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Kinds of Alert Terms modified by Alert Selected AbstractsDevelopmental Considerations for Substance Use Interventions From Middle School Through CollegeALCOHOLISM, Issue 3 2005Elizabeth J. D'Amico This article summarizes a symposium organized by Dr. Elizabeth D'Amico and presented at the 2004 Annual Meeting of the Research Society on Alcoholism in Vancouver, Canada. The four presentations illustrate the importance of creating substance use interventions that are developmentally appropriate for youth. They represent innovative approaches to working with preteens, teenagers, and young adults. Dr. D'Amico's paper describes her research on the development of a voluntary brief intervention targeting alcohol use among middle school students. Findings indicated that by using school and community input, she was able to obtain a diverse a sample of youth across grades, sex, ethnicity, and substance use status. Dr. Ellickson's paper describes her research on Project ALERT, a school-based prevention program for middle school youth. Her findings indicate that Project ALERT worked for students at all levels of risk (low, moderate, and high) and for all students combined. Dr. Wagner's Teen Intervention Project was a randomized clinical trial to test the efficacy of a standardized Student Assistance Program for treating middle and high school students with alcohol and other drug problems. The study provided a unique opportunity to begin to examine how development may impact response to an alcohol or other drug intervention. Dr. Turrisi's paper examined processes underlying the nature of the effects of a parent intervention on college student drinking tendencies. Findings suggested that the parent intervention seems to have its impact on student drinking by reducing the influence of negative communications and decreasing the susceptibility of influences from closest friends. Dr. Kim Fromme provided concluding remarks. [source] No detrimental effect on renal function during long-term use of fluvastatin in renal transplant recipients in the Assessment of Lescol in Renal Transplantation (ALERT) studyCLINICAL TRANSPLANTATION, Issue 6 2006Bengt Fellström Abstract:, Background:, Concerns have recently been raised regarding a potential harmful effect of statins on renal function. This study investigated the effect of fluvastatin treatment on renal function in renal transplant recipients enrolled in the Assessment of Lescol in Renal Transplantation (ALERT) trial. Methods:, ALERT was a randomized, double-blind, placebo-controlled study of the effect of fluvastatin, 40,80 mg daily (n = 1050) or placebo (n = 1052) on cardiac and renal outcomes in renal transplant recipients over a follow-up period of five to six years. The incidence of graft loss, changes in serum creatinine, calculated creatinine clearance and proteinuria, and the incidence of renal adverse events (AEs) were assessed in both treatment groups. Results:, Fluvastatin treatment in ALERT had no significant effect compared with placebo on renal function, assessed by serum creatinine (overall adjusted mean ± SEM: fluvastatin, 175.4 ± 2.20 ,mol/L; placebo, 172.7 ± 2.20 ,mol/L; p = 0.39), creatinine clearance (fluvastatin, 55.3 ± 0.30 mL/min; placebo, 55.8 ± 0.30 mL/min; p = 0.26) or proteinuria (fluvastatin, 0.58 ± 0.03 g/24 h; placebo, 0.53 ± 0.03 g/24 h; p = 0.31). There were no significant differences between treatment groups when the 283 patients suffering graft loss were excluded from the analysis. Fluvastatin also had no detrimental effect on creatinine clearance or proteinuria in the subgroup of 340 diabetic patients without graft loss in ALERT. No notable differences in the rate of renal or musculoskeletal AEs were observed between fluvastatin and placebo groups. Conclusions:, Fluvastatin had no detrimental effect on renal function, or the risk of renal AEs, in renal transplant recipients with or without diabetes enrolled in ALERT. Fluvastatin treatment for the prevention of cardiac events may therefore be used without fear of jeopardizing renal function. [source] Structure validation in chemical crystallographyACTA CRYSTALLOGRAPHICA SECTION D, Issue 2 2009Anthony L. Spek Automated structure validation was introduced in chemical crystallography about 12,years ago as a tool to assist practitioners with the exponential growth in crystal structure analyses. Validation has since evolved into an easy-to-use checkCIF/PLATON web-based IUCr service. The result of a crystal structure determination has to be supplied as a CIF-formatted computer-readable file. The checking software tests the data in the CIF for completeness, quality and consistency. In addition, the reported structure is checked for incomplete analysis, errors in the analysis and relevant issues to be verified. A validation report is generated in the form of a list of ALERTS on the issues to be corrected, checked or commented on. Structure validation has largely eliminated obvious problems with structure reports published in IUCr journals, such as refinement in a space group of too low symmetry. This paper reports on the current status of structure validation and possible future extensions. [source] Can First Responders Be Sent to Selected 9-1-1 Emergency Medical Services Calls without an Ambulance?ACADEMIC EMERGENCY MEDICINE, Issue 4 2003Craig B. Key MD Objectives: To evaluate the feasibility and safety of initially dispatching only first responders (FRs) to selected low-risk 9-1-1 requests for emergency medical services. First responders are rapidly-responding fire crews on apparatus without transport capabilities, with firefighters trained to at least a FR level and in most cases to the basic emergency medical technician (EMT) level. Low-risk 9-1-1 requests include automatic medical alerts (ALERTs), motor vehicle incidents (MVIs) for which the caller was unable to answer any medical dispatch questions designed to prioritize the call, and 9-1-1 call disconnects (D/Cs). Methods: A before-and-after study of patient dispositions was conducted using historical controls for comparison. During the historical control phase of six months, one year prior to the study phase, basic life support ambulances (staffed with two basic EMTs) were dispatched to selected low-risk 9-1-1 incidents. During the six-month study phase, a fire FR crew equipped with automated external defibrillators (AEDs) was sent initially without an ambulance to these incidents. Results: For ALERTs (n= 290 in historical group vs. 330 in study group), there was no statistical difference in the transport rate (7% vs 10%), but there was a statistically significant increase in the follow-up use of advanced life support (ALS) (1% vs 4%, p = 0.009). No patient in the ALERTs historical group required airway management, while one patient in the study group received endotracheal intubation. No patient required defibrillation in either group. Analysis of the MVIs showed a significant decrease (p < 0.0001) in the patient transport rate from 39% of controls to 33% of study patients, but no change in the follow-up use of ALS interventions (2% for each group). For both the ALERTs and MVIs, the FR's mean response time was faster than ambulances (p < 0.0001). Among the 9-1-1 D/Cs with FRs only (n= 1,028), 15% were transported and 43 (4%) received subsequent ALS care. Four of these patients (0.4%) received intubation and two (0.2%) required defibrillation. However, no patient was judged to have had adverse outcomes as a result of the dispatch protocol change. Conclusions: Fire apparatus crews trained in the use of AEDs can safely be used to initially respond alone (without ambulances) to selected, low-risk 9-1-1 calls. This tactic improves response intervals while reducing ambulance responses to these incidents. [source] Effects of a 10% Carbamide Peroxide Bleaching Agent on Roughness and Microhardness of Packable Composite ResinsJOURNAL OF ESTHETIC AND RESTORATIVE DENTISTRY, Issue 4 2005ROBERTA TARKANY BASTING DDS ABSTRACT Purpose:: Bleaching agents containing 10% carbamide peroxide may be applied to the surface of preexisting packable resin-based composite restorations. The aim of this in vitro study was to evaluate the effect of a 10% carbamide peroxide bleaching agent (Review, SS White, Rio de Janeiro, Brazil) on surface roughness and microhardness of three packable resin-based composites (Fill Magic condensable, Vigodent, Rio de Janeiro, Brazil; Alert, Jeneric Pentron, Wallingford, CT, USA; Definite, Degussa, Hanau, Germany). Materials and Methods: For the control (no bleaching) and experimental (bleaching treatment) groups, 12 specimens of each material were prepared in cylindrical acrylic molds. The experimental specimens were exposed to the bleaching agent for 6 hours a day for 3 weeks. During the remaining time (18 h), they were stored in artificial saliva. The control specimens remained immersed in artificial saliva throughout the experiment. Surface roughness and microhardness measurements were performed on the top surface of each specimen. Results: Analysis of variance and the Tukey test showed no significant differences in roughness among the packable composites evaluated (p=.18), but those submitted to the treatment with a 10% carbamide peroxide bleaching agent displayed significantly higher mean surface roughness than did the corresponding control group for each material. For the microhardness tests, there were significant differences among materials (p < .0001). Alert showed the highest microhardness values followed by Definite and Fill Magic condensable. Conclusions: Ten percent carbamide peroxide bleaching agents may change the surface roughness of packable composites, but they do not alter their microhardness. [source] Recollections of Irving H. Sher 1924,1996: Polymath/information scientist extraordinaireJOURNAL OF THE AMERICAN SOCIETY FOR INFORMATION SCIENCE AND TECHNOLOGY, Issue 14 2001Eugene Garfield Over a 35-year period, Irving H. Sher played a critical role in the development and implementation of the Science Citation Index® and other ISI® products. Trained as a biochemist, statistician, and linguist, Sher brought a unique combination of talents to ISI as Director of Quality Control and Director of Research and Development. His talents as a teacher and mentor evoked loyalty. He was a particularly inventive but self-taught programmer. In addition to the SCI,® Social Sciences Citation Index,® and Arts and Humanities Citation Index,® Sher was involved with the development of the first commercial SDI system, the Automatic Subject Citation Alert, now called Research Alert,® and Request-A-Print Cards. Together we developed the journal impact factor and the Journal Citation Reports.® Sher was also the inventor of the SYSTABAR System of coding references and Sherhand. He was involved in key reports on citation-based historiography, forecasting Nobel prizes, and served as a referee for JASIS over a 20-year period. [source] Arsenic and thallium data in environmental samples: Fact or fiction?REMEDIATION, Issue 4 2010Susan D. Chapnick Matrix effects may increasingly lead to erroneous environmental decisions as regulatory limits or risk-based concentrations of concern for trace metals move lower toward the limits of analytical detection. A U.S. Environmental Protection Agency Office of Technical Standards Alert estimated that environmental data reported using inductively coupled plasma spectrometry (ICP-AES) has a false-positive rate for thallium of 99.9 percent and for arsenic of 25 to 50 percent. Although this does not seem to be widely known in the environmental community, using three case studies, this article presents data in environmental samples that demonstrate severe matrix effects on the accuracy of arsenic and thallium results. Case Study 1 involves soil results with concentrations that approached or exceeded the applicable regulatory soil cleanup objectives of 13 mg/kg for arsenic and 2 mg/kg for thallium. Reanalysis using ICP coupled with a mass spectrometer (ICP-MS) confirmed all thallium results were false positives and all arsenic results were biased high, concluding no action was required for soil remediation. Case Study 2 involves groundwater results for thallium at a Superfund site, where thallium was detected in groundwater up to 21.6 , g/L using ICP-AES. Reanalysis by ICP-MS reported thallium as nondetect below the applicable regulatory level in all samples. ICP-MS is usually a more definitive and accurate method of analysis compared to ICP-AES; however, this is not always the case, as we demonstrate in Case Study 3, using data from groundwater samples at an industrial site. Through a weight-of-evidence approach, it is demonstrated that although method quality control results were acceptable, interferences in some groundwater samples caused biased high results for arsenic using ICP-MS, which were significantly lower when reanalyzed using hydride generation atomic fluorescence spectrometry. Causes of these interference effects and conclusions from the three case studies to obtain accurate metal data for site assessment, risk characterization, and remedy selection are discussed. © 2010 Wiley Periodicals, Inc. [source] Simple bedside assessment of level of consciousness: comparison of two simple assessment scales with the Glasgow Coma scale,ANAESTHESIA, Issue 1 2004A. F. McNarry Summary Neurological assessment is an essential component of early warning scores used to identify seriously ill ward patients. We investigated how two simple scales (ACDU , Alert, Confused, Drowsy, Unresponsive; and AVPU , Alert, responds to Voice, responds to Pain, Unresponsive) compared to each other and also to the more complicated Glasgow Coma Scale (GCS). Neurosurgical nurses recorded patients' conscious level with each of the three scales. Over 7 months, 1020 analysable measurements were collected. Both simple scales identified distinct GCS ranges, although some overlap occurred (p < 0.001). Median GCS scores associated with AVPU were 15, 13, 8 and 6 and for ACDU were 15, 13, 10 and 6. The median values of ACDU were more evenly distributed than AVPU and may therefore be better at identifying early deteriorations in conscious level when they occur in critically ill ward patients. [source] IDentify, Educate and Alert (IDEA) trial: an intervention to reduce postnatal depressionBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 9 2003Joan Webster Objective To test the effectiveness of a prenatal intervention in reducing the incidence of postnatal depression. Design A randomized controlled trial. Setting A large metropolitan obstetric hospital. Population or sample Pregnant women with risk factors for postnatal depression. Methods Women attending their first prenatal visit at the Royal Women's Hospital, Brisbane, were screened for risk factors for postnatal depression (IDentify). Positively screened women were randomly allocated to the intervention group or the control group. The intervention consisted of a booklet about postnatal depression, which included contact numbers; prenatal screening using the Edinburgh Postnatal Depression Scale; a discussion with the woman about her risk of developing postnatal depression (Educate); and a letter to the woman's referring general practitioner and local Child Health Nurse, alerting them of the woman's risk for postnatal depression (Alert). Main outcome measure Edinburgh Postnatal Depression Scale Score> 12 at 16 weeks postpartum. Results Of the 509 women who were sent a follow up questionnaire, 371 (72.9%) responded. The proportion of women who reported an Edinburgh Postnatal Depression Scale score of>12 was 26%. There were no significant differences between intervention (46/192, 24%) and control groups (50/177, 28.2%) on this primary outcome measure (OR 0.80; 95% CI 0.50,1.28). Conclusion Over one-quarter of women with risk factors will develop postnatal depression. It is a treatable disorder but under-diagnosis is common. Efforts to reduce postnatal depression by implementing interventions in the prenatal period have been unsuccessful. [source] Comparison of different methods of bacterial detection in blood componentsISBT SCIENCE SERIES: THE INTERNATIONAL JOURNAL OF INTRACELLULAR TRANSPORT, Issue 1 2009M. Schmidt Background, Over the last two decades, the residual risk of acquiring a transfusion-transmitted viral infection has been reduced to less than 1 : 1 000 000 via improvements in different techniques (e.g. donor selection, leuco-depletion, introduction of 3rd or 4th generation enzyme-linked immunosorbent assays and mini-pool nucleic acid testing (MP-NAT). In contrast, the risk for transfusion-associated bacterial infections has remained fairly stable, and is estimated to be in a range between 1 : 2000 and 1 : 3000. Platelets are at an especially higher risk for bacterial contamination, because they are stored at room temperature, which provides good culture conditions for a broad range of bacterial strains. To improve bacterial safety of blood products, different detection systems have been developed that can be divided into culture systems like BacT/ALERT or Pall eBDS, rapid detection systems like NAT systems, immunoassays and systems based on the FACS technique. Culture systems are used for routine bacterial screening of platelets in many countries, whereas rapid detection systems so far are mainly used in experimental spiking studies. Nevertheless, pathogen-reduction systems are currently available for platelet concentrates and plasma, and are under investigation for erythrocytes. Methods, In this review, the functional principles of the different assays are described and discussed with regard to their analytical sensitivity, analytical specificity, diagnostic sensitivity, diagnostic specificity and clinical efficiency. The detection methods were clustered into three groups: (i) detection systems currently used for routine screening of blood products, (ii) experimental detection systems ready to use for routine screening of blood products, and (iii) new experimental detection systems that need to be investigated in additional spiking studies and clinical trials. Results, A recent International Society of Blood Transfusion international forum reported on bacterial detection methods in 12 countries. Eight countries have implemented BacT/ALERT into blood donor screening, whereas in three countries only quality controls were done by culture methods. In one country, shelf-life was reduced to 3 days, so no bacterial screening was implemented. Screening data with culture methods can be used to investigate the prevalence of bacterial contamination in platelets. Differing results between the countries could be explained by different test definitions and different test strategies. Nevertheless, false-negative results causing severe transfusion-related septic reactions have been reported all over the world due to a residual risk of sample errors. Rapid screening systems NAT and FACS assays have improved over the last few years and are now ready to be implemented in routine screening. Non-specific amplification in NAT can be prevented by pre-treatment with Sau3AI, filtration of NAT reagents, or reduction of the number of polymerase chain reaction cycles. FACS systems offer easy fully automated handling and a handling time of only 5 min, which could be an option for re-testing day-5 platelets. New screening approaches like immunoassays, detection of bacterial adenosine triphosphate, or detection of esterase activity need to be investigated in additional studies. Conclusion, Bacterial screening of blood products, especially platelets, can be done with a broad range of technologies. The ideal system should be able to detect one colony-forming unit per blood bag without a delay in the release process. Currently, we are far away from such an ideal screening system. Nevertheless, pathogen-inactivation systems are available, but a system for all blood components will not be expected in the next few years. Therefore, existing culture systems should be complemented by rapid systems like NAT or FACS especially for day-5 platelets. [source] The advantages and disadvantages of a ,herbal' medicine in a patient with diabetes mellitus: a case reportDIABETIC MEDICINE, Issue 6 2004D. M. Wood Abstract Background Patient-initiated alternative treatments in the management of chronic conditions are common and increasing in the United Kingdom. To date, there have been no reports of herbal medicine use alone in the management of diabetes mellitus. We report here the case of a man who attained excellent glycaemic control using a ,herbal' medicine and reveal how important it was to identify the products of active constituents. Case report A 48-year-old man attending our clinic in Tooting, South London with known Type 2 diabetes, with evidence of both micro- and macro-vascular diabetes-related complications, was poorly controlled despite a drug regimen consisting of oral metformin and twice daily insulin. He went to India for at least 1 year and on returning to the clinic had excellent glycaemic control off all diabetic medication. While away he had started himself on a regimen of three different ,herbal' balls. Samples of blood were found to contain chlorpropamide in a therapeutic concentration; chlorpropamide was also found in one of the balls. He has been counselled on the potential risks associated with chlorpropamide and his treatment reverted to a more conventional treatment regimen. Conclusions General practitioners and hospital physicians should be alert to those patients returning from abroad on effective ,herbal' medications that these may in fact contain an active ingredient. [source] Keeping the herds healthy and alert: implications of predator control for infectious diseaseECOLOGY LETTERS, Issue 9 2003Craig Packer Abstract Predator control programmes are generally implemented in an attempt to increase prey population sizes. However, predator removal could prove harmful to prey populations that are regulated primarily by parasitic infections rather than by predation. We develop models for microparasitic and macroparasitic infection that specify the conditions where predator removal will (a) increase the incidence of parasitic infection, (b) reduce the number of healthy individuals in the prey population and (c) decrease the overall size of the prey population. In general, predator removal is more likely to be harmful when the parasite is highly virulent, macroparasites are highly aggregated in their prey, hosts are long-lived and the predators select infected prey. [source] Comparison of Topical Anesthetics and Lubricants Prior to Urethral Catheterization in Males: A Randomized Controlled TrialACADEMIC EMERGENCY MEDICINE, Issue 6 2004John Siderias DO Abstract Although male urethral catheterization in the emergency department (ED) is both common and painful, few studies have evaluated the use of topical anesthesia prior to catheterization. Objectives: To determine whether pretreatment of the urethra with topical lidocaine reduces the pain associated with urethral catheterization. Methods:This was a prospective, double-blind, randomized clinical trial of 36 alert, cooperative male adult patients requiring urethral catheterization, without allergies to the study medications or contraindications to their use, from a suburban university-based ED. Patients in the experimental group had topical lidocaine 2% gel injected in their urethras, whereas control patients received intraurethral lubrication only. Standardized catheterization with a no. 16 Foley was performed followed by pain assessment. The primary outcome measured was pain of catheterization on a 100-mm visual analog scale. Other outcomes included ease of insertion and procedural bleeding. Results: The authors evaluated 36 patients evenly distributed between study groups. Mean age was 62 years (range 22,85). Compared with controls, patients pretreated with lidocaine experienced significantly less pain of catheterization (38 ± 28 mm vs. 58 ± 30 mm; mean difference 20 mm; 95% confidence interval [95% CI] = 0.4 to 32; p = 0.04) and less pain of injection (23 ± 17 mm vs. 40 ± 25 mm; mean difference 17 mm; 95% CI = 3 to 32 mm; p = 0.02). There were no differences in the number of attempts and incidence of adverse events between the groups. Conclusions: Use of topical lidocaine gel reduces the pain associated with male urethral catheterization in comparison with topical lubricants only. [source] Direct toxicity assessment of wastewater: Baroxymeter, a portable rapid toxicity device and the industry perspectiveENVIRONMENTAL TOXICOLOGY, Issue 3 2002Achilles Tzoris Abstract Direct toxicity assessment of wastewater is becoming necessary, and new legislation may render it compulsory for the water industry. At present such assessment is performed at a laboratory away from a site, at considerable cost, and results often come too late, after a toxic event has occurred and the toxin has been released into the environment. Some of the rapid toxicity tests available today require certain conditions to function properly, or their results do not always correlate with other methods. The objective of this study was to assess a portable device, the Baroxymeter, for its suitability as an instrument to test wastewater toxicity. The way the device works is based on monitoring respiration of a bacterial culture by pressure measurements and using respiration inhibition as a toxicity alert. It has been shown that it is possible to detect toxic substances such as 3,5-dichlorophenol and bronopol within 5 min from a 1-mL sample. The benefits and future applications of the Baroxymeter as a high-throughput, cost-effective alternative for toxicity screening are discussed in this article. © 2002 Wiley Periodicals, Inc. Environ Toxicol 17: 284,290, 2002; Published online in Wiley InterScience (www.interscience.wiley.com). DOI 10.1002/tox.10059 [source] Oxidative stress biomarkers in bivalves transplanted to the Guadalquivir estuary after Aznalcóllar spillENVIRONMENTAL TOXICOLOGY & CHEMISTRY, Issue 1 2003Antonio Romero-Ruiz Abstract Biological effects of metals were studied in clams (Scrobicularia plana) transplanted to Guadalquivir estuary (Spain) at several times after the spill of toxic metals from Aznalcóllar pyrite mine (southwest Spain) (April 1998) using biochemical biomarkers responsive to reactive oxygen species. Significant As, Cd, Fe, Mn, Ni, and Pb uptake was found in clams living for seven months at the estuary (from July 1999). Increased activity of antioxidant (catalase, glucose-6-phosphate, and 6-phosphogluconate dehydrogenase) and glutathione-related (glutathione reductase and glyoxalase I and II) enzymes was also found after short exposures; the levels of malondialdehyde and metallothionein increased also, particularly with long exposures. Clams living four weeks at the estuary (from March 2000) but not at a reference site also accumulated metals. The higher malondialdehyde and lower reduced-glutathione levels and the more oxidized glutathione status confirmed the oxidative stress of clams living at the estuary, while no marked increase of antioxidant activities was found this time. Lower metal availability along the second transplant could explain the limited responses in this shorter experiment. Although the status of Guadalquivir estuary has recovered since Aznalcóllar spill, continuous monitoring is needed to confirm its progress and to be alert to possible deterioration after heavy rains. [source] Clinical picture of EPM1-Unverricht-Lundborg diseaseEPILEPSIA, Issue 4 2008Reetta Kälviäinen Summary Unverricht-Lundborg disease (ULD), progressive myoclonic epilepsy type 1 (EPM1, OMIM254800), is an autosomal recessively inherited neurodegenerative disorder characterized by age of onset from 6 to 16 years, stimulus-sensitive myoclonus, and tonic,clonic epileptic seizures. Some years after the onset ataxia, incoordination, intentional tremor, and dysarthria develop. Individuals with EPM1 are mentally alert but show emotional lability, depression, and mild decline in intellectual performance over time. The diagnosis of EPM1 can be confirmed by identifying disease-causing mutations in a cysteine protease inhibitor cystatin B (CSTB) gene. Symptomatic pharmacologic and rehabilitative management, including psychosocial support, are the mainstay of EPM1 patients' care. Valproic acid, the first drug of choice, diminishes myoclonus and the frequency of generalized seizures. Clonazepam and high-dose piracetam are used to treat myoclonus, whereas levetiracetam seems to be effective for both myoclonus and generalized seizures. There are a number of agents that aggravate clinical course of EPM1 such as phenytoin aggravating the associated neurologic symptoms or even accelerating cerebellar degeneration. Sodium channel blockers (carbamazepine, oxcarbazepine) and GABAergic drugs (tiagabine, vigabatrin) as well as gabapentin and pregabalin may aggravate myoclonus and myoclonic seizures. EPM1 patients need lifelong clinical follow-up, including evaluation of the drug-treatment and comprehensive rehabilitation. [source] Movement-Induced Focal Motor Seizures and Choreoathetosis As- sociated with Nonketotic Hyperglycemia: A Case ReportEPILEPSIA, Issue 2000Hisashi Tanaka Case Report: We report the case of a diabetic woman who developed right-sided reflex seizures and bilateral choreoathetosis during an episode of nonketotic hyperglycemia. The patient was a 67-year-old woman with a 14-year history of HCV-related liver cirrhosis who experienced polydipsia and polyuria in January 1998. She began to have episodes of abnormal hyperkinetic movements of the right upper extremity and tonic-clonic seizures in the right arm triggered by voluntary movements of right or bilateral arms in the beginning of March 1998. The seizures increased in frequency and consequently left her disabled. She was admitted to our hospital with complaints of these abnormal motor phenomena on March 9, 1998. Neurological examinations revealed that she was alert, well-oriented, and that cranial nerve functions were normal. Slight motor weakness of the right upper limb and deep tendon hyporeflexes were observed in all extremities. Sensations and cerebellar functions were intact. Choreic or athetotic involuntary movements were seen in the bilateral upper limbs and neck. These involuntary movements were increased by voluntary movement or posturing of the upper limbs. The focal tonic-clonic seizures were easily triggered by voluntary movements such as knotting a cord. This seizure suddenly began by tonic movements in the right upper limb and gradually progressed to the right hemi-face and neck without loss of consciousness. The average duration of seizures was about one minute. The laboratory data demonstrated mild leukocytopenia, thrombocytopenia, hepatic dysfunction, and hyperglycemia without ketosis. Fasting blood glucose was 41 I mg/dl, and HbAlc was 14.5%. Blood ammonia was within normal levels. Cranial CT revealed no abnormalities. Brain MRI on T I-weighted images demonstrated bilateral high signal intensity in the putamen. An interictal EEG revealed a symmetrical slow background activity of 7,8 Hz. An ictal EEG recording showed a 2.5 4 Hz irregular sharp and slow wave discharge in the bilateral frontal-central regions. Treatment with carbamazepine was ineffective for the seizures. However, the seizures completely disappeared after the administration of insulin on March 17. Under good control of the hyperglycemia, the abnormal involuntary movements decreased gradually and then completely disappeared; the patient became neurologically asymptomatic by March 30. The follow-tip EEG demonstrated 9-Hz alpha background activity without any epileptic discharges. Conclusions: Nonketotic hyperglycemia has been rarely reported to cause stimulus-induced seizures or hyperkinetic involuntary movements such as hemichorea-ballism. To our knowledge, this is the first reported case of both induced seizures and involuntary movements simultaneously caused by hyperglycemia. Movement-induced seizures and choreoathetoid movements in this patient can be considered to result from transiently-increased activity in the basal ganglia and/or cerebral cortex associated with metaholic disorders. [source] Clonally rearranged T-cell receptor , chain genes in HTLV-I carriers with abnormal, non-flower-like, lymphocytesEUROPEAN JOURNAL OF HAEMATOLOGY, Issue 4 2005Maria M. Sales Abstract:,Background:,The diagnosis of Adult T-cell leukemia/lymphoma ATLL subtypes in human T-lymphotropic virus type I (HTLV-I) carriers based in morphology and immunophenotype of lymphocytes can be challenger. We propose that polymerase chain reaction (PCR) amplification of the rearranged TCR gene in HTLV-I healthy carriers would be a convenient method for establishing the nature of the circulating T lymphocytes in asymptomatic HTLV-I carriers, presenting only mild and inconclusive signals of deviation from normality. Methods:,Using PCR, we analyzed the genetic recombination pattern of the T-cell , -chain receptor gene (TCR - ,) in order to identify clonal expansion of peripheral blood T lymphocytes in 17 HTLV-I-positive healthy carriers and in nine normal HTLV-I-negative blood donors. To evaluate the performance of PCR in detection of clonality, we also analyzed 18 patients with post-thymic/mature T-cell malignancies presenting circulating abnormal lymphocytes. Results:,Seven of the 17 HTLV-I positive individuals presented circulating abnormal lymphocytes; monoclonal or oligoclonal expansion of T-cells was detected in five of the 17 HTLV-I-positive individuals, all of them presenting abnormal lymphocytes. Clonal expansion was not detected in any of the negative controls or in any of the 12 remaining healthy carriers. All patients in the positive control group tested positive by PCR and Southern blots. Southern blots were negative for all 17 healthy carriers. Conclusions:,PCR amplification of segments of rearranged TCR- , is reliable for allowing early detection of small populations of clonal T cells in blood samples from asymptomatic HTLV-I carriers, providing an additional alert in the follow-up of carriers with abnormal circulating lymphocytes. [source] Migraine and Psychiatric Comorbidity: From Theory and Hypotheses to Clinical ApplicationHEADACHE, Issue 9 2002Fred D. Sheftell MD Objective.,To review psychiatric issues that accompany migraine and means of addressing these issues. Background.,Psychiatric factors and migraine may interact in three general ways, etiologically, psychophysiologically or biobehaviorally, and comorbidly (the two disorders coexist), which is the present focus. There are several possible mechanisms of comorbidity. The relation between two disorders may be a result of chance. One disorder can cause another disorder: Diabetes can cause diabetic neuropathy. There might be shared environmental risks: Head trauma can cause both posttraumatic epilepsy and posttraumatic headache. And there may be environmental or genetic risk factors that produce a brain state giving rise to both conditions, that is, there may be some common biology underlying both conditions. This last mechanism seems to be the most likely one underlying comorbidity of migraine and psychiatric disorders. We introduce a possible role for classical paradigms of learned helplessness in regard to psychiatric comorbid depressive and anxiety disorders and migraine. Results.,There appears to be an association between migraine and affective disorders, particularly depression and anxiety. There are a number of formal tools for recognizing depression, but clinical evaluation should not be overlooked. Once diagnosed, depression and anxiety should be treated, both to improve the success of migraine treatment and to improve the patient's quality of life. Patients with recurring headaches are much more likely to overuse and misuse, rather than abuse, pain medications. It is important to be alert for signs that the patient may be misusing medication. Behavioral approaches can surround and support pharmacological therapy. Conclusions.,Migraine is often comorbid with psychiatric disorders, particularly depression and anxiety. The relationship is likely based on shared mechanisms and successful treatment is possible. [source] Time budgets of Snow Geese Chen caerulescens and Ross's Geese Chen rossii in mixed flocks: implications of body size, ambient temperature and family associationsIBIS, Issue 1 2009JÓN EINAR JÓNSSON Body size affects foraging and forage intake rates directly via energetic processes and indirectly through interactions with social status and social behaviour. Ambient temperature has a relatively greater effect on the energetics of smaller species, which also generally are more vulnerable to predator attacks than are larger species. We examined variability in an index of intake rates and an index of alertness in Lesser Snow Geese Chen caerulescens caerulescens and Ross's Geese Chen rossii wintering in southwest Louisiana. Specifically we examined variation in these response variables that could be attributed to species, age, family size and ambient temperature. We hypothesized that the smaller Ross's Geese would spend relatively more time feeding, exhibit relatively higher peck rates, spend more time alert or raise their heads up from feeding more frequently, and would respond to declining temperatures by increasing their proportion of time spent feeding. As predicted, we found that Ross's Geese spent more time feeding than did Snow Geese and had slightly higher peck rates than Snow Geese in one of two winters. Ross's Geese spent more time alert than did Snow Geese in one winter, but alert rates differed by family size, independent of species, in contrast to our prediction. In one winter, time spent foraging and walking was inversely related to average daily temperature, but both varied independently of species. Effects of age and family size on time budgets were generally independent of species and in accordance with previous studies. We conclude that body size is a key variable influencing time spent feeding in Ross's Geese, which may require a high time spent feeding at the expense of other activities. [source] Identification of Perceived Interviewee Behaviors that Influence Auditors' Assessment of DeceptionINTERNATIONAL JOURNAL OF AUDITING, Issue 3 2008Chih-Chen Lee US and international policy setters recently called for auditors to be alert for anomalous interviewee behaviors that may indicate deception. In this call, they included verbal behaviors, such as implausibility and inconsistency, as suggested indicators. This study empirically identifies the perceived verbal and physical interviewee behaviors that influence auditors' deception detection judgments. Perceptions of informativeness and body movement were found to increase auditors' suspicion of interviewees. The literature provides support for using deception indicators relating to informativeness for deception detection. However, the literature suggests that more body movement is a false deception indicator; that deceivers typically manifest less body movement when lying. The study's results also suggest that entry-level accountants use anxiety-related behaviors for deception detection, whereas experienced auditors do not. The deception detection literature suggests that anxiety-related behaviors do not predict deception. [source] TV viewing and physical activity: a segment analysis for social marketingINTERNATIONAL JOURNAL OF NONPROFIT & VOLUNTARY SECTOR MARKETING, Issue 3 2008Satyendra Singh Elevated television viewing and physical inactivity promote sedentary behavior, leading to obesity. Yet, modifying the behavior has received a limited academic investigation. Thus, the purpose of this exploratory study is to develop segments relating to such behavior, and propose TV viewing-reduction and physical activity-enhancing strategies for the various segments. Using data from a mall, the multiple regression and analysis of variance (ANOVA) led to the identification of four segments: alert, inactive, action, and ideal. Results indicate that those engaged in physical activity appear to watch less TV, and that age and gender do not have a significant impact on TV viewing. The managers can use the findings, segments, and strategies to create appeals for target social marketing. Copyright © 2007 John Wiley & Sons, Ltd. [source] Miliary tuberculosis and necrotizing tuberculous fasciitis , An unusual coexistence in a rheumatoid arthritis patientINTERNATIONAL JOURNAL OF RHEUMATIC DISEASES, Issue 2 2010Hyun-Hee KWON Abstract We report a case of a 65-year-old Korean female patient with rheumatoid arthritis, who presented with extensive necrotizing fasciitis of the gluteus muscles, as an unusual initial manifestation of miliary tuberculosis. The patient had been previously treated with conventional disease-modifying antirheumatic drugs and low-dose steroids for 7 years. However, she recently developed fever, warmth and painful swelling in her right buttock. Magnetic resonance imaging indicated necrotizing fasciitis of the gluteus muscles and a fasciectomy specimen revealed a Mycobacterium tuberculosis infection. Two weeks after a fasciectomy, miliary tuberculosis of the lung was diagnosed by high resolution chest computed tomography. Soft tissue infection due to M. tuberculosis should be included as a differential diagnosis in the immunocompromised host. Clinicians should be alert to the possibility of miliary tuberculosis even in the absence of respiratory symptoms and normal chest radiograph. [source] Living and Teaching Across CulturesINTERNATIONAL STUDIES PERSPECTIVES, Issue 2 2001Raymond Cohen As long as one lives within the confines of a single culture it is difficult to achieve cross-cultural awareness. Multiculturalism is often simply the tolerance of a dominant culture for minority cultures. Cross-cultural awareness is a state of mind in which one is alert to alternity, the existence of others possessing different and equally valid world views and ways of life. This can be acquired living within or alongside other cultures, when one's own and others' strangeness become readily apparent. Culture shock involves just such a realization. The challenge for the teacher of international relations is to convey the possibility of alternity to students in the classroom. After all, international relations is above all about the interaction between communities possessing separate identities and autonomous wills. The article discusses ways of cultivating cross-cultural awareness, comparing the difficulties of doing so in a society under siege,Israel,with the greater scope available in the cosmopolitan setting of an elite American university. [source] Reducing risk of shortages due to drought in water supply systems using genetic algorithms,IRRIGATION AND DRAINAGE, Issue 2 2009V. Nicolosi évaluation des risques; gestion de l'eau; sécheresse; éléments déclenchant pour les plans sécheresse Abstract The evaluation of risk of shortages due to drought in water supply systems is a necessary step both in the planning and in the operation stage. A methodology for unconditional (planning) and conditional (operation) risk evaluation is presented in this study. The risk evaluation is carried out by means of an optimisation model based on genetic algorithms aimed to define thresholds for the implementation of mitigation measures tested through Monte Carlo simulation that makes use of a stochastic generation of streamflows. The GA enables the optimisation of reservoir storages which identify monthly thresholds for shifting three states of the system (normal, alert and alarm) to which correspond different mitigation measures such as water demand rationing, additional supplies from alternative sources or reduction of release for ecological use. For unconditional risk evaluation a long time horizon has been considered (40 years), while the conditional risk evaluation is performed on a short time horizon (2,3 months). Results of simulations have been studied by means of consolidated indices of performance and frequency analysis of shortages of a given entity corresponding to different planning/management policies. A multi-use water system has been used as a case study including competing irrigation and industrial demands. Copyright © 2008 John Wiley & Sons, Ltd. L'évaluation du risque de manques d'eau dus à la sécheresse dans les systèmes d'approvisionnement en eau est une étape nécessaire à la fois pour la planification et l'exploitation. Une méthodologie pour l'évaluation du risque inconditionnel (planification) et conditionnel (exploitation) est présentée dans cette étude. L'évaluation du risque est effectuée au moyen d'un modèle d'optimisation basé sur des algorithmes génétiques visant à définir des seuils pour la mise en ,uvre des mesures d'atténuation testés par une méthode de Monte Carlo générant les débits des rivières. L'algorithme génétique permet d'optimiser les stockages de réservoir avec des seuils mensuels pour identifier trois états du système (normal, alerte et alarme) auxquels correspondent différentes mesures d'atténuation telles que rationnement de la demande en eau, approvisionnements complémentaires par des sources alternatives ou réduction des lâchures pour l'usage écologique. Pour l'évaluation des risques inconditionnels un horizon à long terme a été considéré (40 ans) tandis que l'évaluation conditionnelle est faite sur un horizon à court terme (2 ou 3 mois). Les résultats des simulations ont été étudiés au moyen d'indices de performance consolidés et de l'analyse de la fréquence des manques d'eau pour une entité donnée correspondant à différentes politiques de planification et gestion. L'étude de cas porte sur un système multi-usage comportant une demande d'irrigation en concurrence avec les demandes industrielles. Copyright © 2008 John Wiley & Sons, Ltd. [source] Incidence of In-Hospital Falls in Geriatric Patients Before and After the Introduction of an Interdisciplinary Team,Based Fall-Prevention InterventionJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 12 2007Wolfgang Von Renteln-Kruse MD Falls are among the most common unwanted events in older hospital inpatients, but evidence of effective prevention is still limited compared with that in the community and in long-term care facilities. This article describes a prevention program and its effects on the incidence of falls in geriatric hospital wards. It was a prospective cohort study with historical control including all 4,272 patients (mean age 80, 69% female) before and 2,982 (mean age 81, 69% female) after introduction of the intervention. The intervention included fall-risk assessment on admission and reassessment after a fall; risk alert; additional supervision and assistance with the patients' transfer and use of the toilet; provision of an information leaflet; individual patient and caregiver counseling; encouragement of appropriate use of eyeglasses, hearing aids, footwear, and mobility devices; and staff education. Measurements included standardized fall-incidence reporting, activity of daily living and mobility status, number of falls and injurious falls, and number of patients who fell. Before the intervention was introduced, 893 falls were recorded. After the intervention was implemented, only 468 falls were recorded (incidence rate ratio (IRR)=0.82, 95% confidence interval (CI)=0.73,0.92), 240 versus 129 total injurious falls (IRR=0.84, 95% CI=0.67,1.04), 10 versus nine falls with fracture (IRR=1.40, 95% CI=0.51,3.85) and 611 versus 330 fallers. The relative risk of falling was significantly reduced (0.77, 95% CI=0.68,0.88). A structured multifactorial intervention reduced the incidence of falls, but not injurious falls, in a hospital ward setting with existing geriatric multidisciplinary care. Improvement of functional competence and mobility may be relevant to fall prevention in older hospital inpatients. [source] Evaluation of the Mini-Mental State Examination's Internal Consistency in a Community-Based Sample of Mexican-American and European-American Elders: Results from the San Antonio Longitudinal Study of AgingJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 5 2004David V. Espino MD This study examined the effect of scoring method, education, and language usage on internal consistency of the Folstein Mini-Mental State Examination (MMSE). Trained bilingual staff administered the MMSE in participants' homes as part of the San Antonio Longitudinal Study of Aging home-based assessment battery. Subjects included 833 community-dwelling Mexican-American (MA) and European-American (EA) elders, aged 65 and older, residing in three socioculturally distinct neighborhoods in San Antonio, Texas. Three methods of scoring the MMSE were examined: serial sevens only, spelling only, and serial sevens or spelling, whichever was higher. Mean MMSE scores±standard deviation ranged from 27.7±2.4 to 28.5±1.9 for EAs, from 25.6±3.2 to 27.2±2.9 for MAs interviewed in English, and from 22.5±4.5 to 25.5±3.5 for MAs interviewed in Spanish, depending on scoring method. Across the three ethnic-language subgroups, the lowest mean scores, largest coefficients of variation, and highest alpha coefficients were observed using serial sevens only. Stratification by educational level showed that alpha coefficients for all three scoring methods were consistently lower in high school graduates than in less-educated groups. Serial sevens only was the only scoring method that yielded acceptably high alpha coefficients across all ethnic, language, and education subgroups. Thus, clinicians should use the serial sevens,only method when administering the MMSE and be alert to the increased potential for false-negatives in more highly educated EA and MA elders, particularly in EAs and MAs proficient in English. [source] Prevalence and associated factors of pneumonia in patients with vegetative state in TaiwanJOURNAL OF CLINICAL NURSING, Issue 7 2008Li-Chan Lin PhD Aims., The aim of this study was to investigate the prevalence rate and influencing factors of pneumonia associated with long-term tube feeding in special care units for patients with persistent vegetative states (PVS) in Taiwan. Background., Pneumonia is a significant cause of morbidity, hospitalization and mortality in the nursing home population. Tube feeding has been found as a risk factor for the occurrence of pneumonia. Methods., Two hundred sixty subjects were chosen from three hospital-based special care units for patients with PVS and 10 nursing facilities for persons in PVS in Taiwan. All subjects, who were diagnosed with PVS, received either financial aid for institutional care or were means-tested from The Bureau of Social Welfare of cities and counties in Taiwan. Data were collected through chart review and observations. Results., The prevalence rate of pneumonia in nursing facilities for patients with PVS was 14·2%. The prevalence rate of tube-feeding in nursing facilities for PVS was 91·2%. The mean duration of tube-feeding was 73·21 SD 55·33 months. A total of 90·4% was fed with a nasogastric (NG) tube. Having a lower intake of food and fluids daily and having been institutionalized for a shorter period were three dominant factors associated with the occurrence of pneumonia. Conclusion., Research findings reveal that the incidence of pneumonia is higher in patients who do not receive adequate food and water. Continuing in-service training to improve caregivers' knowledge and skill in providing care to patients in PVS and monitoring their skills in feeding is needed to decrease the occurrence of pneumonia in this population. Relevance to clinical practice., Staff needs to be taught to monitor laboratory data and signs and symptoms of malnutrition and hydration deficit, and also be alert to early indicators of pneumonia in patients with PVS. [source] "The World's Against Me As A Black Man": Charles Mingus and Segregated AmericaJOURNAL OF HISTORICAL SOCIOLOGY, Issue 1 2000Desmond King This paper examines how the artistic output of Charles Mingus was influenced by the question of race in U.S. politics. Employing material from the liner notes of Mingus's albums, his autobiography, and interviews for his oral history, I argue that issues of race and their political manifestation were forced upon Mingus by the circumstances of American politics. Mingus's experience as an African American vehemently opposed to segregated race relations and alert, throughout his life, to racism, is part of his compositional presence. [source] Clozapine treatment of psychosis associated with velo-cardio-facial syndrome: benefits and risksJOURNAL OF INTELLECTUAL DISABILITY RESEARCH, Issue 7 2005S. Gladston Abstract Background Clozapine is licensed for the treatment of psychotic illnesses resistant to other antipsychotic medications. Velo-cardio-facial syndrome (VCFS) is associated with a vulnerability to psychotic illness that may be resistant to treatment with conventional typical and atypical antipsychotics. Patients and methods A 32-year-old man with intellectual disability (ID) and a long history of treatment-resistant psychosis was found to have VCFS. Treatment with typical antipsychotic drugs and with one atypical olanzapine produced no improvement. Results Treatment with clozapine produced an improvement in psychotic symptoms and associated behavioural abnormalities, but caused hypersalivation, constipation and a seizure disorder. The latter led to two fractures, one requiring surgery. The addition of sodium valproate stopped seizures. Conclusions Clozapine may improve psychotic symptoms for people with ID associated with VCFS, but clinicians should be alert for potential adverse effects. [source] | |||||||||||||||||||||||||||||||||||||||||||