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Kinds of Denominator Selected AbstractsEpidemiology of primary systemic vasculitis in the Australian Capital Territory and south-eastern New South WalesINTERNAL MEDICINE JOURNAL, Issue 11 2008A. S. Ormerod Abstract Background:, The aim of the study was to determine the epidemiology of primary systemic vasculitis in the Australian Capital Territory and the surrounding rural region between 1995 and 2005. Methods:, Cases were ascertained by a medical record search according to international consensus classification criteria. For antineutrophil cytoplasmic antibody-associated vasculitides, ascertainment was corroborated by a search of all positive antineutrophil cytoplasmic antibody serology during the study period. Denominators were obtained from region-specific census data collected during the study period. Prevalence, incidence and patient characteristics for primary systemic vasculitides were determined for two 5-year periods, 1995,1999 and 2000,2004. Results:, We identified 41 cases of primary systemic vasculitides (Wegener's granulomatosis (WG), microscopic polyangiitis (MPA), Churg,Strauss syndrome or polyarteritis nodosa) between 1995 and 1999 and 67 between 2000 and 2004, giving prevalences of 95/million (95% confidence interval (CI) 76.9,116.1) and 148/million (95%CI 125.1,173.9), respectively. Annual incidence was similar in both periods (approximately 17/year per million adult population). Disease-specific incidences (per million per year) for each of the two periods were 8.8 and 8.4 for WG, 2.3 and 5.0 for MPA, 2.3 and 2.2 for Churg,Strauss syndrome and 2.3 and 1.1 for polyarteritis nodosa. The rural incidence of MPA was 13.9 (95%CI 7.7,23.5) compared with 1.6 (95%CI 0.2,7.2) in the city and there was a trend towards a higher incidence of WG in rural than urban areas. Conclusion:, The overall incidence of primary systemic vasculitides is similar to that reported from other developed countries. WG is more common in south-eastern Australia than in southern Europe, whereas MPA is less common. There was a trend towards higher incidence of antineutrophil cytoplasmic antibody-associated vasculitides in rural than urban areas. [source] Comparison of military and civilian reporting rates for smallpox vaccine adverse events,PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 6 2007A. W. McMahon MD Abstract Introduction US smallpox vaccination (SMA) started most recently in December 2002. Military and civilian personnel report adverse events (AEs) to the Vaccine Adverse Event Reporting System (VAERS), a surveillance system that relies on spontaneous reports. Although reported rates of probable myo/pericarditis after SMA in the literature are similar between military personnel and civilian healthcare workers, some civilian AE reporting rates after SMA appeared higher than those in the military. Objective Determine if SMA-associated reporting rates are different in civilians than in the military, considering age, sex, seriousness, and expectedness of the AE, as well as self-reporting. Methods Numerators were SMA reports in VAERS from 12/12/02 to 3/1/04. Limitations of VAERS include underreporting and lack of diagnostic confirmation. Denominators were number of military and civilian vaccinees. Results Reporting rates stratified by age and sex of serious and non-serious AEs were significantly higher in civilian than military personnel ages <55 years (rate ratios 4,27). These rate ratios decreased with increasing age. Conclusions Reporting rates in VAERS differed significantly and substantially in civilians compared to military personnel <55 years of age. Differences in stimulated passive surveillance systems, and AE reporting practices, including the ,threshold' for reporting most likely explain these findings. These results suggest that in the case of smallpox vaccine AEs, there may be systematic differences in reporting completeness between the civilian and military sectors, and that passive surveillance data should be interpreted with caution. Copyright © 2006 John Wiley & Sons, Ltd. [source] Angelman Syndrome: Difficulties in EEG Pattern Recognition and Possible MisinterpretationsEPILEPSIA, Issue 8 2003Kette D. Valente Summary: Purpose: This study aimed to evaluate the sensitivity of the EEG in Angelman syndrome (AS), to verify the age at onset of suggestive EEGs and to study EEG patterns, analyzing variations and comparing our findings with nomenclature previously used. Methods: Seventy EEG and 15 V-EEGs of 26 patients were analyzed. Suggestive EEG patterns of AS were classified in delta pattern (DP), theta pattern (TP), and posterior discharges (PDs). Generic terms were used to simplify the analysis. Results: Suggestive EEGs were observed in 25 (96.2%) patients. DP occurred in 22 patients with four variants,hypsarrhythmic-like: irregular, high-amplitude, generalized delta activity (DA) with multifocal epileptiform discharges (EDs); slow variant: regular, high-amplitude, generalized DA with rare EDs; ill-defined slow spike-and-wave: regular, high-amplitude, generalized DA with superimposed EDs characterizing a slow wave, with notched appearance; triphasic-like: rhythmic, moderate-amplitude DA over anterior regions with superimposed EDs. TP was observed in eight patients, as generalized or over the posterior regions. PDs were seen in 19 patients as runs of sharp waves or runs of high-amplitude slow waves with superimposed EDs. TP was the only age-related pattern (younger than 8 years) and observed only in patients with deletion. In 15 patients who had an EEG before the clinical diagnosis, 60% had a suggestive tracing. Conclusions: Although some EEG descriptions are not very detailed, and every author describes findings in a slightly different manner, obviously a common denominator must exist. In this context, EEG seems to be a very sensitive method for the diagnosis of AS, offering an opportunity to corroborate this etiologic diagnosis. Conversely, we do not believe that these patterns may be accounted as specific, except for the delta pattern, which seems to be extremely unusual in other syndromes. Other EEG patterns observed in AS, such as theta activity and PDs, occur in a wide variety of disorders. Nonetheless, their importance for the EEG diagnosis of AS is supported by the fact that they are associated with other features and may be helpful in a proper clinical setting. [source] No Influence of 5-HTTLPR Gene Polymorphism on Migraine Symptomatology, Comorbid Depression, and ChronificationHEADACHE, Issue 3 2010Thomas Wieser MD (Headache 2010;50:420-430) Background., The serotonergic system is thought to play an important role for mediating susceptibility to migraine and depression, which is frequently found comorbid in migraine. The functional polymorphism in the serotonin transporter gene linked polymorphic region (5-HTTLPR/SLC6A4) was previously associated with attack frequency and, thus, possibly with chronification. Objective., We hypothesized that patients with the "s" allele have higher attack frequency and, paralleling results in depression research, higher scores of depression. Methods., Genetic analysis of the SLC6A4 44 bp insertion/deletion polymorphism (5-HTTLPR) was performed in 293 patients with migraine with and without aura. Self-rating questionnaires were used for assessment of depression. Results., Multinomial logistic regression analysis found no evidence for association of the 5-HTTLPR polymorphism with either depression or migraine attack frequency. Conclusion., We were not able to demonstrate any influence of the serotonin transporter 5-HTTLPR polymorphism on migraine phenomenology (attack frequency or comorbid depression), thereby excluding this variant to be a common genetic denominator for chronic migraine and depression. [source] Prevalence and incidence of cluster headache in the Republic of San Marino.HEADACHE, Issue 3 2003C Tonon Neurology. 2002 May 14;58(9):1407-1409 Based on a preceding survey performed in 1985, the authors estimated the prevalence and incidence of cluster headache (CH) in the Republic of San Marino (26 628 inhabitants at 31 December 1999). All cases were diagnosed by direct interview according to International Headache Society criteria. The prevalence rate was 56/100 000 (95% CI 31.3 to 92.4), and the incidence rate was 2.5/100 000/year (95% CI 1.14 to 4.75). Most cases showed rare clusters. This is the first prospective study on the incidence of CH. Comment: There continues to be debate on the prevalence of cluster in the general population. Since San Marino is small, the entire cluster population, with a smaller denominator for the general population, could be estimated, making this a very important study. SJT [source] On future non-medical costs in economic evaluationsHEALTH ECONOMICS, Issue 5 2008Bengt Liljas Abstract Economic evaluation in health care is still an evolving discipline. One of the current controversies in cost-effectiveness analysis regards the inclusion or exclusion of future non-medical costs (i.e. consumption net of production) due to increased survival. This paper examines the implications of a symmetry rule stating that there should be consistency between costs included in the numerator and utility aspects included in the denominator. While the observation that no quality-adjusted life year (QALY) instruments explicitly include consumption and leisure seems to give support to the notion that future non-medical costs should be excluded when QALYs are used as the outcome measure, a better understanding of what respondents actually consider when reporting QALY weights is required. However, the more fundamental question is whether QALYs can be interpreted as utilities. Or more precisely, what are the assumptions needed for a general utility model also including consumption and leisure to be consistent with QALYs? Once those assumptions are identified, they need to be experimentally tested to see whether they are at least approximately valid. Until we have answers to these areas for future research, it seems premature to include future non-medical costs. Copyright © 2007 John Wiley & Sons, Ltd. [source] Should the consumption of survivors be included as a cost in cost,utility analysis?HEALTH ECONOMICS, Issue 5 2004John A. Nyman Abstract Survivor costs are those costs associated with a treatment because it extends the patient's life. A controversy exists regarding whether survivor consumption costs should be included in cost,utility analyses. The present paper uses this controversy to motivate a general reexamination of what costs to include in cost,utility analyses. Rather than the ad hoc inclusion rules currently used , a causal relationship between the intervention and the costs, and a proscription on double counting , this paper suggests three inclusion principles based on standard welfare economics. Thus, costs should be (1) included if they represent resources that directly produce the utility that is being measured in the denominator of the cost,utility ratio, (2) excluded if they represent resources that produce utility that is not being measured in the denominator, even though the costs are causally associated with the intervention, and (3) included if they represent resources consumed that are causally related to the intervention, but that have no counterveiling utility gains. These principles suggest important changes in how we account for recuperation time and unrelated medical care. They also suggest that survival consumption costs and earnings be excluded from existing cost,utility analyses. Copyright © 2003 John Wiley & Sons, Ltd. [source] Rising hospitalization rates for inflammatory bowel disease in the United States between 1998 and 2004,INFLAMMATORY BOWEL DISEASES, Issue 12 2007Geoffrey C. Nguyen MD Abstract Background: Recent epidemiological studies suggest that the prevalences of Crohn's disease (CD) and ulcerative colitis (UC) are increasing in the United States. We sought to determine whether nationwide rates of inflammatory bowel disease (IBD) hospitalizations have increased in response to temporal trends in prevalence. Methods: We identified all admissions with a primary diagnosis of CD or UC, or 1 of their complications in the Nationwide Inpatient Sample between 1998 and 2004. National estimates of hospitalization rates and rates of surgery were determined using the U.S. Census population as the denominator. Results: There were an estimated 359,124 and 214,498 admissions for CD and UC, respectively. The overall hospitalization rate for CD was 18.0 per 100,000 and that for UC was 10.8 per 100,000. There was a 4.3% annual relative increase in hospitalization rate for CD (P < 0.0001) and a 3.0% annual increase for UC (P < 0.0001). Surgery rates were 3.4 bowel resections per 100,000 for CD and 1.2 colectomies per 100,000 for UC and remained stable. There were no temporal patterns for average length of stay for CD (5.8 days) or for UC (6.8 days). The national estimate of total inpatient charges attributable to CD increased from $762 million to $1,330 million between 1998 and 2004, and that for UC increased from $592 million to $945 million. Conclusions: Hospitalization rates for IBD, particularly CD, have increased within a 7-year period, incurring a substantial rise in inflation-adjusted economic burden. The findings reinforce the need for effective treatment strategies to reduce IBD complications. (Inflamm Bowel Dis 2007) [source] A common European foreign policy after Iraq?INTERNATIONAL AFFAIRS, Issue 3 2003Brian Crowe Taking as read the wide range of other instruments that the EU has for international influence (enlargement, aid, trade, association and other arrangements, etc.), the Common Foreign and Security Policy (CFSP), under pressure from the Kosovo conflict, has been shaped by two important decisions in 1999: the creation of the European Security and Defence Policy (ESDP) to give the EU a military capability when NATO as a whole is not engaged, and the appointment as the new High Representative for the CFSP of a high-profile international statesman rather than a senior civil servant. A major European effort will still be needed if Europe is to be effective militarily, whether in the EU/ESDP or NATO framework. The management of the CFSP has been held back by the doctrine of the equality of all member states regardless of their actual contribution. This in turn leads to a disconnect between theory (policy run by committee in Brussels) and practice (policy run by the High Representative working with particular member states and other actors, notably the US). It has been difficult for Javier Solana to develop the authority to do this, not in competition with the Commission as so widely and mistakenly believed, as with member states themselves, and particularly successive rotating presidencies. It is important that misdiagnosis does not lead to politically correct solutions that end up with the cure worse than the disease. Ways need to be found to assure to the High Representative the authority to work with third countries and with the member states making the real contribution, while retaining the support of all. Then, with its own military capability, the EU can have a CFSP that is the highest common factor rather than the lowest common denominator, with member states ready to attach enough priority to the need for common policies to give Europeans a strong influence in the big foreign policy issues of the day. [source] Mechanism of metabolic activation and DNA adduct formation by the human carcinogen diethylstilbestrol: The defining link to natural estrogensINTERNATIONAL JOURNAL OF CANCER, Issue 6 2009Muhammad Saeed Abstract Diethylstilbestrol (DES) is a human carcinogen, based on sufficient epidemiological evidence. DES is mainly metabolized to its catechol, 3,-hydroxyDES (3,-OH-DES), which can further oxidize to DES-3,,4,-quinone (DES-3,,4,-Q). Similarly to estradiol-3,4-quinone, the reaction of DES-3,,4,-Q with DNA would form the depurinating 3,-OH-DES-6,-N3Ade and 3,-OH-DES-6,-N7Gua adducts. To prove this hypothesis, synthesis of DES-3,,4,-Q by oxidation of 3,-OH-DES with Ag2O was tried; this failed due to instantaneous formation of a spiro -quinone. Oxidation of 3,-OH-DES by lactoperoxidase or tyrosinase in the presence of DNA led to the formation of 3,-OH-DES-6,-N3Ade and 3,-OH-DES-6,-N7Gua adducts. These adducts were tentatively identified by LC-MS/MS as 3,-OH-DES-6,-N3Ade, m/z = 418 [M+H]+, and 3,-OH-DES-6,-N7Gua, m/z = 434 [M+H]+. Demonstration of their structures derived from their oxidation by MnO2 to the DES quinone adducts and subsequent tautomerization to the dienestrol (DIES) catechol adducts, which are identical to the standard 3,-OH-DIES-6,-N3Ade, m/z = 416 [M+H]+, and 3,-OH-DIES-6,-N7Gua, m/z = 432 [M+H]+, adducts. The reaction of DIES-3,,4,-Q or lactoperoxidase-activated 3,-OH-DIES with DNA did not produce any depurinating adducts, due to the dienic chain being perpendicular to the phenyl planes, which impedes the intercalation of DIES into the DNA. Enzymic oxidation of 3,-OH-DES suggests that the catechol of DES intercalates into DNA and is then oxidized to its quinone to yield N3Ade and N7Gua adducts. These results suggest that the common denominator of tumor initiation by the synthetic estrogen DES and the natural estrogen estradiol is formation of their catechol quinones, which react with DNA to afford the depurinating N3Ade and N7Gua adducts. © 2008 Wiley-Liss, Inc. [source] Paraneoplastic pemphigus/paraneoplastic autoimmune multiorgan syndromeINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 2 2009FNASC, FRAS(LOND.), Virendra N. Sehgal MD Paraneoplastic pemphigus is the term used for an exclusive subset of pemphigus. The clinical lesions may resemble pemphigus, pemphigoid, erythema multiforme, graft-vs.-host disease, or lichen planus. A common denominator in all patients is the concomitant occurrence of either occult or confirmed systemic neoplasm. It is imperative to confirm the diagnosis through microscopy, where intraepidermal suprabasal cleavage, epidermal acantholysis, dyskeratotic keratinocytes and vacuolar changes in the basal epidermis, interfacial dermatitis, and epidermal exocytosis can be seen. Furthermore, the deposition of immunoglobulin G (IgG) and complement in the epidermal intercellular spaces, detected by direct and/or indirect immunofluorescence, is equally crucial for confirming the diagnosis. [source] Chromosome-mediated alterations of the MYC gene in human cancerJOURNAL OF CELLULAR AND MOLECULAR MEDICINE, Issue 2 2002N. C. Popescu Abstract The step-wise accumulation of genetic and epigenetic alterations in cancer development includes chromosome rearrangements and viral integration-mediated genetic alterations that frequently involve proto-oncogenes. Protooncogenes deregulation lead to unlimited, self-sufficient cell growth and ultimately generates invasive and destructive tumors. C-MYC gene, the cellular homologue of the avian myelocitic leukemia virus, is implicated in a large number of human solid tumors, leukemias and lymphomas as well as in a variety of animal neoplasias. Deregulated MYC expression is a common denominator in cancer. Chromosomal rearrangements and integration of oncogenic viruses frequently target MYC locus, causing structural or functional alterations of the gene. In this article, we illustrate how genomic rearrangements and viruses integration affect MYC locus in certain human lymphomas and solid tumors. [source] KSHV/HHV8-associated primary cutaneous plasmablastic lymphoma in a patient with Castleman's disease and Kaposi's sarcomaJOURNAL OF CUTANEOUS PATHOLOGY, Issue 2006Wenhua Liu Three months following the diagnosis of KS affecting a left cervical lymph node and Castleman's disease with bone marrow involvement, he presented with a subcutaneous, tender lesion on his left arm. A skin biopsy demonstrated a superficial and deep, interstitial-nodular infiltrate of severely atypical lymphoid cells showing plasmacytoid features, numerous mitotic figures, and frequent individual apoptotic tumor cells. The morphologic features were those of plasmablastic lymphoma (PBL). Immunohistochemical study showed that the lymphoma cells strongly expressed CD45, CD30, and KSHV/HHV8 latency-associated nuclear antigen. KSHV/HHV8 was also detected in the biopsy sections of the patient's KS and Castleman's disease. Epstein,Barr virus in situ hybridization was diffusely positive. In situ hybridization demonstrated ,-light chain restriction. Although KSHV/HHV8 has been individually associated with KS, Castleman's disease, and PBL, this appears to be the first reported case in which all three entities were present simultaneously in one person, suggesting a critical role of KSHV/HHV8 as a common denominator in the pathogenesis of these diseases. [source] Keeping Our Ambition Under Control: The Limits of Data and Inference in Searching for the Causes and Consequences of Vanishing Trials in Federal CourtJOURNAL OF EMPIRICAL LEGAL STUDIES, Issue 3 2004Stephen B. Burbank This article offers some reflections stimulated by Professor Galanter's materials, which were the common springboard for the Vanishing Trials Symposium. It suggests that other data, quantitative and qualitative, may be helpful in understanding the vanishing trials phenomenon in federal civil cases, notably data available for years prior to 1962, and questions whether it is meaningful to use total dispositions as the denominator in calculating a trial termination rate. The article argues that care should be taken in using data from state court systems, as also data from criminal cases, administrative adjudication, and ADR, lest one put at risk through careless assimilation of data or muddled thinking a project quite difficult enough without additional baggage. The article describes the limitations of data previously collected by the Administrative Office of the U.S. Courts and highlights unique opportunities created by the AO's switch to a new Case Management/Electronic Case Files system. It argues that Professor Galanter may underestimate the influence of both changing demand for court services (docket makeup) and of changing demand for judicial services (resources) on the trial rate. Finally, the article argues that conclusions about either the causes or consequences of the vanishing trials phenomenon in federal civil cases are premature, suggesting in particular reasons to be wary of emphasis on "institutional factors" such as the discretionary power of first-instance judges and the ideology of managerial judging. [source] Vesicular release of glutamate mediates bidirectional signaling between astrocytes and neuronsJOURNAL OF NEUROCHEMISTRY, Issue 4 2007Yingchun Ni Abstract The major excitatory neurotransmitter in the CNS, glutamate, can be released exocytotically by neurons and astrocytes. Glutamate released from neurons can affect adjacent astrocytes by changing their intracellular Ca2+ dynamics and, vice versa, glutamate released from astrocytes can cause a variety of responses in neurons such as: an elevation of [Ca2+]i, a slow inward current, an increase of excitability, modulation of synaptic transmission, synchronization of synaptic events, or some combination of these. This astrocyte-neuron signaling pathway might be a widespread phenomenon throughout the brain with astrocytes possessing the means to be active participants in many functions of the CNS. Thus, it appears that the vesicular release of glutamate can serve as a common denominator for two of the major cellular components of the CNS, astrocytes and neurons, in brain function. [source] Endoplasmic reticulum dysfunction , a common denominator for cell injury in acute and degenerative diseases of the brain?JOURNAL OF NEUROCHEMISTRY, Issue 4 2001Wulf Paschen Various physiological, biochemical and molecular biological disturbances have been put forward as mediators of neuronal cell injury in acute and chronic pathological states of the brain such as ischemia, epileptic seizures and Alzheimer's or Parkinson's disease. These include over-activation of glutamate receptors, a rise in cytoplasmic calcium activity and mitochondrial dysfunction. The possible involvement of the endoplasmic reticulum (ER) dysfunction in this process has been largely neglected until recently, although the ER plays a central role in important cell functions. Not only is the ER involved in the control of cellular calcium homeostasis, it is also the subcellular compartment in which the folding and processing of membrane and secretory proteins takes place. The fact that blocking of these processes is sufficient to cause cell damage indicates that they are crucial for normal cell functioning. This review presents evidence that ER function is disturbed in many acute and chronic diseases of the brain. The complex processes taken place in this subcellular compartment are however, affected in different ways in various disorders; whereas the ER-associated degradation of misfolded proteins is affected in Parkinson's disease, it is the unfolded protein response which is down-regulated in Alzheimer's disease and the ER calcium homeostasis that is disturbed in ischemia. Studying the consequences of the observed deteriorations of ER function and identifying the mechanisms causing ER dysfunction in these pathological states of the brain will help to elucidate whether neurodegeneration is indeed caused by these disturbances, and will help to fascilitate the search for drugs capable of blocking the pathological process directly at an early stage. [source] The immunocompromised district: a unifying concept for lymphoedematous, herpes-infected and otherwise damaged sitesJOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY & VENEREOLOGY, Issue 12 2009V Ruocco Abstract Systemic immunodeficiency is known to facilitate the onset of opportunistic infections, tumours and immune disorders in any district of the body. There are clinical events, such as chronic lymphoedema, herpetic infections, vaccinations and heterogeneous physical injuries which can selectively damage and immunologically mark the cutaneous district they act upon. After the causing event has disappeared, the affected district may appear clinically normal, but its immune behaviour is often compromised forever. An immunocompromised district becomes a site which is particularly susceptible to subsequent outbreaks of opportunistic infections, tumours and immune disorders confined to the district itself. In this review, there is an ample case-report collection of opportunistic disorders (infectious, neoplastic, immune) which appeared in immunocompromised districts. The cases have been grouped according to the clinical settings responsible for the local immune imbalance: regional chronic lymphoedema; herpes-infected sites, which feature the well-known Wolf's isotopic response; and otherwise damaged areas, comprising sites of vaccination, ionizing or UV radiation, thermal burns and traumas. Whatever the immunocompromising factor, a common denominator which facilitates the occurrence of tumours, infections and dysimmune reactions in an immunocompromised district may reside in locally hampered lymph drainage and/or locally altered neuromediator signalling. In fact, any obstacle to the normal trafficking of immunocompetent cells through lymphatic channels or any interference with the signals that the neuropeptides and neurotransmitters released by peripheral nerves send to cell membrane receptors of immunocompetent cells, can significantly alter the local immune response, thus paving the way for heterogeneous opportunistic disorders in the immunocompromised district. [source] Recent advances in extending the shelf life of fresh Agaricus mushrooms: a reviewJOURNAL OF THE SCIENCE OF FOOD AND AGRICULTURE, Issue 9 2010Preeti Singh Abstract Postharvest browning of Agaricus mushrooms is a severe problem that reduces the shelf life of harvested mushrooms because of their continued respiration and biochemical activity. There are no simple answers and no single treatment is known to limit overall quality deterioration. However, there are several strategies that are being implemented in order to reduce the rate of respiration for mushrooms. Packaging technology is the common denominator that allows us to implement these strategies and thus is key to quality preservation. In this review, first, the major factors involved in postharvest quality deterioration are discussed and then technological advances/methods used to counteract these hurdles are presented. Copyright © 2010 Society of Chemical Industry [source] Neurorehabilitation of Upper Extremities in Humans with Sensory-Motor ImpairmentNEUROMODULATION, Issue 1 2002Dejan B. Popovic PhD Abstract Today most clinical investigators agree that the common denominator for successful therapy in subjects after central nervous system (CNS) lesions is to induce concentrated, repetitive practice of the more affected limb as soon as possible after the onset of impairment. This paper reviews representative methods of neurorehabilitation such as constraining the less affected arm and using a robot to facilitate movement of the affected arm, and focuses on functional electrotherapy promoting the movement recovery. The functional electrical therapy (FET) encompasses three elements: 1) control of movements that are compromised because of the impairment, 2) enhanced exercise of paralyzed extremities, and 3) augmented activity of afferent neural pathway. Liberson et al. (1) first reported an important result of the FET; they applied a peroneal stimulator to enhance functionally essential ankle dorsiflexion during the swing phase of walking. Merletti et al. (2) described a similar electrotherapeutic effect for upper extremities; they applied a two-channel electronic stimulator and surface electrodes to augment elbow extension and finger extension during different reach and grasp activities. Both electrotherapies resulted in immediate and carry-over effects caused by systematic application of FET. In studies with subjects after a spinal cord lesion at the cervical level (chronic tetraplegia) (3,5) or stroke (6), it was shown that FET improves grasping and reaching by using the following outcome measures: the Upper Extremity Function Test (UEFT), coordination between elbow and shoulder movement, and the Functional Independence Measure (FIM). Externally applied electrical stimuli provided a strong central sensory input which could be responsible for the changes in the organization of impaired sensory-motor mechanisms. FET resulted in stronger muscles that were stimulated directly, as well as exercising other muscles. The ability to move paralyzed extremities also provided awareness (proprioception and visual feedback) of enhanced functional ability as being very beneficial for the recovery. FET contributed to the increased range of movement in the affected joints, increased speed of joint rotations, reduced spasticity, and improved functioning measured by the UEFT, the FIM and the Quadriplegia Index of Function (QIF). [source] From W. N. Hohfeld to J. R. Commons, and Beyond?AMERICAN JOURNAL OF ECONOMICS AND SOCIOLOGY, Issue 2 2010A "Law, Economics" Enquiry on Jural Relations In this article we try to reformulate the approaches of Wesley Newcomb Hohfeld and John Rogers Commons on jural relations speculating on the concept of positionality as introduced by Fred Hirsch in his original work on positional good and competition. Furthermore, by placing Hohfeld's jural lowest common denominator within the Commonsian transaction, we propose a more structured economic description of the jural relations theory. [source] Use of parenteral iron products and serious anaphylactic-type reactions,,§AMERICAN JOURNAL OF HEMATOLOGY, Issue 9 2010Diane K. Wysowski Controversy exists about the safety of the parenteral iron dextran products, Dexferrum and INFeD, which have been associated with rare, serious anaphylactic-type reactions. In the United States, their product labels carry boxed warnings of this adverse event; some have called for the withdrawal from marketing of the higher molecular weight Dexferrum. Between 2002 and 2007, sales of Dexferrum, INFeD, and iron gluconate Ferrlecit declined 32.5%, 21%, and 4.8%, respectively, while sales of iron sucrose Venofer increased 160%. Voluntary reports submitted to the Food and Drug Administration show anaphylactic reactions and symptoms for the four parenteral iron products. Because of underreporting, possible differential reporting, absence of iron dextran brand names, and incomplete use (denominator) data, incidence rates and relative risk estimates cannot be calculated. U.S. death certificate data show that for most years from 1979 through 2006, no more than 3 deaths per year were coded to "adverse events in therapeutic use of iron preparations;" brand names were not consistently recorded. Emergency department data show small numbers of visits for treatment of allergic reactions with intravenous iron preparations. The data presented herein show that allergic reactions are possible with all four parenteral iron products, and it is difficult to determine which product has the largest risk based on sales data, voluntarily submitted adverse event reports, death certificates, ED visits, and observational studies performed to date. To help differentiate risk among the parenteral iron products, the brand name of the product always should be provided on medical records, death certificates, and adverse drug reaction reports. Am. J. Hematol., 2010. Published 2010 Wiley-Liss, Inc. [source] Neurophatic Pain Treatment: The ChallengePAIN PRACTICE, Issue 1 2003Jose De Andrés Abstract: Neuropathic pain covers a heterogeneous group of pain conditions characterized by a primary lesion or dysfunction of the sensory nervous system. Its pathophysiology is not yet clear, but neuronal hyperexcitability in those neurons that have lost their normal patterned input seems to be a common denominator for neuropathic pain. A mechanism-based approach is being developed, but still the clinical workup is being based on the anatomical location and the determination of an underlying cause. In addition, clinicians are presented with a challenge because neuropathic pain does not respond well to traditional pain therapies and there are greater individual variations in pain responsiveness. A number of drug classes have been evaluated in the treatment of neuropathic pain syndromes; these are mainly drugs developed for other nervous system diseases, although their precise action and whether their action is central or peripheral remains unknown for the majority of them. First-line agents used in the treatment of neuropathic pain conditions are tricyclic antidepressants and anticonvulsants, especially carbamazepine and gabapentin. Novel therapies are currently being developed for neuropathic pain that are based in experimental models and theoretical frameworks on the pathosphysiological events that initiate this type of pain. [source] Occupational injuries to oregon workers 24 years and younger: An analysis of workers' compensation claims, 2000,2007AMERICAN JOURNAL OF INDUSTRIAL MEDICINE, Issue 10 2010Jaime K. Walters MPH Abstract Background Occupational injuries to adolescents and young adults are a known public health problem. We sought to describe and estimate rates of occupational injuries to workers younger than 25 years of age in Oregon during an 8-year period. Methods Oregon workers' compensation disabling claims data (n,=,23,325) and one commercial insurance carrier's non-disabling claims data (n,=,16,153) were analyzed. Total employment from the Local Employment Dynamics of the U.S. Census Bureau and the Oregon Labor Market Information System was used as a denominator for rates. Results Injuries were more frequent among 22,24 year olds and among males, though females accounted for a higher proportion of claims in the youngest age group. The most common injury type was a sprain or strain, but lacerations and burns were more frequently reported in the 14,18 year olds. When non-disabling claims were included, the rate of injury for 14,18 year olds doubled. The overall rate of injury was 122.7/10,000 workers, but was higher in the construction, manufacturing, and transportation sectors, and in the agriculture, forestry, fishing, and hunting sector for older teens and young adults. Conclusions Young workers continue to be at risk for occupational injuries. Our results show that specific interventions may be needed for older teen and young adult workers to reduce their rate of injury. Am. J. Ind. Med. 53:984,994, 2010. © 2010 Wiley-Liss, Inc. [source] STREET-LEVEL BUREAUCRACY AND PUBLIC ACCOUNTABILITYPUBLIC ADMINISTRATION, Issue 2 2007PETER HUPE The concept of ,street-level bureaucracy' was coined by Michael Lipsky (1980) as the common denominator for what would become a scholarly theme. Since then his stress on the relative autonomy of professionals has been complemented by the insight that they are working in a micro-network of relations, in varying contexts. The conception of ,governance' adds a particular aspect to this: the multi-dimensional character of a policy system as a nested sequence of decisions. Combining these views casts a different perspective on the ways street-level bureaucrats are held accountable. In this article some axiomatic assumptions are drawn from the existing literature on the theme of street-level bureaucracy and on the conception of governance. Acknowledging variety, and arguing for contextualized research, this results in a rethinking of the issue of accountability at the street level. [source] A Simple Noninvasive Test to Detect Vascular Disease in Patients with Erectile Dysfunction: A Novel MethodTHE JOURNAL OF SEXUAL MEDICINE, Issue 2 2006MSc (Urol.), Shawket Alkhayal MB ChB ABSTRACT Introduction., The association between erectile dysfunction (ED) and cardiovascular disease (CVD) is becoming increasingly evident. Both conditions are thought to share a common denominator, which is endothelial dysfunction. Therefore, testing endothelial function in ED patients may serve to detect vascular disease in this cohort of patients. Aims., To investigate whether measuring the reactive hyperemic response (RHR) of the forearm vessels through a simple noninvasive method could identify vascular disease in patients with ED. Patients and Methods., Forty-eight male subjects were recruited into the study, 35 of whom presented to the sexual dysfunction clinic with a complaint of ED, and 13 healthy subjects served as a control group. The ED patients were subdivided into two groups, according to the presence or absence of CVD or its risk factors. The RHR of the forearm vessels was measured noninvasively in all subjects by using a handheld Doppler device. Results., Significant reduction in the peak systolic velocity ration was observed in ED patients with concomitant CVD or risk factors in comparison with the other ED patients with no CVD or risk factors and the control group. Results were highly significant on both occasions (P < 0.001). The 50% recovery time was not significantly different between any of the groups (P > 0.05). Conclusion., Our results suggest that those patients with impaired RHR have an abnormality in their vascular system, which is likely to be the cause of their ED and CVD. Using this simple noninvasive method can help to identify vascular disease in ED patients. It can also be used to suggest vascular disease in any patient, where further tests might be indicated. Alkhayal S, Lehmann V, and Thomas P. A simple noninvasive test to detect vascular disease in patients with erectile dysfunction: A novel method. J Sex Med 2006;3:331,336. [source] EXPENDING MULTIPLICITY: MONEY IN CUBAN IFÁ CULTSTHE JOURNAL OF THE ROYAL ANTHROPOLOGICAL INSTITUTE, Issue 2 2005Martin Holbraad Countering the assumption that money acts as an agent of abstraction and ,disembedment', anthropologists tend to draw money into analogies with other objects of exchange, downplaying its uniquely quantitative nature. This article seeks to disentangle the association, implicit in this tendency, of quantity with abstraction. Focusing on the peculiar character of money as a ,purely multiple' object, the aim is to account for ,embeddedness' without bracketing quantity: what does quantity look like when it is not viewed as an abstract denominator? The question is explored with reference to Ifá, an Afro-Cuban diviner cult that takes monetary transactions as a cosmological premise. [source] ,Eosinophilic Fungal Rhinosinusitis': A Common Disorder in Europe?THE LARYNGOSCOPE, Issue 2 2003Hannes Braun MD Abstract Objectives/Hypothesis The traditional criteria for the diagnosis of allergic fungal sinusitis include chronic rhinosinusitis, "allergic mucin" (mucus containing clusters of eosinophils), and detection of fungi by means of histological examination or culture. In 1999, a group of Mayo Clinic researchers, with a novel method of mucus collection and fungal culturing technique, were able to find fungi in 96% of patients with chronic rhinosinusitis. Immunoglobulin E,mediated hypersensitivity to fungal allergens was not evident in the majority of their patients. Because the presence of eosinophils in the allergic mucin, not a type I hypersensitivity, is probably the common denominator in the pathophysiology of allergic fungal sinusitis, the Mayo Clinic group proposed a change in terminology from allergic fungal sinusitis to eosinophilic fungal rhinosinusitis. Using new techniques of culturing fungi from nasal secretion, as well as preservation and histological examination of mucus, we investigated the incidence of "eosinophilic fungal rhinosinusitis" in our patient population. Study Design Methods In an open prospective study nasal mucus from patients with chronic rhinosinusitis as well as from healthy volunteers was cultured for fungi. In patients, who underwent functional endoscopic sinus surgery, nasal mucus was investigated histologically to detect fungi and eosinophils within the mucus. Results Fungal cultures were positive in 84 of 92 patients with chronic rhinosinusitis (91.3%). In all, 290 positive cultures grew 33 different genera, with 3.2 species per patient, on average. Fungal cultures from a control group of healthy volunteers yielded positive results in 21 of 23 (91.3%). Histologically, fungal elements were found in 28 of 37 patients (75.5%) and eosinophilic mucin in 35 of 37 patients (94.6%). Neither fungi nor eosinophils were present in 2 of 37 patients (5.4%). Conclusions Our data show that the postulated criteria of allergic fungal sinusitis are present in the majority of patients with chronic rhinosinusitis. Either those criteria will be found to be invalid and need to be changed or, indeed, "eosinophilic fungal rhinosinusitis" exists in the majority of patients with chronic rhinosinusitis. Based on our results, fungi and eosinophilic mucin appear to be a standard component of nasal mucus in patients with chronic rhinosinusitis. [source] Quantifying organ donation rates by donation service areaAMERICAN JOURNAL OF TRANSPLANTATION, Issue 4p2 2005Akinlolu O. Ojo Previous measures of OPO performance based on population counts have been deemed inadequate, and the need for new methods has been widely accepted. This article explains recent developments in OPO performance evaluation methodology, including those developed by the SRTR. As a replacement for the previously established measure of OPO performance , donors per million population , using eligible deaths as a national metric has yielded promising results for understanding variations in donation rates among the donation service areas assigned to each OPO. A major improvement uses "notifiable deaths" as a denominator describing a standardized maximal pool of potential donors. Notifiable deaths are defined as in-hospital deaths among ages 70 years and under, excluding certain diagnosis codes related to infections, cancers, etc. A most proximal denominator for determining donation rates is "eligible deaths," which includes only those deaths meeting the criteria for organ donation upon initial assessment. Neither measure is based on the population of a geographic unit, but on restricted upper limits of deaths that could be potential donors in any one locale (e.g., hospital or OPO). The inherent strengths and weaknesses of metrics such as donors per eligible deaths, donors per notifiable deaths, and number of organs per donor are discussed in detail. [source] Dynamical adjustment of propagators in Renormalization Group flowsANNALEN DER PHYSIK, Issue 3 2007M. Salmhofer Abstract A class of continuous renormalization group flows with a dynamical adjustment of the propagator is introduced and studied theoretically for fermionic and bosonic quantum field theories. The adjustment allows to include self,energy effects nontrivially in the denominator of the propagator and to adapt the scale decomposition to a moving singularity, and hence to define flows of Fermi surfaces in a natural way. These flows require no counterterms, but the counterterms used in earlier treatments can be constructed using them. The influence of propagator adjustment on the strong,coupling behaviour of flows is examined for a simple example, and some conclusions about the strong coupling behaviour of renormalization group flows are drawn. [source] One-way analysis of variance with long memory errors and its application to stock return dataAPPLIED STOCHASTIC MODELS IN BUSINESS AND INDUSTRY, Issue 6 2007Jaechoul Lee Abstract Recent empirical results indicate that many financial time series, including stock volatilities, often have long-range dependencies. Comparing volatilities in stock returns is a crucial part of the risk management of stock investing. This paper proposes two test statistics for testing the equality of mean volatilities of stock returns using the analysis of variance (ANOVA) model with long memory errors. They are modified versions of the ordinary F statistic used in the ANOVA models with independently and identically distributed errors. One has a form of the ordinary F statistic multiplied by a correction factor, which reflects slowly decaying autocorrelations, that is, long-range dependence. The other is a test statistic such that the degrees of freedom of the denominator in the ordinary F test statistic is calibrated by the so-called effective sample size. Empirical sizes and powers of the proposed test statistics are examined via Monte Carlo simulation. An application to German stock returns is presented. Copyright © 2007 John Wiley & Sons, Ltd. [source] | ||||||||||||||||||||||||||||||||||||||||