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Great Care (great + care)
Selected AbstractsPrevalence and potential link between E. coli O157:H7 isolated from drinking water, meat and vegetables and stools of diarrhoeic confirmed and non-confirmed HIV/AIDS patients in the Amathole District , South AfricaJOURNAL OF APPLIED MICROBIOLOGY, Issue 2 2008B.O. Abong'o Abstract Aim:, The current study investigated the prevalence and molecular relatedness between Escherichia coli O157:H7 isolated from water, meat and meat products and vegetables and from stools of confirmed and non-confirmed Human Immune Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) patients with diarrhoea. Methods and Results:, Culture-based and polymerase chain reaction techniques were used to identify E. coli O157:H7. Thirty-five per cent of meat products, 25·5% of water, 21·7% of vegetables as well as 56·5% and 43·5% of stools of confirmed and non-confirmed HIV/AIDS patients, respectively, were presumptively positive with E. coli O157. Molecular results indicated that 10·3%, 8·6% and 7·8% of the vegetables, water and meat products examined carried E. coli O157:H7, which had homologous fliCH7, rfbEO157 and eaeA genetic loci to the genes of some E. coli O157:H7 isolated from 12·2% and 8·8% of the stools of confirmed and non-confirmed HIV/AIDS patients, respectively. Conclusions:, Water, meat and meat products and vegetables are potential sources of E. coli O157:H7 that are potentially capable of causing diarrhoea in humans especially HIV/AIDS patients. Significance and Impact of the Study:, Great care should be exercised to ensure that water and foods consumed by HIV/AIDS patients are safe, as contaminated water and foods can cause secondary infections in these patients. [source] Predictive factors for esophageal stenosis after endoscopic submucosal dissection for superficial esophageal cancerDISEASES OF THE ESOPHAGUS, Issue 7 2009H. Mizuta SUMMARY Endoscopic submucosal dissection (ESD) has been utilized as an alternative treatment to endoscopic mucosal resection for superficial esophageal cancer. We aimed to evaluate the complications associated with esophageal ESD and elucidate predictive factors for post-ESD stenosis. The study enrolled a total of 42 lesions of superficial esophageal cancer in 33 consecutive patients who underwent ESD in our department. We retrospectively reviewed ESD-associated complications and comparatively analyzed regional and technical factors between cases with and without post-ESD stenosis. The regional factors included location, endoscopic appearance, longitudinal and circumferential tumor sizes, depth of invasion, and lymphatic and vessel invasion. The technical factors included longitudinal and circumferential sizes of mucosal defects, muscle disclosure and cleavage, perforation, and en bloc resection. Esophageal stenosis was defined when a standard endoscope (9.8 mm in diameter) failed to pass through the stenosis. The results showed no cases of delayed bleeding, three cases of insidious perforation (7.1%), two cases of endoscopically confirmed perforation followed by mediastinitis (4.8%), and seven cases of esophageal stenosis (16.7%). Monovalent analysis indicated that the longitudinal and circumferential sizes of the tumor and mucosal defect were significant predictive factors for post-ESD stenosis (P < 0.005). Receiver operating characteristic analysis showed the highest sensitivity and specificity for a circumferential mucosal defect size of more than 71% (100 and 97.1%, respectively), followed by a circumferential tumor size of more than 59% (85.7 and 97.1%, respectively). It is of note that the success rate of en bloc resection was 95.2%, and balloon dilatation was effective for clinical symptoms in all seven patients with post-ESD stenosis. In conclusion, the most frequent complication with ESD was esophageal stenosis, for which the sizes of the tumor and mucosal defect were significant predictive factors. Although ESD enables large en bloc resection of esophageal cancer, practically, in cases with a lesion more than half of the circumference, great care must be taken because of the high risk of post-ESD stenosis. [source] Road pricing: lessons from LondonECONOMIC POLICY, Issue 46 2006Georgina Santos SUMMARY Road pricing LESSONS FROM LONDON This paper assesses the original London Congestion Charging Scheme (LCCS) and its impacts, and it simulates the proposed extension which will include most of Kensington and Chelsea. It also touches upon the political economy of the congestion charge and the increase of the charge from £5 to £8 per day. The possibility of transferring the experience to Paris, Rome and New York is also discussed. The LCCS has had positive impacts. This was despite the considerable political influences on the charge level and location. It is difficult to assess the impacts of the increase of the charge from £5 to £8, which took place in July 2005, because no data have yet been released by Transport for London. The proposed extension of the charging zone does not seem to be an efficient change on economic grounds, at least for the specific boundaries, method of charging and level of charging that is currently planned. Our benefit cost ratios computed under different assumptions of costs and benefits are all below unity. Overall, the experience shows that simple methods of congestion charging, though in no way resembling first-best Pigouvian taxes, can do a remarkably good job of creating benefits from the reduction of congestion. Nevertheless, the magnitude of these benefits can be highly sensitive to the details of the scheme, which therefore need to be developed with great care. , Georgina Santos and Gordon Fraser [source] Detection of activity among uncultured Actinobacteria in a drinking water reservoirFEMS MICROBIOLOGY ECOLOGY, Issue 3 2006Jeppe L. Nielsen Abstract The abundance, identity and activity of uncultured Bacteria and Actinobacteria present in a drinking water reservoir (North Pine Dam, Brisbane, Australia) were determined using a combination of fluorescence in situ hybridization (FISH) alone or with catalysed reporter deposition (CARD-FISH) with microautoradiography. The CARD-FISH technique was modified relative to previous described procedures and performed directly on gelatine cover slips in order to allow simultaneous combination with microautoradiography. Almost twofold higher numbers of microorganisms could be identified as either Bacteria or Actinobacteria using the CARD-FISH technique as compared with the traditional FISH technique. A combination of FISH or CARD-FISH with microautoradiography showed generally higher activity among the Actinobacteria than among all Bacteria. Another important observation was that many cells within the FISH-negative populations of both Actinobacteria and Bacteria were actively assimilating thymidine. Thus, great care should be taken when extrapolating the active fraction of a prokaryotic community to be equivalent to the FISH-detectable population in such environments. Bacterial groups within Actinobacteria produce the odours geosmin and 2-methylisoborneol, which lower the quality of surface water when used for drinking. The results indicate that combined microautoradiography and CARD-FISH may serve as an effective tool when studying identity and activity of microorganisms within freshwater environments. [source] Pharmacological "cross-inhibition" of connexin hemichannels and swelling activated anion channelsGLIA, Issue 3 2009Zu-Cheng Ye Abstract The study of ion channels has relied heavily on the use of pharmacological blocking agents. However, many of these agents have multiple effects, which may compromise interpretation of results when the affected mechanisms/pathways mediate similar functions. Volume regulated anion channels (VRAC) and connexin hemichannels can both mediate the release of glutamate and taurine, although these channels have distinct activation stimuli and hemichannels, but not VRAC, are permeable to Lucifer Yellow (LY). It has been reported that some anion channel blockers may inhibit connexin hemichannels. We further examined the effects of classic gap junction/hemichannel blockers and anion channel blockers on these channels. The typical VRAC blockers, NPPB, IAA-94, and tamoxifen blocked low divalent cation-induced glutamate and taurine release and LY loading, presumed due to hemichannel opening. The blocking action of these compounds on hemichannels was concentration dependent and fell within the same range where the drugs classically block VRACs. Conversely, carbenoxolone (CBX), the most widely used gap junction/hemichannel blocker, was an effective blocker of VRAC-mediated glutamate and taurine release, and blocked these channels at similar concentrations at which it blocked hemichannels. The CBX effect on VRACs was verified using astrocytes from connexin 43 knock out (Cx43 KO) animals. In these cells, the hypotonic induced amino acid flux was retained whereas the low divalent cation solution-induced flux was lost. These results extend our knowledge about "cross-inhibition" of VRACs and gap junctions/hemichannels by certain pharmacological agents. Given the overlap in function of these two types of channels, great care must be exerted in using pharmacological blockers to identify one channel from the other. © 2008 Wiley-Liss, Inc. [source] Elicited imitation:a brief overviewINTERNATIONAL JOURNAL OF APPLIED LINGUISTICS, Issue 1 2002Thora Vinther This article considers the key concepts of elicited imitation (EI), with the aim of contributing to the understanding of this technique for language testing. EI has been widely debated and often criticized, but there seems now to be an agreement as to its usefulness, as long as it is applied with great care. The article reviews the literature on EI and suggests some issues for discussion, such as the process of imitating, the length and structure of the stimulus, contextual support, whether the test evaluates comprehension or production skills, whether it assesses imitative or spontaneous language capacity, and how scoring is carried out. Although the focus is on foreign language acquisition (FLA), studies about EI within other areas have been included where this is considered useful for the understanding of the technique. [source] Numerical investigation of gas mixing in gas-solid fluidized bedsAICHE JOURNAL, Issue 9 2010Tingwen Li Abstract Gas mixing in a tall narrow fluidized bed operated in the slugging fluidization regime is simulated with the aid of computational fluid dynamics. In the first part, a parametric study is conducted to investigate the influence of various parameters on the gas mixing. Among the parameters studied, the specularity coefficient for the partial-slip solid-phase wall boundary condition had the most significant effect on gas mixing. It was found that the solid-phase wall boundary condition needs to be specified with great care when gas mixing is modeled, with free slip, partial slip and no-slip wall boundary conditions giving substantial differences in the extent of gas back mixing. Axial and radial tracer concentration profiles for different operating conditions are generally in good agreement with experimental data from the literature. Detailed analyses of tracer back mixing are carried out in the second part. Two parameters, the tracer backflow fraction and overall gas backflow fraction, in addition to axial profiles of cross-sectional averaged tracer concentrations, are evaluated for different flow conditions. Qualitative trends are consistent with reported experimental findings. © 2010 American Institute of Chemical Engineers AIChE J, 2010 [source] Acute retinal necrosis six years after herpes simplex encephalitis: An elusive immune deficit suggested by insufficient test sensitivityJOURNAL OF MEDICAL VIROLOGY, Issue 2 2004W. Preiser Abstract A patient presented with acute retinal necrosis of the left eye. Demonstration of herpes simplex virus (HSV) DNA in the aqueous humour confirmed the diagnosis. Negative results of HSV type-specific antibody tests based on gG antigens suggested a primary HSV infection. However, the patient had a past history of laboratory-confirmed herpes simplex encephalitis 6 years ago. Using antibody tests based on whole viral lysate antigens, he was seropositive from the onset, and immunoblot testing confirmed a lack of anti-gG reactivity. To be able to assess whether this might be related to the apparent inability of his immune system to suppress clinically symptomatic HSV infection, serial samples were tested by an HSV neutralisation test and a whole-blood flow cytometric assay to determine the frequency of HSV-specific CD4 lymphocytes. However, this did not yield evidence of obvious immunodeficiency; the patient reacted similarly to known positive controls by both assays. Although type-specific HSV serological tests based on gG are generally more specific than those based on whole viral lysate antigens, they have a somewhat lower sensitivity, as a certain percentage of HSV-infected individuals do not develop antibodies against gG, and others may suffer a secondary loss of anti-gG reactivity. Thus there is a risk of missing individual infected patients. Unless this potential problem is recognised, serious consequences might possibly result. We therefore urge virologists and clinicians to exercise great care if highly specific antibody assays based on recombinant proteins are employed. J. Med. Virol. 73:250,255, 2004. © 2004 Wiley-Liss, Inc. [source] Tip-Enhanced Raman SpectroscopyJOURNAL OF RAMAN SPECTROSCOPY, Issue 10 2009V. Deckert Abstract This special issue of the Journal of Raman Spectroscopy deals with the advances of Tip-Enhanced Raman Spectroscopy (TERS) since its experimental verification about 10 years ago. The contributed papers reflect a snapshot of current research related to experimental, theoretical and, last but not least, application-oriented advances in this field. The contributions highlight the fact that TERS is a very active field of research and, while the rewards with respect to lateral resolution and detection limits are intriguing, great care is necessary to avoid the pitfalls related either to the experimental design or to the interpretation of data. This special issue intends to provide the basis for a further step towards a standardised approach to TERS. Copyright © 2009 John Wiley & Sons, Ltd. [source] Power for detecting genetic divergence: differences between statistical methods and marker lociMOLECULAR ECOLOGY, Issue 8 2006NILS RYMAN Abstract Information on statistical power is critical when planning investigations and evaluating empirical data, but actual power estimates are rarely presented in population genetic studies. We used computer simulations to assess and evaluate power when testing for genetic differentiation at multiple loci through combining test statistics or P values obtained by four different statistical approaches, viz. Pearson's chi-square, the log-likelihood ratio G -test, Fisher's exact test, and an FST -based permutation test. Factors considered in the comparisons include the number of samples, their size, and the number and type of genetic marker loci. It is shown that power for detecting divergence may be substantial for frequently used sample sizes and sets of markers, also at quite low levels of differentiation. The choice of statistical method may be critical, though. For multi-allelic loci such as microsatellites, combining exact P values using Fisher's method is robust and generally provides a high resolving power. In contrast, for few-allele loci (e.g. allozymes and single nucleotide polymorphisms) and when making pairwise sample comparisons, this approach may yield a remarkably low power. In such situations chi-square typically represents a better alternative. The G -test without Williams's correction frequently tends to provide an unduly high proportion of false significances, and results from this test should be interpreted with great care. Our results are not confined to population genetic analyses but applicable to contingency testing in general. [source] Going home from ICU to die: a celebration of life,NURSING IN CRITICAL CARE, Issue 3 2005Michelle Ryder-LewisArticle first published online: 25 APR 200 ABSTRACT There is much literature regarding going home to die in terminally ill cancer patients however, little is written about withdrawing treatment at home in critical care. One intensive care unit's experience in New Zealand demonstrates how this can be done safely. The preparation of families and patients must be done with great care. There are challenges to be overcome including supportive resources in the community, staffing and safety of the patient and family. It is possible to withdraw/withhold treatment in a patient's home and this is highly valued by the families. [source] Abortion, Family Planning, and Population Policy: Prospects for the Common-Ground ApproachPOPULATION AND DEVELOPMENT REVIEW, Issue 3 2009Dennis Hodgson For the past several decades those engaged in shaping the Program of Action documents at international conferences on population have muted their voices when the topic of abortion has been raised. In a desire to side-step entanglement in a bitter debate over the morality of abortion, great care has been taken to define "family planning" in ways that explicitly exclude abortion. The "common-ground" approach to treating abortion can be summarized in two directives found in all contemporary international population documents: "in no case should abortion be promoted as a method of family planning"; and all governments should work "to reduce the recourse to abortion through expanded and improved family-planning services." This article has three goals: first, to examine the appropriateness of these directives with respect to what is currently known about the relationship between abortion, family planning, and population policy; second, to trace how this "contraception-only" definition of family planning became de rigueur at international population conferences; and third, to discuss the prospects for the emergence of a more appropriate "common-ground" approach to abortion and population policy. [source] Comparison of two anoxia models in rainbow trout cells by a 2-DE and MS/MS-based proteome approachPROTEINS: STRUCTURE, FUNCTION AND BIOINFORMATICS, Issue 10 2008Tune Wulff Dr. Abstract In the literature, a variety of ways have been used to obtain anoxia, and most often results are compared between studies without taking into consideration how anoxia has been obtained. Here, we provide a comprehensive study of two types of anoxia, using a proteomics approach to compare changes in protein expression. The two investigated situations were 30,min of chemical anoxia (10,mM NaN3) followed by reoxygenation overnight (CR) and 2,h of N2 -induced anoxia (achieved by flushing with N2) followed by reoxygenation overnight (NR), after which samples were resolved by 2-DE. Forty-five protein spots changed their abundance in response to CR and 35 protein spots changed their abundance in response to NR, but only six proteins changed their abundance in response to both stimuli. By the means of MS/MS, 40 protein spots were identified including proteins involved in processes like cell protection and protein synthesis. It was also revealed that the level of a number of keratins was down-regulated. This study therefore provides a valuable comparison of two different anoxia models and shows that great care should be taken when comparing the effects of anoxia in studies that have used different types and durations of anoxia. [source] Clinical Practice Guidelines for the Use of Axillary Sentinel Lymph Node Biopsy in Carcinoma of the Breast: Current UpdateTHE BREAST JOURNAL, Issue 2 2004Gordon F. Schwartz MD, MBAArticle first published online: 10 MAR 200 Abstract: Axillary sentinel lymph node biopsy (SLNB) has been adopted as a suitable alternative to traditional level I and II axillary dissection in the management of clinically node-negative (N0) breast cancers. There are two current techniques used to identify the sentinel node(s): radiopharmaceutical, technetium sulfur colloid, and isosulfan blue dye (used in the United States) and technetium-labeled albumin and patent blue dye (used in Europe). (The labeled albumin is not U.S. Food and Drug Administration [FDA] approved in the United States.) SLNB to replace axillary dissection should only be performed by surgeons and patient management teams with appropriate training and experience. Although both radiocolloid and blue dye are used together by most surgeons, and training should be in both techniques, some experienced surgeons use one or the other almost exclusively. In addition, surgical pathologists must recognize the need to examine these small specimens with great care, using a generally adopted protocol. Imprint cytology or frozen sections may be used, followed by additional sections for light microscopy. Immunochemical staining with cytokeratin or other techniques to identify "submicroscopic" metastasis is often used, but the results should not be used to influence clinical decisions with respect to adjuvant therapy. "Failed" SLNB implies the surgeon's failure to identify the sentinel nodes, in which case a complete dissection is performed. A "false-negative" SLNB implies the finding of metastasis in the excised sentinel nodes by light microscopy after a negative frozen section examination. Whether a false-negative SLNB mandates completion axillary dissection is controversial, with clinical trials currently under way to answer this question. Although SLNB was initiated to accompany breast-conserving treatment, it is equally useful in patients undergoing mastectomy. It is more difficult to perform with mastectomy. When using blue dye only, SLNB may require a separate incision because of time constraints between injection and identification of the blue-stained nodes; radiocolloid usually does not. Completion axillary dissection after false-negative SLNB is more difficult after mastectomy. SLNB is a useful procedure that may save 70% of women with clinically negative (N0) axillae and all of those with pathologically negative axillae from the morbidity of complete axillary dissection. Ideally the sentinel nodes should be able to identified in more than 95% of patients, with a false-negative rate of less than 5%. Until these rates can be achieved consistently, however, surgeons should not abandon traditional axillary dissection., [source] Identification, measurement and interpretation of tree rings in woody species from mediterranean climatesBIOLOGICAL REVIEWS, Issue 1 2003PAOLO CHERUBINI ABSTRACT We review the literature dealing with mediterranean climate, vegetation, phenology and ecophysiology relevant to the understanding of tree-ring formation in mediterranean regions. Tree rings have been used extensively in temperate regions to reconstruct responses of forests to past environmental changes. In mediterranean regions, studies of tree rings are scarce, despite their potential for understanding and predicting the effects of global change on important ecological processes such as desertification. In mediterranean regions, due to the great spatio-temporal variability of mediterranean environmental conditions, tree rings are sometimes not formed. Often, clear seasonality is lacking, and vegetation activity is not always associated with regular dormancy periods. We present examples of tree-ring morphology of five species (Arbutus unedo, Fraxinus ornus, Quercus cerris, Q. ilex, Q. pubescens) sampled in Tuscany, Italy, focusing on the difficulties we encountered during the dating. We present an interpretation of anomalies found in the wood structure and, more generally, of cambial activity in such environments. Furthermore, we propose a classification of tree-ring formation in mediterranean environments. Mediterranean tree rings can be dated and used for dendrochronological purposes, but great care should be taken in selecting sampling sites, species and sample trees. [source] La dialectique de la surveillance et le nouveau régime d'assurancemédicaments au QuébecCANADIAN PUBLIC ADMINISTRATION/ADMINISTRATION PUBLIQUE DU CANADA, Issue 2 2003Christian Boudreau Sommaire: Les travaux sur la surveillance ont surtout mis en évidence le pouvoir administratif croissant des organisations modernes, principalement 1'État et I'entreprise privée. La présente étude prend le contre-pied de ces travaux. Elle montre que certains systèmes de surveillance, en particulier les banques de données de la Régie de I'assurance-maladie du Québec, peuvent contribuer à la transparence et a I'imputabilité des décisions gouvemementales lors de l'élaboration et de la mise en euvre des politiques publiques. C'est le cas du nouveau régime d'assurance-médicaments au Québec qui, par sa transparence, a permis à des agents de la société civile d'exercer à leur tour une surveillance sur 1'État. Comme I'indique notre étude, l'éitat peut être à la fois un puissant agent de surveillance et un agent étroitement surveillé et publiquement imputable. L'étude montre aussi que la surveillance peut être une arme à double tranchant non seulement pour les dirigeants de I'État, mais aussi pour les agents sociaux qui leur résistent, d'oú l'importance d'être vigilant dans le déploiement de la surveillance. Abstract: Work undertaken on monitoring activities has, for the most part, highlighted the increasing administrative authority of modern organizations, mainly that of the government and of private corporations. This study takes the opposing view of such work. It shows that monitoring systems, more specifically the Régie de l'assurance-maladie du Québec databases, can contribute to the transparency and accountability of government decisions in developing and implementing public policies. Such is the case with the new Prescription Drug Insurance Plan in Quebec, the transparency of which afforded civil-society officials the opportunity to monitor the government. As the study shows, the government can be both a powerful monitoring agent and a closely monitored and publicly accountable one. The study also shows that monitoring can be a double-edged sword, not only for government officials but also for social-agency officials who stand up to them, hence the importance of exercising great care when performing monitoring activities. [source] The beauty of the gift: the wonder of living organ donationCLINICAL TRANSPLANTATION, Issue 4 2007Aaron Spital Abstract:, In a recent opinion piece, Nancy Scheper-Hughes provides a sweeping indictment of living organ donation, even in cases where the gift is directed to a close family member. She describes the process with caustic powerful phrases such as "sacrificial violence" and a "call to ,self-sacrifice.'" She concludes that living organ donation "should be consigned to a back seat as an exceptional back-up to deceased donation." But her conclusions are based on anecdotes and data that are not representative of donor practice and motivation in the United States and other developed countries. At reputable transplant centers great care is taken to identify genuine volunteers and to protect their interests. Under these circumstances living organ donation remains a generally safe and beneficial procedure for the donor as well as the recipient, and a wonderful example of the goodness of people. [source] | ||||||||||||||||||||||