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Terms modified by Included Selected AbstractsO-13 ENDOMETRIAL CARCINOMA DETECTED WITH SUREPATH LIQUID BASED CERVICAL CYTOLOGY: COMPARISON WITH CONVENTIONAL CERVICAL CYTOLOGYCYTOPATHOLOGY, Issue 2006C. J. Patel Introduction:, Conventional Pap Smear (CPS) has had little impact on the detection of endometrial carcinoma (MC). Although Liquid Based Cytology (LBC) is replacing CPS in the UK, experience with identification of endometrial cancers with this is limited. A few studies of ThinPrep LBC show promise with reported increased detection rate, but to date, there has been no reported study of detection with SurePath LBC. Aim:, The purpose of this 2-year retrospective study was to compare the accuracy of the SurePath LBC with that of conventional smear in detecting endometrial cancers. Methods:, Our study group consisted of all SurePath cases of endometrial atypia/carcinoma diagnosed between 1st Jan 2004 and 31st Dec 2005, following 100% conversion of our laboratory to the SurePath system in 2001. Conventional smears reported over a 6-year period (1993,1998), comprised the control group. Histological follow up was obtained. Results:, Endometrial lesions were reported in 95 (0.07%) of 130352 SurePath LBC smears. These included 70 (0.053%) reports of endometrial atypia, 05 (0.003%) suspicious and 20 (0.015%) diagnostic of endometrial carcinoma. A total of 58 (0.014%) cases of 409495 CPS were diagnosed as endometrial carcinoma. Adequate histological follow up was available in 47 (49.5%) SurePath LBC and 52 (89.6%) conventional cases. In these, the positive predictive value (PPV) for endometrial carcinoma of SurePath LBC was 73.3% compared to 55.4% of CPS. The PPV for endometrial carcinoma of the atypical and suspicious LBC categories was 14.3% and 40% respectively. No categorisation as atypical or suspicious in the conventional study was available for comparison. The sensitivity of the SurePath LBC, calculated from retrograde analysis of histologically diagnosed endometrial cancers during the same period was 40%. Conclusion:, The SurePath LBC is at least an as accurate and sensitive method for detecting endometrial cancer as CPS. [source] Six3 promotes the formation of ectopic optic vesicle-like structures in mouse embryosDEVELOPMENTAL DYNAMICS, Issue 3 2001Oleg Lagutin Abstract A few years ago, three novel murine homeobox genes closely related to the Drosophila sine oculis (so) gene (Six1-3) were isolated and were all included in the Six/so gene family. Because of its early expression in the developing eye field, Six3 was initially thought to be the functional ortholog of the Drosophila so gene. This hypothesis was further supported by the demonstration that ectopic Six3 expression in medaka fish (Oryzias latipes) promotes the formation of ectopic lens and retina tissue. Here, we show that similar to Drosophila, where the eyeless/Pax6 gene regulates the eye-specific expression of so, Six3 expression in the murine lens placodal ectoderm is also controlled by Pax6. We also show that ectopic Six3 expression promotes the formation of ectopic optic vesicle-like structures in the hindbrain-midbrain region of developing mouse embryos. © 2001 Wiley-Liss, Inc. [source] Familial dyslexia: neurocognitive and genetic correlation in a large Finnish familyDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 9 2002Jaana Nopola-Hemmi MD Neuropsychological findings of individuals with dyslexia (n=24) from a large, three-generation Finnish family are presented. We have previously performed whole genome linkage scanning in this family and found that dyslexia in this kindred segregates with a single locus in the pericentromeric area of chromosome 3. Those included in the analyses were carefully evaluated for general cognitive ability, reading and spelling skills, and reading-related neurocognitive skills. The neurocognitive type of dyslexia segregating in this family consisted of deficits in phonological awareness, verbal short-term memory, and rapid naming. Severe dyslexia also seemed to be connected with a general language difficulty and was most common in the eldest generation. [source] Research reports on treatments for bipolar disorder: preliminary assessment of methodological qualityACTA PSYCHIATRICA SCANDINAVICA, Issue 1 2005F. Soldani Objective:, To assess frequencies of types of publications about bipolar disorder (BD) and evaluate methodological quality of treatment studies. Method:, We classified 100 randomly selected articles (1998,2002) from five psychiatric journals with highest impact ratings, by topic areas, and assessed methods employed in treatment studies. Results:, Topics ranked: treatment (41%; 37% on pharmacotherapy) > biology (31%) > psychopathology (14%) = miscellaneous (14%). Of treatment studies, only 19% of original articles were randomized, 15% were relatively large (n , 50) but non-randomized, 65% were small non-randomized, case-series or -reports, and 53% relied on baseline-to-endpoint contrasts without a control group. Patient dropout rates were ,40% in 43% of prospective studies. Only two reports provided confidence intervals; one included a power analysis, and 53% included no references on study design or statistical methods. Conclusion:, Even in highly respected journals, the typical methodological quality of recent reports on therapeutics for BD was unexpectedly limited, and psychopathology and psychotherapies were little studied. [source] Potential impacts on the incidence of fatal heroin-related overdose in Western Australia: a time-series analysisDRUG AND ALCOHOL REVIEW, Issue 4 2002KIM HARGREAVES Abstract In response to the rising concerns about the rate of heroin-related fatalities, overdose prevention campaigns, run by both users' organizations and government agencies, have been implemented in a number of states across Australia. In Western Australia (WA) in mid-1997, various overdose prevention initiatives were implemented. These included the implementation of a protocol limiting police presence at overdose events; the commencement of naloxone administration by ambulance staff; and the establishment of the Opiate Overdose Prevention Strategy (OOPS) which provided follow-up for individuals treated for overdose in emergency departments. This paper reports the results of a multiple linear regression analysis of 60 months of time-series data, both prior to and following the implementation of these interventions, to determine their impact on the number of fatal heroin overdoses in WA. The model employed in the analysis controlled for changes over time in proxy indicators of use and community concerns about heroin, as well as market indicators. The results suggest that, although the interventions implemented have managed to reduce the expected number of fatalities, they have become less successful in doing so as time passes. This has implications for both existing and potential interventions to reduce fatal heroin-related overdose. [source] The histone deacetylase inhibitor MS-275 induces p21WAF1/Cip1 expression in human Hep3B hepatoma cellsDRUG DEVELOPMENT RESEARCH, Issue 2 2007Haiyuan Zhang Abstract MS-275 is a novel synthetic benzamide derivative histone deacetylase (HDAC) inhibitor, that has demonstrated antiproliferative activity in a variety of in vitro human cancer cell lines including breast, colon, lung, myeloma, ovary, pancreas, prostate, and leukemia. Currently, little information is available concerning the effects of MS-275 on liver cancer cells. In the current study, MS-275 was found to have potent actions against human hepatoma Hep3B cells including inhibition of cell proliferation and induction of apoptosis. MS-275 selectively up-regulated a cyclin-dependent kinase inhibitor, p21WAF1/Cip1 without alteration of p27WAF1. Expression of p21WAF1/Cip1 is considered to play a pivotal role in Hep3B cell growth arrest and induction of apoptosis. Induction of p21WAF1/Cip1 expression was accompanied by an accumulation of acetylated histones H3 and H4 associated specifically with p21WAF1/Cip1 gene. ChIP analysis revealed remarkable alterations in protein components bound to the promoter region of p21WAF1/Cip1 gene in response to MS-275 treatment. These included the degradation of HDAC1, HDAC3, and c-Myc, and as well as increased p300 and RNA polymerase II. The selective effect of MS-275 on the up-regulation of the p21WAF1/Cip1 gene whose expression was suppressed in the hepatoma cancer cell line indicated that it would be a very attractive approach in clinical liver cancer therapy. Drug Dev Res 68:61,70, 2007. © 2007 Wiley-Liss, Inc. [source] Seeing America,diary of a drug-focused study tour made in 1967ADDICTION, Issue 6 2010Griffith Edwards ABSTRACT In 1965 the British government was forced to admit that the country had an escalating heroin problem, with the supply coming mainly from prescribing by private practitioners. Within the official responses to what was seen at that time as a very worrying public health situation was the decision to fund the setting-up of the Addiction Research Unit (ARU) at the Institute of Psychiatry, London. The US National Institute of Mental Health (NIMH) generously sponsored a study tour for the nominated director of the ARU shortly before the opening of the British research centre. Extensive contemporaneous diary notes of a visit included contact with administrators, researchers, clinicians, parish priests, narcotic agents and addicts themselves. From a mass of often conflicting advice, some insights could be derived. In particular, these included the need for an awareness of any country's way of dealing with drug problems as a dynamic, multi-factorial total system,a holistic ,national response'. A further conclusion was to see policy itself as a complex subject for analysis: drug policy should be as much an issue for research as drug taking. Besides these broad conclusions, the experience provided many specific leads to development of a British addiction research programme, and fostered professional friendships of immeasurable worth. [source] Comparative proteome analysis of culture supernatant proteins from virulent Mycobacterium tuberculosis H37Rv and attenuated M. bovis BCG CopenhagenELECTROPHORESIS, Issue 19-20 2003Jens Mattow Abstract A comprehensive analysis of culture supernatant (CSN) proteins of Mycobacterium tuberculosis H37Rv was accomplished by combination of two-dimensional electrophoresis (2-DE), mass spectrometry, and N -terminal sequencing by Edman degradation. Analytical 2-DE gels resolved approximately 1250 protein spots from CSN of M. tuberculosis H37Rv, 381 of which were identified by mass spectrometry and/or Edman degradation. This study revealed 137 different proteins, 42 of which had previously been described as secreted. Comparative proteome analysis of CSN from virulent M. tuberculosis H37Rv and attenuated Mycobacterium bovis BCG Copenhagen identified 39 M. tuberculosis- specific spots containing 27 different proteins, representing candidate antigens for novel vaccines and diagnostics in tuberculosis. These included five proteins encoded by open reading frames absent from M. bovis BCG, e.g., early secretory antigen target (Esat6), as well as 22 novel differential proteins, such as acetyl-CoA C-acetyltransferase (Rv0243) and two putative Esat6-like proteins (Rv1198, Rv1793). [source] Empirical and modeling evidence of regional atmospheric transport of current-use pesticidesENVIRONMENTAL TOXICOLOGY & CHEMISTRY, Issue 10 2004Derek C. G. Muir Abstract Water samples from 30 lakes in Canada and the northeastern United States were analyzed for the occurrence of 27 current-use pesticides (CUPs). Eleven CUPs were frequently detected in lakes receiving agricultural inputs as well as in remote lakes hundreds of kilometers from known application areas. These included the triazine herbicide atrazine and its desethylated degradation product; the herbicides alachlor, metolachlor, and dacthal; the organophosphate insecticides chlorpyrifos, diazinon, and disulfoton; the organochlorine insecticides ,-endosulfan and lindane; and the fungicides chlorothalonil and flutriafol. For six of the pesticides, empirical half-distances on the order of 560 to 1,820 km were estimated from the water-concentration gradient with latitude. For most of the pesticides, a suite of assessment models failed to predict such atmospheric long-range transport behavior, unless the effect of periods of lower hydroxyl radical concentrations and dry weather were taken into account. Observations and model results suggest that under the conditions prevailing in south-central Canada (relatively high latitude, low precipitation rates), many CUPs will be able to undergo regional-scale atmospheric transport and reach lakes outside areas of agricultural application. When assessing the potential of fairly reactive and water-soluble substances to undergo long-range transport, it is imperative to account for periods of no precipitation, to assure that degradation rate constants are correct, and to apply oxidant concentrations that are valid for the region and time period of interest. [source] A clinical profile of participants in an online support groupEUROPEAN EATING DISORDERS REVIEW, Issue 3 2007Alison M. Darcy Abstract Objective To explore the clinical characteristics of users of an online support group for people with eating disorders (EDs). Method One hundred and thirty-eight support group participants were recruited online and completed measures that were specifically adapted for internet administration. These included two subscales of the Eating Disorder Inventory-2 (EDI-2); the 26-item version of the Eating Attitudes Test (EAT-26); the Hospital Anxiety and Depression Scale (HADS); and the Rosenberg Self-Esteem Scale (RSE). Results Participants scored significantly higher than published normative data on all measures. In addition, while the group scored in line with traditional clinical samples, some self-reported diagnostic groups scored significantly higher on all of the factors. Discussion Participants demonstrated a clinical profile, in terms of reported distress, comparable to, and on some measures in excess of, samples diagnosed with an ED. Online support groups may be ideally placed to offer support and information to some people with EDs. Copyright © 2007 John Wiley & Sons, Ltd and Eating Disorders Association. [source] Processed animal products with emphasis on polyunsaturated fatty acid contentEUROPEAN JOURNAL OF LIPID SCIENCE AND TECHNOLOGY, Issue 5 2009Sabine Sampels Abstract The fat composition of processed fish and meat varies due to the source of the animal diet and to the fats used during processing. The aim of this study was to analyse the fatty acid profiles in some commonly available fish and meat fast foods. Variation between similar products from different brands indicated the use of different fat sources during processing. Especially in fish products, a high variation was found in the n -6/n -3 ratio, being up to more than 400-fold higher than in plain fish, which might be of special concern in the evaluation of diet-related health claims. Many products showed considerable differences compared to those included in the official database used for calculation of dietary intake. This leads to the conclusion that the fat sources used during processing of fast food should be reported and available to the consumers. Interdisciplinary dialogue between all sectors involved in food production, processing and health care is proposed to evaluate optimal development of fast foods with nutritionally favourable fat composition. [source] Odorant specificity of three oscillations and the DC signal in the turtle olfactory bulbEUROPEAN JOURNAL OF NEUROSCIENCE, Issue 3 2003Ying-Wan Lam Abstract The odour-induced population response in the in vivo turtle (Terepene sp.) olfactory bulb consists of three oscillatory components (rostral, middle and caudal) that ride on top of a DC signal. In an initial step to determine the functional role of these four signals, we compared the signals elicited by different odorants. Most experiments compared isoamyl acetate and cineole, odorants which have very different maps of input to olfactory bulb glomeruli in the turtle and a different perceptual quality for humans. We found substantial differences in the response to the two odours in the rise-time of the DC signal and in the latency of the middle oscillation. The rate of rise for cineole was twice as fast as that for isoamyl acetate. Similarly, the latency for the middle oscillation was about twice as long for isoamyl acetate as it was for cineole. On the other hand, a number of characteristics of the signals were not substantially different for the two odorants. These included the latency of the rostral and caudal oscillation, the frequency and envelope of all three oscillations and their locations and spatial extents. A smaller number of experiments were carried out with hexanone and hexanal; the oscillations elicited by these odorants did not appear to be different from those elicited by isoamyl acetate and cineole. Qualitative differences between the oscillations in the turtle and those in two invertebrate phyla suggest that different odour processing strategies may be used. [source] Evaluation of DNA polymorphisms amplified by arbitrary primers (RAPD) as genetically associated elements to differentiate virulent and non-virulent Paracoccidioides brasiliensis isolatesFEMS IMMUNOLOGY & MEDICAL MICROBIOLOGY, Issue 3 2002Teresa R Motta Abstract Randomly amplified polymorphic DNA (RAPD) analysis of 35 Paracoccidioides brasiliensis isolates was carried out to evaluate the correlation of RAPD profiles with the virulence degree or the type of the clinical manifestations of human paracoccidioidomycosis. The dendrogram presented two main groups sharing 64% genetic similarity. Group A included two isolates from patients with chronic paracoccidioidomycosis; group B comprised the following isolates showing 65% similarity: two non-virulent, six attenuated, five virulent, eight from patients with chronic paracoccidioidomycosis and two from patients with acute paracoccidioidomycosis. The virulent Pb18 isolate and six attenuated or non-virulent samples derived from it were genetically indistinguishable (100% of similarity). Thus, in our study, RAPD patterns could not discriminate among 35 P. brasiliensis isolates according to their differences either in the degree of virulence or in the type of the clinical manifestation of this fungal infection. [source] State-dependent fertility in pinnipeds: contrasting capital and income breedersFUNCTIONAL ECOLOGY, Issue 5 2000I. L. Boyd Abstract 1.,The study tested the hypothesis that the occurrence of pregnancy in mammals that are capital breeders will be most closely related to state variables that are indices of food stores. Income breeders would not be expected to have the same relationship. 2.,The study examined the relationships between mass, time of year, age and body length with the occurrence of pregnancy in three species of pinniped. This included two capital breeders (Crabeater Seal, Lobodon carcinophagus Hombron & Jacquinot, and Grey Seal, Halichoerus grypus Fabricius) and one income breeder (Antarctic Fur Seal, Arctocephalus gazella Peters). Multiple logistic regression analysis was used to examine the relationships and the interactions between the different state variables. 3.,In both the capital breeders the state variables used in the study explained approximately twice the amount of variability (55% compared with 25%) in the occurrence of pregnancy than in the income breeder. Mass was the dominant state variable among both the capital breeders whereas in the income breeder mass was less important both relative to other state variables and in absolute terms. The results support the conclusion that the occurrence of pregnancy in capital breeders is more sensitive to body reserves than it is in income breeders. 4.,The results also support the conclusion that life histories are the end result of a variety of functional responses to different state variables that have differing degrees of influence. In particular a size-structured approach to studies of population dynamics in pinnipeds may be a more informative way of predicting population responses to environmental variability than the more traditional age-structured approach. [source] Identification of amplified and expressed genes in breast cancer by comparative hybridization onto microarrays of randomly selected cDNA clonesGENES, CHROMOSOMES AND CANCER, Issue 1 2002Jeremy Clark Microarray analysis using sets of known human genes provides a powerful platform for identifying candidate oncogenes involved in DNA amplification events but suffers from the disadvantage that information can be gained only on genes that have been preselected for inclusion on the array. To address this issue, we have performed comparative genome hybridization (CGH) and expression analyses on microarrays of clones, randomly selected from a cDNA library, prepared from a cancer containing the DNA amplicon under investigation. Application of this approach to the BT474 breast carcinoma cell line, which contains amplicons at 20q13, 17q11,21, and 17q22,23, identified 50 amplified and expressed genes, including genes from these regions previously proposed as candidate oncogenes. When considered together with data from microarray expression profiles and Northern analyses, we were able to propose five genes as new candidate oncogenes where amplification in breast cancer cell lines was consistently associated with higher levels of RNA expression. These included the HB01 histone acetyl transferase gene at 17q22,23 and the TRAP100 gene, which encodes a thyroid hormone receptor-associated protein coactivator, at 17q11,21. The results demonstrate the utility of this microarray-based CGH approach in hunting for candidate oncogenes within DNA amplicons. © 2002 Wiley-Liss, Inc. [source] Detection of unidentified chromosome abnormalities in human neuroblastoma by spectral karyotyping (SKY)GENES, CHROMOSOMES AND CANCER, Issue 3 2001Ninette Cohen Spectral karyotyping (SKY) is a novel technique based on the simultaneous hybridization of 24 fluorescently labeled chromosome painting probes. It provides a valuable addition to the investigation of many tumors that can be difficult to define by conventional banding techniques. One such tumor is neuroblastoma, which is often characterized by poor chromosome morphology and complex karyotypes. Ten primary neuroblastoma tumor samples initially analyzed by G-banding were analyzed by SKY. In 8/10 tumors, we were able to obtain additional cytogenetic information. This included the identification of complex rearrangements and material of previously unknown origin. Structurally rearranged chromosomes can be identified even in highly condensed metaphase chromosomes. Following the SKY results, the G-banding findings were reevaluated, and the combination of the two techniques resulted in a more accurate karyotype. This combination allows identification not only of material gained and lost, but also of breakpoints and chromosomal associations. The use of SKY is therefore a powerful tool in the genetic characterization of neuroblastoma and can contribute to a better understanding of the molecular events associated with this tumor. © 2001 Wiley-Liss, Inc. [source] Contrasting effects of repeated summer drought on soil carbon efflux in hydric and mesic heathland soilsGLOBAL CHANGE BIOLOGY, Issue 10 2008ALWYN SOWERBY Abstract Current predictions of climate change include altered rainfall patterns throughout Europe, continental USA and areas such as the Amazon. The effect of this on soil carbon efflux remains unclear although several modelling studies have highlighted the potential importance of drought for carbon storage. To test the importance of drought, and more importantly repeated drought year-on-year, we used automated retractable curtains to exclude rain and produce repeated summer drought in three heathlands at varying moisture conditions. This included a hydric system limited by water-excess (in the UK) and two mesic systems with seasonal water limitation in Denmark (DK) and the Netherlands (NL). The experimental rainfall reductions were set to reflect single year droughts observed in the last decade with exclusion of rain for 2,3 months of the year resulting in a 20,26% reduction in annual rainfall and 23,38% reduction in mean soil moisture during the drought period. Unexpectedly, sustained reduction in soil moisture over winter (between drought periods) was also observed at all three sites, along with a reduction in the maximum water-holding capacity attained. Three hypotheses are discussed which may have contributed to this lack of recovery in soil moisture: hydrophobicity of soil organic matter, increased water use by plants and increased cracking of the soil. The responses of soil respiration to this change in soil moisture varied among the sites: decreased rates were observed at the water-limited NL and DK sites whilst they increased at the UK site. Reduced sensitivity of soil respiration to soil temperature was observed at soil moisture contents above 55% at the UK site and below 20% and 13% at the NL and DK sites, respectively. Soil respiration rates recovered to predrought levels in the NL and DK sites during the winter re-wetting period that indicates any change in soil C storage due to changes in soil C efflux may be short lived in these mesic systems. In contrast, in the hydric UK site after 2 years of drought treatment, the persistent reduction in soil moisture throughout the year resulted in a year-round increase in soil respiration flux, a response that accelerated over time to 40% above control levels. These findings suggest that carbon-rich soils with high organic matter content may act as a significant source of CO2 to the atmosphere following repeated summer drought. Nonrecovery of soil moisture and a persistent increase in soil respiration may be the primary mechanism underlying the reported substantial losses of soil carbon from UK organic soils over the last 20 years. These findings indicate that the water status of an ecosystem will be a critical factor to consider in determining the impact of drought on the soil carbon fluxes and storage. [source] Importance of changing CO2, temperature, precipitation, and ozone on carbon and water cycles of an upland-oak forest: incorporating experimental results into model simulationsGLOBAL CHANGE BIOLOGY, Issue 9 2005Paul J. Hanson Abstract Observed responses of upland-oak vegetation of the eastern deciduous hardwood forest to changing CO2, temperature, precipitation and tropospheric ozone (O3) were derived from field studies and interpreted with a stand-level model for an 11-year range of environmental variation upon which scenarios of future environmental change were imposed. Scenarios for the year 2100 included elevated [CO2] and [O3] (+385 ppm and +20 ppb, respectively), warming (+4°C), and increased winter precipitation (+20% November,March). Simulations were run with and without adjustments for experimentally observed physiological and biomass adjustments. Initial simplistic model runs for single-factor changes in CO2 and temperature predicted substantial increases (+191% or 508 g C m,2 yr,1) or decreases (,206% or ,549 g C m,2 yr,1), respectively, in mean annual net ecosystem carbon exchange (NEEa,266±23 g C m,2 yr,1 from 1993 to 2003). Conversely, single-factor changes in precipitation or O3 had comparatively small effects on NEEa (0% and ,35%, respectively). The combined influence of all four environmental changes yielded a 29% reduction in mean annual NEEa. These results suggested that future CO2 -induced enhancements of gross photosynthesis would be largely offset by temperature-induced increases in respiration, exacerbation of water deficits, and O3 -induced reductions in photosynthesis. However, when experimentally observed physiological adjustments were included in the simulations (e.g. acclimation of leaf respiration to warming), the combined influence of the year 2100 scenario resulted in a 20% increase in NEEa not a decrease. Consistent with the annual model's predictions, simulations with a forest succession model run for gradually changing conditions from 2000 to 2100 indicated an 11% increase in stand wood biomass in the future compared with current conditions. These model-based analyses identify critical areas of uncertainty for multivariate predictions of future ecosystem response, and underscore the importance of long term field experiments for the evaluation of acclimation and growth under complex environmental scenarios. [source] Salvage surgery after radical accelerated radiotherapy with concomitant boost technique for head and neck carcinomasHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 3 2005Daniel Taussky MD Abstract Background. Definitive radiotherapy (RT) for head and neck cancer is increasingly used to preserve organ function, whereas surgery is reserved for treatment failure. However, data are sparse regarding the feasibility of salvage surgery, particularly for unselected patients after accelerated RT. Methods. From 1991 to 2001, 297 patients, most with stage III to IV cancer (Union Internationale Contre le Cancer) were treated with concomitant boost RT (median dose, 69.9 Gy in 41 fractions) with or without chemotherapy (in 33%, usually cisplatin with or without 5-fluorouracil). The 75 patients seen with local and/or regional failure were studied. We analyzed the factors influencing the decision to attempt surgical salvage, the oncologic outcome, and the associated complications. Results. Seventeen (23%) of the 75 patients had a salvage operation. This included all five patients with laryngeal cancers but only 16% to 20% of patients with tumors in other locations. Most patients could not be operated on because of disease extension (40%) and poor general condition/advanced age (30%). Patients with low initial primary T and N classification were more likely to undergo surgery (p = .002 and .014, respectively). Median post-recurrence survival was significantly better for patients who had salvage operations than for those without surgical salvage treatment (44 vs 11 months, p = .0001). Thirteen patients were initially seen with postoperative complications (mostly delayed wound healing and fistula formation). Conclusions. After definitive accelerated RT with the concomitant boost technique, only a minority of patients with local or regional recurrence underwent salvage surgery. Disease stage, tumor location, and patient's general condition at the initial diagnosis seemed to be the main factors influencing the decision to attempt surgical salvage. For patients with initially resectable disease who undergo radical nonsurgical treatment, more effective follow-up is needed to favor early detection of treatment failure, which may lead to a timely and effective salvage surgery. © 2004 Wiley Periodicals, Inc. Head Neck27: 182,186, 2005 [source] Toward a Continuous Quality Improvement Paradigm for Hemodialysis Providers with Preliminary Suggestions for Clinical Practice Monitoring and MeasurementHEMODIALYSIS INTERNATIONAL, Issue 1 2003Edmund G. Lowrie Background: Consensus processes using the clinical literature as the primary source for information generally drive projects to draft clinical practice guidelines (CPGs). Most such literature citations describe special projects that are not part of an organized quality management initiative, and the publication/review/consensus process tends to be long. This project describes an initiative to develop and explore a flexible and dedicated data-driven paradigm for deciding new CPGs that could be rapidly responsive to changing medical knowledge and practice. Methods: Candidate Clinical Practice Monitoring Measures (CPMM) were selected using a large, national database according to the natures and strengths of their associations with mortality risk among patients during 1994. Thresholds above or below which risk of death increased were evaluated for each CPMM using risk profile charts and spline functions. The fractions of patients outside of those thresholds in each dialysis unit (the %Var) were determined for the years 1993, 1994, and 1995. A standardized mortality ratio (SMR) was also determined for each year for each facility. The associations between the %Var and SMR were evaluated in several single-variable and multivariable statistical models. Results: Eleven CPMM were selected and evaluated based on their associations with death risk. These included the urea clearance x dialysis time product (Kt); the concentrations of albumin, potassium, phosphate, bicarbonate, hemoglobin, neutrophils, and lymphocytes in the blood; the body weight/height ratio; diastolic blood pressure; and vascular access type. Even though the CPMM were strongly associated with death risk among patients, the %Var were weakly and inconsistently associated with SMR among facilities. Conclusions: The paradigm was flexible, easy to implement, quickly executed, and potentially able to accommodate evolving medical practice assuming the availability of large database systems such as this. The primary associates of death risk were easily identified and the thresholds easily adopted. The SMR and %Var from the CPMM were only weakly associated, however, suggesting that one cannot be reliably predicted from the other. As such, quality management programs should likely monitor both the processes and outcomes of care among dialysis facilities. [source] Six-Month-Olds' Detection of Clauses Embedded in Continuous Speech: Effects of Prosodic Well-FormednessINFANCY, Issue 1 2000Thierry Nazzi Three experiments investigated the role of prosodic structure for infants' recognition of embedded word sequences. Six-month-olds were familiarized with 2 versions of the same sequence, 1 corresponding to a well-formed prosodic unit and the other to a prosodically ill-formed sequence (although a successive word series). Next, infants heard 2 test passages. One included the well-formed unit, and the other included the ill-formed sequence. In Experiment 1, infants listened longer to the passage containing the well-formed unit, suggesting that such units, even when they are embedded, are better recognized. Experiments 2 and 3 showed that this better recognition does not depend on an acoustic match between the familiarized sequences and their later embeddings. This suggests that the advantage of the well-formed unit is at least partially due to infants' use of prosody to parse continuous speech. [source] Carcinoid tumors are 15 times more common in patients with Crohn's diseaseINFLAMMATORY BOWEL DISEASES, Issue 9 2007N.E. West Abstract Background: The coexistence of intestinal neoplasms with Crohn's disease (CD) has been reported, but the evidence of an increased risk of carcinoid tumor with Crohn's disease has been mixed. We present 4 patients with CD with associated carcinoid tumor. Methods: The charts of 111 patients with CD who had undergone resection between June 2001 and March 2005 were reviewed. The number of incidental carcinoid tumors in patients who underwent an appendectomy was used as a control. Results: Four cases of carcinoid tumor discovered in patients at resection for CD were identified. None had metastatic disease or carcinoid syndrome. These included 1 cecal (1 mm), 2 appendiceal (3 and 7mm), and 1 transverse colon (7 mm) carcinoid tumors. None of the carcinoid tumors were identified in regions of active Crohn's disease. The incidence of carcinoid tumor in patients with Crohn's disease was 4 of 111 (3.6%). In comparison, 3 of 1199 patients (0.25%) who had appendectomies were identified as having appendiceal carcinoid tumor. Crohn's disease was associated with an increased incidence of carcinoid tumor; OR 14.9 (95% CI 2.5,102.5), P < 0.0001. Conclusions: There was a significantly increased incidence of carcinoid tumor in our Crohn's patients compared to the control patients. None of the carcinoid tumors developed in areas of Crohn's disease. This suggests that the development of carcinoid tumors may be secondary to distant proinflammatory mediators, rather than a local inflammatory effect from adjacent Crohn's disease. Patients with CD may be at increased risk of developing a carcinoid tumor. (Inflamm Bowel Dis 2007) [source] A preliminary linkage map of the hard tick, Ixodes scapularisINSECT MOLECULAR BIOLOGY, Issue 2 2003A. J. Ullmann Abstract A linkage map of the Ixodes scapularis genome was constructed, based upon segregation amongst 127 loci. These included 84 random amplified polymorphic DNA (RAPD) markers, 32 Sequence- Tagged RAPD (STAR) markers, 5 cDNAs, and 5 microsatellites in 232 F1 intercross progeny from a single, field-collected P1 female. A preliminary linkage map of 616 cM was generated across 14 linkage groups with one marker every 10.8 cM. Assuming a genome size of , 109 bp, the relationship of physical to genetic distance was found to be , 300 kb/cM in the I. scapularis genome. [source] Tunnel stability analysis during construction using a neuro-fuzzy systemINTERNATIONAL JOURNAL FOR NUMERICAL AND ANALYTICAL METHODS IN GEOMECHANICS, Issue 15 2005José Luis Rangel Abstract This paper presents an alternative strategy to evaluate the stability of tunnels during the design and construction stages based on a hybrid system, composed by neural, neuro-fuzzy and analytical solutions. A prototype of this system is designed using a database formed by 261 cases, 45 real and the rest synthetic. This system is capable of reproducing the displacements induced at the periphery of the tunnel before and after support installation. The stability of the excavation process is evaluated using a criterion that considers dimensionless parameters based on the shear strength of the media, the induced deformation level in the ground, the plastic radii and the advance of excavation without support. The efficiency and validity of the prototype is verified with two examples of actual tunnels, one included in the database used to train the system and the other not included. The results of both examples show a better approximation than other commonly used techniques. Copyright © 2005 John Wiley & Sons, Ltd. [source] Dietary risk factors for upper aerodigestive tract cancersINTERNATIONAL JOURNAL OF CANCER, Issue 2 2002Christine M. Kasum Abstract We examined the association between whole-grain intake and incident upper aerodigestive tract cancer in a cohort of 34,651 postmenopausal, initially cancer-free women. We also studied established risk factors for upper aerodigestive cancers, including fruit and vegetable intake, smoking and alcohol intake. A mailed questionnaire at baseline in 1986 included a food-frequency questionnaire and assessment of other cancer risk factors. During the 14-year follow-up period, 169 women developed cancer of the upper aerodigestive tract. For all upper aerodigestive cancers together, significant inverse associations were observed for the highest compared to the lowest tertile of whole grains [relative risk (RR) = 0.53, 95% confidence interval (CI) 0.34,0.81] and yellow/orange vegetables (RR = 0.58, 95% CI 0.39,0.87). In addition, those in the highest compared to lowest tertile of fiber intake from whole grain were less likely to develop upper aerodigestive tract cancer (RR = 0.56, 95% CI 0.37,0.84); fiber intake from refined grain was not significantly associated with upper aerodigestive tract cancer. Findings were generally similar for oropharyngeal (n = 53), laryngeal (n = 21), nasopharyngeal/salivary (n = 18), esophageal (n = 21) and gastric (n = 56) cancers, though numbers of cases were too small for statistical testing within individual cancers. These findings confirm previous observations that high intake of fruits and vegetables and that intake of whole grains and the fiber derived from them may reduce risk of upper aerodigestive tract cancers. © 2002 Wiley-Liss, Inc. [source] Low-grade fever: how to distinguish organic from non-organic formsINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 3 2010M. Affronti Summary Background and aim:, Low-grade fever (LGF) is defined as a body temperature between 37.5 and 38.3 °C, which is below the classical value reported for fever of unknown origin (FUO). We attempted to characterise its epidemiology, aetiology and clinical aspects to improve the methodological approach to diagnosis. Design and Methods:, We reviewed and evaluated a survey of patients with LGF, followed as outpatients of our Department, a tertiary referral centre from 1997 to 2008. The same classifications were applied for classical FUO, and in the patients diagnosed with LGF, we also investigated for habitual hyperthermia (HH). Results:, Seventy-three patients were selected and divided into two groups: group A included 32 patients classified with organic fever and group B included 41 patients with HH. Aetiology of organic LGF was: infectious disease 59%; neoplasm 3.1%; inflammatory non-infectious disease 6.2%; miscellaneous 18.7%; undiagnosed 12.5%. Mean age was significantly higher in the organic fever than in the HH group (p < 0.02). Splenomegaly and loss of weight were significantly associated with organic fever (p < 0.05), while dizziness and general malaise were associated with HH. Lack of any pathological signs at physical examination was significantly more frequent in HH (p < 0.0001). Among the biochemical tests, white blood cells and C-reactive protein were more frequently above normal limits in group A than in group B (p < 0.05). Conclusions:, In our experience, LGF requires the same methodological diagnostic approach as FUO, because there is no relationship between body temperature values and the severity of the underlying diseases, and the aetiological spectrum is also the same. [source] Minimising undernutrition in the older inpatientINTERNATIONAL JOURNAL OF EVIDENCE BASED HEALTHCARE, Issue 2 2007Dawn Vanderkroft BSc internshipNutr&Diet APD Abstract Background, Malnutrition among elderly hospitalised patients is widespread and has been shown to lead to adverse health outcomes. The effectiveness of interventions to minimise undernutrition in elderly inpatients is not well documented. Objectives, To identify the best available practices, in the hospital setting, that minimise undernutrition or the risk of undernutrition, in the acute care patient especially for the older patient. The review will assesses the effectiveness of a range of interventions designed to promote adequate nutritional intake in the acute care setting, with the aim of determining what practices minimise malnutrition in the elderly inpatients. Search strategy, English language articles from 1980 onwards were sought using Medline, Premedline, Cinahl, Austrom-Australasian Medical Index and AustHealth, Embase and Science Citations Index. Selection criteria, For inclusion the study had to include an intervention aiming to minimise undernutrition in hospitalised elderly patients aged 65 years or older. All study designs were included. Data collection and analysis, Two independent reviewers assessed the eligibility of each study for inclusion into the review, critically appraised the study quality and extracted data using standardised tools. For each outcome measure results were tabulated by intervention type and discussed in a narrative summary. Results from randomised controlled trials were pooled in meta-analyses where appropriate. Main results, Twenty-nine studies met the inclusion criteria, with a total of 4021 participants. The focus of 15 interventions was the supplying of oral supplements to the participants, six focused on enteral nutrition therapy, four interventions made changes to the foods provided as part of the hospital diet, one included the services of an additional staff member and three incorporated the implementation of evidence-based guidelines. Ten meta-analyses were conducted from which the main findings were: significant improvements in weight status and arm muscle circumferences with an oral supplement intervention, P < 0.05. Reviewers' conclusions, The findings of the review support the use of oral supplements to minimise undernutrition in elderly inpatients. The results also emphasise the need for more high-quality research using appropriate outcome measures in the area of minimisation of undernutrition, particularly interventions that make alterations to the hospital diet and address support for feeding patients at the ward level. [source] The effects of cannabis abuse on the symptoms of schizophrenia: Patient perspectivesINTERNATIONAL JOURNAL OF MENTAL HEALTH NURSING, Issue 4 2008William F. Costain ABSTRACT:, This study explored explanatory models used by individuals with schizophrenia in relation to continuing cannabis abuse. Cannabis is known to exacerbate positive symptoms, compound the effects of negative symptoms, and lead to relapse, having a negative effect upon quality of life. If this is so, why would people choose to continue the drug use? Most previous studies exploring this phenomenon have used quantitative methodology where the questions asked have been preset by the researchers and the subjective experience of the patient has been minimized. Qualitative methodology was utilized in this study in order to give voice to the patients' perspectives, and contribute to the knowledge of the frameworks of meanings employed by patients. The majority of participants in this study did not perceive that they had a mental illness and they held strong beliefs regarding the usefulness of cannabis. They gave explanations for their continuing cannabis use that expanded the understanding from previous studies. These included that they sought the drug effects of cannabis use for clarity of voices, control of symptoms, to feel normal, perceived improvement in cognitive function, reduced psychological pain and increased energy. These beliefs may influence a person's adherence with treatment and their future cannabis use. This research has implications for clinical practice as clinicians may lack insight into the importance of the phenomenological beliefs of a person with schizophrenia. This lack of insight by the clinician into the phenomenological beliefs may impact on the development of a therapeutic relationship. [source] Multiprofessional collaboration promoting home care clients' personal resources: perspectives of older clientsINTERNATIONAL JOURNAL OF OLDER PEOPLE NURSING, Issue 2 2008Sini Eloranta MNSc Home care can be decisive in supporting older people in the home environment. However, one professional in home care cannot take the whole responsibility for promotion alone; on the contrary multiprofessional collaboration is needed. The aim of the study is to describe the experiences of multiprofessional collaboration in promoting personal resources among older home care clients (75+ years) in Finland. The data were collected by unstructured interviews with 21 older home care clients. Their mean age was 83.5 years, ranging from 75 to 91, with 17 female and four male participants. Inductive content analysis was used to analyze the data. The interviewees described the work of professionals from four perspectives: expertise, communication, decision-making and responsibility. Multiprofessional collaboration promoted the personal resources of interviewees with physical, psychological and social support. This study showed that the professionals worked as being expert-oriented: in the multiprofessional collaboration, each expert took care of his/her own part of the client's situation. This included the risk,, that the client's overall situations remained uncharted. However, the client's overall situation is a very important aspect when professionals suppport older people living in their own homes as long as possible. This study revealed the need for developing collaboration skills between social and health care professionals so that the staffs serve the needs of aged clients better together. [source] An educational process to strengthen primary care nursing practices in São Paulo, BrazilINTERNATIONAL NURSING REVIEW, Issue 4 2007A.M. Chiesa rn Objective:, To describe the experience of a registered nurse (RN) training process related to the Family Health Program (FHP) developed in the city of São Paulo, Brazil. Background:, The FHP is a national, government strategy to restructure primary care services. It focuses on the family in order to understand its physical and social structure in regards to the health,illness process. In the FHP, the RN is a member of a team with the same number as medical doctors , an unprecedented situation. The FHP requires a discussion of the RNs' practice, by qualifying and empowering them with tools and knowledge. Methods:, The training process was based on Freire's approach founded on critical pedagogy in order to address the fundamental problem of inequalities in health. The first phase included workshops and the second one included a course. The workshops identified the following problems related to the RN's work: lack of tools to identify the population's needs; overload of work due to the accumulation of management and assistance activities; difficulties regarding teamwork; lack of tools to evaluate the impact of nursing interventions; lack of tools to improve the participation of the community. The course was organized to tackle these problems under five thematic headings. Results:, The RN's training process allowed the group to reflect deeply on its work. This experience led to the need for the construction of tools to intervene in the reality, mainly against social exclusion, rescuing and adapting of the knowledge accumulated in the healthcare practice, identifying settings which demand institutional solutions and engaging the RN in research groups in order to develop projects according to the complexity of the primary care services. Conclusion:, The application of the concept of equity in the health sector represented a reaction against the processes of social exclusion, starting from performance at a local level to become a reality in the accomplishments achieved by the Brazilian National Health System. This training process allowed us to evaluate that partnership, which has produced many concrete results in addressing both parts of the Inequalities in Health dilemma and which is a productive way of building up a new model of health. [source] | ||||||||||||||||||||||||||||||||||||||||||||||