was no difference in mortality between the groups but EPA did reduce unstable angina and nonfatal coronary events. Department pilots information prescriptions The Department of Health has announced 20 sites to pilot information prescriptions prior to a nationwide roll-out in 2008. The prescriptions will guide people with long-term conditions such as diabetes and cancer to sources of support and information about their condition. The Department hopes the project will increase patients' understanding of their discussions with health professionals, empower them to locate the information they need, and provide long-term support. NPSA guidelines for safer prescribing The National Patient Safety Agency (www.npsa.nhs.uk) has published five guidelines to improve medication safety in the NHS. Targeting ,high-risk issues', the guidance covers anticoagulant prescribing, liquid medicines for oral or enteral administration, injectable medicines, epidural injections and infusions, and paediatric intravenous infusions. The implementation of each guide is supported by additional tools and resources. Better adherence not matched to outcomes A systematic review has found that interventions can increase adherence to prescribed medication but there is no evidence that clinical outcomes also improve (Arch Intern Med 2007;167:540-9). The review of 37 trials identified 20 reporting increased adherence. The most effective interventions were behavioural changes to reduce dose demands and those involving monitoring and feedback. Improvements in clinical outcomes were variable and did not correspond to changes in adherence. Antidepressant plus mood stabiliser no better US investigators have found that combining a mood stabiliser with an antidepressant is no more effective than a mood stabiliser alone in preventing mood changes (N Engl J Med 2007; published online 28 March, doi.10.1056/NEJMoa064135). The study found durable recovery occurred in 23.5 per cent of patients treated with a mood stabiliser and adjunctive antidepressant therapy for six months compared with 27.3 per cent of those taking a mood stabiliser plus placebo. [source] | ||||||||||||||||||||||||||||||||||