Home About us Contact
|
Home About us Contact | ||
|
|
||
Ill
Terms modified by Ill Selected AbstractsHigh-resolution neutron protein crystallography with radically small crystal volumes: application of perdeuteration to human aldose reductaseACTA CRYSTALLOGRAPHICA SECTION D, Issue 10 2005I. Hazemann Neutron diffraction data have been collected to 2.2,Å resolution from a small (0.15,mm3) crystal of perdeuterated human aldose reductase (h-AR; MW = 36,kDa) in order to help to determine the protonation state of the enzyme. h-AR belongs to the aldo,keto reductase family and is implicated in diabetic complications. Its ternary complexes (h-AR,coenzyme NADPH,selected inhibitor) provide a good model to study both the enzymatic mechanism and inhibition. Here, the successful production of fully deuterated human aldose reductase [h-AR(D)], subsequent crystallization of the ternary complex h-AR(D),NADPH,IDD594 and neutron Laue data collection at the LADI instrument at ILL using a crystal volume of just 0.15,mm3 are reported. Neutron data were recorded to 2,Å resolution, with subsequent data analysis using data to 2.2,Å. This is the first fully deuterated enzyme of this size (36,kDa) to be solved by neutron diffraction and represents a milestone in the field, as the crystal volume is at least one order of magnitude smaller than those usually required for other high-resolution neutron structures determined to date. This illustrates the significant increase in the signal-to-noise ratio of data collected from perdeuterated crystals and demonstrates that good-quality neutron data can now be collected from more typical protein crystal volumes. Indeed, the signal-to-noise ratio is then dominated by other sources of instrument background, the nature of which is under investigation. This is important for the design of future instruments, which should take maximum advantage of the reduction in the intrinsic diffraction pattern background from fully deuterated samples. [source] Incorporation of methyl-protonated valine and leucine residues into deuterated ocean pout type III antifreeze protein: expression, crystallization and preliminary neutron diffraction studiesACTA CRYSTALLOGRAPHICA SECTION F (ELECTRONIC), Issue 6 2010Isabelle Petit-Haertlein Antifreeze proteins (AFPs) are found in different species from polar, alpine and subarctic regions, where they serve to inhibit ice-crystal growth by adsorption to ice surfaces. Recombinant North Atlantic ocean pout (Macrozoarces americanus) AFP has been used as a model protein to develop protocols for amino-acid-specific hydrogen reverse-labelling of methyl groups in leucine and valine residues using Escherichia coli high-density cell cultures supplemented with the amino-acid precursor ,-ketoisovalerate. Here, the successful methyl protonation (methyl reverse-labelling) of leucine and valine residues in AFP is reported. Methyl-protonated AFP was expressed in inclusion bodies, refolded in deuterated buffer and purified by cation-exchange chromatography. Crystals were grown in D2O buffer by the sitting-drop method. Preliminary neutron Laue diffraction at 293,K using LADI-III at ILL showed in a few 24,h exposures a very low background and clear small spots up to a resolution of 1.80,Å from a crystal of dimensions 1.60 × 0.38 × 0.38,mm corresponding to a volume of 0.23,mm3. [source] Perdeuteration, purification, crystallization and preliminary neutron diffraction of an ocean pout type III antifreeze proteinACTA CRYSTALLOGRAPHICA SECTION F (ELECTRONIC), Issue 4 2009Isabelle Petit-Haertlein The highly homologous type III antifreeze protein (AFP) subfamily share the capability to inhibit ice growth at subzero temperatures. Extensive studies by X-ray crystallography have been conducted, mostly on AFPs from polar fishes. Although interactions between a defined flat ice-binding surface and a particular lattice plane of an ice crystal have now been identified, the fine structural features underlying the antifreeze mechanism still remain unclear owing to the intrinsic difficulty in identifying H atoms using X-ray diffraction data alone. Here, successful perdeuteration (i.e. complete deuteration) for neutron crystallographic studies of the North Atlantic ocean pout (Macrozoarces americanus) AFP in Escherichia coli high-density cell cultures is reported. The perdeuterated protein (AFP D) was expressed in inclusion bodies, refolded in deuterated buffer and purified by cation-exchange chromatography. Well shaped perdeuterated AFP D crystals have been grown in D2O by the sitting-drop method. Preliminary neutron Laue diffraction at 293,K using LADI-III at ILL showed that with a few exposures of 24,h a very low background and clear small spots up to a resolution of 1.85,Å were obtained using a `radically small' perdeuterated AFP D crystal of dimensions 0.70 × 0.55 × 0.35,mm, corresponding to a volume of 0.13,mm3. [source] A preliminary neutron diffraction study of ,-chymotrypsinACTA CRYSTALLOGRAPHICA SECTION F (ELECTRONIC), Issue 3 2009Walter R. P. Novak The crystal preparation and preliminary neutron diffraction analysis of ,-chymotrypsin are presented. Large hydrogenated crystals of ,-chymotrypsin were exchanged into deuterated buffer via vapor diffusion in a capillary and neutron Laue diffraction data were collected from the resulting crystal to 2.0,Å resolution on the LADI-III diffractometer at the Institut Laue,Langevin (ILL) at room temperature. The neutron structure of a well studied protein such as ,-chymotrypsin, which is also amenable to ultrahigh-resolution X-ray crystallography, represents the first step in developing a model system for the study of H atoms in protein crystals. [source] A preliminary neutron crystallographic study of proteinase K at pD 6.5ACTA CRYSTALLOGRAPHICA SECTION F (ELECTRONIC), Issue 2 2009Anna S. Gardberg A preliminary neutron crystallographic study of the proteolytic enzyme proteinase K is presented. Large hydrogenated crystals were prepared in deuterated crystallization buffer using the vapor-diffusion method. Data were collected to a resolution of 2.3,Å on the LADI-III diffractometer at the Institut Laue,Langevin (ILL) in 2.5,d. The results demonstrate the feasibility of a full neutron crystallographic analysis of this structure with the aim of providing relevant information on the location of H atoms, particularly at the active site. This information will contribute to further understanding of the molecular mechanisms underlying the catalytic activity of proteinase K and to an enriched understanding of the subtilisin clan of serine proteases. [source] Interleukin-1 gene polymorphisms and experimental gingivitisJOURNAL OF CLINICAL PERIODONTOLOGY, Issue 2 2003Søren Jepsen Abstract Background: Recently, an association between the severity of periodontitis and specific variations in the interleukin-1 (IL1) , and , genes has been demonstrated. Aim: The purpose of this study was to evaluate the relationship of the IL1 genotype to the development of experimental gingivitis. Materials and Methods: Twenty young adult subjects presenting with healthy gingival conditions participated after giving their informed consent. The group included 10 risk genotype positive (P+) and 10 risk genotype negative (P,) individuals. The IL1 genotypes were determined on DNA samples from peripheral blood using PCR-RFLP analyses for the IL1, and IL1, polymorphisms. Experimental gingivitis was allowed to develop in two posterior sextants per subject. Bleeding on probing (BOP%) and gingival crevicular fluid volume (GCF) were assessed at baseline and days 2, 7, 9, 14, 16 and 21. The day 21 results for BOP and GCF as well as the rate of increase of these parameters , mean area under the curve (AUC) and mean increase per day (slope) , were evaluated using risk analyses for IL1 genotype, smoking status and gender. Results: Experimental gingivitis developed with a gradual increase in BOP scores and GCF values (expressed as Periotron units=PU) from baseline to day 21 (BOP, P+: 0.5 to 26.0%; P,: 1.0 to 28.1%; GCF, P+: 36.8 to 138.5 PU, P,: 43.1 to 143.4 PU). No significant risk was associated with P+ and P, for day 21 results, AUC or slope. Conclusion: The results of this study failed to provide evidence that the IL1 risk genotype was associated with higher GCF volume and percentage BOP during the development of experimental gingivitis. Zusammenfassung Hintergrund: Kürzlich ist eine Beziehung zwischen dem Schweregrad von Parodontitis und speziellen Varianten der Interleukin-1 (IL1),- und -,-Gene gezeigt worden. Zielsetzung: Untersuchung des Zusammenhanges zwischen dem ILl-Genotyp und der Entwicklung einer experimentellen Gingivitis. Material und Methoden: 20 junge Erwachsene mit gesunden parodontalen Verhältnissen, von denen 10 für den Risikogenotyp positiv (P+) und 10 negativ (P-) waren, nahmen an der Studie teil, nachdem sie ihr Einverständnis dazu gegeben hatten. Die IL1 -Genotypen wurden aus DNS-Proben aus peripherem Blut mittels PCR-RFLP-Analyse auf ILl,- und IL1/,-Polymorphismen untersucht. In 2 Seitenzahnsextanten ließ jeder Proband eine experimentelle Gingivitis entwickeln. Bluten auf Sondieren (BOP%) und Sulkiksfiüssigkeitsvolumen (SFV) wurden zu Beginn der Studie und nach 2, 7, 9, 14, 16 und 21 Tagen bestimmt. Sowohl die Ergebnisse für BOP und SFV an Tag 21 als auch die Zunahme dieser Werte , mittlere Fläche unter der Kurve (AUC) und mittlere Zunahme pro Tag (Steigung) , wurden mittels Risikoanalyse fur IL1 -Genotyp, Rauchen und Gescnlecht bestimmt. Ergebnisse: Die experimentelle Gingivitis entwickelte sich mit einem stetigen Anstieg der BOP- und SFV-Werte (ausgedrückt als Periotroneinheiten=PU) vom Beginn der Studie bis zum 21. Tag (BOP, P+: 0,5% to 26,0%, P-: 1,0% to 28,1%; GCF, P+: 36,8 to 138,5 PU, P-: 43,1 to 143,4 PU). Mit P+und P- war kein signifikantes Risiko für die Werte am 21. Tag, die AUC oder die Steigung verbunden. Schlussfolgerung: Die Ergebnisse dieser Studie konnten keine Beziehung zwischen dem IL1 -Risikogenotype und erhöhtem SFV bzw. Anteil von Stellen mit BOP in % während der Entwicklung einer experimentellen Gingivitis zeigen. Résumé Contexte: Récemment, une association entre la sévérité de la parodontite et des variations spéifiques des gènes codant pour l'interleukin-1 (IL1) , et , a été démontrée. But: Cette étude se propose d'évaluer la relation entre le génotype IL1 dans le developpment de la gingivite expérimentale. Méthods: 20 jeunes sujets adultes présentant une bonne santé gingivale ont participé cette étude après consentement éclairé. Dans ce groupe, il y avait 10 individus à risque positif (P+) et 10 individus à génotype de risque négatif (P,). génotypes lL1 furent déterminés sur des échantillons d'ADN prélevés du sang périphérique par analyse en PCR-RFLP pour les polymorphismes d' IL1, et IL1,. On a laissé se développer une gingivite expérimentale sur 2 sextants postérieurs chez chaque sujet. Le saignement au sondage (BOP%) et le volume de fluide gingival (GCF) furent notes au départ et aux jours 2, 7, 9, 14, 16, et 21. Au vingt et unième jour, les résultats pour BOP et GCF ainsi que le taux d'augmentation de ces paramètres- La surface moyenne sous la courbe (AUC) et l'augmentation moyenne par jour (pente) - furent évalués par analyses du risque pour les génotypes IL1, le tabagisme et le sexe. Résultats: gingivite expérimentale se développa avec une augmentation graduelle des et scores de BOP et des valeurs de GCF (exprimées en unités Periotron=PU) du début de l'étude jusqu'au jour 21 (BOP, P+: 0.5%à 26.0%, P-: 1.0%à 28.1%; GCF, P+: 36.8 à 43.1 à 143.4 PU). Aucun risque significatif ne fut associe avec P+et P-ats à 21 jours, AUC ou la pente. Conclusion: -es résultats de cette étude n'ont pas pu donner de preuves d'associations entre le génotype de risque IL1 et un volume accru de GCF et le % BOP lors du t d'une gingivite expérimentale. [source] The Cost-Effectiveness of Independent Housing for the Chronically Mentally Ill: Do Housing and Neighborhood Features Matter?HEALTH SERVICES RESEARCH, Issue 5 2004Joseph Harkness Objective. To determine the effects of housing and neighborhood features on residential instability and the costs of mental health services for individuals with chronic mental illness (CMI). Data Sources. Medicaid and service provider data on the mental health service utilization of 670 individuals with CMI between 1988 and 1993 were combined with primary data on housing attributes and costs, as well as census data on neighborhood characteristics. Study participants were living in independent housing units developed under the Robert Wood Johnson Foundation Program on Chronic Mental Illness in four of nine demonstration cities between 1988 and 1993. Study Design. Participants were assigned on a first-come, first-served basis to housing units as they became available for occupancy after renovation by the housing providers. Multivariate statistical models are used to examine the relationship between features of the residential environment and three outcomes that were measured during the participant's occupancy in a study property: residential instability, community-based service costs, and hospital-based service costs. To assess cost-effectiveness, the mental health care cost savings associated with some residential features are compared with the cost of providing housing with these features. Data Collection/Extraction Methods. Health service utilization data were obtained from Medicaid and from state and local departments of mental health. Non-mental-health services, substance abuse services, and pharmaceuticals were screened out. Principal Findings. Study participants living in newer and properly maintained buildings had lower mental health care costs and residential instability. Buildings with a richer set of amenity features, neighborhoods with no outward signs of physical deterioration, and neighborhoods with newer housing stock were also associated with reduced mental health care costs. Study participants were more residentially stable in buildings with fewer units and where a greater proportion of tenants were other individuals with CMI. Mental health care costs and residential instability tend to be reduced in neighborhoods with many nonresidential land uses and a higher proportion of renters. Mixed-race neighborhoods are associated with reduced probability of mental health hospitalization, but they also are associated with much higher hospitalization costs if hospitalized. The degree of income mixing in the neighborhood has no effect. Conclusions. Several of the key findings are consistent with theoretical expectations that higher-quality housing and neighborhoods lead to better mental health outcomes among individuals with CMI. The mental health care cost savings associated with these favorable features far outweigh the costs of developing and operating properties with them. Support for the hypothesis that "diverse-disorganized" neighborhoods are more accepting of individuals with CMI and, hence, associated with better mental health outcomes, is mixed. [source] Nursing Interventions for a Chronically Ill, Nonadherent Teenager With a Psychiatric DiagnosisJOURNAL FOR SPECIALISTS IN PEDIATRIC NURSING, Issue 4 2003Diane Sieben BSN ISSUES AND PURPOSE To describe the complex care of an adolescent with chronic psychiatric and medical problems. CONCLUSIONS The nonadherent, self-abusing, adolescent was empowered to progress developmentally, as well as medically. PRACTICE IMPLICATIONS A planned team approach helped the adolescent become more developmentally appropriate and independent in self-care. The care plan designed by nursing staff included a change in nursing focus, creative problem solving, team nursing, and utilization of multidisciplinary resources. [source] Obtaining Informed Consent for Research: A Model for Use with Participants Who Are Mentally IllTHE JOURNAL OF LAW, MEDICINE & ETHICS, Issue 3 2002Norman G. Poythress First page of article [source] Care of the Chronically Ill at Home: An Unresolved Dilemma in Health Policy for the United StatesTHE MILBANK QUARTERLY, Issue 4 2007KAREN BUHLER-WILKERSON The problems of caring for patients with disabling illnesses who neither get well nor die are not new. Such patients have always required assistance at home from family, benevolent volunteers, or paid caregivers. Despite two centuries of experimentation, however, no agreement exists concerning the balance between the public and private resources to be allocated through state funding, private insurance, and family contributions for the daily and routine care at home for chronically ill persons of all ages. This article examines these issues and the unavoidable tensions between fiscal reality and legitimate need. It also uses historical and policy analyses to explain why home care has never become the cornerstone for caring for the chronically ill. [source] Who Can Speak for the Emergently Ill?ACADEMIC EMERGENCY MEDICINE, Issue 6 2008Testing a Method to Identify Communities, Their Leaders Abstract Objectives:, The Food and Drug Administration (FDA) requires researchers to consult with the community prior to conducting research with exception from informed consent, but little is known about whether people support this and, if they do, who researchers should consult. We sought to determine if people could identify communities and leaders of those communities who researchers should consult with to represent their views about research that requires an exception from informed consent. Methods:, We conducted a cross-sectional interview study using a convenience sample of patients seeking care in an urban emergency department (ED) to determine if people belonged to specific communities and, if they did, if they could identify communities and leaders appropriate for consultation. Descriptive statistics were used to represent our findings. Results:, Most of the 262 participants approached for the study completed the interview (199; 76%). Of those interviewed, 122 (61%) were African American, 54 (27%) were white, 83 (42%) were male, and the mean (±standard deviation [SD]) age was 36.2 ± 14.4 years. Most, (194; 97%), identified that they belonged to a community and most (177; 89%), said that researchers could consult at least one of their communities for consultation about an exception from informed consent study. Participants typically named geographic and religious-affiliated communities and leaders as appropriate for consultation. Conclusion:, Most participants identified a community and a leader of that community who researchers could consult about research with exception from informed consent. Geographic and faith-based organizations could play an important role in consultation. [source] Conservation action in a changing climateCONSERVATION LETTERS, Issue 2 2008T.R. McClanahan Abstract Climate change will pose new challenges to conserving Earth's natural ecosystems, due to incremental changes in temperature and weather patterns, and to increased frequency and intensity of extreme climate events. Addressing these challenges will require pragmatic conservation actions informed by site-specific understanding of susceptibility to climate change and capacity of societies to cope with and adapt to change. Depending on a location's environmental susceptibility and social adaptive capacity, appropriate conservation actions will require some combination of: (1) large-scale protection of ecosystems; (2) actively transforming and adapting social-ecological systems; (3) building the capacity of communities to cope with change; and (4) government assistance focused on de-coupling communities from dependence on natural resources. We apply a novel analytical framework to examine conservation actions in five western Indian Ocean countries, where climate-mediated disturbance has impacted coral reefs and where adaptive capacity differs markedly. We find that current conservation strategies do not reflect adaptive capacity and are, therefore, ill prepared for climate change. We provide a vision for conservation policies that considers social adaptive capacity that copes with complexities of climate change better than the singular emphasis on government control and the creation of no-take areas. [source] Filicide: A comparative study of maternal versus paternal child homicideCRIMINAL BEHAVIOUR AND MENTAL HEALTH, Issue 3 2008Marieke Liem Background,Filicide is the murder of a child by a parent. Historically, filicide was regarded as a female crime, but nowadays, in the West, men have become increasingly likely to be convicted of killing their child. Previous research on filicide has primarily focussed on either maternal or paternal filicide rather than comparing the two. Aim,The aim of our study is to examine and compare the socio-demographic, environmental and psychopathological factors underlying maternal and paternal filicide. Methods,Data were extracted from records in a forensic psychiatric observation hospital in Utrecht, in the Netherlands for the period 1953,2004. Results,Seventy-nine men and 82 women were detained in the hospital under criminal charges in that period, having killed (132) or attempted to kill (29) their own child(ren). Differences between men and women were found with regard to age, methods of killing and motivation underlying the filicide. Conclusions,The categories of filicide identified corresponded to those in studies from other countries, indicating that filicide follows similar patterns throughout the Western world. The fact that 25% of fathers had killed in reaction to threatened separation or divorce, and that over a third of men and more than half of the women were mentally ill at the time may suggest that increased monitoring by primary care physicians under such circumstances might have preventive value. Copyright © 2008 John Wiley & Sons, Ltd. [source] Psychosis and offending in British Columbia: characteristics of a secure hospital populationCRIMINAL BEHAVIOUR AND MENTAL HEALTH, Issue 3 2001Nicola Hodelet Specialist Registrar Introduction There is an increased likelihood of violence in the mentally ill although the risk is small. Aims The study aimed to ascertain the features in a secure hospital population that linked offending and mental illness. Method A survey of patients in the high security hospital serving the province of British Columbia in Canada was carried out. Information on 175 mentally disordered offenders was extracted and included demographic data and specific characteristics of their offences, diagnoses and psychotic symptoms. Results The most prevalent offences were crimes of violence, but 39% of patients were not primarily violent offenders. Almost two-thirds (61%) had two or more diagnoses. A large majority of the patients were psychotic, schizophrenia being the most common diagnosis. There was a highly significant association between psychosis and violence, but the strength of the association was not increased by the presence of imperative hallucinations or delusions. The sample comprised various ethnic groups, one of which, Native Americans, was over-represented. However, no association was found between violent offending and ethnicity, or age or years of illness. Discussion The study replicates previous findings of the link between violent offending and psychosis, but not a specific link between violent offending and psychotic drive. A surprising finding was a lack of association between violent offences and substance misuse. Copyright © 2001 Whurr Publishers Ltd. [source] SOCIAL DISORGANIZATION OUTSIDE THE METROPOLIS: AN ANALYSIS OF RURAL YOUTH VIOLENCE,CRIMINOLOGY, Issue 1 2000D. WAYNE OSGOOD In order to extend the study of community social disorganization and crime beyond its exclusive focus on large urban centers, we present an analysis of structural correlates of arrest rates for juvenile violence in 264 nonmetropolitan counties of four states. Findings support the generality of social disorganization theory: Juvenile violence was associated with rates of residential instability, family disruption, and ethnic heterogeneity. Though rates of poverty were not related to juvenile violence, this is also in accord with social disorganization theory because, unlike urban settings, poverty was negatively related to residential instability. Rates of juvenile violence varied markedly with population size through a curvilinear relationship in which counties with the smallest juvenile populations had exceptionally low arrest rates. Analyses used negative binomial regression (a variation of Poisson regression) because the small number of arrests in many counties meant that arrest rates would be ill suited to least-squares regression. [source] A double-blind study of the efficacy of venlafaxine extended-release, paroxetine, and placebo in the treatment of panic disorderDEPRESSION AND ANXIETY, Issue 1 2007Mark H. Pollack M.D. Abstract To date, no large-scale, controlled trial comparing a serotonin,norepinephrine reuptake inhibitor and selective serotonin reuptake inhibitor with placebo for the treatment of panic disorder has been reported. This double-blind study compares the efficacy of venlafaxine extended-release (ER) and paroxetine with placebo. A total of 664 nondepressed adult outpatients who met DSM-IV criteria for panic disorder (with or without agoraphobia) were randomly assigned to 12 weeks of treatment with placebo or fixed-dose venlafaxine ER (75,mg/day or 150,mg/day), or paroxetine 40,mg/day. The primary measure was the percentage of patients free from full-symptom panic attacks, assessed with the Panic and Anticipatory Anxiety Scale (PAAS). Secondary measures included the Panic Disorder Severity Scale, Clinical Global Impressions,Severity (CGI-S) and ,Improvement (CGI-I) scales; response (CGI-I rating of very much improved or much improved), remission (CGI-S rating of not at all ill or borderline ill and no PAAS full-symptom panic attacks); and measures of depression, anxiety, phobic fear and avoidance, anticipatory anxiety, functioning, and quality of life. Intent-to-treat, last observation carried forward analysis showed that mean improvement on most measures was greater with venlafaxine ER or paroxetine than with placebo. No significant differences were observed between active treatment groups. Panic-free rates at end point with active treatment ranged from 54% to 61%, compared with 35% for placebo. Approximately 75% of patients given active treatment were responders, and nearly 45% achieved remission. The placebo response rate was slightly above 55%, with remission near 25%. Adverse events were mild or moderate and similar between active treatment groups. Venlafaxine ER and paroxetine were effective and well tolerated in the treatment of panic disorder. Depression and Anxiety 24:1,14, 2007. © 2006 Wiley-Liss, Inc. [source] The functional impact of anxiety sensitivity in the chronically physically illDEPRESSION AND ANXIETY, Issue 4 2005Sonya B. Norman Ph.D. Abstract The symptoms and physical limitations resulting from chronic physical illness often diminish physical functioning. Comorbidity of chronic physical illness and an anxiety disorder is associated with greater impairment in functioning than chronic illness alone. One potential contributor to anxiety in the chronically ill is anxiety sensitivity (AS). The goal of this study was to explore the role of AS on functioning in the chronically ill. Participants were 267 primary care patients. Logistic regression showed that physical AS (but not social or psychological), controlling for age, gender, and negative affect, was associated with hypertension, heart disease, and high cholesterol (P<.01). Higher AS was associated with poorer vitality, mental functioning, and social functioning (P<.05). AS may be a correlate of poorer adjustment to chronic illness. Depression and Anxiety 21:154,160, 2005. © 2005 Wiley-Liss, Inc. [source] The use of systemic antibiotics in the treatment of chronic woundsDERMATOLOGIC THERAPY, Issue 6 2006Robert Hernandez ABSTRACT:, The role of microorganisms in the etiology and persistence of chronic wounds remains poorly understood. The chronic wound bed houses a complex microenvironment that typically includes more than one bacterial species. Difficulty lies in determining when the presence of bacteria impedes wound healing, thereby warranting intervention. Indications for antibiotic therapy and optimal treatment regimens are ill defined. The goal of this article is to describe the appropriate role of systemic antibiotics in the management of chronic wounds. A common sense approach will be offered based on six clinically pertinent questions: ,,Is infection present? ,,Are systemic antibiotics necessary? ,,Should treatment be enteral or parenteral? ,,What antibiotic or combination of antibiotics should be used? ,,What should be the duration of therapy? ,,What special circumstances are present (i.e., concomitant illnesses, potential drug,drug interactions) that can impact therapy? [source] Definitions of response and remission in schizophrenia: recommendations for their use and their presentationACTA PSYCHIATRICA SCANDINAVICA, Issue 2009S. Leucht Objective:, To review and make recommendations for the definition and presentation of the terms ,response' and ,remission' in schizophrenia. Method:, Selective review of publications on definitions of response and remission in schizophrenia. Results:, When the Brief Psychiatric Rating Scale (BPRS) or the Positive and Negative Syndrome Scale (PANSS) are used for definitions of response, a cut-off of at least 50% reduction of the baseline score should be used for acutely ill, non-refractory patients and a cut-off of at least 25% reduction for refractory patients. When percentage BPRS/PANSS reduction is calculated, the 18/30 points minimum scores meaning ,no symptoms' on the should be subtracted. In addition, responder rates from 0,100% could be presented in a table in steps of 25%. For large and simple practical trials, the Clinical Global Impression scale with suggested improvements could be used 1-7 scale. Conclusion:, To show how many patients are still symptomatic at the end of study and to show the overall amount of change in both remission and responder criteria should be presented. [source] The Canadian National Outcomes Measurement Study in Schizophrenia: overview of the patient sample and methodologyACTA PSYCHIATRICA SCANDINAVICA, Issue 2006G. Smith Objective:, The Canadian National Outcomes Measurement Study in Schizophrenia (CNOMSS) is a prospective survey of routine clinical practice. Method:, Patients with schizophrenia or a related disorder were consecutively enrolled from all regions of Canada. Both academic and community psychiatric clinics were included and patients were followed up for 2 years. Clinical and functional status, quality of life, medication and economic costs were assessed at enrollment and monitored throughout the follow-up period. Results:, Patients attending an academic clinic tended to be younger and more severely ill than those from community clinics. Both types of sites prescribed atypical neuroleptics to more than three-quarters of the patients. The majority of those enrolled were unemployed and living in poverty. Poor clinical status was associated with poverty. Conclusion:, The CNOMSS provides demographic, clinical and treatment-related information about a large Canada-wide sample of psychiatric patients. The following three articles in this issue of Acta Psychiatrica Scandinavica explore issues related to medication, quality of life and resource utilization. [source] Quality of diabetes care in patients with schizophrenia and bipolar disorder: cross-sectional studyDIABETIC MEDICINE, Issue 12 2007S. Whyte Abstract Aims To determine whether patients with severe mental illness receive poorer health care for diabetes than patients without. Methods This population-based cross-sectional survey used electronic general practice records from 481 UK general practices contributing to the QRESEARCH database. The records of 11 043 patients with diabetes, drawn from a database population of over 9 million patients, were extracted. Unadjusted and adjusted odds ratios were calculated using unconditional logistic regression for each of 17 quality indicators for diabetes care from the new General Medical Services contract for general practitioners. Results The presence of severe mental illness did not reduce the quality of care received; the only significant difference between groups showed that such patients were more likely to have glycated haemoglobin < 7.5%[adjusted odds ratio = 1.45 (99% confidence interval 1.20,1.76)]. Increasing age was associated with better care [adjusted odds ratios from 1.06 (1.02,1.11) to 1.61 (1.52,1.70)], but other confounding variables had no consistent effect across indicators. Overall, performance against government targets was good. Conclusions The hypothesis of poorer diabetes care for those with severe mental illness is disproved, perhaps surprisingly, in the light of other recent UK studies showing inequalities in care for the mentally ill. The study does not reveal who is providing this good care (general practitioners, psychiatrists or diabetologists) or take account of the estimated 600 000 people in the UK with undiagnosed diabetes. [source] Detention of the mentally ill in Europe , a reviewACTA PSYCHIATRICA SCANDINAVICA, Issue 1 2002Martin Zinkler Objective:,The frequency of compulsory admission varies widely across Europe. Although there has been some research on a nation-wide level, no work has been done to compare mental health legislation in different countries in relation to detention rates and to patients' perception of hospital detention. Method:,Databases and government statistics were searched for regional, national and European data. Legal frameworks were compared and reviewed in relation to patients' and professionals' views. Results:,Nearly 20-fold variations in detention rates were found in different parts of Europe. Criteria for detention of the mentally ill are broadly similar when it comes to patients at risk to themselves or others. However different rules apply for involuntary treatment in the interest of the patient's health. Conclusion:,Variations in detention rates across Europe appear to be influenced by professionals' ethics and attitudes, sociodemographic variables, the public's preoccupation about risk arising from mental illness and the respective legal framework. [source] European perspectives: a carer's viewACTA PSYCHIATRICA SCANDINAVICA, Issue 2001Ursula Brand Objective:,To present the work of the European Federation of Associations of Families of Mentally Ill People (EUFAMI) and discuss issues of concern to family carers. Method:,The problem areas identified and discussed by family carers are presented on the basis of questionnaire surveys organized by EUFAMI. Addresses of national organisations of family carers are included. Results:,A range of problem areas are identified; they include subsistence and welfare payments for the severely mentally ill, some shortage of general hospital units, problems of care co-ordination, issues of respect for family carers and family involvement. Conclusion:,The aim of best practice in mental health care throughout Europe has not yet been reached. Key activities of EUFAMI are aimed at empowerment of families and best practice in psychiatry in Europe. [source] Prison Theology: A Theology of Liberation, Hope and JusticeDIALOG, Issue 3 2008Sadie Pounder Abstract:, In our nation today, the number of prisons and prisoners continue to grow at rates that are out-of-control. One in 100 of our citizens is in jail or prison, the highest ratio in the world. Unlike the poor, homeless, critically ill, and elderly, those in prison are separated from us to the degree they are unseen. Unseen also, is the oppressiveness of the criminal justice system that oversees more than 6.5 million people either in confinement or on probation or parole. Liberation theology, which advocates and works toward freeing people from oppression, includes feminist, black, womanist and Latino/Hispanic movements. This article proposes prison theology as part of the liberation theology family and identifies a prison theology based on liberation, hope and justice. It encourages a prison theology movement led by the church to liberate those under the oppressiveness of the criminal justice system, especially those confined and to energize a passion for justice and compassion for the oppressed throughout the criminal justice system. [source] Political abuse of psychiatryACTA PSYCHIATRICA SCANDINAVICA, Issue 399 2000J. L. T. Birley The abuse of psychiatry in Nazi Germany 60 years ago was the abuse of the ,duty to care'. Its scale was enormous; 300,000 people were sterilized and 100,000 killed in Germany alone and many thousands further afield, mainly in eastern Europe. This episode occurred in a country with a high reputation for its medicine, including psychiatry, and for its interest in the ethics of medical research. The economic conditions which preceded the violent political upheaval had led to increasing concern about ,the burden on the State' of the mentally ill and disabled. These preoccupations are still with us today. There may still be lessons to be learnt from the Nazi episode. [source] The measurement and modelling of rill erosion at angle of repose slopes in mine spoilEARTH SURFACE PROCESSES AND LANDFORMS, Issue 7 2008G. R. Hancock Abstract The process of rill erosion causes significant amounts of sediment to be moved in both undisturbed and disturbed environments and can be a significant issue for agriculture as well as mining lands. Rills also often develop very quickly (from a single rainfall event to a season) and can develop into gullies if sufficient runoff is available to continue their development. This study examines the ability of a terrestrial laser scanner to quantify rills that have developed on fresh and homogeneous mine spoil on an angle of repose slope. It also examines the ability of the SIBERIA erosion model to simulate the rill's spatial and temporal behaviour. While there has been considerable work done examining rill erosion on rehabilitated mine sites and agricultural fields, little work has been done to examine rill development at angle of repose sites. Results show that while the overall hillslope morphology was captured by the laser scanner, with the morphology of the rills being broadly captured, the characteristics of the rills were not well defined. The digital elevation model created by the laser scanner failed to capture the rill thalwegs and tops of the banks, therefore delineating a series of ill defined longitudinal downslope depressions. These results demonstrate that an even greater density of points is needed to capture sufficient rill morphology. Nevertheless, SIBERIA simulations of the hillslope demonstrated that the model was able to capture rill behaviour in both space and time when correct model parameters were used. This result provides confidence in the SIBERIA model and its parameterization. The results demonstrate the sensitivity of the model to changes in parameters and the importance of the calibration process. Copyright © 2007 John Wiley & Sons, Ltd. [source] Association of Bicuspid Aortic Valve Morphology and Aortic Root Dimensions: A Substudy of the Aortic Stenosis Progression Observation Measuring Effects of Rosuvastatin (ASTRONOMER) StudyECHOCARDIOGRAPHY, Issue 2 2010Davinder S. Jassal M.D., F.R.C.P.C. Background: Bicuspid aortic valve (BAV) is the leading cause of aortic stenosis in patients younger than the age of 50. A classification scheme of BAVs is based upon leaflet orientation: Type I (fusion of right and left coronary cusps) and Type II (fusion of right and noncoronary cusps). The correlation between BAV leaflet orientation and aortic root pathology however remains ill defined. Objective: The objective was to describe a potential relationship between BAV leaflet morphology and aortic root measurements in the ASTRONOMER study, a multicenter study to assess the effect of rosuvastatin on the progression of AS. Methods: BAV morphology was classified as Type I or Type II orientation based on the parasternal short-axis view. Echo measurements including left ventricular and aortic root dimensions were obtained. Results: The study population included 89 patients (56 ± 11 years; 44 males). There were 63 patients with Type I and 26 patients with Type II BAV. Baseline demographics, hemodynamics, and left heart dimensions were similar between both groups. Patients with Type I BAV had larger aortic annulus and ascending root dimensions compared to those patients with Type II BAV (P < 0.05). Conclusion: In patients with mild to moderate aortic stenosis due to a BAV, the presence of Type I valve orientation was associated with significantly greater aortic root parameters compared to Type II valve orientation. (ECHOCARDIOGRAPHY 2010;27:174-179) [source] Smoking Stage of Change and Interest in an Emergency Department,based InterventionACADEMIC EMERGENCY MEDICINE, Issue 3 2005Edwin D. Boudreaux PhD Abstract Objectives: To examine factors associated with motivation to quit smoking and interest in an emergency department (ED)-based intervention. Methods: Consecutive ED patients 18 years of age and older were interviewed. Severely ill and cognitively disabled patients were excluded. Smoking history, stage of change, self-efficacy, presence of a smoking-related illness, interest in an ED-based smoking intervention, and screening/counseling by the patient's ED provider were assessed. Results: A total of 1,461 of 2,314 patients (64%) were interviewed. A total of 581 (40%) currently smoked, with 21% in precontemplation (no intention to quit), 43% in contemplation (intention to quit but not within the next 30 days), and 36% in preparation (intention to quit within the next 30 days). Approximately 50% indicated a willingness to remain 15 extra minutes in the ED to receive counseling. Only 8% received counseling by their ED provider. A regression analysis showed that greater readiness to change was associated with multiple lifetime quit attempts, presence of a quit attempt in the past 30 days, and higher self-efficacy. Interest in an ED-based intervention was more likely among patients who reported higher self-efficacy. Conclusions: Approximately 50% of smokers reported at least moderate interest in an ED-based intervention and a willingness to stay 15 extra minutes, but only 8% reported receiving counseling during their ED visit. Considering time and resource constraints, counseling/referral may be best suited for patients characterized by a strong desire to quit, multiple previous quit attempts, high self-efficacy, a smoking-related ED visit, and strong interest in ED-based counseling. [source] Emergency Department Patient Volume and Troponin Laboratory Turnaround TimeACADEMIC EMERGENCY MEDICINE, Issue 5 2010Ula Hwang MD Abstract Objectives:, Increases in emergency department (ED) visits may place a substantial burden on both the ED and hospital-based laboratories. Studies have identified laboratory turnaround time (TAT) as a barrier to patient process times and lengths of stay. Prolonged laboratory study results may also result in delayed recognition of critically ill patients and initiation of appropriate therapies. The objective of this study was to determine how ED patient volume itself is associated with laboratory TAT. Methods:, This was a retrospective cohort review of patients at five academic, tertiary care EDs in the United States. Data were collected on all adult patients seen in each ED with troponin laboratory testing during the months of January, April, July, and October 2007. Primary predictor variables were two ED patient volume measures at the time the troponin test was ordered: 1) number of all patients in the ED/number of beds (occupancy) and 2) number of admitted patients waiting for beds/beds (boarder occupancy). The outcome variable was troponin turnaround time (TTAT). Adjusted covariates included patient characteristics, triage severity, season (month of the laboratory test), and site. Multivariable adjusted quantile regression was carried out to assess the association of ED volume measures with TTAT. Results:, At total of 9,492 troponin tests were reviewed. Median TTAT for this cohort was 107 minutes (interquartile range [IQR] = 73,148 minutes). Median occupancy for this cohort was 1.05 patients (IQR = 0.78,1.38 patients) and median boarder occupancy was 0.21 (IQR = 0.11,0.32). Adjusted quantile regression demonstrated a significant association between increased ED patient volume and longer times to TTAT. For every 100% increase in census, or number of boarders over the number of ED beds, respectively, there was a 12 (95% confidence interval [CI] = 9 to 14) or 33 (95% CI = 24 to 42)-minute increase in TTAT. Conclusions:, Increased ED patient volume is associated with longer hospital laboratory processing times. Prolonged laboratory TAT may delay recognition of conditions in the acutely ill, potentially affecting clinician decision-making and the initiation of timely treatment. Use of laboratory TAT as a patient throughput measure and the study of factors associated with its prolonging should be further investigated. ACADEMIC EMERGENCY MEDICINE 2010; 17:501,507 © 2010 by the Society for Academic Emergency Medicine [source] Delocation and European integration: is structural spending justified?ECONOMIC POLICY, Issue 35 2002Karen Helene Midelfart-Knarvik SUMMARY How is European integration changing the location of industry? And what part are national and EU aids to industry playing in this process? We show that states and regions are becoming more specialized within the EU, but this process is very slow. While there is no evidence of polarization occurring at the national level, some regions are losing out. National state aids to industry appear to have little effect for either good or ill, since their effectiveness at attracting economic activity and employment is limited. European Structural Funds expenditure, by contrast, does have an effect on the location of industry, notably by attracting industries that are intensive in research and development. However, this effect has mostly been acting counter to states' comparative advantage , R&D-intensive industries have been encouraged by these aids to locate in countries and regions that have low endowments of skilled labour. Only in Ireland, where Structural Funds reinforced rather than offset comparative advantage, have poor regions been enabled systematically to catch up with the EU average. [source] | |||||||||||||||||||||||||||||||||||||||||||||||||