Increasing Number (increasing + number)

Distribution by Scientific Domains
Distribution within Medical Sciences

Selected Abstracts

Degradation of Structural and Optical Properties of InGaN/GaN Multiple Quantum Wells with Increasing Number of Wells

S. Pereira
Abstract We compare the structural and spectral properties of two multi quantum wells (MQWs), grown by metal organic chemical vapour deposition under the same nominal conditions, with a different number of periods. The MQWs, each with 20% InN and containing 8 and 18 wells, respectively, grew on-axis and coherent to GaN, as revealed by X-ray diffraction reciprocal space mapping (RSM) analysis. Comparison of the asymmetrical (105) RSMs indicates an overall structural deterioration and greater well-barrier intermixing for the MQW with the larger number of wells. Moreover, the composition of the MQWs was depth-profiled by grazing incidence Rutherford backscattering spectrometry (RBS). RBS further evidences strong intermixing in the 18-well heterostructure. The deleterious effects of intermixing on the emission spectrum are revealed by low temperature photoluminescence spectroscopy. Despite similar peak emission energies (,E < 45 meV) the 8-well structure shows a more symmetric and narrow peak (FWHM , 100 meV) in comparison with that of the 18-well sample (FWHM , 170 meV). Surface analyses by atomic force and scanning electron microscopy show an increased density, size and depth of V-pit defects on the 18-well structure. These results suggest that dislocations and pitting result from a larger elastic strain energy accumulated in the thicker MQW stack and are a fundamental intermixing mechanism for InGaN/GaN MQWs. [source]

Development of a test to evaluate residents' knowledge of medical procedures,,

Shilpa Grover MD
Abstract BACKGROUND AND AIM: Knowledge of core medical procedures is required by the American Board of Internal Medicine (ABIM) for certification. Efforts to improve the training of residents in these procedures have been limited by the absence of a validated tool for the assessment of knowledge. In this study we aimed to develop a standardized test of procedural knowledge in 3 medical procedures associated with potentially serious complications. METHODS: Placement of an arterial line, central venous catheter, and thoracentesis were selected for test development. Learning objectives and multiple-choice questions were constructed for each topic. Content evidence was evaluated by critical care subspecialists. Item test characteristics were evaluated by administering the test to students, residents and specialty clinicians. Reliability of the 32-item instrument was established through its administration to 192 medical residents in 4 hospitals. RESULTS: Reliability of the instrument as measured by Cronbach's , was 0.79 and its test-retest reliability was 0.82. Median score was 53% on a test comprising elements deemed important by critical care subspecialists. Increasing number of procedures attempted, higher self-reported confidence, and increasing seniority were predictors of overall test scores. Procedural confidence correlated significantly with increasing seniority and experience. Residents performed few procedures. CONCLUSIONS: We have successfully developed a standardized instrument to assess residents' cognitive competency for 3 common procedures. Residents' overall knowledge about procedures is poor. Experiential learning is the dominant source for knowledge improvement, but these experiences are increasingly rare. Journal of Hospital Medicine 2009;4:430,432. © 2009 Society of Hospital Medicine. [source]

The influence of various graphical and numeric trend display formats on the detection of simulated changes,

ANAESTHESIA, Issue 11 2009
R. R. Kennedy
Summary Integration of a large amount of information is important in anaesthesia but there is little research to guide the development of data displays. Anaesthetists from two hospitals participated in five related screen based simulation studies comparing various formats for display of historical or ,trend' data. Participants were asked to indicate when they first noticed a change in each displayed variable. Accuracy and latency (i.e. delay) in detection of changes were recorded. Latency was shorter with a graphic display of historical data than with a numeric display. Increasing number of variables or reduction of y -axis height increased the latency of detection. If the same number of data points were included, there was no difference between graphical and numerical displays of historical data. There was no difference in accuracy between graphical or numerical displays. These results suggest that the way trend data is presented can influence the speed of detection of changes. [source]

Abnormalities in sexual development of the amphipod Gammarus pulex (L.) found below sewage treatment works

Melanie Yvette Gross
Abstract Increasing numbers of widely used industrial, agricultural, and natural chemicals are known to elicit endocrine-disrupting effects in a wide range of vertebrate and invertebrate species. The objective of this study was to determine whether the sexual development of the freshwater crustacean Gammarus pulex (L.) was affected below sewage treatment works (STW) previously known to contain endocrine-disrupting chemicals in their effluent. The gonadal structure, external sexual characteristics, and size of gammarids from exposed sites were compared to those of gammarids from a reference site. No significant difference was found in the gonadal structure of males collected below two STW. However, a highly significant number of females collected from a site known to elicit high estrogenic responses in vertebrates displayed an abnormal structure of oocytes in vitellogenesis. Body size was significantly shorter and male/female size differential was significantly reduced below one of the STW. Analysis of gnathopod and genital papillae length data suggests that different allometric relationships of these organs to body size exist between sample sites. [source]

Short-Term Study Abroad: Predicting Changes in Oral Skills

Rob A. Martinsen
Abstract: Increasing numbers of students are opting for study abroad programs of 2 months or less while research on study abroad generally focuses on semester- or year-long programs. This study quantitatively examines changes in students' spoken Spanish after 6 weeks in Argentina using native speaker ratings of student speech. The researcher then uses self-report measures to determine which of the following variables predict improvements in speaking, pre-program motivation and intercultural sensitivity, relationship with the host family, and interaction with native speakers. Results suggest that short-term programs can benefit language skills, as the majority of students in this program demonstrated small yet highly significant improvements in spoken Spanish even though a percentage of students showed a decrease in their skills. Surprisingly, only pre-program levels of cultural sensitivity predicted students' improvements in language skills, providing further evidence of the importance of culture in language learning. [source]

Transnational migration: taking stock and future directions

Peggy Levitt
Increasing numbers of sending states are systematically offering social and political membership to migrants residing outside their territories. The proliferation of these dual memberships contradicts conventional notions about immigrant incorporation, their impact on sending countries, and the relationship between migration and development in both contexts. But how do ordinary individuals actually live their lives across borders? Is assimilation incompatible with transnational membership? How does economic and social development change when it takes place across borders? This article takes stock of what is known about everyday transnational practices and the institutional actors that facilitate or impede them and outlines questions for future research. In it, I define what I mean by transnational practices and describe the institutions that create and are created by these activities. I discuss the ways in which they distribute migrants' resources and energies across borders, based primarily on studies of migration to the United States. [source]

Evaluation of an Inexpensive Small-Diameter Temperature Logger for Documenting Ground Water,River Interactions

Adam N. Johnson
Increasing numbers of studies are recording detailed temperature data for characterization of ground water,stream exchange. We examined laboratory and field operation of a small-diameter, stand-alone and inexpensive temperature logger capable of investigating stream,ground water exchange was examined. The Thermochron iButton is a 17.35-mm-diameter by 6-mm-thick instrument that costs <$10 when ordered in quantity. Testing of the loggers in a controlled temperature bath revealed a precision of ±0.4°C and an accuracy of ±0.5°C for a group of 201. More than 500 loggers have been installed in channels and in subchannel and floodplain ground water environments in two gravel-bedded rivers in the western United States. Loggers were placed as single devices and in vertical arrays in monitoring wells with diameters of 10.16, 5.08, 2.54, and 1.9 cm. We determined that the loggers have four principal advantages over more commonly used wired and currently available stand-alone logging devices: (1) the wireless nature does not require the instrument location to be associated with a control-recording system; (2) the small size allows for installation in small hand-driven or direct-push monitoring wells and thus intimate contact of the instruments with the hydrologic environment; (3) multiple loggers are easily suspended in a single fully perforated monitoring well, allowing for the collection of high-resolution temperature profile data; and (4) the low cost of the loggers allows for the deployment of large numbers, thus improving spatial resolution in shallow ground water floodplain scale studies. [source]

Mechanisms and management of gingival overgrowth in paediatric transplant recipients: a review

D. Chabria
Summary. Increasing numbers of children are receiving solid organ transplants namely kidney, liver, heart and lung. Patient survival rates following such transplants are essentially good with much of the success attributable to the development of Cyclosporine A (CyA), an immunosuppressive drug, that minimizes organ rejection. However the gingival overgrowth (GO) associated with the use of CyA is not only disfiguring but in paediatric recipients, may interfere with normal oral development and function. Objective. The aim of this review is to summarize current knowledge concerning the aetiology, pathogenesis and management of gingival overgrowth. Methods. Literature pertaining to gingival overgrowth is reviewed with particular reference to the paediatric population. Emphasis is placed on summarizing the evidence pertaining to the effectiveness of intervention. Conclusion. CyA undoubtedly causes gingival overgrowth, the effects and levels of which appears to be more severe in younger patients. There is conflicting evidence as to the effectiveness of oral hygiene regimes, antibiotics and surgery in reducing overgrowth. The introduction of an alternative immunosuppressive agent (Tacrolimus) offers potential as it does not appear to cause overgrowth, although research to date is limited by the small sample size of many of the studies. This is an area in which multicentre studies would be of great value. [source]

Upgrading Patients with Chronic Defibrillator Leads to a Biventricular System and Reducing Patient Risk: Contralateral LV Lead Placement

Increasing numbers of patients with indwelling single- or dual- chamber internal cardioverter defibrillators (ICDs) will require upgrading of an existing system to a biventricular ICD providing cardiac resynchronization with back-up defibrillation. Upgrading, usually by the addition of a new left ventricular (LV) lead, can be technically challenging with central venous occlusion or stenosis often being the main obstacle to a successful procedure. We report a new technique of implanting a LV lead from the contralateral side to the existing ICD system to minimize the peri- and postoperative risk to the patient. [source]

Chloroplast-derived vaccine antigens confer dual immunity against cholera and malaria by oral or injectable delivery

Abdoreza Davoodi-Semiromi
Summary Cholera and malaria are major diseases causing high mortality. The only licensed cholera vaccine is expensive; immunity is lost in children within 3 years and adults are not fully protected. No vaccine is yet available for malaria. Therefore, in this study, the cholera toxin-B subunit (CTB) of Vibrio cholerae fused to malarial vaccine antigens apical membrane antigen-1 (AMA1) and merozoite surface protein-1 (MSP1) was expressed in lettuce and tobacco chloroplasts. Southern blot analysis confirmed homoplasmy and stable integration of transgenes. CTB-AMA1 and CTB-MSP1 fusion proteins accumulated up to 13.17% and 10.11% (total soluble protein, TSP) in tobacco and up to 7.3% and 6.1% (TSP) in lettuce, respectively. Nine groups of mice (n = 10/group) were immunized subcutaneously (SQV) or orally (ORV) with purified antigens or transplastomic tobacco leaves. Significant levels of antigen-specific antibody titres of immunized mice completely inhibited proliferation of the malarial parasite and cross-reacted with the native parasite proteins in immunoblots and immunofluorescence studies. Protection against cholera toxin challenge in both ORV (100%) and SQV (89%) mice correlated with CTB-specific titres of intestinal, serum IgA and IgG1 in ORV and only IgG1 in SQV mice, but no other immunoglobulin. Increasing numbers of interleukin-10+ T cell but not Foxp3+ regulatory T cells, suppression of interferon-, and absence of interleukin-17 were observed in protected mice, suggesting that immunity is conferred via the Tr1/Th2 immune response. Dual immunity against two major infectious diseases provided by chloroplast-derived vaccine antigens for long-term (>300 days, 50% of mouse life span) offers a realistic platform for low cost vaccines and insight into mucosal and systemic immunity. [source]

Teachers' perceptions of the emotional and behavioral functioning of children raised by grandparents

Oliver W. Edwards
Increasing numbers of grandparents are becoming full-time surrogate parents to their grandchildren. Grandparents who raise their grandchildren reportedly endure high levels of stress, and grandchildren purportedly experience childhood trauma that can lead to poor psychological adjustment. While anecdotal reports have suggested that grandchildren experience significant behavioral problems, there is a dearth of data to empirically support this view. This research was an initial endeavor to ascertain whether teachers perceive children raised by grandparents as exhibiting serious emotional and behavioral problems. Fifty-four African American children raised by their grandparents and a comparison group of 54 African American children living with their parents were studied to determine the grandchildren's functioning. Teachers perceived the children raised by their grandparents as experiencing significantly more emotional and behavioral problems than their similar schoolmates. Children in these families appear in need of school-based intervention services. © 2006 Wiley Periodicals, Inc. Psychol Schs 43: 565,572, 2006. [source]

Perception of Risk by Administrators and Home Health Aides

Mary Agnes Kendra Ph.D.
Increasing numbers of persons over 65, decreased length of hospital stay, and need for chronic (custodial) health care have placed a strain on home health care agencies. The second largest group of persons providing care is home health aides (HHAs), who perform in-home, nonskilled, technical procedures with little or no on-site supervision. They are generally high school graduates or hold GEDs. The purpose of this study was to compare home health care administrators' (HHCAs) and HHAs' perceptions of risk involved in home visiting. Given HHAs' educational preparation and limited supervision, they are basically on their own for work performed. Although agencies provide orientation sessions for new workers, periodic in-services often relate to tasks and competency testing and little attention directed toward protecting the self,specifically, strategies to decrease personal risk. In order to determine to what extent HHCAs and HHAs perceive risk, the Home Health Care Perception of Risk Questionnaire, a self-report measure, was administered to a national random sample of 93 HHCAs and 227 HHAs. Findings suggest that these groups differ in perception of risk and level of agency support in making home visits. Suggestions for meeting the needs of this HHA provider group are offered. [source]

Breast Cancer in Reduction Mammaplasty Specimens: Case Reports and Guidelines

Angela J. Keleher MD
Abstract: Increasing numbers of women of all ages are electing to have reduction mammaplasty for very large breasts. Breast cancer can be an incidental finding in reduction mammaplasty specimens. We report here the discovery of breast cancer in specimens from four patients who underwent elective breast reduction, three of whom had not had recent mammograms. All four patients underwent modified radical mastectomy. The role of mammography, surgical options, specimen evaluation, and practical guidelines are discussed., [source]

Trust, reputation and corporate accountability to stakeholders

Tracey Swift
This paper explores the relationship between accountability, trust and corporate reputation building. Increasing numbers of corporations are mobilising themselves to put more and more information out into the public domain as a way of communicating with stakeholders. Corporate social accounting and stakeholder engagement is happening on an unprecedented scale. Rather than welcoming such initiatives, academics have been quick to pick faults with contemporary social auditing and reporting, claiming that in its current form it is not about demonstrating accountability at all, but rather about building corporate reputation. Academics argue that ,accountability should hurt', that if accountability is an enjoyable process, then the organisation isn't doing it right. For organisations that are currently engaging with stakeholders and ostensibly becoming more transparent about their corporate social performance, this kind of critique is likely to be bewildering. This paper argues that central to the notion of accountability and to contemporary social accounting practice is the concept of trust. Accountability is based upon a distrust of corporate management, whereas corporate reputation building is about strategically seeking to establish trust in stakeholder relationships in order to negate formal accountability requirements. Using a split trust continuum, the paper seeks to explain and synthesise what seem to be two very different paradigms of organisational transparency. [source]

Suicidal Behavior in Children Younger than Twelve: A Diagnostic Challenge for Emergency Department Personnel

Carl L. Tishler PhD
Suicide is one of the leading causes of death in children younger than 12 years and is the fourth leading cause of death in 12 year olds. Increasing numbers of young children now present to the emergency department (ED) with mental health issues, and ED personnel must determine the most appropriate disposition options for these children, sometimes without the assistance of specialty mental health services. Much of the present body of literature describing suicidality fails to separate children from adolescents for analysis and discussion. This article reviews relevant literature pertaining to suicidal thoughts and behaviors in young children and discusses problems with available data, as well as epidemiology, risk factors, typical motivations, methods, assessment, and disposition for these patients. Suicidal children younger than 12 years are often clinically different from suicidal adolescents and adults and may require unique assessment and disposition strategies in the ED. A child who has ideation without a clear plan, or has made an attempt of low lethality, can sometimes be discharged home, provided that a supportive, responsible caregiver is willing to monitor the child and take him or her to outpatient mental health appointments. If the home environment is detrimental, or the child has used a method of high potential lethality, inpatient treatment is the most appropriate course of action. Mental health specialty services, when available, should be used to help determine the most appropriate disposition. [source]

Allergic rhinitis in children: environmental factors

Y. Okamoto
Summary Increasing numbers of patients with allergic rhinitis are being noted on a global scale. Over 90% of Japanese patients with perennial allergic rhinitis show allergic reaction to the mite antigen and major pollen allergens such as Japanese cedar and Japanese cypress, which are carried long distances (> 100 km) by wind and hence can produce substantial harmful effects even in metropolitan areas. This situation is distinct from that in the West, where the most common anemophilous allergen, ragweed, travels much shorter distances of up to only several hundred metres. Environmental factors such as increased antigen, air pollution, diet, intestinal microflora, decreased incidence of infections, smoking, breastfeeding and vaccination may play important roles in the development and manifestation of allergic rhinitis in genetically predisposed subjects. In particular, in newborn infants, who carry the Th2 predominant state, environmental factors may greatly affect the development of balanced production of Th1 and Th2 cytokines. However, the contribution of any environmental factor to the postnatal development of allergic rhinitis has not been sufficiently determined. A better understanding of the processes involved may lead directly to better treatment or cure of allergic rhinitis. [source]

TouchTone: Interactive Local Image Adjustment Using Point-and-Swipe

Chia-Kai Liang
Recent proliferation of camera phones, photo sharing and social network services has significantly changed how we process our photos. Instead of going through the traditional download-edit-share cycle using desktop editors, an increasing number of photos are taken with camera phones and published through cellular networks. The immediacy of the sharing process means that on-device image editing, if needed, should be quick and intuitive. However, due to the limited computational resources and vastly different user interaction model on small screens, most traditional local selection methods can not be directly adapted to mobile devices. To address this issue, we present TouchTone, a new method for edge-aware image adjustment using simple finger gestures. Our method enables users to select regions within the image and adjust their corresponding photographic attributes simultaneously through a simple point-and-swipe interaction. To enable fast interaction, we develop a memory- and computation-efficient algorithm which samples a collection of 1D paths from the image, computes the adjustment solution along these paths, and interpolates the solutions to entire image through bilateral filtering. Our system is intuitive to use, and can support several local editing tasks, such as brightness, contrast, and color balance adjustments, within a minute on a mobile device. [source]

The Long Road to Better ACHD Care

Gary Webb MD
ABSTRACT The care of adult patients with congenital heart defects in the United States is spotty at best, and needs to improve greatly if the needs of these patients are to be met. The care of American children with congenital heart defects is generally excellent. Pediatric cardiac services are well established and well supported. The care of adults with congenital heart disease (CHD) is well established in only a few American centers. While there are an increasing number of clinics, they are generally poorly resourced with relatively few patients. If located in adult cardiology programs, they are usually minor players. If located in pediatric cardiac programs, they are usually minor players as well. Training programs for adult CHD (ACHD) caregivers are few, informal, and poorly funded. To improve the situation, we need perhaps 25 well-resourced and well-established regional ACHD centers in the United States. We need to stop the loss to care of CHD patients at risk of poor outcomes. We need to educate patients and families about the need for lifelong and skilled surveillance and care. We need to effect an orderly transfer from pediatric to adult care. We need to strengthen the human resource infrastructure of ACHD care through the training and hiring of healthcare professionals of a quality equivalent to those working in the pediatric care environment. We need to demonstrate that adult care is high quality care. We need more high-quality ACHD research. The ACHD community needs to establish its credibility with pediatric cardiac providers, adult cardiology groups, with governments, with professional organizations, and with research funding agencies. Accordingly, there is a need for strong political action on behalf of American ACHD patients. This must be led by patients and families. These efforts should be supported by pediatric cardiologists and children's hospitals, as well as by national professional organizations, governments, and health insurance companies. The goal of this political action should be to see that ACHD patients can receive high-quality lifelong surveillance, that we lose fewer patients to care, and that the staff and other services needed are available nationwide. [source]

Guidelines for Systematic Review in Conservation and Environmental Management

política de la conservación; práctica de la conservación; toma de decisiones; transferencia de conocimiento basado en evidencia Abstract:,An increasing number of applied disciplines are utilizing evidence-based frameworks to review and disseminate the effectiveness of management and policy interventions. The rationale is that increased accessibility of the best available evidence will provide a more efficient and less biased platform for decision making. We argue that there are significant benefits for conservation in using such a framework, but the scientific community needs to undertake and disseminate more systematic reviews before the full benefit can be realized. We devised a set of guidelines for undertaking formalized systematic review, based on a health services model. The guideline stages include planning and conducting a review, including protocol formation, search strategy, data inclusion, data extraction, and analysis. Review dissemination is addressed in terms of current developments and future plans for a Web-based open-access library. By the use of case studies we highlight critical modifications to guidelines for protocol formulation, data-quality assessment, data extraction, and data synthesis for conservation and environmental management. Ecological data presented significant but soluble challenges for the systematic review process, particularly in terms of the quantity, accessibility, and diverse quality of available data. In the field of conservation and environmental management there needs to be further engagement of scientists and practitioners to develop and take ownership of an evidence-based framework. Resumen:,Un mayor número de disciplinas está utilizando marcos de referencia basados en evidencias para revisar y diseminar la efectividad de las intervenciones de gestión y política. El fundamento es que la mayor accesibilidad de la evidencia mejor disponible proporcionará una plataforma de toma de decisiones menos sesgada y más eficiente. Argumentamos que hay beneficios significativos para la conservación al utilizar tal marco de referencia, pero la comunidad científica debe emprender y diseminar revisiones más sistemáticas antes de que se pueda comprender el beneficio completo. Diseñamos un conjunto de directrices para realizar revisiones sistemáticas formales, basado en un modelo de servicios de salud. Las etapas de las directrices incluyen la planificación y conducción de una revisión, incluyendo formación del protocolo, estrategias de búsqueda, inclusión de datos, extracción y análisis de datos. La diseminación de revisiones es abordada en términos del desarrollo actual y los planes futuros para una biblioteca de acceso abierto en la Web. Al utilizar estudios de caso resaltamos modificaciones críticas a las directrices para la formulación del protocolo, evaluación de la calidad de los datos, extracción de datos y síntesis de datos para la gestión ambiental y de conservación. Los datos ecológicos presentaron retos significativos, pero solucionables, para el proceso de revisión sistemática, particularmente en términos de la cantidad, accesibilidad y calidad de los datos disponibles. Se requiere un mayor compromiso de científicos y profesionales de la gestión ambiental y de conservación para desarrollar y apropiarse de un marco de referencia basado en evidencias. [source]

Chlorhexidine anaphylaxis: case report and review of the literature

A. B. Krautheim
Chlorhexidine is a widely used antiseptic and disinfectant. Compared to its ubiquitous use in medical and non-medical environments, the sensitization rate seems to be low. Multivarious hypersensitivity reactions to the agent have been reported, including delayed hypersensitivity reactions such as contact dermatitis, fixed drug eruptions and photosensitivity reactions. An increasing number of immediate-type allergies such as contact urticaria, occupational asthma and anaphylactic shock have been reported. In the case report, we describe anaphylaxis due to topical skin application of chlorhexidine, confirmed by skin testing and sulfidoleukotriene stimulation test (CAST®: cellular antigen stimulation test). The potential risk of anaphylactic reactions due to the application of chlorhexidine is well known, especially that application to mucous membranes can cause anaphylactic reactions and was therefore discouraged. The use of chlorhexidine at a 0.05% concentration on wounds and intact skin was so far thought to be safe. Besides our patient, only one other case of severe anaphylactic reaction due to application of chlorhexidine on skin has been reported. Hypersensitivity to chlorhexidine is rare, but its potential to cause anaphylactic shock is probably underestimated. This review should remind all clinicians of an important potential risk of this widely used antiseptic. [source]

Accounting Conservatism and the Temporal Trends in Current Earnings' Ability to Predict Future Cash Flows versus Future Earnings: Evidence on the Trade-off between Relevance and Reliability

M41; C23; D21; G38 This research reports that an increasing level of accounting conservatism over the 1973,2005 period is associated with: (1) an increase in the ability of current earnings to predict future cash flows and (2) a decrease in the ability of current earnings to predict future earnings. We also find that usefulness of earnings for explaining stock prices over book values is positively related to reliability but not to relevance. Our results hold for the constant and full samples in both in-sample and out-of-sample analyses and are robust to the use of alternative measures for relevance, reliability, earnings usefulness, and conservatism. Our findings about the relations among conservatism, relevance, reliability, and usefulness suggest a trade-off between relevance and reliability and seem to indicate that the adoption of an increasing number of conservative accounting standards has a possible adverse impact on earnings usefulness through a negative effect on reliability. [source]

Integrated Environmental and Financial Performance Metrics for Investment Analysis and Portfolio Management

Simon Thomas
This paper introduces a new measure, based on a study by Trucost and Dr Robert Repetto, combining external environmental costs with established measures of economic value added, and demonstrates how this measure can be incorporated into financial analysis. We propose that external environmental costs are relevant to all investors: universal investors are concerned about the scale of external costs whether or not regulations to internalise them are likely; mainstream investors need to understand external costs as an indication of future regulatory compliance costs; and SRI investors need to evaluate companies on both financial and social performance. The paper illustrates our new measure with data from US electric utilities and illustrates how the environmental exposures of different fund managers and portfolios can be compared. With such measures fund managers can understand and control portfolio-wide environmental risks, demonstrate their environmental credentials quantitatively and objectively and compete for the increasing number of investment mandates that have an environmental component. [source]

Prospects of a unified management system

Dr Tine Herreborg Jørgensen
In this article, the trend among management systems towards a common structure and the inclusion of additional areas of corporate concern (quality, environment, occupational health and safety and social responsibility) is outlined. The article suggests that a large part of the work associated with implementing and maintaining standardized management systems can be rationalized by developing a ,unified system'. The unified system is proposed to consist of a common basic standard of general managerial methodology expandable with supplements, which are related to the specific areas of concern that the company could wish to include in their management system and possibly have certified. It is estimated that such a unified management system would contribute to synergy between the activities related to each area of concern, resulting in a more careful and efficient treatment of the increasing number of areas of concern. Copyright © 2002 John Wiley & Sons, Ltd. and ERP Environment [source]

The Product Piracy Conflict Matrix , Finding Solutions to Prevent Product Piracy

Günther Schuh
Product and brand piracy has developed into a worldwide mass phenomenon. Affected companies are not only burdened with commercial losses such as lost sales volume and lower sales prices, but also by decreasing brand value and company reputation, lower licence revenues and, finally, costs for counteracting product piracy. Companies are gradually facing up to the challenge and taking action. Besides legal measures, an increasing number of firms are also willing to implement strategic and technical measures in their organizations or products respectively. A number of non-legal mechanisms have recently been identified, and efforts to structure these mechanisms are in progress. However, so far systematic, methodological guidance in matching mechanisms with specific products and corporate boundary conditions is basically non-existent. Focusing on this issue, the paper introduces a new TRIZ-based method to create solutions concerning product piracy. The so-called Product Piracy Conflict matrix (PPC matrix) resembles the well-established TRIZ contradiction table and has been designed to help companies create powerful protection concepts while avoiding undesired or harmful effects within their own value chains. [source]

Mesotherapy and Phosphatidylcholine Injections: Historical Clarification and Review

BACKGROUND Mesotherapy was originally conceived in Europe as a method of utilizing cutaneous injections containing a mixture of compounds for the treatment of local medical and cosmetic conditions. Although mesotherapy was traditionally employed for pain relief, its cosmetic applications, particularly fat and cellulite removal, have recently received attention in the United States. Another treatment for localized fat reduction, which was popularized in Brazil and uses injections of phosphatidylcholine, has been erroneously considered synonymous with mesotherapy. Despite their attraction as purported "fat-dissolving" injections, the safety and efficacy of these novel cosmetic treatments remain ambiguous to most patients and physicians. OBJECTIVE To distinguish mesotherapy from phosphatidylcholine injections by reviewing their history and the relevant experimental or clinical findings. METHODS A comprehensive search of Medline indexed literature and conference proceedings. RESULTS All the published studies evaluating the clinical efficacy of traditional mesotherapy currently originate from Europe. These reports focus primarily on musculoskeletal pain and vascular disease, rather than cosmetic applications. Although experimental data suggest that a number of traditional mesotherapy ingredients may theoretically reduce fat, these effects have not been supported in peer-reviewed studies. An increasing number of reports demonstrate that subcutaneous injections of a formula containing phosphatidylcholine combined with its emulsifier, deoxycholate, are effective in removing small collections of adipose tissue. Cell lysis, resulting from the detergent action of deoxycholate, may account for this clinical effect. CONCLUSIONS Mesotherapy is distinct from a method of treating adipose tissue with subcutaneous injections of deoxycholate alone or in combination with phosphatidylcholine. Additional clinical and experimental studies are necessary to more definitively establish the safety and efficacy of these treatments. [source]

Efficacy, Safety, and Cost of Office-Based Surgery: A Multidisciplinary Perspective

Rajesh Balkrishnan PhD
An increasing number of media reports on patient safety risks arising from office-based surgery procedures, as well as growing concerns about patient safety issues in general, have brought office-based surgery as well as its practitioners into focus and placed this very cost-effective medical practice in the eye of the media and regulators. Concerted efforts are now being made to understand the causes and true incidence of patient safety risk associated with office-based surgery and to find ways to minimize this risk. [source]

Therapy of environmental mycobacterial infections

Caterina Fabroni
ABSTRACT: Environmental mycobacteria are the causative factors of an increasing number of infections worldwide. Cutaneous infections as a result of environmental mycobacteria are often misdiagnosed, and their treatment is difficult because these agents can show in vivo and in vitro multidrug resistance. The most common environmental mycobacteria that can cause cutaneous infections are Mycobacterium fortuitum and Mycobacterium marinum. All mycobacteria are characterized by low pathogenicity and they can contaminate affected or traumatized skin only in immunocompetent subjects (mainly in fishermen, swimming-pool attendants, and aquarium owners) whereas medical and esthetic procedures are at risk for the infections because of the quick-growing mycobacteria. Immunocompromised subjects can instead easily develop environmental mycobacterial infections of differing degrees of severity. [source]

Soft tissue augmentation 2006: filler fantasy

Arnold William Klein
ABSTRACT:, As an increasing number of patients seek esthetic improvement through minimally invasive procedures, interest in soft tissue augmentation and filling agents is at an all-time high. One reason for this interest is the availability of botulinum toxin type A, which works superbly in the upper face. The rejuvenation of the upper face has created much interest in injectable filling agents and implant techniques that work equally well in the restoration of the lower face. One of the central tenets of soft tissue augmentation is the concept of the three-dimensional face. The youthful face has a soft, full appearance, as opposed to the flat, pulled, two-dimensional look often achieved by more traditional surgical approaches. Injectable filling agents can augment and even at times, replace pulling. Additionally, with the lip as the focal center of the lower face, subtle lip enhancement is here to stay, and is in fact, the number one indication for injectable fillers. Moreover, minimally invasive soft tissue augmentation offers cosmetic enhancement without the cost and recovery time associated with more invasive procedures. As more and more physicians take interest in minimally invasive surgery, courses in cosmetic surgery techniques are becoming increasingly popular at the medical meetings of many specialties. Today, physicians have a much larger armamentarium of techniques and materials with which to improve facial contours, ameliorate wrinkles, and provide esthetic rejuvenation to the face. For a substance or device to be amenable for soft tissue augmentation in the medical community, it must meet certain criteria. It must have both a high "use" potential, producing cosmetically pleasing results with a minimum undesirable reactions, and have a low abuse potential in that widespread or incorrect or indiscriminate use would not result in significant morbidity. It must be nonteratogenic, noncarcinogenic, and nonmigratory. In addition, the agent must provide predictable, persistent correction through reproducible implantation techniques. Finally, the substance, agent or device must be approved by the U.S. Food and Drug Administration, which assures purity, safety, and accessibility, as well as much-needed information regarding use. Having a thorough understanding of the filling agents available, their indications and contraindications, as well as having thorough knowledge of implant technique are vital in providing the patient with an esthetically pleasing result. [source]

Management of skin cancer in solid organ transplant recipients

Carmen Traywick
ABSTRACT:, The incidence of catastrophic skin cancer in the solid organ transplant population continues to rise. As transplant patients are living longer, it is likely that dermatologists will be looking after an increasing number of organ transplant recipients. The key to managing this patient population lies in a multidisciplinary approach encompassing patient education, skin screening in the immediate post-transplant period, regular follow-up, and rapid referral to a dermatologist once skin lesions suspicious for skin cancer are diagnosed. Of paramount importance is discussion with transplant physicians to negotiate reduction of immunosuppression in the setting of catastrophic skin cancer. This article defines the scope of the problem of skin cancer in the solid organ transplant population, defines the nature of the lesions commonly presented, and reinforces the benefit of a multidisciplinary approach in the management of these patients. [source]

Role and therapeutic potential of microRNAs in diabetes

I. G. M. Kolfschoten
The discovery in mammalian cells of hundreds of small RNA molecules, called microRNAs, with the potential to modulate the expression of the majority of the protein-coding genes has revolutionized many areas of biomedical research, including the diabetes field. MicroRNAs function as translational repressors and are emerging as key regulators of most, if not all, physiological processes. Moreover, alterations in the level or function of microRNAs are associated with an increasing number of diseases. Here, we describe the mechanisms governing the biogenesis and activities of microRNAs. We present evidence for the involvement of microRNAs in diabetes mellitus, by outlining the contribution of these small RNA molecules in the control of pancreatic ,-cell functions and by reviewing recent studies reporting changes in microRNA expression in tissues isolated from diabetes animal models. MicroRNAs hold great potential as therapeutic targets. We describe the strategies developed for the delivery of molecules mimicking or blocking the function of these tiny regulators of gene expression in living animals. In addition, because changes in serum microRNA profiles have been shown to occur in association with different human diseases, we also discuss the potential use of microRNAs as blood biomarkers for prevention and management of diabetes. [source]