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Kinds of Helpful Terms modified by Helpful Selected AbstractsOut-of-Office Blood Pressures,Are They Helpful in Guiding the Treatment of Hypertension Patients?JOURNAL OF CLINICAL HYPERTENSION, Issue 3 2006Marvin Moser MD Following a hypertension symposium in Philadelphia in September 2005, a roundtable was convened to discuss the significance of out-of-office blood pressure. Dr. Marvin Moser of the Yale School of Medicine, New Haven, CT, moderated the panel discussion. Participants included Dr. Raymond Townsend of the University of Pennsylvania School of Medicine, Philadelphia, PA, and Dr. Norman Kaplan of the University of Texas Health Science Center in Dallas, Dallas, TX. [source] Legal Ethics: Why Aristotle Might Be HelpfulJOURNAL OF SOCIAL PHILOSOPHY, Issue 1 2002Michael Milde [source] A web-based 2D structural analysis educational softwareCOMPUTER APPLICATIONS IN ENGINEERING EDUCATION, Issue 2 2003Saulo Faria Almeida Barretto Abstract This paper describes an educational software developed to be helpful to undergraduate engineering students when learning with structural analysis. The software enables the user to analyze plane-framed structures, under static or dynamic loading, and it was fully implemented by using web technology. © 2003 Wiley Periodicals, Inc. Comput Appl Eng Educ 11: 83,92, 2003; Published online in Wiley InterScience (www.interscience.wiley.com); DOI 10.1002/cae.10040 [source] Performance analysis of a semantics-enabled service registryCONCURRENCY AND COMPUTATION: PRACTICE & EXPERIENCE, Issue 3 2008W. Fang Abstract Service discovery is a critical task in service-oriented architectures. In this paper, we study GRIMOIRES, the semantics-enabled service registry of the OMII software distribution, from a performance perspective. We study the scalability of GRIMOIRES against the amount of information that has been published into it. The methodology we use and the data we present are helpful for researchers to understand the performance characteristics of the registry and, more generally, of semantics-enabled service discovery. Based on this experimentation, we claim that GRIMOIRES is an efficient semantics-aware service discovery engine. Copyright © 2007 John Wiley & Sons, Ltd. [source] Integral conflict analysis: A comprehensive quadrant analysis of an organizational conflictCONFLICT RESOLUTION QUARTERLY, Issue 3 2005Richard McGuigan Influenced by Ken Wilber's brilliant synthesis of some of the world's most influential thinkers, including Jürgen Habermas, the authors have developed an integral model of conflict analysis and action. The integral approach has been helpful in explaining conflict dynamics to clients and allows more comprehensive response, thus ensuring a greater chance of successful intervention. [source] Calibrating conservation: new tools for measuring successCONSERVATION LETTERS, Issue 4 2008Valerie Kapos Abstract Conservation practitioners, policy makers, and donors agree that there is an urgent need to identify which conservation approaches are most likely to succeed in order to use more effectively the limited resources available for conservation. While recently developed standards of good practice in conservation are helpful, a framework for evaluation is needed that supports systematic analysis of conservation effectiveness. A conceptual framework and scorecard developed by the Cambridge Conservation Forum help to address common constraints to evaluating conservation success: unclear objectives, ineffective information management, the long time frames of conservation outcomes, scarcity of resources for evaluation, and lack of incentives for such evaluation. For seven major categories of conservation activity, the CCF tools help clarify conservation objectives and provide a standardized framework that is a useful basis for managing information about project outcomes and existing conservation experience. By identifying key outcomes that can predict conservation success and can be assessed in relatively short time frames, they help to make more efficient use of scarce monitoring and evaluation resources. With wide application, the CCF framework and evaluation tool can provide a powerful platform for drawing on the experience of past and ongoing conservation projects to identify quantitatively factors that contribute to conservation success. [source] Detection of contact hypersensitivity to corticosteroids in allergic contact dermatitis patients who do not respond to topical corticosteroidsCONTACT DERMATITIS, Issue 2 2005Müzeyyen Gönül The delayed hypersensitivity development against topical corticosteroids which are used in allergic contact dermatitis (ACD) treatment is an important clinical problem. In our study, 41 ACD patients who did not show any response to topical corticosteroid treatment were patch tested with corticosteroid series and the commercial preparations of corticosteroids and their vehicles. In corticosteroid series, there were budesonide, bethametasone-17-valerate, triamcinolone acetonide, tixocortol pivalate, alclomethasone-17-21-dipropionate, clobetasole-17-propionate, dexamethasone-21-phosphate disodium and hydrocortisone-17-butyrate. We detected positive reaction to corticosteroids in 9 of our cases (22%) (5 single and 4 multiple). The sensitivity was mostly produced by tixocortol pivalate (6 patients). This was followed by triamcinolone acetonide (2 patients) budesonide (2 patients), alclomethasone dipropionate (2 patients), dexamethasone 21 phosphate disodium (2 patients) and betamethasone-17-valerate (1 patient). As a result, it should not be forgotten that the corticosteroids used to treat ACD patients may cause ACD themselves. In ACD patients who did not respond to corticosteroid treatment, routinely applying patch test with corticosteroids should be helpful in directing the treatment. [source] An audit of the value of patch testing and its effect on quality of lifeCONTACT DERMATITIS, Issue 5 2003P. N. Woo We have assessed the value of patch testing from the patient's perspective and examined the impact of patch testing on their quality of life (QoL). 140 patients were recruited over 5 months. 2 questionnaires were designed to investigate the patient's views on patch testing. The 1st questionnaire was completed at the final visit to the clinic and the 2nd was posted 6 weeks later. The Dermatology Life Quality Index (DLQI) questionnaire was completed on both occasions. There was a significant improvement of the DLQI score in all patch-tested subjects (P = 0·003). Patients with involvement of the trunk had worse QoL. At the 4-day visit, 77 patients (55%) expressed the opinion that patch testing had been helpful. 6 weeks later, 71 patients replied. 47 patients were diagnosed as having allergic contact dermatitis: 87% of them found that patch testing had been useful, 91% were able to avoid the allergen(s) and 57% reported improvement/clearing in their skin condition. 58% of the 24 patients with negative results also found that patch testing had been beneficial. Overall, patient perception was that they understood verbal information (92%) better than written information (76%). Patch testing is beneficial to patients, leading to improved QoL. Patient perception was that they understood verbal advice better than written information. [source] Accounting Policy Disclosures and Analysts' ForecastsCONTEMPORARY ACCOUNTING RESEARCH, Issue 2 2003Ole-Kristian Hope Abstract Using an international sample, I investigate whether the extent of firms' disclosure of their accounting policies in the annual report is associated with properties of analysts' earnings forecasts. Controlling for firm- and country-level variables, I find that the level of accounting policy disclosure is significantly negatively related to forecast dispersion and forecast error. In particular, I find that accounting policy disclosures are incrementally useful to analysts over and above all other annual report disclosures. These findings suggest that accounting policy disclosures reduce uncertainty about forecasted earnings. I find univariate but not multivariate support for the hypothesis that accounting policy disclosures are especially helpful to analysts in environments where firms can choose among a larger set of accounting methods. [source] Agency Relations within the Family Business System: an exploratory approachCORPORATE GOVERNANCE, Issue 3 2003L.A.A. Van den Berghe Researchers use various definitions to describe the family firm. The characteristics of family firms that are stressed in each of these definitions are somehow related to family control. All characteristics together reflect a spectrum of family firm types along one core dimension: family involvement in the firm. However, it is more helpful to distinguish among family firms by using their precise type. Each particular family firm type is characterised by a set of agency relations within and between the family system, ownership system and the business system. This paper is a first attempt to apply the insights from agency theory on a highly simplified (reference) family firm situation where the father is full owner and the daughter manager of the family firm. Agency theory establishes the foundation for the optimal contract conditions between father and daughter. While real life is often characterised by bounded rationality and incomplete information, future research should help identify the "optimal contract" be-tween the family/shareholders and management in various family firm types under these circumstances. [source] Genetic manipulation, whole-cell recordings and functional imaging of the sensorimotor cortex of behaving miceACTA PHYSIOLOGICA, Issue 1 2009C. C. H. Petersen Abstract Sensory processing, sensorimotor integration and motor control are amongst the most basic functions of the brain and yet our understanding of how the underlying neuronal networks operate and contribute to behaviour is very limited. The relative simplicity of the mouse whisker sensorimotor system is helpful for detailed quantitative analyses of motor control and perception during active sensory processing. Recent technical advances now allow the measurement of membrane potential in awake-behaving mice, using whole-cell recordings and voltage-sensitive dye imaging. With these recording techniques, it is possible to directly correlate neuronal activity with behaviour. However, in order to obtain causal evidence for the specific contributions of different neuronal networks to behaviour, it is critical to manipulate the system in a highly controlled manner. Advances in molecular neurobiology, gene delivery and mouse genetics provide techniques capable of layer, column and cell-type specific control of gene expression in the mouse neocortex. Over the next years, we anticipate considerable advances in our understanding of brain function through measuring and manipulating neuronal activity with unprecedented precision to probe the molecular and synaptic mechanisms underlying simple forms of active sensory perception and associative learning. [source] Factors affecting the formation of misoriented domains in 6H-SiC single crystals grown by PVT methodCRYSTAL RESEARCH AND TECHNOLOGY, Issue 4 2009T. H. Peng Abstract Misoriented domains (MDs) are common defects in 6H-SiC single crystals. We performed an experimental study on the formation of MDs in 2-inch 6H-SiC single crystals. Micro-Raman spectroscopy revealed that the polytype of MDs was mainly 4H-SiC. By changing growth conditions, it was found that the MDs' formation was closely related to growth rate and the position of highest temperature relative to growth interface. When the growth rate of ingots was relatively high the MDs were more likely to form. Furthermore, the nearer growth interface the position of highest temperature was, the larger the size of the MDs. Based on our experimental findings we suggested that the MDs' formation and the polytype switching from 6H- to 4H-SiC were due to too large axial and/or radial temperature gradients. The results would be helpful to improve the quality of SiC single crystals grown by PVT technique. (© 2009 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim) [source] On slow protein crystal nucleation: cluster-cluster aggregation on diffusional encountersCRYSTAL RESEARCH AND TECHNOLOGY, Issue 1 2009C. N. NanevArticle first published online: 7 NOV 200 Abstract With a view to experimental results on protein crystal nucleation the effects of cluster coalescence are probed semi-quantitatively. The steric association restriction, which stems from the patchy surface of the protein molecules, explains both experimentally measured low crystal nucleation rate and coalescence limitations for crystalline clusters of protein molecules. The conclusion is that due to its action, and the impact of rotational diffusion, the coalescence of critical (and/or supercritical) clusters should be rejected as a conceivable alternative for explaining the slow nucleation of protein crystals. Besides, the analysis of cluster-cluster aggregation on diffusional encounters may be of more general interest; it may be helpful by considering the coalescence of structured bio-nano-particles. (© 2009 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim) [source] A novel growth method for ZnAl2O4 single crystalsCRYSTAL RESEARCH AND TECHNOLOGY, Issue 3 2006K. Kumar Abstract ZnAl2O4 is a well-known wide band gap compound semiconductor (Eg=3.8eV), ceramic, opto-mechanical, anti-thermal coating in aero-space vehicles and UV optoelectronic devices. A novel method for the growth of single crystals of a ternary oxide material was developed as a fruit of a long term work. Material to be grown as metal incorporated single crystal was taken as precursor and put into a bath containing acid as reaction speed up reagent (catalyst) as well as solvent with a metal foil as cation scavenger. Using this method, ZnAl2O4 crystals having hexagonal facets are prepared from a single optimized bath. Structural and compositional properties of crystals were studied using Philips, Xpert - MPD: X-ray diffractometer and Philips, ESEM-TMP + EDAX. Thus technique was found to be a new low cost and advantageous method for growth of single crystals of ternary oxide a material. We hope that these data be helpful either as a scientific or technical basis in material processing. Dedicated to Prof. P. Ramasamy © 2006 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim [source] Acute exercise causes an enhancement of tissue renin,angiotensin system in the kidney in ratsACTA PHYSIOLOGICA, Issue 1 2005S. Maeda Abstract Aims:, Initially, the renin,angiotensin system (RAS) produced through the classical endocrine pathway was well known for its regulation of blood pressure. However, it was revealed that a local autocrine and/or paracrine RAS may exist in a number of tissues (such as kidney). Exercise causes a redistribution of tissue blood flow, by which the blood flow is greatly increased in active muscles, whereas it is decreased in the splanchnic circulation (such as in the kidney). We hypothesized that exercise causes an enhancement of tissue RAS in the kidney. Methods:, We studied whether exercise affects expression of angiotensinogen and angiotensin-converting enzyme (ACE) and tissue angiotensin II level in the kidney. The rats performed treadmill running for 30-min. Immediately after this exercise, kidney was quickly removed. Control rats remained at rest during this 30-min period. Results:, The expression of angiotensinogen mRNA in the kidney was markedly higher in the exercise rats than in the control rats. ACE mRNA in the kidney was significantly higher in the exercise rats than in the control rats. Western blot analysis confirmed significant upregulation of ACE protein in the kidney after exercise. Tissue angiotensin II level was also increased by exercise. Conclusion:, The present study suggests that the exercise-induced enhancement of tissue RAS in the kidney causes vasoconstriction and hence decreases blood flow in the kidney, which are helpful in increasing blood flow in active muscles, thereby contributing to the redistribution of blood flow during exercise. [source] Learning from Difference: Considerations for Schools as CommunitiesCURRICULUM INQUIRY, Issue 3 2000Carolyn M. Shields In today's highly complex and heterogeneous public schools, the current notion of schools as homogeneous communities with shared beliefs, norms, and alues is inadequate. Drawing on Barth's (1990) question of how to use ifference as a resource, I take up ideas from feminism, multiculturalism, and inclusive education to consider the development of community in schools. I argue that despite the valuable contributions of these theoretical perspectives, each lso includes the potential for increased fragmentation and polarization. As we consider how to use differences as a foundation for community, it is important ot to reify any particular perspective, thus marginalizing others and erecting new barriers. Explicitly embracing the need to identify and respect difference, being open to new ideas without taking an exclusionary position, and committing to ongoing participation in dialogical processes may help schools to develop as more authentic communities of difference. Among the dominant issues identified in today's climate of turbulent educational reform are concerns about how to restructure schools to ensure equality of student opportunity and excellence of instruction (Elmore, 1990; Lieberman, 1992; Murphy, 1991). Many proposals include modifying present leadership and governance structures, overcoming the hegemony of existing power bases, developing mechanisms for accountability, enhancing professionalism, and co-ordinating community resources. One of the suggestions frequently made to address these issues is to change from a focus on schools as organizations to a recognition of schools as communities (Barth, 1990; Fullan, 1993; Lupart & Webber, 1996; Senge, 1990). However, despite the widespread use of the metaphor of community as an alternative to the generally accepted concept of schools as rational or functional organizations, there seems to be little clarity about the concept of community, what it might look like, how it might be implemented, or what policies might sustain it. Indeed, theories about schools as communities have often drawn from Tönnies (1887/1971) concept of gemeinschaft,a concept which perhaps evokes a more homogeneous and romanticized view of the past than one which could be helpful for improving education in today's dynamic, complex, and heterogeneous context (Beck & Kratzer, 1994; Sergiovanni, 1994a). More recently, several writers (Fine et al., 1997; Furman, 1998; Shields & Seltzer, 1997) have advanced the notion of communities of otherness or difference. These authors have suggested that rather than thinking of schools as communities that exist because of a common affiliation to an established school ethos or tradition, it might be more helpful to explore an alternative concept. A school community founded on difference would be one in which the common centre would not be taken as a given but would be co-constructed from the negotiation of disparate beliefs and values as participants learn to respect, and to listen to, each other. In this concept, bonds among members are not assumed, but forged, and boundaries are not imposed but negotiated. Over the past eight years, as I have visited and worked with a large number of schools trying earnestly to address the needs of their diverse student bodies, I have become increasingly aware of the limitations of the concept of community used in the gemeinschaft sense with its emphasis on shared values, norms, and beliefs, and have begun to reflect on the question framed by Barth (1990): ,How can we make conscious, deliberate use of differences in social class, gender, age, ability, race, and interest as resources for learning?' (p. 514). In this article, I consider how learning from three of these areas of difference: gender, race, and ability, may help us to a better understanding of educational community. This article begins with some illustrations and examples from practice, moves to consider how some theoretical perspectives may illuminate them, and concludes with reflections on how the implications of the combined reflections on practice and theory might actually help to reconceptualize and to improve practice. While it draws heavily on questions and impressions which have arisen out of much of my fieldwork, it is not intended to be an empirical paper, but a conceptual one,one which promotes reflection and discussion on the concept of schools as communities of difference. The examples of life in schools taken from longitudinal research studies in which I have been involved demonstrate several common ways in which difference is dealt with in today's schools and some of the problems inherent in these approaches. Some ideas drawn from alternative perspectives then begin to address Barth's question of how to make deliberate use of diversity as a way of thinking about community. Taken together, I hope that these ideas will be helpful in creating what I have elsewhere called ,schools as communities of difference' (Shields & Seltzer, 1997). [source] Flow cytometric differential of leukocyte populations in normal bone marrow: Influence of peripheral blood contamination1,CYTOMETRY, Issue 1 2009R. A. Brooimans Abstract Background: Availability of immunophenotypic reference values for the various leukocyte populations distributed in bone marrow may be helpful to recognize abnormal bone marrow development and, therefore, useful as first screening of individuals with suspected hematological malignancies or other hematopoietic disorders. Methods: A single tube four-color staining panel (CD66abce/CD14/CD45/CD34) together with a predefined gating strategy was utilized to immunologically differentiate the distribution of the major leukocyte populations in bone marrow aspirates of healthy donors. The sample-blood erythrocyte ratio was applied to assess the amount of blood contamination of marrow and account for this in the marrow value estimates. Results: The frequency of the major leukocyte populations in bone marrow of 134 normal donors were for granulocytes: mean, 69.4%; SD, 10.3%; monocytes: mean, 4.7%; SD, 2.3%; lymphocytes: mean, 18.3%; SD, 8.7%. The frequency of the immature cell population that included precursor cells of each of the cell lineages among other cell types were mean 5.0%; SD 2.2%. The mean percentage of CD34 positive cells was 1.5%; SD 0.7%. Our results showed further that the frequency of cell populations, of which the presence is restricted to the bone marrow (e.g., CD34+ progenitor cells), is influenced by the degree of peripheral blood admixture. Between the total immature cells and purity of the bone marrow, there was a significant positive correlation demonstrated, whereas a negative correlation was found between the percentages of both lymphocytes as monocytes and the purity of the bone marrow. Conclusions: With a single tube-staining panel, we obtained reference values for flow cytometric assessment of all relevant leukocyte populations present in bone marrow that can be used as a frame of reference for better recognition of individuals with abnormal hematopoiesis. In addition, we have demonstrated the influence of the degree of peripheral blood admixture in the bone marrow aspirates on those reference values. © 2008 Clinical Cytometry Society [source] Utility of CD26 in flow cytometric immunophenotyping of T-cell lymphomas in tissue and body fluid specimens,CYTOMETRY, Issue 6 2008Diane M. Pierson Abstract Background CD26 is expressed by most CD4+ T cells in normal peripheral blood specimens. Neoplastic T cells are frequently CD26, in mycosis fungoides/Sezary syndrome involving the peripheral blood. However, CD26 expression by reactive and neoplastic T cells in solid tissues and body fluids has not been fully characterized by flow cytometry (FC). Methods Solid tissue and body fluid specimens were assayed for CD26 expression using four-color FC immunophenotyping, by qualitative assessment of population clusters, and by quantitation with comparison with isotype controls. Benign T cells were studied in reactive tissues and in the background of other malignancies. Results Many T-cell lymphomas were dim or negative for CD26, whereas a few were brightly positive. In the majority of T-cell lymphomas, CD26 expression could potentially help identify aberrant population clusters. T cells in reactive tissue specimens and tumor-infiltrating T cells were commonly dim to negative for CD26. Conclusions Both T-cell lymphomas and reactive T cells in tissue and body fluid specimens often show low levels of CD26 expression. Therefore, quantitative methods may not reliably distinguish benign from neoplastic T cells in these specimens. However, CD26, in combination with other T-cell markers, can be helpful for identifying aberrant population clusters in T-cell lymphomas. © 2008 Clinical Cytometry Society [source] Difficulties in diagnosing small round cell tumours of childhood from fine needle aspiration cytology samplesCYTOPATHOLOGY, Issue 2 2008ekArticle first published online: 18 MAR 200, iva Pohar-Marin There are four basic reasons for the difficulties in diagnosing small round cell tumours (SRCT) in childhood from fine needle aspiration cytology (FNAC) samples. First, SRCTs are rare and it is difficult for cytopathologists to obtain enough experience for rendering reliable diagnoses. Second, SRCTs are morphologically very similar. Third, many SRCTs do not have specific antigens which could be demonstrated with immunocytochemistry (ICC) or they lose them when poorly differentiated. In addition, cross reactivity exists between some SRCTs. Unstandardized performance of ICC also contributes to the difficulties due to unreliable results. Fourth, suboptimal FNAC samples add additional pitfalls. The latter may be due to partly degenerate samples or to unrepresentative ones in cases where a SRCT is a heterologous component of another nosological entity. Lymphoma, neuroblastoma, nephroblastoma, Ewing's tumour/primitive neuroendocrine tumours and rhabdomyosarcoma are discussed in detail, while other less common SRCTs are mentioned as differential diagnoses when appropriate. The use of cytogenetic and molecular techniques for differentiating between certain SRCTs is helpful in some doubtful cases. However, there are still problems in the use of these techniques, especially their cost which may delay their being introduced in every cytopathology laboratory. [source] O-10 Endometrial cells in cervical smears: cytological features associated with clinically significant endometrial pathologyCYTOPATHOLOGY, Issue 2007R. N. Tiam Introduction:, To establish the significance of cytological features which could predict clinically significant endometrial pathology, and therefore guide reporting practice in cervical samples. Methods:, A retrospective review of SurePath liquid-based cytology (LBC) cervical samples between 2002 and 2006, obtained at screening and colposcopy. These smears contained normal endometrial cells present at inappropriate times of the menstrual cycle, endometrial cells with atypia (borderline change) and with features suspicious / diagnostic of endometrial carcinoma (glandular neoplasia). False negative and false positive cases detected on subsequent histology were also included. The control group comprised negative samples and a few abnormal smears. All smears were randomly assigned and blinded to menopausal status, age, use of oral contraceptive pill and hormone replacement therapy and presence of intrauterine device. Each smear was reviewed for 16 cytologic criteria and a cytological diagnosis was given for each. Results:, A total of 219 smears were available for review; 137 were negative, out of which 85 contained normal endometrial cells, 41 contained endometrial cells with atypia, 10 contained endometrial cells with features suggestive of adenocarcinoma and 31 contained endometrial cells with features diagnostic of adenocarcinoma. The feature most associated with benign endometrial cells is top hat with central cell condensation. In contrast, the features associated with malignant endometrial cells are smooth nuclear membrane, pale chromatin, small nucleoli and scalloped borders. Discussion:, The criteria identified in this study do not definitively define a neoplastic process, but appear to be helpful in individual cases. This study emphasises that endometrial changes should be always interpreted with the relevant clinical information, which would otherwise lead to overdiagnosis in premenopausal women. [source] Fine needle aspiration cytology in non-neoplastic non-toxic recurrent nodular goitreCYTOPATHOLOGY, Issue 4 2003ska-Klencka The aim of the study was to examine whether evaluation of anisokaryosis is helpful in the cytological diagnosis of focal lesions in non-toxic recurrent goitre (NRG) after thyroidectomy for non-malignant goitre. Karyometric analysis was performed in routine cytological smears obtained from 80 females: 40 with focal lesions in non-toxic primary goitre (NPG) and 40 with NRG (postoperative histopathological examination revealed nodular goitre in both groups in all cases). We found that the level of anisokaryosis was significantly (P < 0.005) higher in NRG than in NPG. There were no significant differences between the two lesions, in cellular composition or thyroid follicular cell arrangement. Thus, isolated anisokaryosis, a feature of malignancy in patients without a prior thyroidectomy, has limited diagnostic value in recurrent goitre. [source] In-Class Simulation of Pooling Safety StockDECISION SCIENCES JOURNAL OF INNOVATIVE EDUCATION, Issue 2 2005D. Brent Bandy ABSTRACT In managing business process flows, safety stock can be used to protect against stockouts due to demand variability. When more than one location is involved, the concept of aggregation enables the pooling of demands and associated inventories, resulting in improved service levels without increasing the total level of safety stock. This pooling of safety stock can be done physically by consolidating inventory in one location, or by using virtual centralization, where inventories are kept at decentralized locations, but information is centralized. In teaching the concept of pooling safety stock, a simple in-class simulation can be helpful in demonstrating why the approach works. The approach presented here involves operations for a company where total product demand is constant, but there are two products and product mix can vary. The simulation can also be implemented using an electronic spreadsheet for classes that are taught on the Internet. A quiz was given to two sections, one that experienced the simulation and one that did not. A comparison of the results from the quiz provided evidence of the effectiveness of the simulation in helping students understand the impact of pooling safety stock. In addition, a brief anonymous survey that was administered in the section that had the simulation provided further support for the effectiveness of the simulation. [source] A randomized, placebo-controlled trial of paroxetine in nursing home residents with non-major depressionDEPRESSION AND ANXIETY, Issue 3 2002Adam B. Burrows M.D. Abstract Depression is common across a broad spectrum of severity among nursing home residents. Previous research has demonstrated the effectiveness of antidepressants in nursing home residents with major depression, but it is not known whether antidepressants are helpful in residents with less severe forms of depression. We conducted a randomized double-blind placebo-controlled 8-week trial comparing paroxetine and placebo in very old nursing home residents with non-major depression. The main outcome measure was the primary nurse's Clinical Impression of Change (CGI-C). Additional outcome measures were improvement on the interview-derived Hamilton Depression Rating Scale (HDRS) and Cornell Scale for Depression (CS) scores. Twenty-four subjects with a mean age of 87.9 were enrolled and twenty subjects completed the trial. Placebo response was high, and when all subjects were considered, there were no differences in improvement between the paroxetine and placebo groups. Two subjects that received paroxetine developed delirium, and subjects that received paroxetine were more likely to experience a decrease in Mini Mental State Exam scores (P = .03). There were no differences in serum anticholinergic activity between groups. In a subgroup analysis of 15 subjects with higher baseline HDRS and CS scores, there was a trend toward greater improvement in the paroxetine group in an outcome measure that combined the CGI-C and interview-based measures (P = .06). Paroxetine is not clearly superior to placebo in this small study of very old nursing home residents with non-major depression, and there is a risk of adverse cognitive effects. Because of the high placebo response and the trend towards improvement in the more severely ill patients, it is possible that a larger study would have demonstrated a significant therapeutic effect for paroxetine as compared with placebo. The study also illustrates the discordance between patient and caregiver ratings, and the difficulties in studying very elderly patients with mood disorders. Depression and Anxiety 15:102,110, 2002. © 2002 Wiley-Liss, Inc. [source] Recognition of depressive symptoms in the elderly: What can help the patient and the doctorDEPRESSION AND ANXIETY, Issue 3 2002Ioannis A. Parashos M.D. Abstract The general public heavily underrecognizes depression and depressive symptoms. This underrecognition is more pronounced among elderly people, and this study is an initial attempt to quantify the problem in a Greek elderly sample. Additionally the authors attempt to identify patient-related factors, which can assist a subject to recognize the depressive symptoms and the general practitioner to note their existence. Members of senior citizen centers (n = 682) participated in presentations about "depression in the elderly" and completed a questionnaire including the GDS-4 scale, four questions concerning depression risk factors and a question concerning a recent visit to a physician for depressive symptoms. Amongst those participating, 35.8% presented depressive symptoms (GDS-4 , 2). The calculated rate for recognition of depression in the studied population was very low (17.3%). Patients with depressive symptoms were more often females and had a higher proportion of past history of depression and a lack of social support. Patients with a past history of depression and more severe forms of illness consulted a doctor more frequently. Finally, subjects suffering from depressive symptoms and comorbid medical illness were characterized by a higher proportion of past history, lack of support, and existence of multiple risk factors. The authors propose that the inclusion in public campaigns of activities with an experiential dimension, e.g., patient videos and the use of a very simple screening tool, such as the GDS-4 scale by general practitioners (GP), could be helpful in improving the recognition of depressive symptoms by the patient and his/her relatives and its diagnosis by the doctor. This proposition awaits formal proof in future studies. Depression and Anxiety 15:111,116, 2002. © 2002 Wiley-Liss, Inc. [source] Current Progress of Immunostains in Mohs Micrographic Surgery: A ReviewDERMATOLOGIC SURGERY, Issue 12 2008MAYA K. THOSANI MD Mohs micrographic surgery is often considered the treatment of choice for a variety of skin malignancies. In recent years, the application of immunostaining techniques has facilitated the successful removal of a number of common and less common cutaneous malignancies, including basal cell carcinoma, squamous cell carcinoma, malignant melanoma, dermatofibrosarcoma protuberans, microcystic adnexal carcinoma, sebaceous carcinoma, atypical fibroxanthoma, extramammary Paget's disease, and even sarcomas. Immunostains highlight the tumor cells and allow the Mohs surgeons to pinpoint and eliminate the residual tumor at the surgical margin. It is especially helpful when a tumor presents with subtle or nonspecific histologic features or when a tumor is masked in a pocket of dense inflammation. However, the cost, the labor, and the time consumption are of concern to many of our peers, as are the diversity of antigens, which may overwhelm some. This article serves as a review of the literature on current uses of immunostaining in Mohs micrographic surgery and as a summary of their realistic applications in the dermatologic surgeon's practice. We conclude that immunohistochemical technique has played an important role in Mohs surgery advancement. With greater use and more cost-effective staining methods, we believe that the use of immunostains in a Mohs practice will become routine. [source] Curettage prior to Mohs' Micrographic Surgery for Previously Biopsied Nonmelanoma Skin Cancers: What Are We Curetting?DERMATOLOGIC SURGERY, Issue 1 2005Comparative Study, Prospective, Retrospective Background Curettage prior to excision and Mohs' micrographic surgery for nonmelanoma skin cancer is performed based on the assumption that the curette will remove softer, more friable tumor-infiltrated dermis and leave structurally intact normal skin. This assumption, however, has not been objectively examined in the dermatologic surgery literature. Objective We performed a study to examine the ability of curettage to selectively remove and delineate nonmelanoma skin cancer prior to Mohs' micrographic surgery. Methods The study included 150 previously biopsied basal cell and squamous cell carcinomas less than 1.5 cm in size. We conducted (1) a retrospective study of 50 tumors curetted prior to Mohs' surgery by a surgeon who routinely curettes preoperatively; (2) a prospective study in which a surgeon who routinely does not curette preoperatively curetted 50 tumors prior to Mohs' surgery; and (3) a comparative historical group of 50 noncuretted tumors treated with Mohs' surgery by the latter surgeon. All curetted tissue was evaluated histologically. Results Only 50% of the curetted tissue demonstrated the presence of tumor in the curettings, but in 76% of these, the curette left residual tumor at the surgical margins. Of the other 50% in which the curette removed only non,cancer-containing skin, 34% had tumor present at the surgical margin. Overall, the curette removed tumor, leaving no residual tumor at the surgical margins in only 12% of lesions. Comparison with historical noncuretted tumors operated on by the same surgeon showed that curettage did not affect the mean number of stages or the proportion of tumors requiring more than one stage for histologic clearance. Conclusion Although curettage may be helpful in debulking friable skin prior to Mohs' micrographic surgery, it does not reliably delineate the extent of a tumor. MING H. JIH, MD, PHD, PAUL M. FRIEDMAN, MD, LEONARD H. GOLDBERG, MD, AND ARASH KIMYAI-ASADI, MD, HAVE INDICATED NO SIGNIFICANT INTEREST WITH COMMERCIAL SUPPORTERS. [source] The Efficacy of Curettage in Delineating Margins of Basal Cell Carcinoma Before Mohs Micrographic SurgeryDERMATOLOGIC SURGERY, Issue 9 2003Désirée Ratner MD Background. Curettage may be helpful as a preliminary step to outline the gross subclinical extensions of high-risk basal cell carcinomas (BCCs) before the first stage of Mohs micrographic surgery. Although many Mohs surgeons use curettage in the Mohs surgical setting, no prospective studies have as yet been performed that demonstrate the efficacy of curettage in delineating tumor margins before Mohs surgery. Objective. To document the efficacy of curettage in delineating BCC margins before Mohs micrographic surgery. Methods. This was a prospective evaluation of 599 patients with biopsy-proven BCCs treated with Mohs surgery. The preoperative dimensions of each tumor, the curetted dimensions before the first surgical stage, the proposed excisional margins before each surgical stage, and the final defect dimensions after each surgical stage were measured. The maximum curetted margin around each tumor was calculated and compared with typical Mohs excisional margins of 1, 2, 3, and 4 mm. A hypothetical 1-, 2-, 3-, or 4-mm excisional margin was added to the preoperative X and Y dimensions of each tumor, and the actual final defect sizes were compared with the hypothetical final defect sizes to determine whether an additional surgical stage would have been needed had curettage not been performed. The amount of tissue stretch occurring after specimen removal was calculated to determine whether tissue stretch falsely elevated the number of instances in which an additional surgical stage would have been needed had curettage not been performed. Results. The curetted margin around the observed extent of each tumor exceeded 1 mm in 87.6% of cases, 2 mm in 47.1% of cases, 3 mm in 19.7% of cases, and 4 mm in 5.7% of cases. The mean curetted margin was 1.7 mm. Taking a 1-mm margin in the first stage of Mohs surgery without first performing curettage would have necessitated an extra surgical stage in 99.2% of cases, whereas taking a 2-, 3-, or 4-mm margin would have necessitated an extra surgical stage in 93.0%, 88.1%, and 49.4% of cases, respectively. After calculating and eliminating the effects of tissue stretch, it was found that a 1-mm excisional margin taken in the first stage of Mohs surgery without first performing curettage would have necessitated an extra surgical stage in 99.0% of the cases. Taking a 2-, 3-, or 4-mm margin would have necessitated an extra surgical stage in 87.5%, 57.9%, and 29.5% of cases, respectively. Conclusion. Careful debulking and palpation with the curette significantly reduce the number of Mohs surgical stages required for BCC clearance. Even after taking the effects of tissue stretch into consideration, a significant proportion of tumors would still require an additional stage for tumor clearance without aggressive presurgical curettage. [source] The histopathology of alopecia areata in vertical and horizontal sectionsDERMATOLOGIC THERAPY, Issue 4 2001David A. Whiting Alopecia areata (AA) is a relatively common disease affecting 1.7% of Americans by the age of 50 years. The diagnosis is usually made on clinical grounds. In some cases the diagnosis is elusive and biopsies are necessary. In other cases biopsies are useful from a prognostic point of view to determine whether there are enough follicles left for possible future regrowth. In view of the active research being conducted into AA, biopsies provide valuable material for further investigation. The diagnosis of AA is improved by the use of horizontal sections in addition to or instead of vertical sections of scalp biopsies. The histopathologic features favoring the diagnosis of AA include peribulbar and intrabulbar mononuclear infiltrates, degenerative changes in the hair matrix, decreased numbers of terminal anagen follicles, increased numbers of terminal catagen and telogen follicles, an increased number of follicular stelae, an increased number of miniaturized vellus hair follicles, and pigment incontinence of hair bulbs and follicular stelae. Follicular counts with horizontal sections are particularly helpful in making the diagnosis of AA when the biopsy has been taken between acute episodes and the characteristic peribulbar inflammatory infiltrate is absent. [source] DEFINING STANDARD OF CARE IN THE DEVELOPING WORLD: THE INTERSECTION OF INTERNATIONAL RESEARCH ETHICS AND HEALTH SYSTEMS ANALYSISDEVELOPING WORLD BIOETHICS, Issue 2 2005ADNAN A. HYDER ABSTRACT In recent years there has been intense debate regarding the level of medical care provided to ,standard care' control groups in clinical trials in developing countries, particularly when the research sponsors come from wealthier countries. The debate revolves around the issue of how to define a standard of medical care in a country in which many people are not receiving the best methods of medical care available in other settings. In this paper, we argue that additional dimensions of the standard of care have been hitherto neglected, namely, the structure and efficiency of the national health system. The health system affects locally available medical care in two important ways: first, the system may be structured to provide different levels of care at different sites with referral mechanisms to direct patients to the appropriate level of care. Second, inefficiencies in this system may influence what care is available in a particular locale. As a result of these two factors locally available care cannot be equated with a national ,standard'. A reasonable approach is to define the national standard of care as the level of care that ought to be delivered under conditions of appropriate and efficient referral in a national system. This standard is the minimum level of care that ought to be provided to a control group. There may be additional moral arguments for higher levels of care in some circumstances. This health system analysis may be helpful to researchers and ethics committees in designing and reviewing research involving standard care control groups in developing country research. [source] Escaping Violence, Seeking Freedom: Why Children in Bangladesh Migrate to the StreetDEVELOPMENT AND CHANGE, Issue 2 2007Alessandro Conticini ABSTRACT In Bangladesh, as in many developing countries, there is a widespread belief amongst the public, policy makers and social workers that children ,abandon' their families and migrate to the street because of economic poverty. Ignoring and avoiding mounting evidence to the contrary, this dominant narrative posits that children whose basic material needs cannot be met within the household move to the street. This article explores this narrative through the analysis of detailed empirical research with children in Bangladesh. It finds that social factors lie behind most street migration and, in particular, that moves to the street are closely associated with violence towards and abuse of children within the household and local community. These findings are consistent with the wider literature on street migration from other countries. In Bangladesh, those who seek to reduce the flow of children to the streets need to focus on social policy, especially on how to reduce the excessive control and emotional, physical and sexual violence that occur in some households. Economic growth and reductions in income poverty will be helpful, but they will not be sufficient to reduce street migration by children. [source] | |||||||||||||||||||||||||||||||||||||||||||||||||