Individual Cases (individual + case)

Distribution by Scientific Domains
Distribution within Medical Sciences

Terms modified by Individual Cases

  • individual case report

  • Selected Abstracts

    Point process methodology for on-line spatio-temporal disease surveillance

    ENVIRONMETRICS, Issue 5 2005
    Peter Diggle
    Abstract We formulate the problem of on-line spatio-temporal disease surveillance in terms of predicting spatially and temporally localised excursions over a pre-specified threshold value for the spatially and temporally varying intensity of a point process in which each point represents an individual case of the disease in question. Our point process model is a non-stationary log-Gaussian Cox process in which the spatio-temporal intensity, ,(x,t), has a multiplicative decomposition into two deterministic components, one describing purely spatial and the other purely temporal variation in the normal disease incidence pattern, and an unobserved stochastic component representing spatially and temporally localised departures from the normal pattern. We give methods for estimating the parameters of the model, and for making probabilistic predictions of the current intensity. We describe an application to on-line spatio-temporal surveillance of non-specific gastroenteric disease in the county of Hampshire, UK. The results are presented as maps of exceedance probabilities, P{R(x,t)c|data}, where R(x,t) is the current realisation of the unobserved stochastic component of ,(x,t) and c is a pre-specified threshold. These maps are updated automatically in response to each day's incident data using a web-based reporting system. Copyright © 2005 John Wiley & Sons, Ltd. [source]

    Beyond Multilingualism: On Different Approaches to the Handling of Diverging Language Versions of a Community Law

    EUROPEAN LAW JOURNAL, Issue 1 2010
    Theodor Schilling
    This article deals with a problem created by the EU's multilingualism, the fallibility of translators and the ruses of politicians: for different reasons, it is quite common that equally authentic language versions of a Community law have different meanings if taken on their own. While the ECJ's uniform interpretation approach to this problem, which must be seen as required under the non-discrimination principle, has permitted equitable results in those cases decided by the ECJ, it would not be adequate for the simplest type of case, ie that a citizen has every reason to trust her own language version of a law. In such a case, her legitimate expectations in the equal authenticity of that version requires protection. De lege lata the article therefore proposes, in the interest of generally equitable solutions, a balancing, in the individual case, of the protection of legitimate expectations and the non-discrimination principle. De lege ferenda it proposes a more radical solution, ie that there be only one authentic version of every Community law. [source]

    Truth-telling, honesty and compassion: A virtue-based exploration of a dilemma in practice

    Ann M Begley
    In this paper a discussion of the strengths of a virtue-based approach to ethics in nursing is discussed. Virtue ethics is often depicted as vague and lacking in any convincing application to the reality of practice. It is argued that exploring issues from a virtue perspective offers the possibility of a sensitive moral response which is grounded in the context of the client and his family. Far from being vague, virtue ethics offers guidance in practice, but this guidance acknowledges the complexity of individual lives as opposed to the impartiality and abstract nature of traditional moral theory, rules and principles. The vehicle for discussion is a case in practice. The position presented here is that in taking account of the salient features of each individual case, withholding the truth from adults with a life threatening illness can be justified for compassionate reasons. [source]

    Epidemiology and clinical classification of onychomycosis

    I Effendy
    ABSTRACT Objectives, To review recent data , what is new in the epidemiology of onychomycoses? To identify the most relevant diagnostic criteria for effective therapy. Methods, The preliminary results of the European Onychomycosis Observatory (EUROO) study were analysed. In this international study, physicians completed questionnaires concerning patient profile and the disease. Results, One of the most interesting novel findings was that sampling requests were often not made [only 3.4% of general physicians (GPs) and 39.6% of dermatologists]. This means that no information about causative agent(s) was available, hindering appropriate treatment choice. Furthermore, contrary to previous findings, 70.7% of participants did not practice sports. Lastly, these preliminary findings showed that treatment strategy depends largely on the type of treating physician, with GPs preferring monotherapy and dermatologists preferring combination therapy. Conclusions, A consensus was reached that treatment strategy should depend on the severity of nail involvement and the causative fungus. It is thus important to promote the importance of sampling. To simplify the choice of an appropriate treatment, onychomycosis may be divided into just two clinical groups: onychomycosis with and without nail matrix area involvement. However, the distinct clinical findings (number and type of affected nails, multimorbidity, drug interaction, etc.) in each individual case must be taken into account to ensure an appropriate treatment decision. [source]

    Cellulose Acetate- graft -Poly(hydroxyalkanoate)s: Synthesis and Dependence of the Thermal Properties on Copolymer Composition

    Yoshikuni Teramoto
    Abstract Summary: Several different series of cellulose acetate- graft -poly(hydroxyalkanoate)s (CA- g -PHAs) were synthesized over a wide range of compositions by the graft copolymerization of lactic acid, L -lactide, (R,S)- , -butyrolactone, , -valerolactone and , -caprolactone onto the residual hydroxyl positions of CA, by virtue of a suitable catalyst, solvent and procedure for each individual case. To achieve a diversity of molecular architectures of the respective graft copolymer series, the degree of acetyl substitution (acetyl DS) of the CA starting material was also varied, resulting in different levels of the intramolecular density of grafts. The CA- g -PHAs thus obtained were subjected to differential scanning calorimetric measurements and the relationship between their molecular structure and thermal transition behavior was estimated, in comparison with some semi-empirical equations available for polymer blends or comb-like polymers. In particular, the composition dependence of the Tgs of the graft copolymers was represented well in terms of a formula proposed by Reimschuessel for comb-like polymers, when CAs of acetyl DS ,2 were employed as a trunk polymer. The deviation of the glass transition data from the model function was discussed in connection with the manner of graft modification. [source]

    Application of parallel imaging to fMRI at 7 Tesla utilizing a high 1D reduction factor

    Steen Moeller
    Abstract Gradient-echo EPI, blood oxygenation level-dependent (BOLD) functional MRI (fMRI) using parallel imaging (PI) is demonstrated at 7 Tesla with 16 channels, a fourfold 1D reduction factor (R), and fourfold maximal aliasing. The resultant activation detection in finger-tapping fMRI studies was robust, in full agreement with expected activation patterns based on prior knowledge, and with functional maps generated from full field of view (FOV) coverage of k -space using segmented acquisition. In all aspects the functional maps acquired with PI outperformed segmented coverage of full k -space. With a 1D R of 4, fMRI activation based on PI had higher statistical significance, up to 1.6-fold in an individual case and 1.25 ± .25 (SD) fold when averaged over six studies, compared to four-segment/full-FOV data in which the reduction in the image signal-to-noise ratio (SNR) due to k -space undersampling was compensated for by acquiring additional repetitions of the undersampled k -space. When this compensation for loss in SNR was not performed, the effect of PI was determined by the ratio of physiologically induced vs. intrinsic (thermal) noise in the fMRI time series and the extent to which physiological "noise" was amplified by the use of segmentation in the full-FOV data. The results demonstrate that PI is particularly beneficial at this ultrahigh field strength, where both the intrinsic image SNR and temporal signal fluctuations due to physiological processes are large. Magn Reson Med, 2006. © 2006 Wiley-Liss, Inc. [source]

    A comparison of learning outcomes and attitudes in student- versus faculty-led problem-based learning: an experimental study

    MEDICAL EDUCATION, Issue 1 2000
    David J Steele
    Objectives To compare learning outcomes and perceptions of facilitator behaviours and small-group process in problem-based learning (PBL) groups led by students and those led by faculty. Design A prospective, Latin-square cross-over design was employed. Second-year medical students participated in 11 PBL cases over the course of the academic year. For each case, half the student groups were led by faculty and the other half by a student group member selected randomly to serve in the facilitator role. Learning outcomes were assessed by performance on objective examinations covering factual materials pertinent to the case. Perceptions of facilitator behaviours and of group functioning were assessed with a questionnaire completed at the end of each individual case. Focus-group discussions were held to gain more in-depth information about student perceptions and experience. Student-led sessions were observed at random by the investigators. Setting A state-supported, US medical school with a hybrid lecture-based and problem-based curriculum. Subjects One hundred and twenty-seven second-year medical students and 30 basic science and clinical faculty. Results No differences were detected in student performance on the objective evaluation based on whether the facilitator was a faculty member or peer group member, nor were there any differences in the perceptions of group process. Students gave peer facilitators slightly higher ratings in the second semester of the experiment. In the focus-group discussions, students voiced a general preference for student-led groups because they felt they were more efficient. Observation and focus-group reports suggest that groups led by students sometimes took short cuts in the PBL process. Conclusion In a hybrid lecture- and PBL-based curriculum, student performance on objective examinations covering PBL materials is unaffected by the status of the facilitator (student vs. faculty). However, in peer-facilitated groups, students sometimes took short cuts in the PBL process that may undermine some of the intended goals of PBL. [source]

    I,Varieties of Support and Confirmation of Climate Models

    Elisabeth A. Lloyd
    Today's climate models are supported in a couple of ways that receive little attention from philosophers or climate scientists. In addition to standard ,model fit', wherein a model's simulation is compared to observational data, there is an additional type of confirmation available through the variety of instances of model fit. When a model performs well at fitting first one variable and then another, the probability of the model under some standard confirmation function, say, likelihood, goes up more than under each individual case of fit alone. Thus, two instances of fit of distinct variables of a global climate model using distinct data sets considered collectively will provide stronger evidence for a model than either one of the instances considered individually. This has consequences for model robustness. Sets of models that produce robust results will, if their assumptions vary enough and they each are observationally sound, provide reasons to endorse common structures found in those models. Finally, independent empirical support for aspects and assumptions of the model provides an additional confirmational virtue for climate models, contrary to what is implied by some current philosophical writing on this topic. [source]

    A Constructive Graphical Model Approach for Knowledge-Based Systems: A Vehicle Monitoring Case Study

    Y. Xiang
    Graphical models have been widely applied to uncertain reasoning in knowledge-based systems. For many of the problems tackled, a single graphical model is constructed before individual cases are presented and the model is used to reason about each new case. In this work, we consider a class of problems whose solution requires inference over a very large number of models that are impractical to construct a priori. We conduct a case study in the domain of vehicle monitoring and then generalize the approach taken. We show that the previously held negative belief on the applicability of graphical models to such problems is unjustified. We propose a set of techniques based on domain decomposition, model separation, model approximation, model compilation, and re-analysis to meet the computational challenges imposed by the combinatorial explosion. Experimental results on vehicle monitoring demonstrated good performance at near-real-time. [source]

    O-10 Endometrial cells in cervical smears: cytological features associated with clinically significant endometrial pathology

    CYTOPATHOLOGY, Issue 2007
    R. N. Tiam
    Introduction:, To establish the significance of cytological features which could predict clinically significant endometrial pathology, and therefore guide reporting practice in cervical samples. Methods:, A retrospective review of SurePath liquid-based cytology (LBC) cervical samples between 2002 and 2006, obtained at screening and colposcopy. These smears contained normal endometrial cells present at inappropriate times of the menstrual cycle, endometrial cells with atypia (borderline change) and with features suspicious / diagnostic of endometrial carcinoma (glandular neoplasia). False negative and false positive cases detected on subsequent histology were also included. The control group comprised negative samples and a few abnormal smears. All smears were randomly assigned and blinded to menopausal status, age, use of oral contraceptive pill and hormone replacement therapy and presence of intrauterine device. Each smear was reviewed for 16 cytologic criteria and a cytological diagnosis was given for each. Results:, A total of 219 smears were available for review; 137 were negative, out of which 85 contained normal endometrial cells, 41 contained endometrial cells with atypia, 10 contained endometrial cells with features suggestive of adenocarcinoma and 31 contained endometrial cells with features diagnostic of adenocarcinoma. The feature most associated with benign endometrial cells is top hat with central cell condensation. In contrast, the features associated with malignant endometrial cells are smooth nuclear membrane, pale chromatin, small nucleoli and scalloped borders. Discussion:, The criteria identified in this study do not definitively define a neoplastic process, but appear to be helpful in individual cases. This study emphasises that endometrial changes should be always interpreted with the relevant clinical information, which would otherwise lead to overdiagnosis in premenopausal women. [source]

    Guidelines for the Management of Squamous Cell Carcinoma in Organ Transplant Recipients

    DERMATOLOGIC SURGERY, Issue 4p2 2004
    Thomas Stasko MD
    Background. Solid-organ transplant recipients have a high incidence of cutaneous squamous cell carcinoma (SCC) and often develop multiple and aggressive tumors. There are few published studies or reviews, which provide guidance to the clinician in the treatment of these patients. Objective. The objective was to develop useful clinical guidelines for the treatment of skin cancer in organ transplant recipients (OTRs). Methods. The members of the Guidelines Committee of the International Transplant,Skin Cancer Collaborative (ITSCC) carried out a computerized search utilizing the databases of the National Library of Medicine for reports in the literature on SCC in OTRs. These reports were collectively examined by the group and combined with experiences from the members' clinical practices in the development of the guidelines. Results. More than 300 articles relating to SCC in OTRs were reviewed. In general, reports concerning the prevention and treatment of SCC in OTRs are of individual cases or small case series. They are retrospective in nature, statistically nonrigorous, and lack the complete epidemiologic data necessary to derive definitive conclusions. Combining these studies and collective clinical experience, however, is at present the best available method for devising guidelines for the treatment of SCC in OTRs. Conclusion. Guidelines developed for the treatment of skin cancer in OTRs, supported by the best available data and collective clinical experience, may assist in the management of OTRs with SCC. The development of clinical pathways and complete documentation with rigorous prospective study is necessary to improve and refine future guideline development. [source]

    The Challenge to the State in a Globalized World

    Christopher Clapham
    Individual instances of state failure and collapse must be placed within a broader appreciation of the evolution of statehood within the international system. The idea that the inhabited area of the globe must be divided between sovereign states is a recent development, and likely to prove a transient one. Largely the product of European colonialism, and turned into a global norm by decolonization, it is threatened both by the inherent difficulties of state maintenance, and by processes inherent in globalization. States are expensive organizations to maintain, not only in economic terms but also in the demands that they make on their citizens and their own employees. Poor and dispersed peoples, and those whose values derive from societies without states, have found these demands especially burdensome. The end of the Cold War and the collapse of the Soviet Union revealed the hollowness of existing models of sovereign states, and challenged the triple narratives on which the project of global statehood has depended: the narratives of security, representation, and wealth and welfare. While individual cases of state failure and collapse may owe much to specific circumstances and the behaviour of particular individuals, they must also be understood within the context of a world in which maintaining states has become increasingly difficult. [source]

    Prediction of transition from cognitive impairment to senile dementia: a prospective, longitudinal study

    S. Artero
    Objective: The purpose of this investigation was to replicate the statistical approach used in a previous investigation (Toronto study) within a French population to determine the best predictive model for Alzheimer's disease (AD). Method: Data from neuropsychological tests from two prospective studies were entered into a regression model. Results: Replication of the statistical approach in the Montpellier sample produced a three-test model with a specificity of 99% and sensitivity of 73%. This model consisted of a delayed auditory verbal recall test, a construction test, a category fluency test and provides probability estimates for the transition to dementia in individual cases. Conclusion: The models derived from these two longitudinal studies provide an empirical basis for the selection of tests for the definition of mild cognitive impairment of the Alzheimer type (MCI-A). The small set of tests derived are suitable for use in general practice. [source]

    Insulin-treated diabetes and driving in the UK

    DIABETIC MEDICINE, Issue 6 2002
    G. Gill
    Abstract Diabetes, and particularly insulin-treated diabetes, has important implications for motor vehicle driving, largely because of its association with potential hypoglycaemia. For this reason, most countries operate some driving restrictions on insulin-treated diabetic patients, as well as systems of intermittent reassessment of hypoglycaemic risk. In the UK, regulations are operated by the Driver and Vehicle Licensing Agency (DVLA), which is an agency of the Department of the Environment, Transport and the Regions (DETR). They are supported by an Expert Panel which advises the Secretary of State on diabetes-related issues relating to fitness to drive. The patient organization Diabetes UK is also concerned with diabetes and driving issues, largely from a position of lobbying policy-influencers and supporting individual cases. All parties involved with diabetes and driving issues recognize the need for more research on the subject, as the current literature is flawed in design, though no convincing excess of accidents amongst diabetic drivers has been conclusively demonstrated. Currently in the UK, Class 2 vehicles (large trucks and passenger vehicles) are barred to diabetic drivers on insulin. European law has recently extended this to so-called C1 (large vans and small lorries) and D1 (minibuses) vehicles, though the law has recently been revised to allow individual consideration for potential diabetic C1 drivers on insulin treatment. Diabetes and insulin-treated diabetes is an emotive and difficult issue, for which a stronger evidence base is urgently needed. [source]

    The genetics of autism

    M. Lauritsen
    Objective: To review systematically the empirical evidence for the involvement of genetic risk factors in infantile autism. Method: We aimed at including all relevant papers written in English. We conducted a Medline search in September 2000. In addition we searched the reference lists of related papers. Results: A relatively small number of reports including family and twin studies, comorbidity, cytogenetic and molecular genetic studies were reviewed. Conclusion: As well family, twin, cytogenetic and molecular genetic studies supported the importance of genetic risk factors in infantile autism. In most individual cases probably at least a few gene variants simultaneously determine the genetic risk. Presently the most interesting chromosome regions concerning the aetiology of autism are chromosomes 7q31,35, 15q11,13 and 16p13.3 which have been suggested by different lines of genetic research. [source]

    Critical Evidence: The Politics of Trauma in French Asylum Policies

    ETHOS, Issue 3 2007
    Didier Fassin
    However obvious it might seem today that victims of persecutions suffer from psychological consequences of the violence inflicted on them, its political implications are a recent phenomenon. In the last decade, asylum seekers in France, as in other European countries, have been more and more often subject to demands of psychiatric expertise to prove the cogency of their claim to the status of refugee. This social innovation results from the convergence of two processes: on the one hand, the rapid decline in the legitimacy of asylum, leading to increasing expectations for evidence to establish the reality of persecutions; on the other hand, the emergence of trauma as a nosographical category legitimizing the traces of violence. At the crossroads of these two histories, a social field, mainly occupied by NGOs, has developed to answer this new need for proof from state institutions, with an increasing specialization on victims of torture and on psychic trauma, the two dimensions being partially independent. The final paradox is, however, that in a context of generalized suspicion toward refugees, the recognition of trauma at a collective level is counterbalanced by its limited impact on the evaluation of individual cases. [source]

    Long-term prognosis and satisfaction after percutaneous endoscopic gastrostomy in a general hospital,

    Joji Onishi
    Background: Percutaneous endoscopic gastrostomy (PEG) has been widely acknowledged as a safer method for enteral feeding; however, its long-term impact on prognosis and quality of life in elderly patients is not sufficiently understood. There are issues still to be studied regarding the indications for PEG, due to the lack of convincing evidence that it reduces expected complications such as aspiration pneumonia or for improving the prognosis of patients with severe dementia. Method: In this study we investigated the survival rate after PEG and the families' satisfaction in 78 inpatients who underwent PEG. We conducted the investigation by sending questionnaires to the families. Results: The results for the 69 cases (88%) in which the patient recovered showed that the 1-year survival rate was 64.0%, and the 2-year survival rate was 55.5%. Fifty-three per cent of patients' families indicated overall satisfaction regarding of PEG. Conclusions: The survival rates were relatively higher than those from previously reported studies. This may be attributed to variations in patients' clinical, socio-economic, or cultural backgrounds in therapeutic interventions. We recognized the importance of clarifying factors that would affect the living and functional prognosis and quality of life in elderly patients who underwent PEG. The indications for PEG are based on a comprehensive assessment of the relevant factors in individual cases, and by taking patients' and families' wishes into consideration. [source]

    Does psychological counseling alter the natural history of inflammatory bowel disease?

    Mahmood Wahed MBBS
    Abstract Background: There is increasing evidence that psychological stress can increase mucosal inflammation and worsen the course of inflammatory bowel disease (IBD). We have now assessed whether psychotherapy by a counselor specially trained in the management of IBD can influence the course of disease. Methods: Using retrospective case note review, we compared the course of IBD in 24 patients (13 ulcerative colitis; 11 Crohn's disease), during the year before (year 1) and the year after referral (year 2) for supportive outpatient psychotherapy to an IBD counselor, to that of 24 IBD controls who were matched to individual cases for age, sex, disease, duration of disease, medication at baseline, and for relapse rate in year 1. Counselor assessments were made using a visual analog scale 0,6 (0 denotes poor, 6 excellent response to counseling). The results are shown as median (range). Results: Patients were referred for counseling because of disease-related stress (14 patients), work problems (3), concerns about surgery (5), and bereavement (2); they received 6 (1,13) 1-hour sessions in year 2. In the year after starting counseling (year 2), patients had fewer relapses (0 [0,2]) and outpatient attendances (3.5 [1,10]) than in the year before referral (year 1) (2 [0,5], P = 0.0008; and 6.5 [1,17], P = 0.0006, respectively; furthermore, steroid usage (1 course [0,4] before, 0 [0,2] after, P = 0.005) and relapse-related use of other IBD medications declined during psychotherapy (1 drug [0,5] before, 0 [0,2] after, P = 0.002). There were no differences in any of these measures between years 1 and 2 in the control group. Numbers of hospital admissions did not change between year 1 and 2 in either group. In the 20 patients who attended >1 session counseling helped solve stress-related difficulties (counselor's score 4 [3,5]), the counselor scored them 4 (3,6) overall in psychological well-being after the counseling sessions. Conclusions: IBD-focused counseling may improve not only psychological well-being, but also the course of IBD in individuals with psychosocial stress. (Inflamm Bowel Dis 2009;) [source]

    Clinical versus statistical prediction: The contribution of Paul E. Meehl

    William M. GroveArticle first published online: 22 JUL 200
    The background of Paul E. Meehl's work on clinical versus statistical prediction is reviewed, with detailed analyses of his arguments. Meehl's four main contributions were the following: (a) he put the question, of whether clinical or statistical combinations of psychological data yielded better predictions, at center stage in applied psychology; (b) he convincingly argued, against an array of objections, that clinical versus statistical prediction was a real (not concocted) problem needing thorough study; (c) he meticulously and even-handedly dissected the logic of clinical inference from theoretical and probabilistic standpoints; and (c) he reviewed the studies available in 1954 and thereafter, which tested the validity of clinical versus statistical predictions. His early conclusion that the literature strongly favors statistical prediction has stood up extremely well, and his conceptual analyses of the prediction problem (especially his defense of applying aggregate-based probability statements to individual cases) have not been significantly improved since 1954. © 2005 Wiley Periodicals, Inc. J Clin Psychol 61: 1233,1243, 2005. [source]

    Medullary thyroid carcinoma and biomarkers: past, present and future

    W. Van Veelen
    Abstract. The clinical management of patients with persistent or recurrent medullary thyroid carcinoma (MTC) is still under debate, because these patients either have a long-term survival, due to an indolent course of the disease, or develop rapidly progressing disease leading to death from distant metastases. At this moment, it cannot be predicted what will happen within most individual cases. Biomarkers, indicators which can be measured objectively, can be helpful in MTC diagnosis, molecular imaging and treatment, and/or identification of MTC progression. Several MTC biomarkers are already implemented in the daily management of MTC patients. More research is being aimed at the improvement of molecular imaging techniques and the development of molecular systemic therapies. Recent discoveries, like the prognostic value of plasma calcitonin and carcino-embryonic antigen doubling-time and the presence of somatic RET mutations in MTC tissue, may be useful tools in clinical decision making in the future. In this review, we provide an overview of different MTC biomarkers and their applications in the clinical management of MTC patients. [source]

    Spontaneous neoplasia in the baboon (Papio spp.)

    Rachel E. Cianciolo
    Abstract Background, There are several comprehensive reviews of spontaneous neoplasia in non-human primates that compile individual cases or small numbers of cases, but do not provide statistical analysis of tumor incidence, demographics, or epidemiology. Methods, This paper reports all spontaneous neoplasms (n = 363) diagnosed over a 15-year period in a baboon colony with an average annual colony population of 4000. Results, A total of 363 spontaneous neoplasms were diagnosed in 313 baboons: 77 cases were males (25%) and 236 were females (75%); ages ranged from 1 month to 33 years (mean 16.5, median 17). Conclusions, The organ systems affected in descending order of number of neoplasms were hematopoietic organs (n = 101, 28%), urogenital tract (n = 78, 21%), integument (n = 43, 12%), alimentary tract (n = 43, 12%), endocrine organs (n = 40, 11%), nervous system (n = 33, 9%), musculoskeletal system (n = 5, 1%), and respiratory system (n = 4, 1%). Malignant cases numbered 171 (47%); 192 (53%) cases were benign. [source]

    Acupuncture for Alcohol Dependence: A Systematic Review

    ALCOHOLISM, Issue 8 2009
    Seung-Hun Cho
    Background:, Acupuncture has been used in the treatment of substance-related disorders for the past 30 years. However, a systematic review to assess the effect of various types of acupuncture for alcohol dependence has not yet been performed. The present systematic review assessed the results of randomized controlled trials (RCTs). Methods:, Nineteen electronic databases, including English, Korean, Japanese, and Chinese databases, were systematically searched for RCTs of acupuncture for alcohol dependence up to June 2008 with no language restrictions. The methodological qualities of eligible studies were assessed using the criteria described in the Cochrane Handbook. Results:, Eleven studies, which comprised a total of 1,110 individual cases, were systematically reviewed. Only 2 of 11 trials reported satisfactorily all quality criteria. Four trials comparing acupuncture treatment and sham treatments reported data for alcohol craving. Three studies reported that there were no significant differences. Among 4 trials comparing acupuncture and no acupuncture with conventional therapies, 3 reported significant reductions. No differences between acupuncture and sham treatments were found for completion rates (Risk Ratio = 1.07, 95% confidence interval, CI = 0.91 to 1.25) or acupuncture and no acupuncture (Risk Ratio = 1.15, 95% CI = 0.79 to 1.67). Only 3 RCTs reported acupuncture-related adverse events, which were mostly minimal. Conclusions:, The results of the included studies were equivocal, and the poor methodological quality and the limited number of the trials do not allow any conclusion about the efficacy of acupuncture for treatment of alcohol dependence. More research and well-designed, rigorous, and large clinical trials are necessary to address these issues. [source]

    Congenital Cardiac Defects in Neonatal Foals: 18 Cases (1992,2007)

    T.L. Hall
    Background: Literature available regarding congenital cardiac defects in foals is limited to reports of individual cases or small case series. Objective: To describe the clinical, echocardiographic, and necropsy findings and breed predilection of congenital cardiac defects in neonatal foals. Animals: Eighteen foals <15 days of age with 1 or more congenital cardiac defects. Methods: Medical records of foals diagnosed with congenital cardiac defects at the William R. Pritchard Veterinary Medical Teaching Hospital were reviewed. Data collected included history, signalment, clinical signs, laboratory data, diagnostic and necropsy results, and outcome. Results: Arabian foals represented 39% of cases with congenital cardiac defects and were significantly (P= .004) overrepresented (OR = 4.7 [CI: 1.8,12.4]) compared with the general hospital population. Ventricular septal defect (VSD) (14/18), tetralogy of Fallot (5/18), and tricuspid valve atresia (4/18) were the most common defects identified. A ,3/6 heart murmur (14/14) accompanied by tachycardia (14/17), tachypnea (17/17), and cyanosis of mucous membranes (7/16) were the most common clinical signs. Concurrent congenital defects were common (9/18). Two foals, both with VSD, survived for , 8 years after diagnosis and 1 was a successful performance horse. Conclusions and Clinical Relevance: Arabian horses appear to have a predisposition for cardiac defects. The presence of a loud murmur (, 3/6), cyanotic membranes, and tachycardia or tachypnea in a neonatal foal should warrant thorough evaluation of the heart for congenital defects. Foals with cardiac defects should be closely evaluated for concurrent congenital defects in other body systems. [source]

    The impact of case specificity and generalisable skills on clinical performance: a correlated traits,correlated methods approach

    MEDICAL EDUCATION, Issue 6 2008
    Paul F Wimmers
    Context, The finding of case or content specificity in medical problem solving moved the focus of research away from generalisable skills towards the importance of content knowledge. However, controversy about the content dependency of clinical performance and the generalisability of skills remains. Objectives, This study aimed to explore the relative impact of both perspectives (case specificity and generalisable skills) on different components (history taking, physical examination, communication) of clinical performance within and across cases. Methods, Data from a clinical performance examination (CPX) taken by 350 Year 3 students were used in a correlated traits,correlated methods (CTCM) approach using confirmatory factor analysis, whereby ,traits' refers to generalisable skills and ,methods' to individual cases. The baseline CTCM model was analysed and compared with four nested models using structural equation modelling techniques. The CPX consisted of three skills components and five cases. Results, Comparison of the four different models with the least-restricted baseline CTCM model revealed that a model with uncorrelated generalisable skills factors and correlated case-specific knowledge factors represented the data best. The generalisable processes found in history taking, physical examination and communication were responsible for half the explained variance, in comparison with the variance related to case specificity. Conclusions, Pure knowledge-based and pure skill-based perspectives on clinical performance both seem too one-dimensional and new evidence supports the idea that a substantial amount of variance contributes to both aspects of performance. It could be concluded that generalisable skills and specialised knowledge go hand in hand: both are essential aspects of clinical performance. [source]

    Predictive value of allergy and pulmonary function tests for the diagnosis of asthma in elite athletes

    ALLERGY, Issue 10 2007
    M. Bonini
    Background:, Asthma is frequently found in athletes, often associated with rhinitis and allergy. Aim:, To study the predictive value of allergy and pulmonary function tests for the diagnosis of asthma in athletes. Subjects and methods:, Ninety-eight national preOlympic athletes underwent an accurate medical examination including a validated questionnaire for asthma and rhinitis, spirometric recordings and skin prick testing with a panel of the most frequent inhalant allergens. Bronchodilator and/or exercise challenge were also performed in asthmatic subjects. Results:, Clinical asthma was present in 20.4% of athletes, rhinitis in 35.3% (in 21.4% of cases alone and in 13.9% associated with asthma). Positive prick tests were recorded in 44.4% of athletes (in 60.5% of asthmatics, in 95.2% of rhinitics and in 21.0% of nonasthmatic , nonrhinitic subjects). Mean spirometric values and distribution of abnormal values were not different among asthmatics, rhinitics and nonasthmatics , nonrhinitic patients. Skin-tests positivity was not related to the abnormal spirometric data found in individual cases. Provocation tests with bronchodilators or exercise did not appear sensitive enough to diagnose mild forms of asthma in subjects with normal basal spirometric values. Conclusions:, Allergy testing and spirometry should be performed routinely in athletes because of the high prevalence of allergy, rhinitis and asthma in this population. However, the predictive value of these tests and of the bronchial provocation tests performed in this study seems too low to document mild or subclinical asthma in athletes. [source]

    Scheduling of depalletizing and truck loading operations in a food distribution system

    Zhi-Long Chen
    Abstract This paper studies a scheduling problem arising in a beef distribution system where pallets of various types of beef products in the warehouse are first depalletized and then individual cases are loaded via conveyors to the trucks which deliver beef products to various customers. Given each customer's demand for each type of beef, the problem is to find a depalletizing and truck loading schedule that fills all the demands at a minimum total cost. We first show that the general problem where there are multiple trucks and each truck covers multiple customers is strongly NP-hard. Then we propose polynomial-time algorithms for the case where there are multiple trucks, each covering only one customer, and the case where there is only one truck covering multiple customers. We also develop an optimal dynamic programming algorithm and a heuristic for solving the general problem. By comparing to the optimal solutions generated by the dynamic programming algorithm, the heuristic is shown to be capable of generating near optimal solutions quickly. © 2003 Wiley Periodicals, Inc. Naval Research Logistics, 2003 [source]

    Overlap between neurodegenerative disorders

    NEUROPATHOLOGY, Issue 2 2005
    Richard A. Armstrong
    Neurodegenerative disorders are characterized by the formation of distinct pathological changes in the brain, including extracellular protein deposits, cellular inclusions, and changes in cell morphology. Since the earliest published descriptions of these disorders, diagnosis has been based on clinicopathological features, namely, the coexistence of a specific clinical profile together with the presence or absence of particular types of lesion. In addition, the molecular profile of lesions has become an increasingly important feature both in the diagnosis of existing disorders and in the description of new disease entities. Recent studies, however, have reported considerable overlap between the clinicopathological features of many disorders leading to difficulties in the diagnosis of individual cases and to calls for a new classification of neurodegenerative disease. This article discusses: (i) the nature and degree of the overlap between different neurodegenerative disorders and includes a discussion of Alzheimer's disease, dementia with Lewy bodies, the fronto-temporal dementias, and prion disease; (ii) the factors that contribute to disease overlap, including historical factors, the presence of disease heterogeneity, age-related changes, the problem of apolipoprotein genotype, and the co-occurrence of common diseases; and (iii) whether the current nosological status of disorders should be reconsidered. [source]

    Toward quantifying the usage costs of human immunity: Altered metabolic rates and hormone levels during acute immune activation in men

    Michael P. Muehlenbein
    There is a paucity of data on the energetic demands of human immune functions, despite the fact that both clinical medicine and evolutionary biology would benefit from further clarification of these costs. To better understand the energetic requirements of mounting a mild immune response, as well as some of the major hormonal changes underlying these metabolic changes, we examined changes in resting metabolic rate (RMR) and hormones during and after respiratory tract infection in young adult men. An epidemiologic passive detection design was used to recruit 25 nonfebrile subjects naturally infected with respiratory tract pathogens. Symptomology, percent body fat, RMR, salivary testosterone and cortisol, and other information were collected at a minimum of three time points during and after convalescence. Comparisons of the differences in RMR, testosterone, and cortisol between sampling days within individual cases were made using paired t -tests. Participants experienced 8% higher RMR during illness, and a subset of these men experienced a mean increase greater than 14%. The participants also experienced 10% lower testosterone levels during illness, and a subset of these participants experienced a mean decrease of 30%, although cortisol levels did not change significantly. These results document elevated RMR following natural pathogen exposure in adult humans, demonstrating that even mild immune reactions can elicit significant increases in energy expenditure. Understanding the costs of immunity and the immunomodulatory actions of hormones are central to understanding the role of immunity in human life history evolution. Am. J. Hum. Biol. 2010. © 2010 Wiley-Liss, Inc. [source]

    Successful Renal Transplantation in Factor H Autoantibody Associated HUS with CFHR1 and 3 Deficiency and CFH Variant G2850T

    A. M. Waters
    Factor H (CFH) autoantibodies are associated with atypical hemolytic uremic syndrome (aHUS). Peritransplantation plasma exchange therapy and intensification of immunosuppression, with adjuvant use of anti-CD20 monoclonal antibodies has recently been advocated for cases of CFH-autoantibody associated aHUS. In this report, we describe successful deceased donor renal transplantation in a case of CFH-autoantibody associated aHUS with combined CFHR1 and 3 deficiency in addition to the CFH sequence variant, (cG2850T, pGln950His). CFH-autoantibodies were detected 2 weeks prior to transplantation. Disease recurrence was not observed using basiliximab, an IL2-receptor antagonist and high-dose corticosteroids with mycophenolate mofetil. Adjuvant therapies such as Rituximab nor intensification of plasma therapy were employed. Consequently, careful consideration needs to be given to the use of additional immunosuppression in certain cases of CFH-autoantibody associated aHUS. Serial measurement of CFH-autoantibodies is required in the immediate pre- and posttransplantation period to further clarify their role as a factor in the recurrence of aHUS posttransplantation. Furthermore, delineation of the functional significance of CFH-autoantibodies is warranted in individual cases. [source]

    The New European Medicines Agency Guideline on the Investigation of Bioequivalence

    José Augusto Guimarães Morais
    Several new features have been added to this guideline, as well as changes aimed at improving the clarity of the guidance provided. The first issue to be addressed was to limit the scope of the guideline to bioequivalence studies for immediate release dosage forms with systemic action. Therefore, the guideline refers to bioequivalence alone. Moreover, the new definition of Generic Medicinal Product has been incorporated. Clearer guidance covering more specific cases is now given on sections such as: fed/fasting conditions, use of metabolite data, enantiomers and strength to be used in the bioequivalence study. Steady-state design is now restricted and other designs, such as parallel group design, replicate design and two-stage design, are now incorporated in a more explicit form. New practical guidance on Highly Variable Drug Products and Narrow Therapeutic Index Drugs has been incorporated. The possibility for a biowaiver based on the Biopharmaceutics Classification System is now more explicit for Class I drugs and can be extended to Class III drugs under restricted conditions. We are aware that the initial goal of providing a very specific and clear guidance on these issues has not been entirely achieved, mainly because it is almost impossible to cover all individual cases and predict every possible situation that may arise. Demonstration of bioequivalence will still require in many instances a case by case approach. [source]