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Great Caution (great + caution)
Selected AbstractsPredicting the behaviour of offenders with personality disorder: issues for investigative psychologyJOURNAL OF INVESTIGATIVE PSYCHOLOGY AND OFFENDER PROFILING, Issue 1-2 2008Simon Duff Abstract This paper explores the extent to which the diagnosis of personality disorder is valid and reliable, whether such a diagnosis conveys useful information of predictive value to forensic psychology, and thus, the extent to which such a diagnosis may be of use in investigative psychology. It argues that the diagnostic criteria are of questionable reliability, validity, and utility. Using a recently developed model of the psychological underpinnings of the problematic thoughts, emotions, and behaviours encompassed by the term ,personality disorder', it argues that such problems emerge from psychological processes that are part of the ,normal' architecture of cognition rather than from an ,abnormal' psychology particular to personality disorder. Great caution is therefore urged before investigative psychology adopts such terminology and associated methodologies from clinical psychology or psychiatry. Copyright © 2008 John Wiley & Sons, Ltd. [source] Effect of coadministered lopinavir and ritonavir (Kaletra) on tacrolimus blood concentration in liver transplantation patientsLIVER TRANSPLANTATION, Issue 9 2003Ashokkumar B. Jain With the advent of highly active antiretroviral therapy (HAART), HIV positivity is no longer a contraindication for liver transplantation. Some of the antiretroviral agents, particularly protease inhibitors (e.g., ritonavir, indinavir, and nelfinavir) have been described as potent inhibitors of the metabolism of certain immunosuppressive drugs. In this article we describe a profound interaction between tacrolimus and Kaletra (Abbott Laboratories, Chicago, IL) (a combination of lopinavir and ritonavir) in 3 liver transplantation patients. Patient 1, who was maintained on a 5 mg twice daily dose of tacrolimus with a trough blood concentration around 10.6 ng/mL, required only 0.5 mg of tacrolimus per week after addition of Kaletra to achieve similar tacrolimus blood concentrations, with a half-life of 10.6 days. In patient 2, the area under the blood concentration versus time curve for tacrolimus increased from 31 ng/mL/h to 301 ng/mL/h after addition of Kaletra, with a corresponding half-life of 20 days. When the patient was subsequently switched to nelfinavir, the half-life decreased to 10.3 days. Patient 3, who was maintained with 4 to 8 mg/d of tacrolimus and a corresponding blood concentration of 10 ng/mL before Kaletra, required a tacrolimus dose of 1 mg/wk and tacrolimus concentrations of 5 ng/mL with Kaletra. In conclusion, a combination of lopinavir and ritonavir led to a much more profound increase in tacrolimus blood concentrations than use of single protease inhibitor, nelfinavir. A tacrolimus dose of less than 1 mg/wk may be sufficient to maintain adequate blood tacrolimus concentrations in patients on Kaletra. Patients may not need a further dose of tacrolimus for 3 to 5 weeks depending on liver function when therapy with Kaletra is initiated. Great caution is required in the management of tacrolimus dosage when Kaletra is introduced or withdrawn in HIV-positive patients after liver transplantation, particularly in the presence of hepatic dysfunction. [source] The importance of drinking frequency in evaluating individuals' drinking patterns: implications for the development of national drinking guidelinesADDICTION, Issue 7 2009Catherine Paradis ABSTRACT Aims This paper examines the relationship between frequency of drinking, usual daily consumption and frequency of binge drinking, taking into consideration possible age and gender differences. Participants and design Subjects were 10 466 current drinkers (5743 women and 4723 men) aged between 18 and 76 years, who participated in the GENACIS Canada (GENder Alcohol and Culture: an International Study) study. Setting Canada. Measurements The independent variable was the annual drinking frequency. The dependent variables were the usual daily quantity consumed, annual, monthly and weekly frequency of binge drinking (five drinks or more on one occasion). Findings Logistic regressions show (i) that those who drink less than once a week are less likely than weekly drinkers to take more than two drinks when they do drink; (ii) that the usual daily quantity consumed by weekly drinkers is not related to their frequency of drinking; but that (iii) the risk and frequency of binge drinking increase with the frequency of drinking. Conclusions Given that risk and frequency of binge drinking among Canadians increases with their frequency of drinking, any public recommendation to drink moderately should be made with great caution. [source] Increased hepatotoxicity of tumor necrosis factor,related apoptosis-inducing ligand in diseased human liver,HEPATOLOGY, Issue 5 2007Xandra Volkmann Tumor necrosis factor,related apoptosis-inducing ligand (TRAIL) induces apoptosis in tumor cells but not in most normal cells and has therefore been proposed as a promising antitumor agent. Recent experiments suggested that isolated primary human hepatocytes but not monkey liver cells are susceptible to certain TRAIL agonists, raising concerns about the use of TRAIL in cancer treatment. Whether TRAIL indeed exerts hepatotoxicity in vivo and how this is influenced by chemotherapeutic drugs or liver disease are completely unknown. Employing different forms of recombinant TRAIL, we found that the cytokine can induce proapoptotic caspase activity in isolated human hepatocytes. However in marked contrast, these different TRAIL preparations induced little or no cytotoxicity when incubated with tissue explants of fresh healthy liver, an experimental model that may more faithfully mimic the in vivo situation. In healthy liver, TRAIL induced apoptosis only when combined with histone deacetylase inhibitors. Strikingly, however, TRAIL alone triggered massive apoptosis accompanied by caspase activation in tissue explants from patients with liver steatosis or hepatitis C viral infection. This enhanced sensitivity of diseased liver was associated with an increased expression of TRAIL receptors and up-regulation of proapoptotic Bcl-2 proteins. Conclusion: These results suggest that clinical trials should be performed with great caution when TRAIL is combined with chemotherapy or administered to patients with inflammatory liver diseases. (HEPATOLOGY 2007.) [source] Functional traits of woody plants: correspondence of species rankings between field adults and laboratory-grown seedlings?JOURNAL OF VEGETATION SCIENCE, Issue 3 2003J.H.C. Cornelissen Castroviejo et al. (1986,2000); Stace (1991) Abstract. Research into interspecific variation in functional traits is important for our understanding of trade-offs in plant design and function, for plant functional type classifications and for understanding ecosystem responses to shifts in species composition. Interspecific rankings of functional traits are a function of, among other factors, ontogenetic or allometric development and environmental effects on phenotypes. For woody plants, which attain large size and long lives, these factors might have strong effects on interspecific trait rankings. This paper is the first to test and compare the correspondence of interspecific rankings between laboratory grown seedlings and field grown adult plants for a wide range of functional leaf and stem traits. It employs data for 90 diverse woody and semiwoody species in a temperate British and a (sub)Mediterranean Spanish flora, all collected according to a strict protocol. For 12 out of 14 leaf and stem traits we found significant correlations between the species ranking in laboratory seedlings and field adults. For leaf size and maximum stem vessel diameter > 50 % of variation in field adults was explained by that in laboratory seedlings. Two important determinants of plant and ecosystem functioning, specific leaf area and leaf N content, had only 27 to 36 and 17 to 31 % of variation, respectively, in field adults explained by laboratory seedlings, owing to subsets of species with particular ecologies deviating from the general trend. In contrast, interspecific rankings for the same traits were strongly correlated between populations of field adults on different geological substrata. Extrapolation of interspecific trait rankings from laboratory seedlings to adult plants in the field, or vice versa, should be done with great caution. [source] Detecting the effects of introduced species: a case study of competition between Apis and BombusOIKOS, Issue 3 2006Diane M. Thomson Developing tools for rapid assessment of introduced species impacts is one of the most important challenges in invasion ecology. Most assessments of impact rely on correlational data or other indirect measures. Yet few studies have evaluated invasion effects using multiple, simultaneously applied monitoring and experimental approaches, in order to compare easily obtained metrics with more difficult but direct measures of reproductive success or population dynamics. In this study, I use data from an experimental test of introduced honey bee (Apis mellifera) impacts on native bumble bees (Bombus spp.) to address two major questions: 1) how well did observational data on niche overlap and spatial correlations between Apis and Bombus predict the results of experimental tests of competitive effects? and 2) how well did effects of the experimental Apis manipulations on Bombus foragers, which are easy to observe, predict changes in reproductive success of colonies, which are difficult to measure? Niche overlap between Apis and Bombus varied substantially, but increased to levels as high as 80,90% during periods of resource scarcity. Correlations between numbers of Apis foragers and numbers of Bombus foragers were also highly variable, but I detected a significant negative relationship in only one of the seven months observed. In contrast, the experimental results showed that mean numbers of Bombus foragers observed on a given transect increased significantly with greater distance from introduced Apis colonies. Of these three measures (niche overlap, correlations in abundances, and effects of experimental introductions), only the experimental data on forager abundances accurately estimated competitive effects on colony reproductive success previously reported for the same experiment, and the correlational data in particular completely failed to predict the effects observed in the experimental study. This work suggests that great caution is warranted in making assessments of invasion impact on the basis of spatial or temporal correlations between invasive and native species. Thus, investing in even small and limited experimental studies may be more valuable than extensive observational work in quantifying invasion impacts. [source] Work-related carpal tunnel syndrome in Washington State workers' compensation: Utilization of surgery and the duration of lost workAMERICAN JOURNAL OF INDUSTRIAL MEDICINE, Issue 12 2009William E. Daniell MD Abstract Background Work-related carpal tunnel syndrome (CTS) is a leading cause of lengthy disability. Methods This population-based retrospective cohort study used Washington State workers' compensation claims for CTS to characterize associations between utilization of CTS surgery and duration of lost work. The sample included all claims (n,=,8,224) filed during 1990,1994 (followed through 2000) and receiving lost-work compensation. Results Sixty-four percent of studied workers had CTS surgery. Among workers with >1 month of lost work, the total duration was much shorter when workers had surgery, versus those who did not (median 4.3 and 6.2 months, respectively; P,<,0.001); there was no difference when disability extended >6 months. When workers had surgery, disability was less likely to end before 6 months if non-CTS conditions were present, surgery occurred >3 months after claim filing, or employment was in an industry with high incidence of CTS; disability was more likely to end if the diagnosing provider and operating surgeon had higher CTS claims volume. Physical and rehabilitation medicine services were associated with lower probability of returning to work, with or without surgery. Conclusions There is a need to scrutinize the role of surgery and physical-rehabilitation medicine modalities in the management of CTS covered by workers' compensation. The findings suggest disability can be minimized by establishing the CTS diagnosis as early as possible and, if surgery is appropriate, conducting surgery without substantial delay and maximizing post-operative efforts to facilitate return to work. Use of surgery >6 months after filing should be considered with great caution. Am. J. Ind. Med. 52:931,942, 2009. © 2009 Wiley-Liss, Inc. [source] Enamel matrix derivative (Emdogain®) for periodontal tissue regeneration in intrabony defectsAUSTRALIAN DENTAL JOURNAL, Issue 1 2010M Esposito Background:, Periodontitis is a chronic infective disease of the gums caused by bacteria present in dental plaque. This condition induces the breakdown of the tooth supporting apparatus until teeth are lost. Surgery may be indicated to arrest disease progression and regenerate lost tissues. Several surgical techniques have been developed to regenerate periodontal tissues including guided tissue regeneration (GTR), bone grafting (BG) and the use of enamel matrix derivative (EMD). EMD is an extract of enamel matrix and contains amelogenins of various molecular weights. Amelogenins are involved in the formation of enamel and periodontal attachment formation during tooth development. Objectives:, To test whether EMD is effective, and to compare EMD versus GTR, and various BG procedures for the treatment of intrabony defects. Search strategy:, We searched the Cochrane Oral Health Group Trials Register, CENTRAL, MEDLINE and EMBASE. Several journals were handsearched. No language restrictions were applied. Authors of randomized controlled trials (RCTs) identified, personal contacts and the manufacturer were contacted to identify unpublished trials. Most recent search: February 2009. Selection criteria:, RCTs on patients affected by periodontitis having intrabony defects of at least 3 mm treated with EMD compared with open flap debridement, GTR and various BG procedures with at least 1 year follow-up. The outcome measures considered were: tooth loss, changes in probing attachment levels (PAL), pocket depths (PPD), gingival recessions (REC), bone levels from the bottom of the defects on intraoral radiographs, aesthetics and adverse events. The following time-points were to be evaluated: 1, 5 and 10 years. Data collection and analysis:, Screening of eligible studies, assessment of the methodological quality of the trials and data extraction were conducted in duplicate and independently by two authors. Results were expressed as random-effects models using mean differences for continuous outcomes and risk ratios (RR) for dichotomous outcomes with 95% confidence intervals (CI). It was decided not to investigate heterogeneity, but a sensitivity analysis for the risk of bias of the trials was performed. Main results:, Thirteen trials were included out of 35 potentially eligible trials. No included trial presented data after 5 years of follow-up, therefore all data refer to the 1-year time point. A meta-analysis including nine trials showed that EMD treated sites displayed statistically significant PAL improvements (mean difference 1.1 mm, 95% CI 0.61 to 1.55) and PPD reduction (0.9 mm, 95% CI 0.44 to 1.31) when compared to placebo or control treated sites, though a high degree of heterogeneity was found. Significantly more sites had <2 mm PAL gain in the control group, with RR 0.53 (95% CI 0.34 to 0.82). Approximately nine patients needed to be treated (NNT) to have one patient gaining 2 mm or more PAL over the control group, based on a prevalence in the control group of 25%. No differences in tooth loss or aesthetic appearance as judged by the patients were observed. When evaluating only trials at a low risk of bias in a sensitivity analysis (four trials), the effect size for PAL was 0.62 mm (95% CI 0.28 to 0.96), which was less than 1.1 mm for the overall result. Comparing EMD with GTR (five trials), GTR showed statistically significant more postoperative complications (three trials, RR 0.12, 95% CI 0.02 to 0.85) and more REC (0.4 mm 95% CI 0.15 to 0.66). The only trial comparing EMD with a bioactive ceramic filler found statistically significant more REC (-1.60 mm, 95% CI ,2.74 to ,0.46) at the EMG treated sites. Authors' conclusions:, One year after its application, EMD significantly improved PAL levels (1.1 mm) and PPD reduction (0.9 mm) when compared to a placebo or control, however, the high degree of heterogeneity observed among trials suggests that results have to be interpreted with great caution. In addition, a sensitivity analysis indicated that the overall treatment effect might be overestimated. The actual clinical advantages of using EMD are unknown. With the exception of significantly more postoperative complications in the GTR group, there was no evidence of clinically important differences between GTR and EMD. Bone substitutes may be associated with less REC than EMD. Plain language summary:, Enamel matrix derivative (Emdogain®) for periodontal tissue regeneration in intrabony defects. Emdogain might have some advantages over other methods of regenerating the tissue supporting teeth lost by gum disease, such as less postoperative complications, but has not been shown to save more compromised teeth or that patients noticed any aesthetic improvement 1 year after its application. Bacteria in plaque can cause gum disease (periodontitis) that breaks down tissue supporting teeth. Surgical cleaning tries to stop the disease to save loose teeth. Bone grafting, guided tissue regeneration and enamel matrix derivatives (such as Emdogain) aim to regenerate support tissues. Emdogain contains proteins (derived from developing pig teeth) believed to regenerate tooth attachment. The review found that adjunctive application of Emdogain regenerates about 1 mm more tissue than surgical cleaning alone, although it is unclear to which extent such improvement is noticeable since patients did not find any difference in the aesthetic results. Emdogain showed similar clinical results to guided tissue regeneration, but is simpler to use and determines less complications. Bone substitutes may induce less gum retraction than Emdogain. No serious adverse reactions to Emdogain were reported in trials. [source] The "Thin Dividing Line": Prime Ministers and the Problem of Australian Nationalism, 1972,1996AUSTRALIAN JOURNAL OF POLITICS AND HISTORY, Issue 4 2002James Curran This paper is concerned with the way in which Australian prime ministers gave expression to an idea of "national community" in the post,1972 era. With the declining relevance of the British connection, the departure of "great and powerful" friends from the region, the imperative of engagement with Asia and the emerging concept of Australia as a "multicultural" society, one of the central challenges for these leaders has been whether or not they could offer an alternative myth of community which would preserve social cohesion in the new times. This raises an important historical question concerning Australian political culture at this time , what happened to the need for nationalism? By examining the speeches of Prime Ministers Whitlam, Fraser, Hawke and Keating, it can be seen that far from asserting an old,style, exclusive Australian nationalism, in most cases these leaders expressed great caution and hesitation towards the idea of nationalism itself. [source] 2334: The challenge of interpreting the histomorphology of human fetal lensesACTA OPHTHALMOLOGICA, Issue 2010KU LOEFFLER Purpose On histology, the crystalline lens is , especially in fetal and infant eyes - an organ susceptible to numerous artifacts. Nevertheless, evaluation of the lens is often of paramount importance in the classification of fetal syndromes or forensic questions. Thus, the aim of our study is to evaluate various factors that might have an impact on lens histomorphology. Methods Our collection of eyes by now comprises more than 500 specimens from fetuses with a gestational age between 8 and 38 weeks, including a variety of syndroms. Apart from induced fetocid, death occured due to spontaneous abortion or post-natally. Specimens were fixed in formalin, and in selected cases one eye was put into Karnovsky's solution for comparison. All systemic findings as well as data related to the termination procedure were recorded. - Some individual cases shall be presented to demonstrate the variability of histopathologic findings. Results Most of the eyes revealed lens features different from the descriptions available in textbooks. At all ages, there were various morphologic changes particularly of the subcapsular cortex, compatible with cataractous lenses in the adult, while the well-known phenomenon of an indentation at the posterior pole was seen especially in older fetuses. The difference in fixatives had only a moderate impact on structural alterations. Conclusion Alterations in fetal lens morphology are extremely frequent and variable. These can be due to delayed fixation, cutting artifacts and other variables and have to be carefully taken into account particularly when interpreting post-mortem findings. The diagnosis of a fetal cataract should therefore only be made with great caution and not without a careful macroscopic evaluation. [source] Early indicators of child abuse and neglect: a multi-professional Delphi studyCHILD ABUSE REVIEW, Issue 1 2003Catherine Powell Abstract Through the application of the Delphi technique, this study draws on the expertise of British child protection academics and practitioners from a wide range of disciplines in seeking to develop a consensus opinion on possible early indicators of child abuse and neglect. The search for early indicators is described in the context of a secondary preventative approach to the problem of child maltreatment. A very tentative conclusion arising from the study is that the early indicators of child abuse and neglect that achieved consensus of agreement may help in diagnosing child abuse and neglect at an earlier stage, although they are not necessarily diagnostic. Alternative explanations, differential diagnoses and information-gathering are paramount, as is a willingness and ability to act on concerns. Although great caution is urged, it is suggested that the findings from the study are credible and of interest to those who are working towards more timely recognition and referral of abused and neglected children. Copyright © 2003 John Wiley & Sons, Ltd. [source] | |||||||||||||