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Selected AbstractsA Thin Tracheal Silicone Washer to Solve Periprosthetic Leakage in Laryngectomies: Direct Results and Long-Term Clinical Effects,THE LARYNGOSCOPE, Issue 4 2008Frans J. M. Hilgers MD Abstract Objectives: Assessment of the immediate results and long-term clinical effects of a thin silicone washer placed behind the tracheal flange of voice prostheses to treat periprosthetic leakage. Patients and Methods: Three year retrospective analysis of 32 laryngectomized patients with 107 periprosthetic leakage events (PLEs). Custom-made silicone washers (outer diameter 18 mm, inner diameter 7.5 mm, thickness 0.5 mm) were placed behind the tracheal flange either in combination with prosthesis replacement or later. Results: There was immediate resolution of periprosthetic leakage in 88 PLEs (median, 38 d; mean, 53 d; range, 8,330 d) and in 6 PLEs with the washer still in situ at the date of analysis (median, 75; mean, 97 d; range, 38,240 d). There was no resolution for periprosthetic leakage in 13 PLEs. Thus, in total, 94 of 107 PLEs (88%) were successfully resolved. In 29 of 32 (91%) patients, the washer resolved the problem at least in one PLE successfully. Twelve of 32 patients, including all 3 with washer failures, also required other interventions to ultimately solve the problem. The vast majority of patients (80%) did not consider placement of the washer to be inconvenient. Conclusions: In consideration of the high success rate and limited inconvenience for patients, this simple thin silicon washer application provides a good first option for the treatment of periprosthetic leakage. [source] Quality control of CD4+ T-lymphocyte enumeration: Results from the last 9 years of the United Kingdom national external quality assessment scheme for immune monitoring (1993,2001)CYTOMETRY, Issue 2 2002Liam Whitby Abstract The human immunodeficiency virus (HIV) global epidemic has necessitated the routine enumeration of T-lymphocyte subsets, which has created a need for external quality assurance (EQA). The United Kingdom National External Quality Assessment Scheme (UK NEQAS) for Immune Monitoring provides EQA for 296 laboratories in 40 countries. In 1993, UK NEQAS developed and incorporated into its program stabilized whole blood that enables the accurate monitoring of laboratory performance. Overall, the mean interlaboratory coefficient of variation (CV) for percentage CD4+ T-lymphocyte subset enumeration has fallen from 15% to less than 5%, as a direct result of the increased use of CD45/ side scatter (SSC) gating. Laboratories using alternative gating strategies (i.e., CD45/CD14 or forward scatter [FSC]/SSC) were about 7.4 times more likely to fail an EQA exercise. Furthermore, the adoption of single-platform technology resulted in a reduction of the overall mean interlaboratory CV for absolute CD4+ T lymphocytes from 56% (prior to the widespread use of single-platform technology) to 9.7%. Individual laboratory deficiencies were also identified using a performance monitoring system and, through re-education by collaboration with the coordinating center, satisfactorily resolved. In conclusion, during the last 9 years, the UK NEQAS for Immune Monitoring program has highlighted the significant technological advances made by laboratories worldwide that undertake lymphocyte subset enumeration. Cytometry (Clin. Cytometry) 50:102,110, 2002. © 2002 Wiley-Liss, Inc. [source] Social Implications of Hyperfunctional Facial LinesDERMATOLOGIC SURGERY, Issue 5 2003J. Charles Finn MD The face is the focus of human interactions, and facial appearance profoundly affects self-esteem. Facial appearance is not only a compilation of the dimensions of the primary morphologic features but is also a direct result of the emotional expressions exhibited on the face. Facial expressions are central in the communication of emotions, as well as in signaling characteristics such as age. The repeated expression of emotions produces hyperfunctional facial lines, and the presence of these lines when the face is at repose may give an erroneous impression of emotions or personality characteristics. These lines are also perceived as a sign of aging. Treatment of hyperfunctional facial lines is beneficial for patients who believe that their faces are not communicating their emotions properly, who want to delay the outward appearance of aging, or who simply want to look their best. [source] Determining toxicity of lead and zinc runoff in soils: Salinity effects on metal partitioning and on phytotoxicityENVIRONMENTAL TOXICOLOGY & CHEMISTRY, Issue 12 2003Daryl P. Stevens Abstract When assessingcationic metal toxicity in soils, metals are often added to soil as the chloride, nitrate, or sulfate salts. In many studies, the effects of these anions are ignored or discounted; rarely are appropriate controls included. This study used five soils varying in pH, clay content, and organic matter to determine whether salinity from counter-ions contributed to or confounded metal phytotoxicity. Varying rates of Pb and Zn were applied to soils with or without a leaching treatment to remove the metal counter-ion (NO3 -). Lactuca sattva (lettuce) plants were grown in metal-treated soils, and plant dry weights were used to determine median effective concentrations where there was a 50% reduction in yield (EC50s) on the basis of total metals measured in the soil after harvest. In two of the five soils, leaching increased the EC50s significantly for Zn by 1.4- to 3.7-fold. In three of the five soils, leaching increased the EC50s significantly for Pb by 1.6- to 3.0-fold. The shift in EC50s was not a direct result of toxicity of the nitrate ion but was an indirect effect of the salinity increasing metal concentrations in soil solution and increasing its bioavailability for a given total metal concentration. In addition, calculation of potential salinity changes in toxicological studies from the addition of metals exhibiting strong sorption to soil suggested that if the anion associated with the metal is not leached from the soil, direct salinity responses could also lead to significant overestimation of the EC50 for those metals. These findings question the relevance of the application of single-metal salts to soils as a method of assessing metal phytotoxicity when, in many cases in our environment, Zn and Pb accumulate in soil over a period of time and the associated counter-ions are commonly removed from the soil during the accumulation process (e.g., roof and galvanized tower runoff). [source] Psychodrama: helping families to adapt to childhood diabetesEUROPEAN DIABETES NURSING, Issue 3 2006B Bektas RN. Abstract Effective management of diabetes in children requires a holistic approach that takes into account the roles of diabetes education, treatment and disease management, and the integral role of family relationships. Psychodrama is a group-based psychological support technique that aims to improve the acceptance and understanding of diabetes within the families of diagnosed children. Through group improvisation, role plays and feedback sessions, the families of children with diabetes participate in a cathartic process that helps them to share their problems, benefit from others' insight and feedback and to discuss behavioural changes that will avoid similar problems in the future. The families that participated in this study reported an enhanced understanding of the contribution that relationships with their children have on the successful management of their diabetes. Through recognition of the reasons for their anxieties about their children's diabetes, they were able to address fixed behavioural patterns in a supportive, non-judgmental arena, and to work towards positive change. Their children benefited indirectly through changes in their parents' behaviour and improved communication within their families. A reduction in the children's HbA1c levels was observed through the course of the study, although this could not be considered a direct result of psychodrama. Copyright © 2006 FEND. [source] Comprehensive validation of competencies for dental vocational training and general professional trainingEUROPEAN JOURNAL OF DENTAL EDUCATION, Issue 4 2003L. Prescott This paper outlines a study designed to validate competencies for dental vocational training (DVT) and general professional training (GPT) in order to ensure their accuracy and acceptability. A highly inclusive approach is described whereby all trainers in Scotland were invited to participate in the exercise. The 168 individuals recruited were drawn from all branches of the dental services and all regions in Scotland. Using online or paper questionnaires, quantitative and qualitative data were collected for each competency statement over 9 months, after which focus groups discussed and decided which changes should be made. A high response rate was observed and from the 160 competencies originally identified, almost half (47.5%) were redrafted as a direct result of the validation process. Sections of the competency document that required most attention are discussed, as are the nature of changes made to the competencies. As a result of this study, a fully validated competency document for DVT and GPT has been produced and will allow a high degree of standardization of training through the provision of essential consistent information to trainers and VDPs. [source] Chemical Bonding Assembly of Multifunctional Oxide NanocompositesADVANCED FUNCTIONAL MATERIALS, Issue 2 2010Gary Evans Abstract The synthesis, functionalization and assembly of metal oxide nanoparticles BaTiO3 and CoFe2O4 is presented. The ferroelectric (BaTiO3) and ferromagnetic (CoFe2O4) oxide nanoparticle surfaces are directly functionalized via the anchoring of phosphonic acid and aminosilane molecules that engender the nanoparticles with terminal carboxylic acid and amine functional groups, respectively. These promote the electrostatic self-assembly of the particles in non-polar solvents and permit the synthesis of more chemically robust assemblies linked by the covalent amide bond via the addition of the chemical coupling agent N - N, -dicyclohexylcarbodiimide. This functionalization and assembly procedure is applied to two systems: the first comprised of 50,nm BaTiO3 and 10,nm CoFe2O4 particles and the second of 200,nm BaTiO3 and 12.5,nm CoFe2O4 particles. The latter composites possess magnetoelectric properties when processed into dense ceramics and, as a direct result of the assembly performed in solution, have a high degree of homogeneity between the ferroelectric and ferromagnetic phases. The developed functionalization and assembly procedure is considered to be adaptable to the preparation of other hybrid oxide nanomaterials with different property combinations. [source] Parasites can cause selection against migrants following dispersal between environmentsFUNCTIONAL ECOLOGY, Issue 4 2010Andrew D. C. MacColl Summary 1.,The potential for selection against migrants to promote population divergence and speciation is well established in theory, yet there has been relatively little empirical work that has explicitly considered selection against migrants as a form of reproductive barrier, and its importance in the accumulation of reproductive isolation between populations has been overlooked until recently. 2.,Parasites often differ between environments and can be an important source of selection on hosts, yet their contribution to population divergence in general, and selection against migrants in particular, is poorly understood. 3.,Selection against migrants might be reduced if organisms escape parasitism when they disperse (natural enemy release). Alternatively, parasites could increase selection against migrants if, when they disperse, organisms encounter parasites to which they are poorly adapted. 4.,Here we test experimentally the contribution that parasites could make to selection against migrants in the adaptive radiation of three-spined sticklebacks. These fish have repeatedly colonized freshwater environments from marine ones, and this has repeatedly lead to rapid speciation. 5.,We use transplant experiments of lab-raised fish to simulate dispersal, and antihelminthic treatment to show that ancestral-type marine sticklebacks contract higher burdens of novel parasites when introduced to freshwater, than in saltwater, and suffer a growth cost as a direct result. 6.,Susceptibility to parasites and their detrimental effect is less in derived, freshwater fish from evolutionarily young populations, possibly as a result of selection for resistance. 7.,Our results support a role for parasites in selection against migrants and population diversification. They do not support the hypothesis of ,natural enemy release'. [source] Sport, Localism and Social Capital in Rural Western AustraliaGEOGRAPHICAL RESEARCH, Issue 4 2006KIM M. ATHERLEY Abstract Whilst there has been some research conducted on the role of sport in Australian rural communities, to date there has been little detailed discussion by social scientists and geographers on the association between sport and social capital. This paper identifies elements of social capital, at a community and regional social scale, which have been expressed through the activities and adaptive strategies of twenty-five sporting clubs from the wheatbelt region of Western Australia. Most of the adaptive strategies are a direct result of the clubs being exposed to the processes of rural restructuring and include amalgamation and the spatial reorganisation of sporting competition locations. The importance of localism in rural communities is also examined through the issues of trust and distrust within a regional hierarchy context. The paper illustrates how sport is not only an important part of rural life but also an activity which plays an integral role in the formation of bonding and bridging social capital. [source] Napoleon and the Universal MonarchyHISTORY, Issue 319 2010PHILIP DWYER Although the idea of ,Universal Monarchy' has existed since the early middle ages, the term started to be used pejoratively from the sixteenth century onwards. This article looks at the manner in which contemporaries perceived Napoleon's actions on the international scene, and how they used the term in relation to his foreign policy. Most of Europe's political elite believed that Napoleon was bent on some sort of ,universal domination', and that it was not limited to Europe. That perception was a direct result of an aggressive, expansionist French foreign policy. Napoleon's intentions, on the other hand, are more ambiguous. While at times he adopted a rhetoric which informed contemporary fears, the practical limits to his foreign policy were such that ,Universal Monarchy' could never be anything more than an ephemeral dream. [source] Is hospital admission a sufficiently sensitive outcome measure for evaluating medication review services?INTERNATIONAL JOURNAL OF PHARMACY PRACTICE, Issue 2 2007A descriptive analysis of admissions within a randomised controlled trial Objective The aims of the study were: to describe and assess hospital admissions occurring during a randomised controlled trial (RCT) of a pharmacist-led medication review service; to describe the admissions in terms of emergency status and main cause; to estimate the potential contribution of pharmaceutical care issues (PCIs) to admission; and to assess the proportion of admissions that could be influenced by a pharmacist intervention. Setting Within the context of a RCT of pharmacists providing medication review for 332 elderly patients living at home, taking at least four repeat medicines, carried out in one region of Scotland. Method Hospital data were obtained for all admissions occurring during the 9-month period studied, summarised and evaluated by two independent medical reviewers for the contribution of PCIs to admission. Two pharmacists assessed the extent to which PCIs were preventable by pharmacist intervention. Key findings Approximately two-thirds of the 77 admissions were unplanned, and two-thirds were to medical wards. Only 17 (22%) of all admissions were considered to be related to PCIs and 10 (13%) possibly preventable by pharmacist intervention. Although the majority of surgical admissions were considered to be unrelated to PCIs (26/29), both unplanned and planned medical admissions were related to PCIs. One of these occurred as a direct result of the pharmacist's recommendation. Conclusion The overall numbers of hospital admissions, medical admissions and unplanned admissions may not be sufficiently sensitive outcome measures for evaluating the impact of pharmacist interventions. Consideration could be given to developing categories of admission that are related to medicines or are likely to be preventable as more relevant measures. Including more details of hospital admissions in future studies may be useful. [source] Physical Rehabilitation Alters Body Composition in Chronically Obese CatJOURNAL OF ANIMAL PHYSIOLOGY AND NUTRITION, Issue 2 2008Sarah K. Abood Successful weight loss in obese dogs and cats is difficult, and even more so in pets who don't exercise regularly or are inactive. Over the past 10 years, physical rehabilitation (or physio-therapy) as a treatment or wellness modality has been gaining popularity in small animal veterinary practice. This case report describes the use of physical rehabilitation to achieve weight loss and a decreased body condition score in a chronically obese cat. A 7-year old, female-spayed domestic, short-haired cat, weighing 15 lbs, was evaluated by the Nutrition Support Service at Michigan State University's Veterinary Teaching Hospital for a weight management consultation. The cat had a history of chronic obesity and the owner reported feeding a variety of reduced or restricted-calorie foods, both canned and dry versions, over the previous 5 years. The home environment included three other cats, none of which were overweight. All cats were fed once daily in the evening; separate food bowls were provided for each cat, but multiple water bowls and litter boxes were shared. A course of 8 weeks of physio-therapy was recommended, with a target weight of 12 lbs identified, to which the owner agreed. Body weight, body condition score and circumference measures of axillary, rib and flank areas were taken at the initial visit, and at 3 weeks and 8 weeks. At the beginning of the 8th week, the cat's body weight had dropped from 15 lbs to 14.2 lbs, and the body condition score shifted down from 9 to 8 out of 9. More dramatically, however, were changes measured in body circumference: from 43 cm to 38.6 cm in the axilla (11% decrease); 50.3 cm to 42.5 cm in the ribs (15.5% decrease); 46 cm to 41 cm in the flank (11% decrease). To the author's knowledge, this is the first report confirming weight loss, reduced body condition score, and altered body composition in a cat as a direct result of physical rehabilitation. [source] The influence of age on reproductive performance in the Brown ThornbillJOURNAL OF AVIAN BIOLOGY, Issue 1 2001David J. Green I examined age effects on reproduction in the Brown Thornbill Acanthiza pusilla in Canberra, Australia. I found that the reproductive performance of both males and females improved with age, although only age-related improvement in male performance had a significant effect on annual reproductive success. Reproductive success improved with male age as a result of improved performance during two stages of the breeding cycle: first-year males were less likely to fledge young than those aged two or more, while both first and second-year males were less successful at raising fledglings to independence than males of three or more. Male performance appears to improve over three years as they gain experience at provisioning nestlings and caring for fledglings without attracting predators, rather than as a direct result of improved foraging skills. In contrast, reproductive success only improved slightly with female age, although females of two or more years initiated their first clutch earlier in the season than one-year-old females, and tended to be more likely to re-nest if a breeding attempt failed. The poor performance of young females appears unlikely to be related to their foraging ability but may be associated with costs imposed by dispersing to a breeding vacancy earlier in the year. Although the reproductive performance of Brown Thornbills improves considerably with age I found no evidence that performance improved as a result of repeated breeding attempts with the same partner. [source] Abandonment of farmland and vegetation succession following the Eurasian plague pandemic of ad 1347,52JOURNAL OF BIOGEOGRAPHY, Issue 4 2007Dan Yeloff Abstract Aim, This paper reviews the available documentary, archaeological and palaeoecological evidence for the abandonment of agricultural land and consequent regeneration of the forest in Europe after the Black Death. Location, Western and northern Europe. Methods, This review is the result of an exhaustive search of the historical, archaeological and palaeoecological literature for evidence indicating agricultural decline and forest regeneration in Eurasia during the 14th century. The available evidence for landscape change can be divided into two categories: (1) documentary and archaeological sources, and (2) palaeoecological reconstructions of past vegetation. In the past few years, several pollen diagrams from north-west Europe have been reported with precise chronologies (decadal and even annual scale) showing the abandonment of farmland and consequent ecological change in the late medieval period. Results and main conclusions, There is strong evidence of agricultural continuity at several sites in Western Europe at the time of the Black Death. The effects of the Black Death on the European rural landscape varied geographically, with major factors probably including the impact of the plague on the local population, and soil quality. At two sites in western and northern Ireland, the late medieval decline in cereal agriculture was probably a direct result of population reduction following the Black Death. In contrast, the decline in cereal production began at sites in Britain and France before the Black Death pandemic of ad 1347,52, and was probably due to the crisis in the agricultural economy, exacerbated by political instability and climate deterioration. Much of the abandoned arable land was probably exploited for grazing during the period between the decline in cereal farming and the Black Death. In the aftermath of the Black Death, grazing pressure was greatly reduced owing to reductions in the grazing animal population and a shortage of farmers. Vegetation succession on the abandoned grazing land resulted in increased cover of woody tree species, particularly Betula and Corylus, by the late 14th century. The cover of woodland was greatest at c.ad 1400, before forest clearance and agriculture increased in intensity. [source] Understanding social suffering: a phenomenological investigation of the experience of inequalityJOURNAL OF COMMUNITY & APPLIED SOCIAL PSYCHOLOGY, Issue 4 2005S. J. Charlesworth Abstract As global market conditions erode traditional forms of solidarity, there is evidence of psychological disturbance among a number of social groups as a direct result. This paper investigates this issue among a disadvantaged working-class group in South Yorkshire (England) and argues that understanding emerging forms of social suffering requires both a social and a person-centred approach that transcends normal clinical/psycho-analytic accounts. The attempt here is to create well-founded terms of reference that will support investigators who seek to embed agents' case histories in a social-psychological framework as they set about illuminating social pathologies. The paper attempts to trace the contours of pathology holistically by following its traces as they are manifest in everyday experience and articulated in conversation; thus putting agents' everyday perceptions of the data at the heart of this account. Copyright © 2005 John Wiley & Sons, Ltd. [source] Evolution of bite performance in turtlesJOURNAL OF EVOLUTIONARY BIOLOGY, Issue 6 2002A. Herrel Abstract Among vertebrates, there is often a tight correlation between variation in cranial morphology and diet. Yet, the relationships between morphological characteristics and feeding performance are usually only inferred from biomechanical models. Here, we empirically test whether differences in body dimensions are correlated with bite performance and trophic ecology for a large number of turtle species. A comparative phylogenetic analysis indicates that turtles with carnivorous and durophagous diets are capable of biting harder than species with other diets. This pattern is consistent with the hypothesis that an evolutionary increase in bite performance has allowed certain turtles to consume harder or larger prey. Changes in carapace length tend to be associated with proportional changes in linear head dimensions (no shape change). However, maximum bite force tends to change in proportion to length cubed, rather than length squared, implying that changes in body size are associated with changes in the design of the jaw apparatus. After the effect of body size is accounted for in the analysis, only changes in head height are significantly correlated with changes in bite force. Additionally, our data suggest that the ability to bite hard might trade off with the ability to feed on fast agile prey. Rather than being the direct result of conflicting biomechanical or physiological demands for force and speed, this trade-off may be mediated through the constraints imposed by the need to retract the head into the shell for defensive purposes. [source] Thermal stability of vaccinesJOURNAL OF PHARMACEUTICAL SCIENCES, Issue 2 2003Duane T. Brandau Abstract Worldwide vaccination programs against infectious diseases and toxins are estimated to save approximately 3 million lives yearly. Tragically, however, another 3 million individuals (primarily children) die of vaccine-preven diseases. A significant portion of this problem results from the thermal instability of many of the currently used vaccines. This review argues that modern methods of physical and chemical analysis permit for the first time characterization of the degradative pathways of thermally labile vaccines. A rigorous description of these pathways permit a more rational and systematic approach to the stabilization of vaccines. A direct result of the replacement of currently employed, primarily empirical, approaches to vaccine stabilization with a more molecular-based methodology should be the development of more universally available vaccinations against life-threatening diseases. This has the potential to have a dramatic impact on world health. © 2003 Wiley-Liss, Inc. and the American Pharmaceutical Association J Pharm Sci 92:218,231, 2003 [source] Isolation and characterization of microsatellite loci in Bemisia tabaciMOLECULAR ECOLOGY RESOURCES, Issue 1 2003P. J. De Barro Abstract Bemisia tabaci (Hemiptera: Aleyrodidae) is a haplo-diploid species with a global distribution demonstrating strong geographical structure with eight recognizable genetic groups. Fifteen microsatellite loci (335 alleles, 6,44 alleles per locus) were derived from four of the eight groups and were then screened across 33 populations. These loci clearly differentiate the populations. The microsatellites amplified best in individuals from genetic groups rep-resenting the Mediterranean, Middle East, Asia (three groups) and Australasia/Oceania and amplified less well with populations from sub-Saharan Africa and the New World. This differential amplification pattern is a direct result of the relatedness to the microsatellite source material. [source] Tribute chromite mining and environmental management on the northern Great Dyke of ZimbabweNATURAL RESOURCES FORUM, Issue 2 2002Oliver Maponga A combination of poor mining methods, waste storage and disposal systems, as well as the day-to-day activities associated with tribute and contract chromite mining are primarily responsible for environmental problems on the Zimbabwe Great Dyke. For instance, the unsystematic dumping of waste rocks in rivers blocks channels and results in flooding, which further sterilizes agricultural land and mineral resources. Erosion of these haphazardly located dumps causes siltation of water bodies and results in the dispersion of heavy metals in soils and watercourses. Vegetation growth on waste dumps is limited and constrained by the high pH levels from phytotoxic metals in soils, the lack of nutrients, poor moisture retention qualities of the mining waste and critical cation imbalances within dumps. This article attributes poor environmental management on the Dyke to poverty, a direct result of the nature of tribute agreements and output prices. Prices based on output targets are exploitative and undervalue labour and thus perpetuate poverty. By absolving claim holders from environmental liability, tribute agreements contribute directly to environmental problems. Thus, the incorporation of enforceable dual environmental responsibility requirements in contract mining agreements is needed to overcome this problem. This article recommends that, to break the poverty cycle, the primary cause of environmental mismanagement in the sector, miners need to be empowered through claim ownership and the enhancement of their capacity to negotiate prices with buyers of chrome. [source] The impact of formal education and training on urodynamic practice in the United Kingdom: A surveyNEUROUROLOGY AND URODYNAMICS, Issue 5 2006Julie Ellis-Jones Abstract Aim A previous survey of personnel performing urodynamics had shown that half of the respondents thought that their training had been inadequate. In order to address this the outcome of a 4-day practical course for teaching urodynamics, which has been running since 1995 at the Bristol Urological Institute, was reviewed. We were not aware of any published studies that have assessed the impact of formal urodynamic training on clinical practice. With this in mind we set out to determine whether the education and training we had given had changed urodynamic practice in the UK. Methods Postal questionnaires were sent out to 84 delegates who had attended the course over a 2-year period (2001,2003). Paired questionnaires were used to assess urodynamic practice before and after the course and also to establish whether their practice had changed as a direct result of attending the certificate course. Results The results suggested that 79% of those responders had changed their practice since completing the course. Significant changes to practice were observed in checking calibration, confidence in setting-up equipment, interpretation of urodynamic traces and ability to check the accuracy of the results. Conclusions The results of this survey suggest that attendance at a recognised urodynamic training course has had an impact on clinical practice in the UK. Training and education raises the level of confidence and ability to perform and interpret urodynamic investigations, which has wide implications for the accuracy, reliability and consistency of urodynamic investigations performed by those without formal training. Neurourol. Urodynam. © 2006 Wiley-Liss, Inc. [source] Leg clubs: A new approach to patient-centred leg ulcer managementNURSING & HEALTH SCIENCES, Issue 3 2000DNCERT, DipHE, Ellie Lindsay BSC(HONS) Abstract Loneliness is a significant health-care issue for many elderly patients in the community. The correlation between social isolation, poor compliance to treatment, and low healing rates for patients suffering from leg ulcers is well documented. Pain, odour, bandages etc. contribute to low self-esteem, depression and social stigma. Home visits by community nurses cannot provide the social and psychological support required by these patients. Responding to the holistic needs of this client group, the author set up Debenham Leg Club in 1995 to provide leg ulcer management in an informal, non-medical setting, where the emphasis is on social interaction, participation, empathy and peer support. This social model was conceived as a unique partnership between the district nurses and the local community, in which patients are empowered, through a sense of ownership, to become stakeholders in their own treatment. The value of the ,club' concept is evident in the happy, welcoming, uninhibited atmosphere that characterizes the clinic. Non-compliance to treatment has been virtually eliminated and evidence of greater healing rates has been illustrated through many patients whose long-standing ulcers have healed or greatly improved as a direct result of this change in approach. Patients' willingness to attend for systematic ,well leg' checks and ongoing health education has dramatically reduced the incidence of recurrence. [source] Experiences of intensive care nurses assessing sedation/agitation in critically ill patientsNURSING IN CRITICAL CARE, Issue 4 2008Stephanie Weir Abstract Background:, Patients admitted to the intensive care unit (ICU) will more often than not require sedative and analgesic drugs to enable them to tolerate the invasive procedures and therapies caused as a result of their underlying condition and/or necessary medical interventions. Aim:, This article reports a study exploring the perceptions and experiences of intensive care nurses using a sedation/agitation scoring (SAS) tool to assess and manage sedation and agitation amongst critically ill patients. The principle aims and objectives of this study were as follows: ,,to explore nurse's everyday experiences using a sedation scoring tool; ,,to explore and understand nurse's attitudes and beliefs of the various components of assessing and managing sedation among critically ill patients. Method:, Using a descriptive qualitative approach, semistructured interviews were carried out with a purposive sample of eight ICU nurses within a district general hospital ICU. The interviews focused on nurse's own experiences and perceptions of using a sedation scoring tool in clinical practice. Burnard's 14-stage thematic content analysis framework was employed to assist in the data analysis process. Results:, Three key themes emerged that may have implications not only for clinical practice but for further research into the use of the SAS tool. ,,Benefits to patient care as a direct result of using a sedation scoring tool. ,,The concerns of nursing staff. ,,The implications of using such a tool in clinical practice. Conclusion:, This paper reinforces the potential benefits to patients as a direct result of implementing the SAS scoring tool and clinical guidelines. Furthermore, it highlights the reluctance of a number of staff to adhere to such guidelines and discusses the concerns regarding less experienced nurses administering sedative agents. Attention was also drawn to the educational requirements of nursing and medical staff when using the SAS scoring tool. [source] Settlement, Landscape and Social Identity: The Early-Middle Bronze Age Transition in Wessex, Sussex and the Thames ValleyOXFORD JOURNAL OF ARCHAEOLOGY, Issue 3 2000Joanna Brück In southern England, the end of the Early Bronze Age is marked by the appearance of archaeologically visible farmsteads and field systems. This paper explores and critiques the widespread idea that these changes are the direct result of a need to intensify agricultural production. Such discussions have implicitly drawn on evolutionist images of economic maximization and environmental exploitation that do not sit easily with our knowledge of other aspects of Bronze Age society. In this paper, I shall consider economic change as a consequence rather than the cause of wider changes to the social fabric at this time. A review of the Early and Middle Bronze Age settlement evidence provides insights into how society became transformed over the period and begins to hint at some of the reasons why subsistence practices changed so visibly. [source] Vertebral artery atherosclerosis: a risk factor in the use of manipulative therapy?PHYSIOTHERAPY RESEARCH INTERNATIONAL, Issue 3 2002Jeanette Mitchell BSc (Physiotherapy), MSc Senior Lecturer Abstract Background and Purpose Vertebrobasilar insufficiency, a direct result of compromised blood flow in the vertebrobasilar circulation, may be caused by stretching and/or compression of the vertebral arteries, particularly if superimposed on underlying atherosclerosis of the vessels. This is an important consideration when using manipulative therapy techniques. The aim of the present study was to investigate the incidence of atherosclerosis and to calculate the relative associated decrease in blood flow in the third and fourth parts of the vertebral artery, in a sample of the adult population. Method A laboratory-based experimental investigation was used to study 362 vertebral arteries from embalmed adult cadavers that were routinely processed for light microscopic study. The incidence of each grade of atherosclerosis in the vessels was recorded. Atherosclerosis was classified as grades 0,5, where Grade 0 represented no atherosclerosis and Grade 5 a fully developed plaque occluding more than 75% of the vessel lumen. From mean measurements of 188 of these arteries, the estimated decrease in luminal cross-sectional area and the relative decrease in blood flow in the atherosclerotic vessels were calculated. Results The highest incidence of atherosclerosis found was Grade 3 (third part of the vertebral artery (VA3): 42.0%; fourth part of the vertebral artery (VA4): 35.2%). An estimated decrease in artery luminal cross-sectional area to 6.2% of normal in Grade 5 atherosclerosis was found. Because blood flow is proportional to the fourth power of the vessel radius, relative decreases in blood flow in grades 1,5 atherosclerosis from 100% to 0% (with critical closing pressure in vessels), respectively, are likely to occur. Conclusions These data suggest that, as significant numbers of the sample showed marked (Grade 3+) atherosclerosis, concomitant with decreased blood flow in the vertebral arteries, this population is at risk for developing vertebrobasilar insufficiency. Because other Western populations may be similarly at risk, particular care should be taken when considering the use of rotational manipulative therapy techniques in treatments of the cervical spine. Copyright © 2002 Whurr Publishers Ltd. [source] What should we do about the obesity epidemic?PRACTICAL DIABETES INTERNATIONAL (INCORPORATING CARDIABETES), Issue 4 2002Dr Julian H. Barth MD The current increase in obesity is occurring despite increasing awareness by the population at large of the benefits of healthy eating and exercise. Although weight gain is the direct result of a mismatch in energy balance, it is important to realise that there is a complex interplay between the environment and individual biology and behaviour. Management of obesity whether in a primary or secondary care setting requires a multi-disciplinary team to produce an individualised approach to embrace food, exercise and behavioural change. The prevention of obesity requires a three-level approach. First, there needs to be a co-ordinated public health policy at national level to create an environment where it is easy to make healthy choices for physical activity and food. Second, there needs to be a policy that targets those individuals who are at risk of becoming obese and those who have lost weight to help prevent weight regain. Finally, there needs to be a systematic uptake of the established protocols for the management of individuals with obesity and its co-morbidities. The challenge in the UK is to build imaginative networks that integrate all available resources both within the NHS and without, such as sports centres, fitness clubs and slimming clubs. Copyright © 2002 John Wiley & Sons, Ltd. [source] Electro-Thermal Dynamic Stripping Process for in situ remediation under an occupied apartment buildingREMEDIATION, Issue 3 2003Bruce C.W. McGee The implementation and performance results of the Electro-Thermal Dynamic Stripping Process (ET-DSPÔ) used in combination with high-vacuum dual-phase extraction are presented here. The technology was selected to remove vapor pressure-sensitive benzene, toluene, ethyl benzene, and xylene (BTEX) compounds from under an occupied residential apartment building. Operating within several engineering, environmental, and safety constraints, a design was developed to conduct electrical heating and in situ extraction operations without disruption of the daily activities of the residents within the apartment complex and general area. The results consistently showed a significant reduction in the concentration of hydrocarbons with non-detectable levels being achieved in all of the samples that were tested. This is a direct result of a substantial temperature increase of the soil and concurrent increase in the hydrocarbon vapor pressure from the ET-DSPÔ system. © 2003 Wiley Periodicals, Inc. [source] Toronto's gay village (1969,1982): plotting the politics of gay identityTHE CANADIAN GEOGRAPHER/LE GEOGRAPHE CANADIEN, Issue 1 2006Catherine Jean Nash Between the late 1960s and the early 1980s, a loose association of gay social spaces consolidated into what is now known as the ,gay village' in the Church and Wellesley street areas in downtown Toronto. Scholars argue that, while these residential and commercial districts evolved prior to the formation of organized gay political organizations, they suggest that the emergence of these districts as political and commercial districts was a direct result of deliberate local gay activism. I argue here that contrary to this literature and for much of its history, the gay movement was largely opposed to the existence of specifically gay-identified spaces, particularly those operated by both heterosexual and homosexual businesspersons. Toronto's gay activists, using different ideological frameworks, struggled to constitute a homosexual identity that stood mainly in opposition to the so-called ,ghetto gay' and to construct alternative spaces that were seen as more appropriate to the formation of a properly politicized homosexual identity. Nevertheless, by the early 1980s, as the gay village continued to thrive and as the players in gay movement politics changed, the gay ghetto became the gay village and was celebrated as a location of political strength and social necessity. This article explores that material and symbolic transformation. Entre les années 60 en retard et le début des années 80, une association lâche des espaces sociaux gais consolidés dans ce qui est maintenant connu comme ,village gai ,dans l'église et la région de rues de Wellesley dedans Toronto du centre. Les disciples discutent cela tandis que ces résidentiel et commercial les zones ont évolué avant la formation de politique gai organisé des organismes, ils proposent que l'apparition de ces zones comme politique et les zones commerciales étaient un résultat direct d'activisme gai local délibéré. J'argue du fait ici que contraire à cette littérature et pour beaucoup de son histoire, le mouvement gai a été en grande partie opposéà l'existence spécifiquement de gai les espaces identifiés, en particulier ceux ont fonctionné par le hétérosexuel et hommes d'affaires homosexuels. Les activistes gais de Toronto, en utilisant idéologique différent cadres, luttés pour constituer homosexuel d'identité tenu principalement dedans opposition au prétendu ,ghetto gai ,et aux espaces d'alternative de construction cela ont été vus comme plus appropriéà la formation de l'correctement politisée identité homosexuelle. Néanmoins, par le début des années 80, comme village gai suite pour prospérer et pendant que les joueurs dans la politique gaie de mouvement changeaient, le ghetto gai est devenu le village gai et a été célébré comme endroit de politique force et nécessité sociale. Ces article explore ce matériel et symbolique transformation. [source] Therapeutic Efficacy of the Epley Canalith Repositioning Maneuver,THE LARYNGOSCOPE, Issue 6 2001Michael J. Ruckenstein MD Abstract Objectives/Hypotheses The hypotheses of the current study are as follows: 1) That if the Epley canalith repositioning maneuver is an effective treatment for benign positional vertigo (BPV), relief from the vertigo should occur virtually immediately after the performance of the maneuver; 2) that the Epley canalith repositioning maneuver does provide almost immediate relief in BPV and should be the established treatment of choice for this disorder in both primary and tertiary care settings; and 3) that residual symptoms of lightheadedness and imbalance do persist after the resolution of the vertigo. The distinction of these symptoms from the vertigo is required for the accurate evaluation of the efficacy of positional maneuvers. Study Design Prospective cohort study in a tertiary care balance center. Methods Eighty-six patients (95 cases) with a history and physical examination consistent with active BPV were entered in the study. Patients were treated with a modified Epley canalith repositioning maneuver. A modified 360° roll was used to treat those patients with horizontal canal BPV. Patients were provided with a preprinted diary in which they were to circle the answer most relevant to their symptoms for 14 days after the maneuver. Patients were then re-evaluated in the office at 2 weeks after the maneuver. Results The mean duration of the BPV before treatment was 9 weeks. Seventy-four percent of cases that were treated with one or two canalith repositioning maneuvers had a resolution of vertigo as a direct result of the maneuver. A resolution attributable to the first intervention was obtained in 70% of cases within 48 hours of the maneuver. An additional 14% of cases that were treated had a resolution of vertigo; however, it is not possible to say that these patients definitely benefited from the canalith repositioning maneuver. Only 4% of cases (three patients) manifested BPV that persisted after four treatments. Residual symptoms of lightheadedness or imbalance, or both, were frequent (47% of cases) but rarely required formal intervention with vestibular rehabilitation physical therapy. Conclusions The Epley canalith repositioning maneuver results in a resolution of vertigo in the majority of patients (70% of cases) immediately after one treatment. It is safe and requires no special equipment or investigations. It should be established as the treatment of choice for BPV in both primary and tertiary care settings. [source] Some dynamical aspects of tropical cyclone concentric eyewallsTHE QUARTERLY JOURNAL OF THE ROYAL METEOROLOGICAL SOCIETY, Issue 632 2008Christopher M. Rozoff Abstract The intensification of tropical cyclones is often interrupted by an eyewall replacement cycle, a process in which an outer eyewall forms, contracts, and replaces an inner eyewall. The radial distributions of inertial stability and diabatic heating change during such events, impacting the transverse circulation. To examine the effects of such changes, an analytical solution of the transverse circulation equation associated with a balanced vortex model is derived using a parameterization that distinguishes five radial regions subdividing the domain by each region's values of inertial stability and diabatic heating. These regions define the eye, inner eyewall, moat, outer eyewall, and far-field. In mature concentric eyewall situations, the solutions do not support the hypothesis that the inner eyewall collapses as a direct result of subsidence from the outer eyewall. However, the results suggest subsidence and warming temperatures in the moat are governed by enhanced inertial stability associated with a strengthening outer eyewall. The model solutions also illustrate how the diabatic heating in the inner eyewall, imbedded in a region of high inertial stability, induces larger temperature tendencies than the diabatic heating in the outer eyewall, which borders the far-field region of low inertial stability. Thus, as the inner eyewall dies, the storm temporarily loses its ability to produce an intense, localized warm region. This ability is restored during the contraction and intensification of the outer eyewall. These results provide a partial dynamical explanation of how an eyewall replacement cycle can act as a temporary brake on tropical cyclone intensification. Copyright © 2008 Royal Meteorological Society [source] Identifying the origins of fishing gear ingested by seabirds: a novel multivariate approachAQUATIC CONSERVATION: MARINE AND FRESHWATER ECOSYSTEMS, Issue 6 2010Cindy Ridley Abstract 1.The global decline of albatrosses (Diomedidae: Procellariiformes) is thought to have occurred largely as a direct result of fishery-related mortality. Albatrosses and other large petrels interact with fisheries in several ways, including scavenging used bait and discarded offal, which may contain hooks. 2.Hooks that are ingested by breeding birds are often fed to chicks which subsequently regurgitate them shortly before fledging. 3.In this study a series of mathematical (cladistic, cluster and principal components) analyses are applied to a sample of 241 items of fishing gear (hook, snood and hook/snood unit) collected from seabird nest sites on Bird Island, South Georgia, and 44 reference gear items provided by four South Atlantic regional fisheries. 4.The five separate analyses failed to assign most gear to a particular fishery or to identify any consistent annual trends. The homogeneous nature of the material, which was largely derived from the same manufacturers, meant that gear origin could not be determined. This suggests that hooks found at seabird colonies in this, and potentially other regions, will be of limited use in identifying offending fisheries, unless operators are obliged to deploy gear with unique marks in the future. 5.Nevertheless, it is suggested that this approach should work effectively where birds interact with a range of fisheries targeting different species using variable gear. This study therefore represents an innovative approach to the characterization of lost fishing gear with potentially widespread application. Copyright © 2010 John Wiley & Sons, Ltd. [source] | |||||||||||||||||||||||||||||||||||||