Home About us Contact
|
Home About us Contact | ||
|
|
||
Improved Quality (improved + quality)
Selected AbstractsLaryngeal Preservation With Supracricoid Partial Laryngectomy Results in Improved Quality of Life When Compared With Total Laryngectomy,THE LARYNGOSCOPE, Issue 2 2001Gregory S. Weinstein MD Abstract Objectives/Hypotheses Study 1: To assess the oncologic outcome following supracricoid partial laryngectomy (SCPL). Study 2: To compare the quality of life (QOL) following SCPL to total laryngectomy (TL) with tracheoesophageal puncture (TEP). Study 3: To analyze whole organ TL sections to determine the percentage of lesions amenable to SCPL. Study Design Study 1: A retrospective review of patients who underwent SCPL. Study 2: A non-randomized, prospective study using QOL instruments to compare patients who underwent either SCPL or TL. Study 3: A retrospective histopathologic study of TL specimens assessed for the possibility of performing an SCPL. Methods Study 1: Twenty-five patients with carcinoma of the larynx underwent SCPL between June 1992 and June 1999. Various rates of oncologic outcome were calculated. Study 2: Thirty-one patients participated in the QOL assessment. This included the SF-36 general health status measure, the University of Michigan Head and Neck Quality of Life (HNQOL) instrument, and the University of Michigan Voice-Related Quality of Life (VRQOL) instrument. Study 3: Ninety surgical specimens were obtained and studied from the total laryngectomy cases in the Tucker Collection. Multiple sites were evaluated for the presence of carcinoma. A computer program was written to classify whether the patient was amenable to SCPL. Results Study 1: The overall local control rate was 96% (24/25). The local control rate following SCPL with cricohyoidoepiglottopexy (CHEP) was 95% (20/21). The local control rate following SCPL with cricohyoidopexy (CHP) was 100% (4/4). Study 2: The SCPL had significantly higher domain scores than TL and TEP in the following categories for the SF-36: physical function, physical limitations, general health, vitality, social functioning, emotional limitations, and physical health summary. The significantly higher domains for the SCPL when compared with the TL and TEP for the HNQOL were eating and pain. Finally, when voice-related QOL was assessed with the V-RQOL, the domains of physical functioning and the total score were significantly better with SCPL when compared with TL and TEP. Study 3: Forty of 90 (44%) laryngeal whole organ specimens were determined to be resectable by SCPL. In 16 (18%) specimens, the patients could have undergone SCPL with CHEP and in 24 (27%) specimens the patients could have undergone SCPL with CHP. Among the 40 (44%) specimens determined to be able to have undergone SCPL, 19 were glottic (1 T1, 15 T2, 3 T3) and 21 were supraglottic (9 T2, 12 T3). Conclusions 1) A review of the literature and an analysis of the data in this study indicate that excellent local control may be expected following SCPL. 2) The QOL following SCPL, as measured by three validated QOL instruments, is superior to TL with TEP. 3) A histologic assessment of whole organ sections of TL specimens indicates that many patients who have been subjected to TL may have been candidates for SCPL. 4) If the indications and contraindications are rigorously adhered to, SCPLs are reasonable alternatives to TL in selected cases. [source] Improved quality of root fillings provided by general dental practitioners educated in nickel,titanium rotary instrumentationINTERNATIONAL ENDODONTIC JOURNAL, Issue 4 2007A. Molander Abstract Aim, To test the hypothesis that an increased utilization of nickel,titanium rotary instrumentation (NTRI) by general dental practitioners will lead to an increased frequency of good quality root fillings. A second aim was to determine whether the educational format would exert influence on the quality. Methodology, Dentists were assigned at random to three intervention groups: a 4-h lecture (L-group, n = 40); a 4-h lecture plus a full day hands-on course (LH-group, n = 40); or a control group receiving no instruction (n = 68). The control group received education later on in the study. Radiographs of two root filled molar teeth per dentist were selected at random before the start of the education program and after a 6-month clinical learning period. Using length, seal and shape of root-fillings a 5-level variable was created. Results, The rate of good quality root fillings increased after the introduction of NTRI. Calculated over all types of roots the frequency of excellent (score 1) root fillings increased from 31% to 51% (P = 0.006) in the L-group and from 27% to 47% (P = 0.016) in the LH-group. The frequency of low quality root-fillings (score 5) dropped in the L-group from 22% to 16% (P = 0.29) and in the LH-group from 13% to 9% (P = 0.48). No statistically significant difference was seen among the controls. Conclusions, When NTRI technology replaced manual stainless steel techniques the rate of good quality root fillings increased. A significant drop in the rate of low quality root fillings was not found. [source] Dewetted growth of CdTe in microgravity (STS-95)CRYSTAL RESEARCH AND TECHNOLOGY, Issue 6 2004M. Fiederle Abstract Two CdTe crystals had been grown in microgravity during the STS-95 mission. The growth configuration was dedicated to obtain dewetting of the crystals and to achieve high quality material. Background for the performed experiments was based on the theory of the dewetting and previous experience. The after flight characterization of the crystals has demonstrated existance of the dewetting areas of the crystals and their improved quality regarding the earth grown reference sample. The samples had been characterized by EDAX, Synchrotron X-ray topography, Photoluminescence and Optical and IR microscopy. (© 2004 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim) [source] Risk factor control in patients with Type 2 diabetes and coronary heart disease: findings from the Swedish National Diabetes Register (NDR)DIABETIC MEDICINE, Issue 1 2009S. Gudbjörnsdottir Abstract Aims Patients with Type 2 diabetes and coronary heart disease (CHD) are infrequently treated to risk factor targets in current guidelines. We aimed to examine risk factor management and control levels in a large sample of patients with Type 2 diabetes with CHD. Methods This was an observational study of 1612 patients with first incidence of CHD before 2002, and of 4570 patients with first incidence of CHD before 2005, from the Swedish National Diabetes Register (NDR). Results In patients with CHD 1,2 years before follow-up, the achievement of cardiovascular risk factor targets (follow-up 2002/follow-up 2005) was: HbA1c < 7%, 47%/54% (P < 0.01); blood pressure , 130/80 mmHg, 31%/40% (P < 0.001); total cholesterol < 4.5 mmol/l, 47%/60% (P < 0.001); and low-density lipoprotein-cholesterol < 2.5 mmol/l, 49%/65% (P < 0.001). Use of medication: antihypertensives, 90%/94% (P < 0.01); lipid-lowering drugs, 75%/86% (P < 0.001); and aspirin, 85%/89% (P < 0.05). A high prevalence of adverse lifestyle characteristics prevailed (2002/2005): overweight [body mass index (BMI) , 25 kg/m2], 86%/85%; obesity (BMI , 30 kg/m2), 41%/42%; smokers in age group < 65 years, 16,23%/18,19%; as well as waist circumference , 102 cm (men) or , 88 cm (women), 68% in 2005. Conclusions Patients with a combination of Type 2 diabetes and CHD showed an increased use of lipid-lowering drugs over time, corresponding to improving blood lipid levels. A discrepancy existed between the prevalent use of antihypertensive drugs and the low proportion reaching blood pressure targets. Regretfully, a high prevalence of adverse lifestyle characteristics prevailed. Evidence-based therapy with professional lifestyle intervention and drugs seems urgent for improved quality of secondary prevention in these patients. [source] Dynamics of 17,-Ethynylestradiol exposure in rainbow trout (Oncorhynchus mykiss): Absorption, tissue distribution, and hepatic gene expression patternENVIRONMENTAL TOXICOLOGY & CHEMISTRY, Issue 11 2006Ann D. Skillman Abstract 17,-Ethynylestradiol (EE2) is a synthetic estrogen identified in sewage effluents. To understand better the absorption kinetics of EE2 and the induction of vitellogenin (VTG) and estrogen receptor , (ER,) mRNA, we subjected male rainbow trout (Onchorynchus mykiss) to continuous water exposures of 125 ng/L of EE2 for up to 61 d. Trout were either repetitively sampled for blood plasma or serially killed at selected time intervals. Vitellogenin, ER, mRNA, and EE2 were measured using enzymelinked immunosorbent assay and using quantitative polymerase chain reaction and gas chromatography,mass spectrometry, respectively. In separate experiments, trout were exposed to EE2 for 7 d, and hepatic gene expression was assessed using a low- and high-density cDNA microarray. The EE2 was rapidly absorbed by the trout, with an apparent equilibrium at 16 h in plasma and liver. The ER, mRNA levels also increased rapidly, reaching near-peak levels by 48 h. In contrast, plasma levels of VTG continuously increased for 19 d. After 61 d, tissues with the highest levels of VTG were the liver, kidney, and testes. Microarray-based gene expression studies provided unexpected results. In some cases, known estrogen-responsive genes (e.g., ER,) were unresponsive, whereas many of the genes that have no apparent link to estrogen function or EE2 toxicity were significantly altered in expression. Of the two microarray approaches tested in the present study, the high-density array appeared to be superior because of the improved quality of the hybridization signal and the robustness of the response in terms of the number of genes identified as being EE2 responsive. [source] Effects of Vagus Nerve Stimulation on Progressive Myoclonus Epilepsy of Unverricht-Lundborg TypeEPILEPSIA, Issue 8 2000Brien Smith Summary: Purpose: A 34-year-old woman with progressive myoclonus epilepsy of Unverricht-Lundborg type was considered for vagus nerve stimulation (VNS) therapy. Methods: After demonstration of intractability to multiple antiepileptic regimens and progressive deterioration in cerebellar function, the patient was implanted with a vagus nerve stimulator and followed for 1 year. Neurological status, seizure frequency, and parameter changes were analyzed. Results: VNS therapy resulted in reduction of seizures (more than 90%) and a significant improvement in cerebellar function demonstrated on neurological examination. The patient reported improved quality of life based in part on her ability to perform activities of daily living. Conclusions: VNS therapy may be considered a treatment option for progressive myoclonus epilepsy. The effects of VNS on seizure control and cerebellar dysfunction may provide clues to the underlying mechanism(s) of action. [source] The Sarbanes-Oxley Act of 2002 and Market LiquidityFINANCIAL REVIEW, Issue 3 2008Pankaj K. Jain G14; M41 Abstract Investors rely heavily on the trustworthiness and accuracy of corporate information to provide liquidity to the capital markets. We find that the rash of financial scandals caused a severe deterioration in market liquidity in the form of wider spreads, lower depths, and a higher adverse selection component of spreads vis-à-vis their benchmark levels. Regulatory responses including the Sarbanes-Oxley Act of 2002 (SOX) had inconsequential short-term liquidity effects but highly significant and positive long-term liquidity effects. These liquidity improvements are positively associated with the improved quality of financial reports, several firm-specific variables (e.g., size), and market factors (e.g., price, volatility, volume). [source] Home management of haemophiliaHAEMOPHILIA, Issue 2 2004J. M. Teitel Summary., The demonstrated benefits of home care for haemophilia include improved quality of life, less pain and disability, fewer hospitalizations, and less time lost from work or school. Although reduced mortality has not been demonstrated, the substantial increase in longevity since the early 1980s correlates with the introduction of home treatment and prophylaxis programmes. These programmes must be designed and monitored by haemophilia treatment centres (HTC), which are staffed with professionals with broad and complementary expertise in the disease and its complications. In return, patients and their families must be willing to accept the reciprocal responsibilities that come from administering blood products or their recombinant equivalents at home. Patients with inhibitors to factors VIII or IX pose special challenges, but these complications do not obviate participation in home care programmes. Home care was an essential prerequisite to the introduction of effective prophylactic factor replacement therapy. Prophylaxis offers significant improvements in quality of life, but requires a substantial commitment. The use of implantable venous access devices can eliminate some of the difficulty and discomfort of peripheral venous access in small children, but brings additional risks. The future holds the promise of factor concentrates for home use that have longer half-lives, or can be administered by alternate routes. Knowledge of patient genotypes may allow treatments tailored to avoid complications such as inhibitor development. Gene therapy trials, which are currently ongoing, will ultimately lead to gene-based treatments as a complement to traditional protein-based therapy. [source] Short Daily Dialysis (SDHD) Efficacy : Pilot Multicentric Study with Nine Patients from MadridHEMODIALYSIS INTERNATIONAL, Issue 1 2003G. Barril Interest in quotidian (daily) hemodialysis (HD) seems to be growing. Clinical data consistently showed improved quality of life, better control of blood pressure, less need for medications including erythropoietin (EPO) and better nutrition. We evaluate the SDHD efficacy in 9 patients in conventional HD (3 weekly sesions/4 hours), mean age 57,78 years range (33,75), 6 males and 3 females who needed increased dialysis efficiency by different medical indications: 5 cases with hypertensive miocardiopathy and severe LVH, 2 of them with EFLV 26% and 27%. 2 cases with ischemic cardiopathy symptoms, one of them with anger and restless dysnea with a non resvascularizable coronary lesion, and other with cardiac insufficiency episodes requiring hospitalization once a month. 1 patient with big body surface area and elevated phosphorus levels although without control, with conventional three times/week HD. 1 patient indication was made by 12 years on HD with multiple vascular accesses failed needing a Tessio cathéter being into infradialysis regimen for his malnutrition status. The schedule in all of them was 6 days per week sessions between 2.15 hrs till 3 hours depending of body surface area to obtain a weekly kt/v nearest to 4. HD session were realized in the Hospital (4 pts) or in satellite unit (5 pts) due to the characteristics of the patients. The time remaining in this schedule was between 5 months to 2 years and 9 months. All the patients showed clinical improvement, subjective and objective, since the first weeks of starting SDHD. Sleep symptoms were the first to improve. All patients showing good coping with this HD alternative. Blood pressure levels were controlled without need for antihypertensive drugs, although the dry weight increased significantly in all cases. Albumin serum levels increased as nutrition parameter, controlling also the osteodystrophy and phosphorus. In a patient the EFLV was normalized from 6 months (26%,50%) improving in other. Two patients could be included in Tx waiting list. Again, anemia improved and decreasing EPO was required. No vascular access (autologous AVF) malfunction was detected in relation to daily procedure. Conclusion: Our pilot experience shows a clinical and biochemical improvement in the patients and quality of life as well. Prospective studies to demonstrate the financial benefits of these modalities are needed. [source] Treating hepatitis C in the prison population is cost-saving,HEPATOLOGY, Issue 5 2008Jennifer A. Tan The prevalence of chronic hepatitis C infection in U.S. prisons is 12% to 31%. Treatment of this substantial portion of the population has been subject to much controversy, both medically and legally. Studies have demonstrated that treatment of chronic hepatitis C with pegylated interferon (PEG IFN) and ribavirin is a cost-effective measure in the general population; however, no study has addressed whether the same is true of the prison population. The aim of this study was to determine the cost-effectiveness of hepatitis C treatment with PEG IFN and ribavirin in the U.S. prison population. Cost-effectiveness was determined via a decision analysis model employing Markov simulation. The cohort of prisoners had a distribution of genotypes and stages of fibrosis in accordance with prior studies evaluating inmate populations. The probability of transitioning from one health state to another, reinfection rates, in-prison and out-of-prison mortality rates, sustained viral response rates, costs, and quality of life weights were also obtained from the literature. Sensitivity analysis was performed. In a strategy without a pretreatment liver biopsy, treatment was cost-effective for all ages and genotypes. This model was robust to rates of disease progression, mortality rates, reinfection rates, sustained viral response rates, and costs. In a strategy employing a pretreatment liver biopsy, treatment was also cost-saving for prisoners of all ages and genotypes with portal fibrosis, bridging fibrosis, or compensated cirrhosis. Treatment was not cost-effective in patients between the ages of 40 and 49 with no fibrosis and genotype 1. Conclusion: Treatment of chronic hepatitis C with PEG IFN and ribavirin in U.S. prisons results in both improved quality of life and savings in cost for almost all segments of the inmate population. If the decision to treat hepatitis C is based on pharmaco-economic measures, this significant proportion of infected individuals should not be denied access to therapy. (HEPATOLOGY 2008.) [source] Experimental modelling and intelligent control of a wood-drying kilnINTERNATIONAL JOURNAL OF ADAPTIVE CONTROL AND SIGNAL PROCESSING, Issue 8 2001Givon Chuen Kee Yan Abstract Proper control of the wood-drying kiln is crucial in ensuring satisfactory quality of dried wood and in minimizing drying time. This paper presents the development, implementation, and evaluation of a control system for a lumber drying kiln process incorporating sensory feedback from in-wood moisture content sensors and intelligent control such that the moisture content of lumber will reach and stabilize at the desired set point without operator interference. The drying process is difficult to model and control due to complex dynamic nonlinearities, coupling effects among key variables, and process disturbances caused by the variation of lumber sizes, species, and environmental factors. Through system identification scheme using experimental data and recursive least-squares algorithm for parameter estimation, appropriate models are developed for simulation purpose and controller design. Two different control methodologies are employed and compared: a conventional proportional-integral-derivative (PID) controller and a direct fuzzy logic controller (FLC), and system performance is evaluated through simulations. The developed control system is then implemented in a downscaled industrial kiln located at the Innovation Centre of National Research Council (NRC) of Canada. This experimental set-up is equipped with a variety of sensors, including thermocouples for temperature feedback, an air velocity transmitter for measuring airflow speed in the plenum, relative humidity sensors for measuring the relative humidity inside the kiln, and in-wood moisture content sensors for measuring the moisture content of the wood pieces. For comparison, extensive experimental studies are carried out on-line using the two controllers, and the results are evaluated to tune the controller parameters to achieve good performance in the wood-drying kiln. The combination of conventional control with the intelligent control promises improved performance. The control system developed in this study may be applied in industrial wood-drying kilns, with a clear potential for improved quality and increased speed of drying. Copyright © 2001 John Wiley & Sons, Ltd. [source] Food process engineering and dairy technology at the Technical University of MunichINTERNATIONAL JOURNAL OF DAIRY TECHNOLOGY, Issue 4 2003Ulrich Kulozik The Chair for Food Process Engineering and Dairy Technology at the Technical University of Munich in Freising-Weihenstephan has been installed since 1992 in a new building hosting modern and well-equipped laboratories and pilot-plant facilities. Its objectives in terms of research are to participate in the development of the scientific understanding of complex food systems and their constitutive components, and the way they interact with the process during manufacturing. The aim is to allow the production of food products with desired properties, improved quality and optimal safety, while ensuring an efficient use of raw materials and of the energy required for industrial production. The methodology used involves the fractionation of complex systems and the systematic study of their constitutive components taken in isolation as well as in various combinations. Milk, as a naturally complex raw material, receives particular attention, but research activities increasingly extend to other functional food substrates such as eggs. The research activities are organized into three working groups that reflect the core competencies developed at the chair throughout the years: Bio-Processes and Aseptic Processing, Formation of Structures in Food Systems, and Protein Technology. Its key position within the ,Centre of Life and Food Science' of the Technical University of Munich fosters interdisciplinary interactions with many specialized scientists, and therefore provides a broad perspective regarding the comprehension of the complex implications of modern food and pharmaceutical product manufacturing. [source] Super giant basal cell carcinoma of the abdominal wall: still possible in the 21st centuryINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 7 2010Eelco De Bree MD Basal cell carcinoma (BCC) is very common and usually encountered when it is small in size. Giant BCC (i.e. greater than 5 cm in diameter) is quite rare and comprises 0.5 percent of all BCC. Extremely rarely, tumors larger than 20 cm have been reported. Herein, a case with an enormous, vegetating BCC of the abdominal wall, 30 x 20 cm in size, is described. This report demonstrates that such a case can still be observed in the civilized world of the 21st century, which remains profoundly astonishing. A literature survey was performed and revealed only 7 cases with such super giant BCC (i.e. larger than 20 cm in diameter). Generally, this tumor attains these enormous proportions due to neglect on the patient's part, and is usually located at sites covered by clothes. Treatment is mainly surgical and generally curative, resulting also in an improved quality of life. Tumor size of more than 10 cm in diameter is associated with increased risk for metastatic disease, severe morbidity and consequently impaired prognosis. [source] Ross Procedure for Aortic Insufficiency Due to Doubly Committed Subarterial Ventricular Septal Defect in AdultsJOURNAL OF CARDIAC SURGERY, Issue 5 2005Ph.D., Shoh Tatebe M.D. Preoperatively, she developed congestive heart failure because of less compliance to oral medication, raising concerns regarding life-threatening thromboembolism if she undergoes mechanical valve replacement. Despite the pulmonary autograft being defective, there were no difficulties in completing the surgery. The defect of pulmonary autograft and the VSD was closed by an expanded polytetrafluoroethylene patch. She tolerated the procedure well and now enjoys improved quality of life. We present a discussion of the indication of Ross procedure in the rare presentation of congenital heart disease, as well as several issues raised in this case. [source] Prediction of protein folding rates from primary sequences using hybrid sequence representationJOURNAL OF COMPUTATIONAL CHEMISTRY, Issue 5 2009Yingfu Jiang Abstract The ability to predict protein folding rates constitutes an important step in understanding the overall folding mechanisms. Although many of the prediction methods are structure based, successful predictions can also be obtained from the sequence. We developed a novel method called prediction of protein folding rates (PPFR), for the prediction of protein folding rates from protein sequences. PPFR implements a linear regression model for each of the mainstream folding dynamics including two-, multi-, and mixed-state proteins. The proposed method provides predictions characterized by strong correlations with the experimental folding rates, which equal 0.87 for the two- and multistate proteins and 0.82 for the mixed-state proteins, when evaluated with out-of-sample jackknife test. Based on in-sample and out-of-sample tests, the PPFR's predictions are shown to be better than most of other sequence only and structure-based predictors and complementary to the predictions of the most recent sequence-based QRSM method. We show that simultaneous incorporation of several characteristics, including the sequence, physiochemical properties of residues, and predicted secondary structure provides improved quality. This hybridized prediction model was analyzed to reveal the complementary factors that can be used in tandem to predict folding rates. We show that bigger proteins require more time for folding, higher helical and coil content and the presence of Phe, Asn, and Gln may accelerate the folding process, the inclusion of Ile, Val, Thr, and Ser may slow down the folding process, and for the two-state proteins increased ,-strand content may decelerate the folding process. Finally, PPFR provides strong correlation when predicting sequences with low similarity. © 2008 Wiley Periodicals, Inc. J Comput Chem, 2009 [source] Self-determination, social abilities and the quality of life of people with intellectual disabilityJOURNAL OF INTELLECTUAL DISABILITY RESEARCH, Issue 11 2007L. Nota Summary Background The international literature has documented that self-determination is impacted by environmental factors, including living or work settings; and by intraindividual factors, including intelligence level, age, gender, social skills and adaptive behaviour. In addition, self-determination has been correlated with improved quality of life (QoL). This study sought to contribute to the growing literature base in this area by examining the relationship among and between personal characteristics, self-determination, social abilities and the environmental living situations of people with intellectual disabilities (ID). Methods The study involved 141 people with ID residing in Italy. Healthcare professionals and social workers who had known participants for at least 1 year completed measures of self-determination, QoL and social skills. Analysis of variance was conducted to verify whether different levels of intellectual impairment were associated with different degrees of the dependent variables. The Pearson product,moment correlation was used to examine any relationships among dependent variables and IQ scores. Finally, discriminant function analysis was used to examine the degree to which IQ score, age, self-determination and social abilities predicted membership in groups that were formed based on living arrangement, and on QoL status (high vs. low). Results The anova determined, as expected, that participants with more severe ID showed the lowest levels of self-determination, QoL and social abilities. Discriminant function analysis showed that (a) individuals attending day centres were distinguished from those living in institutions in that they were younger and showed greater autonomy of choice and self-determination in their daily activities; (b) basic social skills and IQ score predicted membership in the high or low QoL groups; and (c) the IQ score predicted membership in the high or low self-determination groups. A manova conducted to examine gender- and age-level differences on self-determination found gender differences; women had higher self-determination scores than men. Conclusions These findings contribute to an emerging knowledge base pertaining to the role of intraindividual and environmental factors in self-determination and QoL. In general, the study replicated findings pertaining to the relative contribution of intelligence to self-determination and QoL, added information about the potential contribution of social abilities, and pointed to the potentially important role of opportunities to make choices as a particularly important aspect of becoming more self-determined, at least in the context of residential settings. [source] Improved slice selection for R2* mapping during cryoablation with eddy current compensation,JOURNAL OF MAGNETIC RESONANCE IMAGING, Issue 1 2008Aiming Lu PhD Abstract Purpose To improve the slice profile and image quality of R2* mapping in the iceball during cryoablation with ultrashort echo time (UTE) imaging by compensating for eddy currents induced by the selective gradient when half-pulse radiofrequency (RF) excitation is employed to achieve UTEs. Materials and Methods A method to measure both B0 and linear eddy currents simultaneously is first presented. This is done with a least-square fitting process on calibration data collected on a phantom. Eddy currents during excitation are compensated by redesigning the RF pulse and the selective gradient accordingly, while that resultant from the readout gradient are compensated for during image reconstruction. In vivo data were obtained continuously during the cryoablation experiments to calculate the R2* values in the iceball and to correlate them with the freezing process. Results Image quality degradation due to eddy currents is significantly reduced with the proposed approaches. R2* maps of iceball throughout the cryoablation experiments were achieved with improved quality. Conclusion The proposed approaches are effective for compensating eddy currents during half-pulse RF excitation as well as readout. TEs as short as 100 ,sec were obtained, allowing R2* maps to be obtained from frozen tissues with improved quality. J. Magn. Reson. Imaging 2008;28:190,198. © 2008 Wiley-Liss, Inc. [source] Nurse leadership within primary care: the perceptions of community nurses, GPs, policy makers and members of the publicJOURNAL OF NURSING MANAGEMENT, Issue 1 2004AdvDipEd, DipN (Lond), FRCS, Hugh McKenna BSc(Hons) Aim, The aim of this section of a wider study was to seek the views of community nurses, general practitioners, members of the public and policy makers on nursing leadership in primary care. The wider study aimed to review the role and function of primary care services and community nursing with reference to developments in practice, education, research and policy. Background, Key messages, challenges and opportunities for leaders within nursing have been highlighted in the literature and in turn emphasis placed on the positive effect this would have on improved quality of services [Department of Health and Social Services (1998) Valuing Diversity.. A Way Forward. Department of Health and Social Service, Belfast]. In order to grasp these opportunities, nursing has to invest in the development of leaders. Methods, A two round Delphi technique was employed using a focus group approach in round one and a postal questionnaire in round two. Semi-structured interviews were carried out with senior policy makers. Results, Findings show that there was agreement that strong leadership was needed for the development of community nursing but that at present there is confusion and disagreement over whether it exists currently. Other findings focus on problems inherent in identifying future nurse leaders. Conclusion, The traditional subservient culture of community nursing is blamed for the perceived inability to nurture strong leaders. Recommendations are made for the development of nurse leaders. [source] Retraining cervical joint position sense: The effect of two exercise regimesJOURNAL OF ORTHOPAEDIC RESEARCH, Issue 3 2007Gwendolen Jull Abstract This study compared the effects of conventional proprioceptive training and craniocervical flexion (C-CF) training on cervical joint position error (JPE) in people with persistent neck pain. The aim was to evaluate whether proprioceptive training was superior in improving proprioceptive acuity compared to another form of exercise, which has been shown to be effective in reducing neck pain. This may help to differentiate the mechanisms of effect of such interventions. Sixty-four female subjects with persistent neck pain and deficits in JPE were randomized into two exercise groups: proprioceptive training or C-CF training. Exercise regimes were conducted over a 6-week period, and all patients received personal instruction by an experienced physiotherapist once per week. A significant pre- to postintervention decrease in JPE, neck pain intensity, and perceived disability was identified for both the proprioceptive training group (p,<,0.001) and the C-CF training group (p,<,0.05). Patients who participated in the proprioceptive training demonstrated a greater reduction in JPE from right rotation compared to the C-CF training group (p,<,0.05). No other significant differences were observed between the two groups. The results demonstrated that both proprioceptive training and C-CF training have a demonstrable benefit on impaired cervical JPE in people with neck pain, with marginally more benefit gained from proprioceptive training. The results suggest that improved proprioceptive acuity following intervention with either exercise protocol may occur through an improved quality of cervical afferent input or by addressing input through direct training of relocation sense. © 2006 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 2007 [source] Oxidative stress of the newborn in the pre- and postnatal period and the clinical utility of melatoninJOURNAL OF PINEAL RESEARCH, Issue 2 2009Eloisa Gitto Abstract:, Newborns, and especially those delivered preterm, are probably more prone to oxidative stress than individuals later in life. Also during pregnancy, increased oxygen demand augments the rate of production of reactive oxygen species (ROS) and women, even with normal pregnancies, experience elevated oxidative stress and lipid peroxidation compared with nonpregnant women. Also, there appears to be an increase in ROS generation in the placenta of pre-eclamptic women. In comparison with healthy adults, newborn infants have lower levels of plasma antioxidants such as vitamin E, ,-carotene, and sulphydryl groups, lower levels of plasma metal binding proteins including ceruloplasmin and transferrin, and reduced activity of erythrocyte superoxide dismutase. This review summarizes conditions of newborns where there is elevated oxidative stress. Included in this group of conditions is asphyxia, respiratory distress syndrome and sepsis and the review also summarizes the literature related to clinical trials of antioxidant therapies and of melatonin, a highly effective antioxidant and free radical scavenger. The authors document there is general agreement that short-term melatonin therapy may be highly effective and that it has a remarkably benign safety profile, even when neonates are treated with pharmacological doses. Significant complications with long-term melatonin therapy in children and adults also have not been reported. None of the animal studies of maternal melatonin treatment or in postnatal life have shown any treatment-related side effects. The authors conclude that treatment with melatonin might result in a wide range of health benefits, improved quality of life and reduced healthcare costs and may help reduce complications in the neonatal period. [source] Diagnosis and management of geriatric insomnia: A guide for nurse practitionersJOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 12 2008MN (Nurse Practitioner), Preetha Krishnan RN Abstract Purpose: To discuss the assessment, diagnosis, and management of geriatric insomnia, a challenging clinical condition of older adults frequently seen by primary care providers. Data sources: Extensive literature review of the published research articles and textbooks. Conclusions: Complaints of insomnia among older adults are frequently ignored, considered a part of the normal aging process or viewed as a difficult to treat condition. Geriatric insomnia remains a challenge for primary care providers because of the lack of evidence-based clinical guidelines and limited treatment options available. Effective management of this condition is necessary for improved quality of life, which is a primary issue for the elderly and their families. Therefore, geriatric insomnia warrants thorough attention from the nurse practitioners (NPs) who provide care for older adults. Implications for practice: Undiagnosed or under treated insomnia can cause increased risk for falls, motor vehicle accidents, depression, and shorter survival. Insomniacs double their risk for cardiovascular disease, stroke, cancer, and suicide compared to their counterparts. Insomnia is also associated with increased healthcare utilization and institutionalization. NPs could play a central role in reducing the negative consequences of insomnia through a systematic approach for diagnosis, evaluation, and management. [source] Effectiveness of LPG® treatment in morpheaJOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY & VENEREOLOGY, Issue 5 2004W-I Worret ABSTRACT Background, The LPG® technique, also known as Endermology® treatment, is a noninvasive technique consisting of a tissue mobilization process in which a skin fold is created between two rollers, stretching the underlying tissue and mobilizing the fold. The LPG® technique is very effective in treating scars. Because the lesions of morphea or circumscribed scleroderma are similar to atrophic scars, it seemed reasonable to treat them with a method proven helpful for scars. Materials and methods, We treated 17 lesions of 10 patients (four males and six females) with the diagnosis of morphea ranging in age from 17 to 78 years (mean age 55 years) and investigated and documented the evolution of their lesions and changes in their quality of life. Results, In all patients there was a large improvement in the clinical appearance of the lesions, the induration and the pain. Elasticity was particularly increased, not only based on clinical findings but also as documented with objective assessment. The acceptability of the treatment was good and the patients reported an improved quality of life. Conclusion, The LPG® technique (Endermology®) is an adjunctive treatment for morphea. It cannot eliminate the disease but can relieve the pain, soften the skin and improve the quality of life for these patients. [source] Shotgun lipidomics: Electrospray ionization mass spectrometric analysis and quantitation of cellular lipidomes directly from crude extracts of biological samplesMASS SPECTROMETRY REVIEWS, Issue 3 2005Xianlin Han Abstract Lipidomics, after genomics and proteomics, is a newly and rapidly expanding research field that studies cellular lipidomes and the organizational hierarchy of lipid and protein constituents mediating life processes. Lipidomics is greatly facilitated by recent advances in, and novel applications of, electrospray ionization mass spectrometry (ESI/MS). In this review, we will focus on the advances in ESI/MS, which have facilitated the development of shotgun lipidomics and the utility of intrasource separation as an enabling strategy for utilization of 2D mass spectrometry in shotgun lipidomics of biological samples. The principles and experimental details of the intrasource separation approach will be extensively discussed. Other ESI/MS approaches towards the quantitative analyses of global cellular lipidomes directly from crude lipid extracts of biological samples will also be reviewed and compared. Multiple examples of lipidomic analyses from crude lipid extracts employing these approaches will be given to show the power of ESI/MS techniques in lipidomics. Currently, modern society is plagued by the sequelae of lipid-related diseases. It is our hope that the integration of these advances in multiple disciplines will catalyze the development of lipidomics, and such development will lead to improvements in diagnostics and therapeutics, which will ultimately result in the extended longevity and an improved quality of life for humankind. © 2004 Wiley Periodicals, Inc., Mass Spec Rev 24:367,412, 2005 [source] Early patient contact in primary care: a new challengeMEDICAL EDUCATION, Issue 9 2001Ann-Christin Haffling Background The Medical School of Lund University, Sweden, has introduced an early patient contact course, including training in communication and examination skills. The course runs parallel with theoretical subjects during the students' first two-and-a-half years. General practitioner (GP) participation is gradually increasing, and in the last half-year of the course GPs in all health centres in the area are involved. Little is known about the GPs' interest, competence and time for this new task. Aim To describe the GPs' attitudes towards teaching and the rewards and problems they experience. Subjects 30 GPs teaching third-year medical students. Method Semistructured interview study. Data analysis by a method described by Malterud. Results The attitude towards teaching was mostly positive and the teachers were confident about teaching examination procedure. Among rewards of teaching, improved quality of clinical practice was the main theme, but imparting knowledge to others, contact with enthusiastic students, and gains in self-esteem were also mentioned. Problems with teaching were mostly due to external factors such as lack of time and space, but concern about a negative effect on patient care was also recognized. Educational objectives of the course were not completely accepted. GPs were not fully aware about what to expect from the students, with subsequent problems concerning how to assess students' performance and how to give effective feedback. Conclusions The teaching of junior medical students is maintained by the GPs' enthusiasm for teaching. However, teacher training is required and the crucial issues of time and space have to be considered. [source] An appraisal of medical students' reflection-in-learningMEDICAL EDUCATION, Issue 3 2000Sobral Introduction How do students reflect as they strive for some control of learning early in their clinical activities? The purpose of this study was to examine the reflection-in-learning profile of medical students as they started their clinical apprenticeship. Methods A measure of reflection-in-learning was used to appraise the level and direction of change of reflection in relation to a course experience. The study involved 103 medical students of both sexes who were beginning clinical activities. Assessments of self-regulation of learning, of the meaningfulness of the learning experience, and of diagnostic thinking were also obtained. Results The results showed that 81% of the students had an increase in scores for reflection-in-learning between the beginning and the end of a course. At the end of the course, the level of reflection-in-learning was significantly associated with self-perceived competence for self-regulated learning and with the meaningfulness of the learning experience. In the following term, students who had high reflection-in-learning scores at the end of the course had higher grade-point averages and greater self-reported diagnostic ability in comparison with those with low scores. Conclusions There was some evidence of an improved quality of reflection as the students strive for some control of learning. Overall, the findings support the idea that a greater effort at reflection is associated with a more positive learning experience. They also suggest that reflection-in-learning is related to readiness for self-regulation of learning and may be conducive to enhanced diagnostic ability. In conclusion, measuring reflection-in-learning may be a useful tool in the appraisal of medical students' learning profiles. [source] The globalisation of the nursing workforce: barriers confronting overseas qualified nurses in AustraliaNURSING INQUIRY, Issue 4 2001Lesleyanne HawthorneArticle first published online: 25 FEB 200 The globalisation of the nursing workforce: barriers confronting overseas qualified nurses in Australia Recent decades have coincided with the rapid globalisation of the nursing profession. Within Australia there has been rising dependence on overseas qualified nurses (OQNs) to compensate for chronic nurse shortages related to the continued exodus of Australian nurses overseas and to emerging opportunities in other professions. Between 1983/4 and 1994/5, 30 544 OQNs entered Australia on either a permanent or temporary basis, counter-balancing the departure overseas of 23 613 locally trained and 6519 migrant nurses (producing a net gain of just 412 nurses in all). The period 1995/6,1999/2000 saw an additional 11 757 permanent or long-term OQN arrivals, with nursing currently ranked third target profession in Australia's skill migration program, in the context of continuing attrition among local nurses. This pattern of reliance on OQNs is a phenomenon simultaneously occurring in the UK, the US, Canada and the Middle East , the globalisation of nursing reflecting not merely Western demand but the growing agency and participation of women in skilled migration, their desire for improved quality of life, enhanced professional opportunity and remuneration, family reunion and adventure. [source] Pain in Long-Term Breast Cancer Survivors: Frequency, Severity, and ImpactPAIN MEDICINE, Issue 7 2010Mark P. Jensen PhD Abstract Objective., To better understand the severity and impact of pain in women who are breast cancer survivors. Design., Cross-sectional survey. Setting., Cancer wellness clinic. Patients., Two hundred fifty-three women with a history of early-stage breast cancer who had completed therapy and were without evidence of disease. Interventions., None. Outcome Measures., A survey that included questions about cancer history, pain, sleep problems, and physical and psychological functioning. Results., About half of the participants (117 or 46%) reported some pain, although most rated its intensity as mild. Both average and worst pain ratings showed significant associations with physical functioning (rs, ,0.48 and ,0.43, respectively), severity of sleep problems (rs, 0.31 and 0.30), and psychological functioning (rs, ,0.27 and ,0.24). Age (with younger participants slightly more likely to report pain) and history of antiestrogen therapy showed nonsignificant trends to predict the presence of pain. Conclusions., The study findings provide new and important knowledge regarding the severity and impact of pain in female breast cancer survivors. The results indicate that clinicians should assess pain regularly in breast cancer survivors and treat this pain when indicated. The findings also support the need for research to determine whether improved pain management would result in improved quality of life for women with a history of breast cancer. [source] Process improvement evaluation approach using flow diagramsQUALITY ASSURANCE JOURNAL, Issue 3 2006Paul C. Constant Jr. Abstract Maintaining company processes will afford optimum operation and enhance the company's quality management system. A vital part of maintaining processes is their periodic evaluation. An important part of the monitoring and evaluation process is the flow diagram. A detailed flow diagram is an important tool that affords ease in visualizing the total process and is an aid in locating problem areas. The evaluation of a process is broken down into 15 steps. These steps cover gathering pertinent information, such as problem symptoms from knowledgeable sources and carrying these through their route to potential problem areas to the problems, potential causes, and the root cause of the problem. Knowing the problems brings about the need to assess their impact on the process operation as well as what changes to the process are needed and what impact these changes will have on the product , its improved quality and cost , and other vital information, such as, production rate increase, competition status, and company image. With this information, the appropriate changes are made according to a process change action plan. The plan is executed, and the process is continuously monitored according to a monitoring and evaluation plan. The paper ends with conclusions. Copyright © 2006 John Wiley & Sons, Ltd. [source] Sjögren's syndrome: a review of aetiology, pathogenesis, diagnosis and managementAUSTRALIAN DENTAL JOURNAL, Issue 2010K Bayetto Abstract Sjögren's syndrome is a chronic autoimmune disease that affects many individuals within the community. Despite this, its exact aetiology and pathogenesis is still unclear. Sjögren's syndrome affects many organ systems in the body. However, for dental practitioners it is important to recognize the many oral and dental manifestations that are associated with the syndrome. In addition to these oral manifestations, this review will discuss the systemic manifestations of Sjögren's syndrome as well as the current understanding of factors that have a role in its aetiology and pathogenesis. Furthermore, this review will highlight the difficulties and complexities that are inherent in the diagnosis of Sjögren's syndrome and the important role that dental practitioners can play in the management of its oral manifestations. The effective management of oral manifestations and minimization of oral disease in patients with Sjögren's syndrome can result in improved quality of life for these patients. [source] Breast reconstructive surgery in medically underserved women with breast cancerCANCER, Issue 20 2009The role of patient-physician communication Abstract BACKGROUND: Breast reconstructive surgery can improve mastectomy patients' emotional relationships and social functioning, but it may be underutilized in low-income, medically underserved women. This study assessed the impact of patient-physician communication on rates of breast reconstructive surgery in low-income breast cancer (BC) women receiving mastectomy. METHODS: A cross-sectional, California statewide survey was conducted of women with income less than 200% of the Federal Poverty Level and receiving BC treatment through the Medicaid Breast and Cervical Cancer Treatment Program. A subset of 327 women with nonmetastatic disease who underwent mastectomy was identified. Logistic regression was used for data analysis. The chief dependent variable was receipt of or planned breast reconstructive surgery by patient report at 6 months after diagnosis; chief independent variables were physician interactive information giving and patient perceived self-efficacy in interacting with physicians. RESULTS: Greater physician information giving about BC and its treatment and greater patient perceived self-efficacy positively predicted breast reconstructive surgery (OR = 1.12, P = .04; OR = 1.03, P = .01, respectively). The observed negative effects of language barriers and less acculturation among Latinas and lower education at the bivariate level were mitigated in multivariate modeling with the addition of the patient-physician communication and self-efficacy variables. CONCLUSIONS: Empowering aspects of patient-physician communication and self-efficacy may overcome the negative effects of language barriers and less acculturation for Latinas, as well as of lower education generally, on receipt of or planned breast reconstructive surgery among low-income women with BC. Intervening with these aspects of communication could result in breast reconstructive surgery rates more consistent with the general population and in improved quality of life among this disadvantaged group. Cancer 2009. © 2009 American Cancer Society. [source] | ||||||||||||||||||||||||||||||||||