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Additional Year (additional + year)
Selected AbstractsStudent satisfaction with curriculum modifications in a French dental schoolEUROPEAN JOURNAL OF DENTAL EDUCATION, Issue 3 2000P. Farge Since 1994, important modifications have been implemented in the dental curriculum in France, and an additional year has been included in the dental curriculum. The 1st year has remained unchanged; it is common to both medical and dental schools and leads to a selection procedure of 1 in 10 dental students. In the new curriculum, the dental student is engaged in a 5-year programme in dental school (years 2 to 6), as opposed to 4 years in the former programme (years 2 to 5). Basically, this new curriculum emphasises research initiation, links with medical training and offers broader clinical experience. During the academic year 1998,1999, dental schools had 2 different types of students: the 4th year students belonging to the new programme along with the 5th year students in their final year of the old curriculum. Using a specially devised questionnaire, we investigated the students' perception of their respective training, their motivation and professional plans. At the Faculty of Odontology in Lyon, the new curriculum is perceived as an increased strain by the dental students. [source] International survey on willingness-to-pay (WTP) for one additional QALY gained: what is the threshold of cost effectiveness?HEALTH ECONOMICS, Issue 4 2010Takeru Shiroiwa Abstract Although the threshold of cost effectiveness of medical interventions is thought to be £20,000,£30,000 in the UK, and $50,000,$100,000 in the US, it is well known that these values are unjustified, due to lack of explicit scientific evidence. We measured willingness-to-pay (WTP) for one additional quality-adjusted life-year gained to determine the threshold of the incremental cost-effectiveness ratio. Our study used the Internet to compare WTP for the additional year of survival in a perfect status of health in Japan, the Republic of Korea (ROK), Taiwan, Australia, the UK, and the US. The research utilized a double-bound dichotomous choice, and analysis by the nonparametric Turnbull method. WTP values were JPY 5 million (Japan), KWN 68 million (ROK), NT$ 2.1 million (Taiwan), £23,000 (UK), AU$ 64,000 (Australia), and US$ 62,000 (US). The discount rates of outcome were estimated at 6.8% (Japan), 3.7% (ROK), 1.6% (Taiwan), 2.8% (UK), 1.9% (Australia), and 3.2% (US). Based on the current study, we suggest new classification of cost-effectiveness plane and methodology for decision making. Copyright © 2009 John Wiley & Sons, Ltd. [source] Cutaneous sarcoid-like granulomas with alveolar hemorrhage and c-ANCA PR-3INTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 9 2004Natividade Rocha MD A 28-year-old woman, employed as a leather factory worker, noted asymptomatic, well-delimited plaques on both knees, 6 years ago. The plaques were violaceous with a smooth surface. One appeared over a post-traumatic scar from childhood (Fig. 1). Two years later, she began to complain of symptoms suggestive of polyarthritis, first of the small joints of the hands (proximal interphalanges) and then of the larger joints (wrists, elbows, and knees). She was diagnosed with rheumatoid arthritis and began treatment with nonsteroidal anti-inflammatory drugs for 1 month without any change. Deflazacort, 12 mg/day, and hydroxychloroquine, 400 mg/day, were administered for 3 months, with improvement of her articular complaints, but not her skin lesions. Figure 1. Well-delimited, violaceous plaques with a smooth surface on the knees, one over an old post-traumatic scar One year later, she complained of dysphonia, which remitted spontaneously after some weeks. After one additional year, she noted papules, with similar characteristics to the plaques, on the elbows, and two well-delimited orange-to-brown plaques on the forehead (Fig. 2). Figure 2. Orange,brown plaques symmetrically placed on the forehead During the fifth year of the disease, she was referred for the first time to a dermatologist, who biopsied one of the knee lesions. The histologic result was compatible with "sarcoid granuloma." At that time, she presented with skin lesions as her only complaint. Sarcoidosis was suspected based on a chest X-ray, which revealed hilar lymphadenopathy and diffuse accentuation of the interstitium. In November 2000, she suddenly developed fever (40 °C), cough with hemoptysis, dysphonia, and subcutaneous nodules on the palmar surface of the fingers of both hands that were painless, well-delimited, 5 mm in diameter, and firm (Fig. 3). She reported a weight loss of 12 kg in the previous 3 months. Pulmonary condensation was found on auscultation, and she had palpable hepatomegaly. Peripheral lymphadenopathy was not present. Figure 3. Painless, well-delimited, firm subcutaneous nodules on the palmar surface of the fingers Laboratory investigations revealed normochromic, normocytic anemia (hemoglobin, 7.7 g/dL), iron deficit, a white blood cell count of 16,000/µL with neutrophilia, an erythrocyte sedimentation rate of 130 mm/h, elevation of liver enzymes, a slight increase in angiotensin-converting enzyme (ACE) level (72 U/L), hypergammaglobulinemia (IgG, 3350 mg/dL), antinuclear antibody (ANA) of 1 : 320, and a slight increase in CD4 and decrease in CD8 lymphocytes with normal cellular morphology in blood. Renal function, urine sediment, urine and serum calcium, complement (C4), dsDNA, antimitochondrial antibody, direct and indirect Coombs test, antineutrophil cytoplasmic antibody (ANCA), tuberculin skin tests, viral markers of hepatitis B, C, and human immunodeficiency virus (HIV), electrocardiogram (ECG), ophthalmic examinations, and culture for infectious agents in blood and sputum were all normal or negative. Computed tomography (CT) scan showed an infiltrate in the upper right pulmonary lobule with a central cavity and bilateral hilar lymphadenopathy (Fig. 4). Homogeneous hepatosplenomegaly was present. The bronchoalveolar lavage (BAL) showed a slight lymphocytic increase predominantly of CD8 cells and hemosiderosis. Stains for infectious agents, including acid-fast bacillus, fungi, Mycoplasma, and Legionella, were negative. Three biopsies from the forehead, elbows, and knees showed well-formed noncaseating epithelioid cell granulomas with giant cells of the Langhans type in the dermis, suggestive of sarcoidosis (Figs 5 and 6). A fourth biopsy from a finger nodule demonstrated inflammatory infiltration of the dermis and necrosis with cellular debris. Vasculitis was not seen (Fig. 7). Figure 4. Computed tomography scan showing an infiltrate in the upper right pulmonary lobule with a central cavity Figure 5. Beneath a flattened epidermis, several sarcoid granulomas composed of epithelioid histiocytes and several multinucleated giant cells of Langhans type can be seen (hematoxylin and eosin, ×10) Figure 6. Less well-formed sarcoid granulomas in a hyperkeratotic area, surrounded by a sparse rim of lymphocytes (hematoxylin and eosin, ×20) Figure 7. Foci of necrosis and fibrinoid degeneration with some neutrophil infiltration and nuclear dusting (hematoxylin and eosin, ×40) The patient was treated with a broad-spectrum empirical antimicrobial (levofloxacin, 500 mg daily intravenously) over 12 days, with prompt improvement in her symptoms and remission of the forehead and finger lesions. Nevertheless, on the first evaluation after hospitalization, the CT scan showed persistence of the pulmonary cavity (Fig. 8). A repeat ANCA determination was positive (cytoplasmic pattern, c-ANCA) at 1 : 640 by indirect immunofluorescence (IIF). Antiproteinase-3 antibody was demonstrated at 78 by enzyme-linked immunosorbent assay (ELISA). Figure 8. Computed tomography scan showing persistence of the pulmonary cavity She underwent an open lung biopsy which revealed intra-alveolar hemorrhage and scanty noncaseating epithelioid cell granulomas of the sarcoidosis type in the peripheral blood vessels without vasculitis. A diagnosis of Wegener's granulomatosis was made and she began prednisolone (1 mg/kg/day) and oral cyclophosphamide (2 mg/kg/day). One year later, she is asymptomatic, the skin lesions have completely remitted, c-ANCA is negative, and the CT scan shows partial regression of the pulmonary cavity. [source] Management of Noncancer Pain in Community-Dwelling Persons with DementiaJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 12 2006Joseph W. Shega MD OBJECTIVES: To explore the pharmacological treatment of noncancer pain in persons with dementia and identify predictors associated with insufficient analgesia. DESIGN: Cross-sectional analysis of an observational cohort study. SETTING: Academic outpatient geriatric clinic in Chicago, Illinois. PARTICIPANTS: A total of 115 dyads, mostly African American, consisting of community-dwelling persons with dementia and their caregivers. MEASUREMENTS: Patient report of demographics, noncancer pain, function, cognition, and depression. Caregiver report of patient agitation and over-the-counter and prescription medications. RESULTS: Sixty-two of 115 (54%) patients reported pain "on an average day." The caregivers of more than half of persons with dementia who reported pain "on an average day" did not report analgesic use. The majority of caregivers who reported analgesic use reported that patients took a World Health Organization Class I medication. No patients had been prescribed a Class III (strong opioid) drug. Fifty-three of 115 (46%) patients had potentially insufficient analgesia. In the logistic regression, insufficient analgesia was associated with greater age, Mini-Mental State Examination score of less than 10, and impairment in daily functioning. Insufficient analgesia was 1.07 times as likely (95% confidence interval (CI)=1.01,1.14) for each additional year of age, 3.0 times as likely (95% CI=1.05,9.10) if the subject had advanced dementia, and 2.5 times as likely (95% CI=1.01,6.25) if the patient had any impairment in activities of daily living. CONCLUSION: In this convenience sample from a geriatric clinic, many persons with dementia and noncancer pain were not receiving pharmacological treatment. Those at greatest risk for insufficient analgesia were older, had moderate to severe dementia, and experienced impairments in activities of daily living. [source] Human Capital Spillovers within the Workplace: Evidence for Great Britain,OXFORD BULLETIN OF ECONOMICS & STATISTICS, Issue 5 2003Harminder Battu Abstract In this paper, we use a unique matched worker,workplace data set to estimate the effect on own earnings of co-workers' education. Our results, using the 1998 GB Workplace Employee Relations Survey, show significant effects. An independent, significantly positive effect from average workplace education is evident; own earnings premia from years of education fall only slightly when controlling for workplace education. This result suggests that the social returns to education are strongly positive , working with colleagues who each had 1.2 years (1 standard deviation) of more education than the average worker, boosts own earnings by 11.1%. An additional year of any single co-worker's education is worth about 3.2% of an additional own year of education. We also test for interactions between own and co-worker education levels and for ,skills incompatibility' when worker education levels are heterogeneous. The interactions appear negative: own education is not much valued at workplaces where co-workers' education levels are already high. There is no evidence that workplace heterogeneity in worker education levels adversely affects own earnings. This result runs counter to theoretical predictions, and suggests that workers compete in tournaments for high-paying jobs. [source] Communication of positive newborn screening results for sickle cell disease and sickle cell trait: Variation across states,AMERICAN JOURNAL OF MEDICAL GENETICS, Issue 1 2008Patricia L. Kavanagh Abstract In the US, all states and the District of Columbia have universal newborn screening (NBS) programs for sickle cell disease (SCD), which also identify sickle cell trait (trait). In this project, we surveyed follow-up coordinators, including one in the District of Columbia and two in Georgia, about protocols for stakeholder notification for SCD and trait. The primary outcomes were total number and type of stakeholder informed of a positive screen. We received 52 completed surveys (100% response). Primary care providers (PCPs) (100%), hematologists (81%), hospitals (73%), and families (40%) were the most commonly notified stakeholders of positive SCD screens, while PCPs (88%), hospitals (63%), and families (37%) were most commonly notified for trait. On average, 3.4 stakeholders were notified for a positive screening for SCD, compared to 2.4 stakeholders for sickle cell trait (P,<,0.001). In multivariate analyses for SCD, we found a 2.9% increase in stakeholders notified for each additional year of universal screening mandated in a state (95% CI: 1.4,4.4%). For trait, we found an 8.5% increase in stakeholders notified for each additional follow-up staff (95% CI: 1.3,15.7%), and a 1.3% increase for each additional percent of black births in the state (95% CI: 0.1,2.5%). Wide variation exists in stakeholder notification by NBS programs of positive screenings for SCD and trait. This variation may alter the effectiveness of NBS programs by location of birth. © 2008 Wiley-Liss, Inc. [source] Role of Education in Cigarette Smoking: An Analysis of Malaysian Household Survey Data,ASIAN ECONOMIC JOURNAL, Issue 1 2009Andrew K.G. Tan D12; I21 Heckman's sample selection model is used to examine the role of education on household purchase decisions and expenditures of tobacco products in Malaysia. Results of the marginal effects of education, segmented by ethnic and gender groups, suggest that education decreases the probability, conditional levels and unconditional levels of tobacco expenditures amongst Malaysian households. Specifically, an additional year of education of the household head, irrespective of ethnic or gender considerations, decreases smoking probability by 1.5 percent. However, the negative effect of education seems to be higher for Chinese (US$1.07) than Malay (US$0.26) households in terms of conditional expenditures. Furthermore, education significantly decreases conditional tobacco expenditures within male-headed households. [source] Inequality and Determinants of Earnings in Malaysia, 1984,1997,ASIAN ECONOMIC JOURNAL, Issue 2 2006Branko Milanovic J21; J31; J7; O12 Using three large nationally-representative Malaysian Household Income Surveys from 1984, 1989 and 1997, the present paper examines inequality and determinants of earnings. During the period 1984,1997, Malaysia's real per capita GDP increased by approximately 70percent, the participation rates for both men and women went up among all age groups, and the average number of years of schooling increased by 1.2years. There was a significant relative wage improvement among the bottom deciles. The rate of return to an additional year of schooling remained high (at 10percent), despite the huge increase in the supply of the highly educated. The stable overall rate, however, masks an increased rate of return on women's education, and a decreased rate for men. Wage discrimination against women amounts to 16,20percent, and the bias has increased in 1997. The pro-Chinese earning ethnic bias is estimated at 31percent. [source] Impact of feral water buffalo and fire on growth and survival of mature savanna trees: An experimental field study in Kakadu National Park, northern AustraliaAUSTRAL ECOLOGY, Issue 6 2005PATRICIA A. WERNER Abstract The impact of feral Asian water buffalo (Bubalus bubalis) and season of fire on growth and survival of mature trees was monitored over 8 years in the eucalypt savannas of Kakadu National Park. Permanently marked plots were paired on either side of a 25-km-long buffalo-proof fence at three locations on an elevational gradient, from ridge-top to the edge of a floodplain; buffalo were removed from one side of the fence. All 750 trees ,,1.4 m height were permanently marked; survival and diameter of each tree was measured annually; 26 species were grouped into four eco-taxonomic groups. The buffalo experiment was maintained for 7 years; trees were monitored an additional year. Fires were excluded from all sites the first 3 years, allowed to occur opportunistically for 4 years and excluded for the final year. Fires were of two main types: low-intensity early dry season and high-intensity late dry season. Growth rates of trees were size-specific and positively related to diameters as exponential functions; trees grew slowest on the two ends of the gradient. Eucalypt mortality rates were 1.5 and 3 times lower than those of pantropics and of arborescent monocots, respectively, but the relative advantage was lost with fires or buffalo grazing. Without buffalo grazing, ground level biomass was 5,8 t ha,1 compared with 2,3 t ha,1, within 3 years. In buffalo-absent plots, trees grew significantly slower on the dry ridge and slope, and had higher mortality across the entire gradient, compared with trees in buffalo-present plots. At the floodplain margin, mortality of small palms was higher in buffalo-present sites, most likely due to associated heavy infestations of weeds. Low-intensity fires produced tree growth and mortality values similar to no-fire, in general, but, like buffalo, provided a ,fertilization' effect for Eucalyptus miniata and Eucalyptus tetrodonta, increasing growth in all size classes. High-intensity fires reduced growth and increased mortality of all functional groups, especially the smallest and largest (>35 cm d.b.h.) trees. When buffalo and fires were excluded in the final year, there were no differences in growth or mortality between paired sites across the environmental gradient. After 8 years, the total numbers of trees in buffalo-absent plots were only 80% of the number in buffalo-present plots, due to relatively greater recruitment of new trees in buffalo-present plots; fire-sensitive pantropics were particularly disadvantaged. Since the removal of buffalo is disadvantageous, at least over the first years, to savanna tree growth and survival due to a rebound effect of the ground-level vegetation and subsequent changes in fire-vegetation interactions, process-orientated management aimed at reducing fuel loads and competitive pressure may be required in order to return the system to a previous state. The ,footprint' of 30 years of heavy grazing by buffalo has implications for the interpretation of previous studies on fire-vegetation dynamics and for current research on vegetation change in these savannas. [source] The lack of significant changes in scalp hair follicle density with advancing ageBRITISH JOURNAL OF DERMATOLOGY, Issue 4 2005R. Sinclair Summary Background, Age-related reduction in hair is seen in the axillary and pubic regions as well as the scalp; however, it has not been investigated qualitatively on the scalp. Horizontally sectioned scalp biopsy is an ideal tool to investigate the impact of advancing age on scalp hair follicle density and morphology. Objectives, To examine the effect of age and follicle miniaturization on total hair count in 1666 horizontally sectioned mid-scalp biopsies from 928 women aged between 13 and 84 years with hair loss. Methods Setting:, Specialist hair loss referral clinic in a teaching hospital. Design: Analysis of data set. Methods:, All scalp biopsies were 4 mm in diameter and taken from the crown. Miniaturization was assessed by calculating the ratio of terminal to vellus-like hairs (T/V) at the mid-isthmus level and considered significant if the ratio was , 4 : 1. Fibrosis was documented when present. Linear regression was used to examine the association between total hair count, age and miniaturization. Results, The average number of hair follicles per biopsy was 39·6 (SD ± 10·8). A highly significant negative association (P < 0·0001) was found between age and total follicle number, although the predictive value of age in total hair count was found to be small [root error mean square (R2) < 2%]. Controlling for T/V , 4 : 1, the association was weakened, but remained significant. The relationship unconfounded by T/V , 4 : 1 shows that for every additional year of ageing, 0·077 total hair follicles (0·22%) are lost per biopsy. Conclusions, Age and follicular miniaturization were found to be extremely weak predictors of total hair count in women with hair loss. [source] Does Education Still Pay Off in Rural China: Revisit the Impact of Education on Off-farm Employment and WagesCHINA AND WORLD ECONOMY, Issue 2 2008Haiqing Zhang I21; J24; O15 Abstract The present study considers how education affects off-farm job participation and wages. We use a nationally representative dataset from a survey conducted in 5 provinces, 101 villages and 808 households by the authors in early 2005. The empirical results show that educational attainment, skill training and years of experience of rural residents have positive, statistically significant effects on off-farm employment. The average return to a year of education is 7 percent, which is higher than those observed in previous studies. We also find the return to an additional year of schooling to be higher for post-junior high schooling than for junior high and below schooling: 11.8 versus 3.2 percent. We conclude that not only does education still pays off in rural China, but also the rate of return to education is increasing over time. [source] Variation in mitochondrial DNA control region haplotypes in populations of the bank vole, Clethrionomys glareolus, living in the Chernobyl environment, UkraineENVIRONMENTAL TOXICOLOGY & CHEMISTRY, Issue 2 2006Jeffrey K. Wickliffe Abstract Bank vole, Clethrionomys glareolus, specimens have been annually sampled from the radioactive Chernobyl, Ukraine, environment and nonradioactive reference sites since 1997. Exposed voles continually exhibit increased mitochondrial DNA hap-lotype (h) and nucleotide diversity (ND), observed in the hypervariable control region (1997,1999). Increased maternal mutation rates, source,sink relationships, or both are proposed as hypotheses for these differences. Samples from additional years (2000 and 2001) have been incorporated into this temporal study. To evaluate the hypothesis that an increased mutation rate is associated with increased h, DNA sequences were examined in a phylogenetic context for novel substitutions not observed in haplotypes from bank voles from outside Ukraine or in other species of Clethrionomys. Such novel substitutions might result from in situ mutation events and, if largely restricted to samples from radioactive environments, support an increased maternal mutation rate in these areas. The only unique substitution meeting this criterion was found in an uncontaminated reference site. All other substitutions are found in other haplotypes of the bank vole or in other species. Increased maternal mutation rates do not appear to explain trends in h and ND observed in northern Ukraine. Studies examining ecological dynamics will clarify the reasons behind, and significance of, increased levels of h in contaminated areas. [source] Guided tissue regeneration combined with a deproteinized bovine bone mineral (Bio-Oss®) in the treatment of intrabony periodontal defects: 6-year results from a randomized-controlled clinical trialJOURNAL OF CLINICAL PERIODONTOLOGY, Issue 2 2010Andreas Stavropoulos Stavropoulos A, Karring T. Guided tissue regeneration combined with a deproteinized bovine bone mineral (Bio-Oss®) in the treatment of intrabony periodontal defects: 6-year results from a randomized-controlled clinical trial. J Clin Periodontol 2010; 37: 200,210. doi: 10.1111/j.1600-051X.2009.01520.x. Abstract Aim: To present the 6-year results of a randomized-controlled clinical trial evaluating guided tissue regeneration (GTR) combined with or without deproteinized bovine bone mineral (DBBM) in intrabony defects. Material & Methods: In each of 45 patients, one defect was treated with GTR combined with DBBM hydrated in saline (DBBM,) or gentamicin sulphate (DBBM+) or with GTR alone. Clinical parameters were recorded pre-surgery, at 1 and 6 years postsurgery. Results: Thirty-six patients/33 teeth were available for the 6-year control. Statistically significant clinical improvements were observed for all treatments. Clinical attachment level (CAL) gain averaged 2.5 mm (DBBM,), 4.1 mm (DBBM+), and 3.0 mm (GTR) at 1 year postsurgery, and remained stable over 5 additional years (2.3, 4.1, and 2.7 mm, respectively). Treatment did not appear to influence residual probing depths (PDs) or CAL gains at 6 years postsurgery, or the extent of PD and CAL change from 1 to 6 years, and did not associate with sites losing CAL during follow-up. No association of grafting with sites showing CAL gain 4 mm at the 1- or 6-year control was observed. Conclusion: The improvements in periodontal conditions obtained after GTR treatment with or without the adjunct use of DBBM can be preserved on a long-term basis. [source] Impact of experience on maintenance skillsJOURNAL OF SOFTWARE MAINTENANCE AND EVOLUTION: RESEARCH AND PRACTICE, Issue 2 2002Magne Jørgensen Abstract This study reports results from an empirical study of 54 software maintainers in the software maintenance department of a Norwegian company. The study addresses the relationship between amount of experience and maintenance skills. The findings were, amongst others, as follows. (1) While there may have been a reduction in the frequency of major unexpected problems from tasks solved by very inexperienced to medium experienced maintainers, additional years of general software maintenance experience did not lead to further reduction. More application specific experience, however, further reduced the frequency of major unexpected problems. (2) The most experienced maintainers did not predict maintenance problems better than maintainers with little or medium experience. (3) A simple one-variable model outperformed the maintainers' predictions of maintenance problems, i.e. the average prediction performance of the maintainers seems poor. An important reason for the weak correlation between length of experience and ability to predict maintenance problems may be the lack of meaningful feedback on the predictions. Copyright © 2002 John Wiley & Sons, Ltd. [source] Incidence-based estimates of life expectancy of the healthy for the UK: coherence between transition probabilities and aggregate life-tablesJOURNAL OF THE ROYAL STATISTICAL SOCIETY: SERIES A (STATISTICS IN SOCIETY), Issue 1 2008Ehsan Khoman Summary., Will the UK's aging population be fit and independent, or suffer from greater chronic ill health? Life expectancy of healthy people represents the expected number of years of healthy well-being that a life-table cohort would experience if age-specific rates of mortality and disability prevailed throughout the cohort's lifetime. Robust estimation of this life expectancy is thus essential for examining whether additional years of life are spent in good health and whether life expectancy is increasing faster than the decline of rates of disability. The paper examines a means of generating estimates of life expectancy for people who are healthy and unhealthy for the UK that are consistent with exogenous population mortality data. The method takes population transition matrices and adjusts these in a statistically coherent way so as to render them consistent with aggregate life-tables. [source] Lebenserwartung, medizinischer Fortschritt und Gesundheitsausgaben: Theorie und EmpiriePERSPEKTIVEN DER WIRTSCHAFTSPOLITIK, Issue 2006Stefan Felder The rising health share can be explained by a standard economic model: As people get richer they purchase additional years of life and less additional consumption, provided that satiation occurs more rapidly in non-health consumption. The gains in life years increasingly occur late in the lifespan. As a result the incremental cost-benefit ratio of health care deteriorates: marginal costs increase as the marginal productivity of medical inputs decreases in old age while marginal benefits decrease due to a rising hazard rate. On average, medical progress is worth it. Future income growth will further increase the health share, while population ageing will only marginally affect health care expenditures. [source] Mortality of workers employed in shoe manufacturing: An update,AMERICAN JOURNAL OF INDUSTRIAL MEDICINE, Issue 7 2006Everett J. Lehman MS Abstract Background In the late 1970s, the National Institute for Occupational Safety and Health identified two shoe manufacturing facilities where workers experienced relatively "pure" exposures to toluene. A mortality study was conducted through December 31, 1982. An original study did not detect elevated leukemia mortality but did detect increased lung cancer mortality. The present study is an update of the mortality of the original cohort. Methods The study cohort consisted of workers employed 1 month or more between 1940 and 1979 at two Ohio shoe manufacturing plants. Vital status was ascertained through December 31, 1999. Results Seven thousand eight hundred twenty eight workers, contributing 300,777 person years, were available for analysis. An excess of lung cancer deaths persisted with additional years of follow-up (SMR,=,1.36, 95% confidence interval (CI),=,1.19,1.54). Trend tests did not indicate a positive trend between lung cancer risk and duration of employment. Mortality from leukemia was not significantly elevated in the updated analysis. Conclusions Results indicate a possible association between lung cancer mortality and exposure to chronic, low-levels of organic solvents. Although the strength of this conclusion was weakened by the lack of increasing lung cancer risk in relation to duration of employment, other studies have supported this association. Am. J. Ind. Med. 49:535,546, 2006. Published 2006 Wiley-Liss, Inc. [source] Craniofacial Resection for Nonmelanoma Skin Cancer of the Head and Neck,THE LARYNGOSCOPE, Issue 6 2005Douglas D. Backous MD Abstract Objectives/Hypothesis: We reviewed our experience with craniofacial resection for advanced, nonmelanoma skin cancer of the head and neck to determine prognostic factors, local control rate, disease free survival, morbidity, and mortality. Study Design: Retrospective review of consecutive patients treated at a tertiary referral center from 1982 to 1993. Methods: Charts of patients having craniofacial resection for aggressive nonmelanoma cutaneous malignancies were reviewed and living patients followed for 10 additional years. Demographics, histology, previous interventions, treatment, surgical pathology, reconstructions, and complications were examined. The product-limit method was used to calculate survival functions, and the log-rank test was used to compare survival distributions. Results: Thirty-five patients, mean age 66.7 years, received treatment at our facility. Follow-up ranged from 2 to 191 (mean 47.4) months. Histology included 20 squamous cell carcinomas (SCC) and 15 basal cell carcinomas (BCC). Sixty percent had craniofacial resection alone, and 28.6% also had postoperative radiotherapy. There were two perioperative deaths, and 37.1% suffered early and 14.3% late surgical complications. Two- and five- year survival was significantly better (P = .02) with BCC (92% and 76%) than with SCC (54% and 24%). Long-term disease-specific survival was 20%, and 11.4% of our subjects were living with disease. Intracranial extension (P = .02), perineural invasion (P = .049), and prior radiotherapy significantly decreased 5-year survival. Conclusions: Acceptable mortality and morbidity is possible using craniofacial resection to treat advanced nonmelanoma skin cancer. Although disease-specific survival remains poor, positive trends were noted in local control beginning at 2 years of follow-up. Because patients often have few remaining options for cure, craniofacial resection is justified when technically feasible. [source] Calcineurin Inhibitor Minimization in the Symphony Study: Observational Results 3 Years after TransplantationAMERICAN JOURNAL OF TRANSPLANTATION, Issue 8 2009H. Ekberg The Symphony study showed that at 1 year posttransplant, a regimen based on daclizumab induction, 2 g mycophenolate mofetil (MMF), low-dose tacrolimus and steroids resulted in better renal function and lower acute rejection and graft loss rates compared with three other regimens: two with low-doses of cyclosporine or sirolimus instead of tacrolimus and one with no induction and standard cyclosporine dosage. This is an observational follow-up for 2 additional years with the same endpoints as the core study. Overall, 958 patients participated in the follow-up. During the study, many patients changed their immunosuppressive regimen (e.g. switched from sirolimus to tacrolimus), but the vast majority (95%) remained on MMF. During the follow-up, renal function remained stable (mean change: ,0.6 ml/min), and rates of death, graft loss and acute rejection were low (all about 1% per year). The MMF and low-dose tacrolimus arm continued to have the highest GFR (68.6 ± 23.8 ml/min vs. 65.9 ± 26.2 ml/min in the standard-dose cyclosporine, 64.0 ± 23.1 ml/min in the low-dose cyclosporine and 65.3 ± 26.2 ml/min in the low-dose sirolimus arm), but the difference with the other arms was not significant (p = 0.17 in an overall test and 0.077, 0.039 and 0.11, respectively, in pair-wise tests). The MMF and low-dose tacrolimus arm also had the highest graft survival rate, but with reduced differences between groups over time, and the least acute rejection rate. In the Symphony study, the largest ever prospective study in de novo kidney transplantation, over 3 years, daclizumab induction, MMF, steroids and low-dose tacrolimus proved highly efficacious, without the negative effects on renal function commonly reported for standard CNI regimens. [source] Followup radiographic data on patients with rheumatoid arthritis who participated in a two-year trial of prednisone therapy or placeboARTHRITIS & RHEUMATISM, Issue 5 2006Johannes W. G. Jacobs Objective In a previous clinical trial of patients with early rheumatoid arthritis (RA), it was determined that patients who received 10 mg of prednisone per day for 2 years had less radiographic joint damage compared with those who received placebo. Our goal was to investigate whether this beneficial effect persisted after the end of the trial. Methods A blinded assessment of radiographic joint damage was performed ,3 years after the end of the original 2-year study. Twenty-four patients from the original prednisone group (60%) and 28 patients from the original placebo group (68%) participated in this followup study. At the end of the original trial, prednisone dosages were tapered down in the prednisone group and stopped, if possible. Patients from the original prednisone group took prednisone during 35% of the followup period (,1 year) at a mean daily dose of ,5 mg. Two patients from the original placebo group started taking prednisone during followup. Radiographs of the hands and feet were scored according to the van der Heijde modification of the Sharp method. Results During 3 additional years of followup, radiographic scores showed significantly less progression in the original prednisone group than in the original placebo group. Radiographic damage in the original prednisone group did not show an accelerated rate of progression during the followup period. Conclusion The inhibition of radiographic joint damage in patients with early active RA treated with 10 mg of prednisone per day for 2 years seems to persist after the end of prednisone therapy. [source] | |||||||||||||||||||