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Little Data (little + data)
Kinds of Little Data Terms modified by Little Data Selected AbstractsPamidronate treatment of bone fibrous dysplasia in nine children with McCune-Albright syndromeACTA PAEDIATRICA, Issue 2 2000R Lala McCune-Albright syndrome is a rare genetic disorder consisting of skin and bone dysplasia and peripheral endocrinopathies. Little data have been collected regarding bisphosphonate treatment of bone fibrous dysplasia in paediatric patients with this syndrome. The aim of our study was to investigate the therapeutic efficacy of pamidronate in these patients. Nine patients with moderate to severe forms of bone fibrous dysplasia were treated with pamidronate intravenously (0.5-1 mg/ kg/daily for 2-3 d) at 0.5-1-y intervals. Patients were treated over a time period of 0.5-3.5 y. During treatment no spontaneous fracture occurred. Bone pain and gait abnormality due to pain disappeared after 2-3 therapeutic cycles. Cranial asymmetry and limb length discrepancy remained unchanged. Elevated serum alkaline phosphatase and urine hydroxyproline values were reduced by the treatment, demonstrating drug activity at the lesional level. The effectiveness of pamidronate was also seen at the non-lesional level through an increase in bone density. Radiographic and scintigraphic evidence of lesion healing was not attained. Pamidronate treatment can ameliorate the course of bone fibrous dysplasia in children and adolescents with McCune-Albright syndrome. [source] Combination therapy with ribavirin and interferon in a cohort of children with hepatitis C and haemophilia followed at a pediatric haemophilia treatment centerHAEMOPHILIA, Issue 1 2004J. Puetz Summary., Nearly all children with bleeding disorders who received factor concentrates prior to the late 1980s were infected with hepatitis C. Treatment of adults infected with hepatitis C with combination therapy consisting of ribavirin and interferon has shown sustained response rates of 30,60%. Little data is available on the response of children infected with hepatitis C treated with combination therapy, especially those with bleeding disorders. We wish to report a single paediatric haemophilia treatment center's results of treatment of adolescents with haemophilia and hepatitis C infection with combination therapy. All patients followed at the haemophilia treatment center with hepatitis C, who were human immunodeficiency virus (HIV) negative and had a measurable hepatitis C viral load were eligible. Study patients received at least 6 months of 3 MU interferon- , via subcutaneous injection three times per week and 1000 mg day,1 of ribavirin. Eleven patients agreed to participate in the study. Three patients had an un measurable viral load after 6 months of combination therapy. All three completed 12 months of medication and continued to remain free of hepatitis C for 12 months after discontinuation of therapy. Side-effects of combination therapy were significant but tolerable. The sustained response rate in this study is similar to the historical response rate seen in adults but less than the other reported response rates seen in children treated with combination therapy. Given the toxicity of combination therapy, and natural history of hepatitis C infection in children, consideration of a liver biopsy to evaluate disease progression prior to considering antiviral medications is warranted. [source] Interspecialty and intraspecialty differences in the management of thyroid nodular disease and cancerHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 6 2005FRACS, Jonathan R. Clark MBBS Abstract Introduction. The management of thyroid cancer includes multiple medical specialties. Physicians from different specialties may vary in opinion regarding the optimal investigation and treatment of patients. Little data exist evaluating the differences within or between various specialties treating thyroid disease. This study aims to examine responses from a variety of specialty physicians closely involved in the medical or surgical management of thyroid disease to provide evidence as to whether any difference exists. Methods. A cross-sectional survey of attendees at the 5th Biennial Course on the Management of Thyroid Nodular Disease and Cancer was conducted using an anonymous electronic touch pad system. Touch pads were given to 213 attendees who were asked to respond to 44 questions. This study analyzes the responses obtained from 19 selected questions (43%) and compares the results between endocrinologists (n = 48), general surgeons (n = 41), otolaryngologists (n = 61), and pathologists (n = 20). Results. Responses were obtained from 69% of endocrinologists, 68% of general surgeons, 72% of otolaryngologists, and 65% of pathologists. Statistically significant interspecialty differences were observed in 12 (63%) of 19 questions. Each question and a summary of responses from all touch pads were recorded. Conclusions. Significant differences in the attitudes toward, and presumably the practice of, managing thyroid nodular disease and cancer exist between specialties. An understanding of these differences is helpful when working as a multidisciplinary team to optimize patient care. © 2005 Wiley Periodicals, Inc. Head Neck27: XXX,XXX, 2005 [source] Molecular characterization of adenovirus circulating in Central and South America during the 2006,2008 periodINFLUENZA AND OTHER RESPIRATORY VIRUSES, Issue 6 2009Josefina García Background, Human Adenoviruses are recognized pathogens, causing a broad spectrum of diseases. Serotype identification is critical for epidemiological surveillance, detection of new strains and understanding of HAdvs pathogenesis. Little data is available about HAdvs subtypes in Latin America. Methods, In this study, we have molecularly characterized 213 adenoviruses collected from ILI presenting patients, during 2006-08, in Central and South America. Results, Our results indicate that 161(76%) adenoviruses belong to subgroup C, 45 (21%) to subgroup B and 7 (3%) to subtype E4. [source] What are the high risk periods for incident substance use and transitions to abuse and dependence?INTERNATIONAL JOURNAL OF METHODS IN PSYCHIATRIC RESEARCH, Issue S1 2008Implications for early intervention, prevention Abstract Background: For a better understanding of the evolution of addictive disorders and the timely initiation of early intervention and prevention, we have to learn when and how quickly the critical transitions from first substance use (SU) to regular use and from first SU and regular SU to abuse and dependence occur. Little data are currently available on the transitions to substance use disorders (SUDs) across the spectrum of legal and illegal drugs taking into account gender differences. It is the aim of this paper to describe the high density incidence and transition periods of SU and SUD for alcohol, nicotine, cannabis and other illicit drugs for young males and females. Methods: A sample of (N = 3021) community subjects aged 14,24 at baseline were followed-up prospectively over 10-years. SU and SUD were assessed using the DSM-IV/M-CIDI. Results: Ages 10,16 are the high risk period for first alcohol and nicotine use (up to 38% of subjects start before age 14). Onset of illegal SU occurs later. Substantial proportions of transitions to regular SU and SUD occur in the first three years after SU onset. Only few gender differences were found for time patterns of SU/SUD incidence and transition. Conclusion: Except for alcohol the time windows for targeted intervention to prevent progression to malignant patterns in adolescence are critically small, leaving little time for targeted intervention to prevent transition. The fast transitions to abuse and dependence in adolescence may be indicative for the increased vulnerability to substance effects in this time period. Basic research on the determinants of transitions should thus target this period in adolescence. Copyright © 2008 John Wiley & Sons, Ltd. [source] Sustained virological responses following standard anti-viral therapy in decompensated HCV-infected cirrhotic patientsALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 2 2009A. IACOBELLIS Summary Background, Little data is available about predictors of sustained virological response (SVR) during anti-viral therapy of patients with decompensated HCV cirrhosis. Aims, To determine whether rapid and early virological responses (RVR and EVR) could predict SVR and help optimize treatment in these patients. Methods, A total of 94 cirrhotics underwent treatment with peg-interferon alfa-2b (1.5 ,g/kg weekly) and ribavirin (800/1200 mg daily) for 48 or 24 weeks for genotypes 1/4 or genotypes 2/3, respectively. Results, Overall, SVR was achieved in 33 patients (35.1%), 16% with genotype 1/4 and 56.8% with genotype 2/3 (P < 0.01). At treatment week 4, 34 patients had undetectable HCV-RNA, 10 with genotype 1/4 and 24 with genotype 2/3. Of RVR patients, 24 achieved SVR (70.5%), 6 and 18 with genotypes 1 and non-1. At the multivariate analysis, only EVR, genotypes 2 and 3, and adherence to full course and dosage of therapy retained their independent predictive power, with corresponding ORs of 25.5 (95% CI 3.0,217.3), 4.2 (95% CI 1.2,15.3) and 9.1 (95% CI 2.2,38.0), respectively. Conclusion, In decompensated cirrhotic patients, anti-viral therapy with current regimens is feasible and associated with an overall SVR rate of 35.1%. Treatment ought to be pursued among patients who attain an EVR, and maintain a full course and dosage of therapy. [source] Seizures in children after kidney transplantation: Has the risk changed and can we predict who is at greatest risk?PEDIATRIC TRANSPLANTATION, Issue 5 2008Lorie D. Hamiwka Abstract:, Children undergoing kidney transplantation are at increased risk for symptomatic seizures with a previously reported incidence of approximately 20%. Little data exist to help predict which children may be at risk. We retrospectively reviewed all children who underwent kidney transplantation evaluation at our center between October 1993 and August 2007 and identified 41 children who had an EEG prior to transplant. Demographic data as well as the following were collected: immunosuppressive medications, developmental status, history of seizures, family history of seizures, post-transplant seizures and EEG results. EEGs were classified as normal or abnormal. Prior to transplantation, one child had a history of febrile seizures and six experienced afebrile seizures. Nine (22%) children identified had an abnormal EEG prior to transplant. In eight cases the EEG was non-epileptiform and in one case was epileptiform. Abnormal EEGs did not correlate with a family history of seizures. Delayed development was noted in seven children and was not associated with an epileptiform EEG. Following kidney transplantation, no child experienced a seizure. Our single center study suggests that current rates of seizures following kidney transplantation are lower than previously reported and that routine EEG as part of the pretransplant evaluation in these children is of limited use to predict those at risk. [source] Neurological complication analysis of 1000 ultrasound guided peripheral nerve blocks for elective orthopaedic surgery: a prospective study,ANAESTHESIA, Issue 8 2009M. J. Fredrickson Summary Little data exists regarding the frequency of neurological complications following ultrasound guided peripheral nerve blockade. Therefore, we studied single injection and continuous ultrasound guided interscalene, supraclavicular, infraclavicular, femoral and sciatic nerve blocks in patients undergoing orthopaedic extremity surgery. All patients were contacted during postoperative weeks 2,4 and questioned for numbness or altered sensation anywhere in the involved extremity, and pain or weakness unrelated to surgery. The presumed aetiology of symptoms was based on the collective agreement of principal investigator, primary surgeon and a neurologist. Multivariate analysis was performed for characteristics potentially important in the causation of neurological complications. Of 1010 consecutive blocks, successful follow up between weeks 2 and 4 occurred in 98.6%. New, all-cause, neurological symptoms were present in 56/690 blocks (8.2%) at day 10, 37/1010 (3.7%) at 1 month and 6/1010 (0.6%) at 6 months. Most symptoms were due to causes unrelated to the block. Of 452 patients directly questioned at the time of the block, new neurological symptoms were more common in patients who experienced procedure-induced paraesthesia (odds ratio = 1.7, p = 0.029). The postoperative neurological symptom rate in this series is very similar to those previously reported following traditional techniques. [source] Cytokine response of electrolytic ablation in an ex vivo perfused liver modelANZ JOURNAL OF SURGERY, Issue 7-8 2010Gianpiero Gravante Abstract Background:, The inflammatory response following hepatic ablation depends on different factors including the method used, the duration and intensity of the treatment and the presence or absence of ischemia. Debate continues about the use of different modalities and whether some aspects of the response may be advantageous by releasing immunological active substances. Little data have been published concerning the cytokine response elicited by hepatic electrolytic ablation (EA). Study of an ex vivo liver model could allow for the evaluation of this response without the influence of confounding systemic factors. Methods:, Livers explanted from 11 pigs were perfused extracorporeally with normothermic autologous blood. Four of them underwent EA after 1 h of reperfusion. Serum samples were obtained up to 6 h after the reperfusion and assayed for IL-1,, IL-2, IL-4, IL-6, IL-8, IL-10, IL-12, IFN-,, TNF-,. Results:, Significant changes in the control group were observed for IL-6 after the second hour and IL-8 after the first hour compared with baseline levels (P < 0.001). In the EA group, IL-6 and IL-12 were raised after the second hour and IL-8 and IL-10 after the first hour (P < 0.001). The comparison between groups showed significant differences for IL-2, IL-4 (decreased in the EA group compared with controls), IL-10 and TNF-, (EA group increased compared with controls; P < 0.001). Conclusions:, The ex vivo perfused liver model demonstrated changes in levels of IL-2, IL-4, IL-10 and TNF-, following hepatic EA. [source] Muscarinic receptor subtypes in neuronal and non-neuronal cholinergic functionAUTONOMIC & AUTACOID PHARMACOLOGY, Issue 3 2006R. M. Eglen Summary 1 Muscarinic M1,M5 receptors mediate the metabotropic actions of acetylcholine in the nervous system. A growing body of data indicate they also mediate autocrine functions of the molecule. The availability of novel and selective muscarinic agonists and antagonists, as well as in vivo gene disruption techniques, has clarified the roles of muscarinic receptors in mediating both functions of acetylcholine. 2 Selective M1 agonists or mixed M1 agonists/M2 antagonists may provide an approach to the treatment of cognitive disorders, while M3 antagonism, or mixed M2/M3 antagonists, are approved for the treatment of contractility disorders including overactive bladder and chronic obstructive pulmonary disease. Preclinical data suggest that selective agonism of the M4 receptor will provide novel anti-nociceptive agents, while therapeutics-based upon agonism or antagonism of the muscarinic M5 receptor have yet to be reported. 3 The autocrine functions of muscarinic receptors broadly fall into two areas , control of cell growth or proliferation and mediation of the release of chemical mediators from epithelial cells, ultimately causing muscle relaxation. The former particularly are involved in embryological development, oncogenesis, keratinocyte function and immune responsiveness. The latter regulate contractility of smooth muscle in the vasculature, airways and urinary bladder. 4 Most attention has focused on muscarinic M1 or M3 receptors which mediate lymphocyte immunoresponsiveness, cell migration and release of smooth muscle relaxant factors. Muscarinic M4 receptors are implicated in the regulation of keratinocyte adhesion and M2 receptors in stem cell proliferation and development. Little data are available concerning the M5 receptor, partly due to the difficulties in defining the subtype pharmacologically. 5 The autocrine functions of acetylcholine, like those in the nervous system, involve activation of several muscarinic receptor subtypes. Consequently, the role of these subtypes in autocrine, as well neuronal cholinergic systems, significantly expands their importance in physiology and pathophysiology. [source] Pre- and post-natal exposure to antibiotics and the development of eczema, recurrent wheezing and atopic sensitization in children up to the age of 4 yearsCLINICAL & EXPERIMENTAL ALLERGY, Issue 9 2010S. Dom Summary Background Little data are available on the relationship between indirect antibiotic exposure of the child in utero or during lactation and allergic diseases. On the other hand, several studies have been conducted on the association with direct post-natal antibiotic exposure, but the results are conflicting. Objective The aim of this study was to investigate pre- and post-natal antibiotic exposure and the subsequent development of eczema, recurrent wheeze and atopic sensitization in children up to the age of 4 years. Methods We conducted an aetiologic study in 773 children based on a prospective birth cohort project in which environmental and health information were collected using questionnaires. Antibiotic exposure was assessed as maternal antibiotic intake during pregnancy and during lactation and as medication intake of the child. The chronology of exposures and outcomes was taken into account during the data processing. At the age of 1 and 4 years, a blood sample was taken for the quantification of specific IgE. Results Prenatal antibiotic exposure was significantly positively associated with eczema, whereas no association was found with recurrent wheeze and atopic sensitization. We found a positive, although statistically not significant, association between antibiotic exposure through breastfeeding and recurrent wheeze. Neither eczema nor atopic sensitization was significantly associated with antibiotic exposure through breastfeeding. Finally, we observed a negative association between the use of antibiotics in the first year of life and eczema and atopic sensitization, and also between antibiotic use after the first year of life and recurrent wheeze, eczema and atopic sensitization. Conclusion Indirect exposure to antibiotics (in utero and during lactation) increases the risk for allergic symptoms in children, while direct exposure to antibiotics appears to be protective. The biological mechanisms underlying these findings still need to be elucidated. Cite this as: S. Dom, J. H. J. Droste, M. A. Sariachvili, M. M. Hagendorens, E. Oostveen, C. H. Bridts, W. J. Stevens, M. H. Wieringa and J. J. Weyler, Clinical & Experimental Allergy, 2010 (40) 1378,1387. [source] Childhood trauma in obsessive-compulsive disorder, trichotillomania, and controlsDEPRESSION AND ANXIETY, Issue 2 2002Christine Lochner M.A. Abstract There is relatively little data on the link between childhood trauma and obsessive-compulsive/putative obsessive-compulsive spectrum disorders. The revised Childhood Trauma Questionnaire (CTQ), which assesses physical, emotional, and sexual abuse as well as physical and emotional neglect, was administered to female patients with obsessive-compulsive disorder (OCD; n = 74; age: 36.1 ± 16.3), TTM (n = 36; age: 31.8 ± 12.3), and a group of normal controls (n = 31; age: 21.5 ± 1.0). The findings showed a significantly greater severity of childhood trauma in general, and emotional neglect specifically, in the patient groups compared to the controls. Although various factors may play a role in the etiology of both OCD and trichotillomania (TTM), this study is consistent with some evidence from previous studies suggesting that childhood trauma may play a role in the development of these disorders. Depression and Anxiety 15:66,68, 2002. © 2002 Wiley-Liss, Inc. [source] Maternal blood glucose in diabetic pregnancies and cognitive performance in offspring in young adulthood: a Danish cohort studyDIABETIC MEDICINE, Issue 7 2010G. L. Nielsen Diabet. Med. 27, 786,790 (2010) Abstract Aims, Maternal diabetes is a known risk factor for perinatal complications, but there are little data on consequences for long-term intellectual outcome in offspring. We assess cognitive performance in military conscripts according to maternal blood glucose levels during pregnancy. Methods, We identified a cohort of 60 Danish male offspring of insulin-treated diabetic mothers born between 1976 and 1984 and followed this cohort to military conscription. From medical records, we extracted data on all available values of maternal blood glucose categorized as fasting and non-fasting and by day in pregnancy, together with maternal White class, smoking habits and socio-economic status. The main outcome was cognitive performance at conscription measured with a validated intelligence test. The association between maternal blood glucose level and cognitive performance was assessed by multivariate linear regression and a fitted fractional polynomial. Results, Median fasting blood glucose values in the second half of pregnancy was negatively associated with cognitive scores at conscription [adjusted coefficient ,1.7; 95% confidence interval (CI) ,3.0; ,0.4]. Restriction to only first-born sibling slightly strengthened the association (coefficient ,1.9; 95% CI ,3.3; ,0.5), but after exclusion of two pregnancies with the blood glucose > 10 mmol/l the association became insignificant (coefficient ,0.6; 95% CI ,2.6; 1.4). Conclusions, Maternal blood glucose level during diabetic pregnancy is negatively associated with cognitive performance in offspring at military conscription. In pregnancies with fasting blood glucose levels below 10 mmol/l, the association is weak and considered to be without clinical relevance. [source] Extreme events controlling erosion and sediment transport in a semi-arid sub-andean valleyEARTH SURFACE PROCESSES AND LANDFORMS, Issue 13 2002R. Coppus Abstract The importance of extreme events in controlling erosion and sediment transport in semi-arid areas has long been appreciated but in practice being by definition rare and episodic they are difficult to study. When they are observed this is frequently in catchments for which little data are available. Another difficulty is that even when catchments are being monitored the instruments that record discharge, sediment load and hillslope sediment fluxes perform inaccurately or unpredictably during extreme weather conditions. This paper describes slope and channel processes that were actually observed by the authors during a (at least) 1 : 30 year 30 minute event with a rainfall intensity of 240 mm h,1 in a second-order tributary of the Rio Camacho near Tarija in southern Bolivia. During the event, it could be observed how different tributary streams and slope sections contributed sediments and flow to the main channel. Evidence for these contributions did not survive the event, which has implications for both modelling and monitoring. Before the onset of the event open erosion plots were functioning on the slopes where rainfall and runoff were being measured. Rainfall experiments were used to obtain infiltration rates. The storm began with a moderate intensity of about 5 cm per hour but increased after 5 minutes to 30 cm per hour and continued for 30 minutes. At this time, the rainfall intensity greatly exceeded the infiltration capacity and water started draining the steep slopes. The ephemeral channel rapidly filled up with runoff. Erosion by hailstones was considerable. Provisionally, the discharge during peak runoff was estimated at 43·7 m3 s,1 (Manning equation). On the basis of sediment loads carried by previous storms, (average concentration of 21 g l,1) the total suspended load discharge during the storm would have been 15 ton ha,1. Within the ephemeral channel, 10 to 50 cm thick layers of coarse sediments were deposited. The collectors of the open erosion plots could not handle the large amounts of runoff and sediment and were completely filled to overflowing. Comparing these data with soil losses during less intense storms it can be concluded that extreme events largely contribute to erosion and sediment transport and that the majority of the rainstorms play only a minor role. The results also show how limited the values of rainfall experiments are in understanding geomorphic events. This makes modelling of erosion and soil losses a difficult and hazardous task. Copyright © 2002 John Wiley & Sons, Ltd. [source] Toxicity reduction of metal pyrithiones by near ultraviolet irradiationENVIRONMENTAL TOXICOLOGY, Issue 4 2006Hideo Okamura Abstract Zinc pyrithione (ZnPT) or copper pyrithione (CuPT) have been effectively used as ship-antifouling agents, as an alternative to organotin compounds. Because of their instability in light and a lack of suitable analytical procedures, there is little data on their residue levels in environmental matrices. It is possible to investigate the fate of such compounds by toxicity alteration with certain treatments. The purpose of this study was to evaluate the degradation of pyrithiones through toxicity reduction by near ultraviolet (UV-A) irradiation. Metal pyrithiones dissolved in acetonitrile were irradiated with a UV-A lamp for 0, 0.5, 1, and 2 h, and were subjected to UV spectral measurement and toxicity evaluation using both sea urchin and freshwater rotifer bioassays. For the bioassays, photolyzed samples were dissolved in dimethyl sulfoxide after evaporation of the acetonitrile. The changes in UV spectra of photolyzed ZnPT or CuPT showed a time-dependent degradation, and the UV spectra at 2 h irradiation suggested substantial decomposition. Toxicities of ZnPT and CuPT were 12 and 5 ,g/L as 24 h LC50 to the survival of rotifers and 10,6 ng/L and 2.3 ng/L as 27 h EC50 to normal pluteus formation, respectively. By evaporation of the acetonitrile, the EC50 of ZnPT was 2.2 ng/L, which was the same as that of CuPT. The EC50s of ZnPT or CuPT for both species increased with longer irradiation times. Photolyzed ZnPT or CuPT demonstrated substantial degradation in the UV spectra, but possessed marked toxicity, which is probably due to toxic degradation products. One reason why photolyzed CuPT was toxic to rotifers was explained by the high toxicity of copper ions formed by UV-A irradiation. © 2006 Wiley Periodicals, Inc. Environ Toxicol 21: 305,309, 2006. [source] Methyl- tert -hexyl ether and methyl- tert -octyl ether as gasoline oxygenates: Anticipating widespread risks to community water supply wells,ENVIRONMENTAL TOXICOLOGY & CHEMISTRY, Issue 11 2007Jeff Snelling Abstract The widespread contamination of groundwater resources associated with methyl- tert -butyl ether (MtBE) use has prompted a search for replacement oxygenates in gasoline. Among the alternatives currently under development are higher methyl- tert -alkyl ethers, notably methyl- tert -hexyl ether (MtHxE) and methyl- tert -octyl ether (MtOcE). As was the case with MtBE, the introduction of these ethers into fuel supplies guarantees their migration into groundwater resources. In the present study, a screening-level risk assessment compared predicted well water concentrations of these ethers to concentrations that might cause adverse effects. A physicochemical model which has been successfully applied to the prediction of MtBE concentrations in community water supply wells (CSWs) was used to predict well water concentrations of MtHxE and MtOcE. The results indicate that these ethers are likely to contaminate water supply wells at slightly lower levels than MtBE as a result of migrating from leaking underground fuel tanks to CSWs. Because very little data is available on the physicochemical and environmental properties of MtHxE and MtOcE, estimation methods were employed in conjunction with the model to predict well water concentrations. Model calculations indicated that MtHxE and MtOcE will be present in many CSWs at concentrations approaching the concentrations that have caused widespread public health concern for MtBE. Based on these results and the possibility that MtHxE and MtOcE are potential carcinogens, testing of the toxicological properties of these ethers is recommended before they are used to replace MtBE in gasoline. [source] Antarctic climate change during the last 50 yearsINTERNATIONAL JOURNAL OF CLIMATOLOGY, Issue 3 2005John Turner Abstract An erratum has been published for this article in International Journal of Climatology 25 (8) 2005, 1147,1148. The Reference Antarctic Data for Environmental Research (READER) project data set of monthly mean Antarctic near-surface temperature, mean sea-level pressure (MSLP) and wind speed has been used to investigate trends in these quantities over the last 50 years for 19 stations with long records. Eleven of these had warming trends and seven had cooling trends in their annual data (one station had too little data to allow an annual trend to be computed), indicating the spatial complexity of change that has occurred across the Antarctic in recent decades. The Antarctic Peninsula has experienced a major warming over the last 50 years, with temperatures at Faraday/Vernadsky station having increased at a rate of 0.56 °C decade,1 over the year and 1.09 °C decade,1 during the winter; both figures are statistically significant at less than the 5% level. Overlapping 30 year trends of annual mean temperatures indicate that, at all but two of the 10 coastal stations for which trends could be computed back to 1961, the warming trend was greater (or the cooling trend less) during the 1961,90 period compared with 1971,2000. All the continental stations for which MSLP data were available show negative trends in the annual mean pressures over the full length of their records, which we attribute to the trend in recent decades towards the Southern Hemisphere annular mode (SAM) being in its high-index state. Except for Halley, where the trends are constant, the MSLP trends for all stations on the Antarctic continent for 1971,2000 were more negative than for 1961,90. All but two of the coastal stations have recorded increasing mean wind speeds over recent decades, which is also consistent with the change in the nature of the SAM. Copyright © 2005 Royal Meteorological Society [source] Depressive symptoms and suicidal ideation among older adults receiving home delivered mealsINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 12 2008Jo Anne Sirey Abstract Objective Homebound older adults may be vulnerable to the deleterious impact of untreated depression. Yet because these elders are difficult to reach, there is little data on the rates of depressive symptoms and suicidal ideation among this group. The objective of this study is to document the rates of depression and correlates among a population of homebound elders. Methods Using a community based participatory research partnership, we implemented a routine screening for depressive symptoms and suicidal ideation among older recipients of Westchester County's home meal program. Older adults enrolled in the home delivered meal program were administered the Physician Health Questionnaire,9 (PHQ-9), and questions to assess pain, falls, alcohol abuse and perceived emotional distress. Results In our sample of 403 meal recipients, 12.2% of older adults reported clinically significant depression (PHQ-9,>,9) and 13.4% reported suicidal thoughts. One-third of recipients with significant depressive symptoms were currently taking an antidepressant. Almost one-third of older adults who endorsed suicide ideation did not report clinically significant depressive symptoms. Among men, suicidal thoughts were associated with chronic pain and greater depression severity, whereas pain was not a predictor of suicidal thoughts among women. Conclusion More than one in nine elders suffer from depression; most are untreated with one-third undertreated. Through partnerships between public agencies that provide age related services and academic investigators there is an opportunity for improved detection of unmet mental health needs. Future research should explore innovative models to improve access to mental health services once unmet need is detected. Copyright © 2008 John Wiley & Sons, Ltd. [source] Cholinesterase inhibitors in advanced Dementia with Lewy bodies: increase or stop?INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 8 2006Sanjeet Pakrasi Abstract Introduction There is little data on stopping cholinesterase inhibitors in Dementia with Lewy bodies (DLB). Equally, it is not known if increasing the dose of cholinesterase inhibitors may help neuropsychiatric symptoms in advanced DLB. Method We conducted an open label trial with donepezil involving 16 patients with LBD when the dose was reduced and treatment stopped over 4 weeks. Another 7 patients were given a trial of an increased dose of donepezil (15,mg) to resolve re-emergent neuropsychiatric symptoms. Results The slow discontinuation protocol was well tolerated in advanced DLB. Five of the seven patients given a trial of a higher dose of donepezil were rated as clinically improved after 12 weeks treatment. Conclusion Cholinesterase inhibitors can be discontinued slowly in advanced DLB. Increasing the dose of donepezil may be of benefit to some patients with DLB who experience a recurrence in their neuropsychiatric symptoms. Copyright © 2006 John Wiley & Sons, Ltd. [source] The Permanency of Pulmonary Vein Isolation Using a Balloon Cryoablation CatheterJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 7 2010HUMERA AHMED B.A. Chronic PV Isolation With the Cryoballoon.,Background: Because of its technical feasibility and presumed safety benefits, balloon cryoablation is being increasingly employed for pulmonary vein (PV) isolation. While acute isolation has been demonstrated in most patients, little data are available on the chronic durability of cryoballoon lesions. Methods and Results: Twelve atrial fibrillation patients underwent PV isolation using either a 23-mm or 28-mm cryoballoon. For each vein, after electrical isolation was verified with the use of a circular mapping cathether, 2 bonus balloon ablation lesions were placed. Gaps in balloon occlusion were overcome using either a spot cryocatheter or a "pull-down" technique. A prespecified second procedure was performed at 8,12 weeks to assess for long-term PV isolation. Acute PV isolation was achieved in all PVs in the patient cohort (n = 48 PVs), using the cryoballoon alone in 47/48 PVs (98%); a "pull-down" technique was employed for 5 PVs (1 right superior pulmonary vein, 2 right inferior pulmonary veins, and 2 left inferior pulmonary veins). The gap in the remaining vein was ablated with a spot cryocatheter. During the second mapping procedure, 42 of 48 PVs (88%) remained isolated. One vein had reconnected in 2 patients, while 2 veins had reconnected in another 2 patients. All PVs initially isolated with the "pull-down" technique remained isolated at the second procedure. Conclusions: Cryoballoon ablation allows for durable PV isolation with the use of a single balloon. With maintained chronic isolation in most PVs, it may represent a significant step toward consistent and lasting ablation procedures. (J Cardiovasc Electrophysiol, Vol. pp. 731-737, July 2010) [source] Validation of LAB Color Mode as a Nondestructive Method to Differentiate Black Ballpoint Pen Inks,JOURNAL OF FORENSIC SCIENCES, Issue 4 2007Derek L. Hammond B.A. Abstract:, Nondestructive digital processing methods such as lab color mode (available in Adobe® Photoshop®) are emerging as alternative methods for forensic document examiners to use when attempting to differentiate writing instrument inks. Although these techniques appear to be viable, little data currently exists regarding the known or potential error rates associated with these techniques. Without adequate data, the validity and reliability of these techniques, including lab color, can not be established. In an attempt to begin to address these issues, 44 black ballpoint ink pens were obtained and used to create 990 pen-pair samples for analysis using established lab color mode techniques. No erroneous findings of "different" were reported following the examination of the known pen-pair combinations in which the same pen was used to create the samples (n = 44). Of the remaining 946 samples, 737 pen-pair samples were differentiated using the lab color mode method, while 209 samples were unable to be differentiated and were recorded as either being "similar" (n = 153) or "unsure" (n = 56). Comparison of the lab color mode results with the results obtained through additional testing using traditional infrared reflectance and infrared luminescence test methods showed that lab color differentiated 102 pen-pair samples (11%; 102/946) that were not differentiated using a VSC-4C. [source] Managing discontinuity in academic medical centers: Strategies for a safe and effective resident sign-outJOURNAL OF HOSPITAL MEDICINE, Issue 4 2006Arpana R. Vidyarthi MD Abstract BACKGROUND Restrictions in the hours residents can be on duty have resulted in increased sign-outs, that is, transfer of patient care information and responsibility from one physician to a cross-coverage physician, leading to discontinuity in patient care. This sign-out process, which occurs primarily in the inpatient setting, traditionally has been informal, unstructured, and idiosyncratic. Although studies show that discontinuity may be harmful to patients, this is little data to assist residency programs in redesigning systems to improve sign-out and manage the discontinuity. PURPOSE This article reviews the relevant medical literature, current practices in non,health professions in managing discontinuity, and summarizes the existing practice and experiences at 3 academic internal medicine hospitalist-based programs. CONCLUSIONS We provide recommendations and strategies for best practices to design safe and effective sign-out systems for residents that may also be useful to hospitalists working in academic and community settings. Journal of Hospital Medicine 2006;1:257,266. © 2006 Society of Hospital Medicine. [source] A comparison of three methods for estimating height in the acutely ill elderly populationJOURNAL OF HUMAN NUTRITION & DIETETICS, Issue 1 2003M. Hickson Abstract Background Most estimates of nutritional status rely on accurate recording of not only body weight but also height. Standing height is difficult to measure accurately in older adults due to mobility problems and kyphosis. Surrogate methods have been developed to estimate height including arm-span, demi-span and knee height. There are currently little data on the accuracy of these methods in the sick elderly population or which method is the most suitable in the clinical situation. Objective To compare three commonly used clinical measurements that can estimate height and analyse their agreement with current height. Also to evaluate which method can be used most frequently. Methods We used data collected as part of a larger intervention trial, in which elderly in-patients (over 65 years), were measured for demi-span, half arm-span, knee height and standing height. Results The results showed that demi-span and half arm-span could be measured in the largest proportions of our population, 75.6 and 72.3%, respectively. The correlation coefficients were high for all three estimates of height, r = 0.86 for demi-span, r = 0.87 for arm-span, and r = 0.89 for knee height (P < 0.0001 for all three). However, agreement analysis demonstrated very poor agreement between standing height and all the methods of estimation. The mean differences were 4.33 cm for demi-span, 7.04 cm for arm-span and ,0.6 cm for knee height. [source] No-Reflow Phenomenon Following Percutaneous Coronary Intervention for Acute Myocardial Infarction: Incidence, Outcome, and Effect of Pharmacologic TherapyJOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 5 2010F.A.C.C., F.A.C.P., SHEREIF H. REZKALLA M.D. Background: No-reflow (NR) phenomenon is a well-known problem, often accompanying percutaneous coronary intervention for acute ST elevation myocardial infarction (STEMI). There are little data on effects of pharmacologic therapy on the resolution, outcome, and long-term natural history of NR. Objective: Retrospectively assess incidence, management, and prognosis of NR in a tertiary referral hospital. Methods: Study included patients with STEMI, treated with percutaneous coronary intervention (PCI). Effect of pharmacologic therapy and long-term outcome were assessed. NR was defined by thrombolysis in myocardial infarction (TIMI) < 3 or myocardial blush grade (MBG) < 3. Results: Of 347 identified subjects, NR occurred in 110 (32%) by TIMI and 198 (57%) by MBG. Higher incidence was identified in men versus women (34% vs. 25% by TIMI, P = 0.08; and 60% vs. 48% by MBG, P = 0.04). Pharmacologic therapy was equally effective in restoring normal flow, increasing TIMI score from 1.62 ± 0.07 to 2.78 ± 0.06 (P < 0.0001) and MBG score from 0.43 ± 0.08 to 2.09 ± 0.11 (P < 0.0001). Twenty-three percent who did not receive pharmacologic therapy developed clinical composite of congestive heart failure, cardiogenic shock, and/or death; only 9% of patients who received pharmacologic therapy developed this composite. Patients with severe NR despite treatment had poorer prognosis. Sixty-five percent of patients who survived and had repeat angiogram about 1.5 years later had spontaneous improvement in coronary flow by MBG. Conclusion: NR is common in STEMI. Treatment with nicardipine, nitroprusside, and verapamil are equally effective in improving flow. If not treated, prognosis is poor. (J Interven Cardiol 2010;23:429,436) [source] Mortality Benefit of Beta Blockade in Patients with Acute Coronary Syndromes Undergoing Coronary Intervention:JOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 4 2003Capture, Epilog, Epistent, Pooled Results from the Epic, Rapport Trials The effects of beta blocker therapy in the settings of heart failure and coronary artery disease have been well described, although little data exist in patients presenting with acute coronary syndromes undergoing percutaneous coronary intervention. The current study will attempt to evaluate the efficacy of beta blocker therapy in this setting. Pooled data from five randomized, controlled trials of abciximab during coronary intervention were used to analyze the clinical efficacy of beta blocker therapy. The pooled analysis evaluated the end points of all-cause mortality, myocardial infarction, repeat revascularization, and the combined endpoint of death and myocardial infarction in 2,894 patients. At 30 days, death occurred in 12 of 1,939 (0.6%) patients receiving beta blocker therapy and in 19 of 955 (2.0%) patients not receiving beta blocker therapy, (P < 0.001). At 6 months, death occurred in 33 of 1,939 (1.7%) patients receiving beta blocker therapy and 35 of 955 (3.7%) not receiving beta blocker therapy, (P < 0.001). After creating a propensity model and adjusting for variables predictive of mortality in the multivariable analysis, beta blocker therapy continued to be associated with a significant reduction in mortality. The findings were similar to those shown for the effects of beta blocker therapy in separate subgroups of patients with unstable angina and acute myocardial infarction. This analysis demonstrates a lower short-term mortality in patients receiving beta blocker therapy who undergo percutaneous coronary intervention for unstable angina or acute myocardial infarction. (J Interven Cardiol 2003;16:299,305) [source] Kinematics of the knee at high flexion angles: An in vitro investigationJOURNAL OF ORTHOPAEDIC RESEARCH, Issue 1 2004Guoan Li Abstract Restoration of knee function after total knee, meniscus, or cruciate ligament surgery requires an understanding of knee behavior throughout the entire range of knee motion. However, little data are available regarding knee kinematics and kinetics at flexion angles greater than 120° (high flexion). In this study, 13° cadaveric human knee specimens were tested using an in vitro robotic experimental setup. Tibial anteroposterior translation and internal,external rotation were measured along the passive path and under simulated muscle loading from full extension to 150° of flexion. Anterior tibial translation was observed in the unloaded passive path throughout, with a peak of 31.2 ± 13.2 mm at 150°. Internal tibial rotation increased with flexion to 150° on the passive path to a maximum of 11.1 ± 6.7°. The simulated muscle loads affected tibial translation and rotation between full extension and 120° of knee flexion. Interestingly, at high flexion, the application of muscle loads had little effect on tibial translation and rotation when compared to values at 120°. The kinematic behavior of the knee at 150° was markedly different from that measured at other flexion angles. Muscle loads appear to play a minimal role in influencing tibial translation and rotation at maximal flexion. The results imply that the knee is highly constrained at high flexion, which could be due in part to compression of the posterior soft tissues (posterior capsule, menisci, muscle, fat, and skin) between the tibia and the femur. © 2003 Orthopaedic Research Society. Published by Elsevier Ltd. All rights reserved. [source] Predicting long-term sickness absence from sleep and fatigueJOURNAL OF SLEEP RESEARCH, Issue 4 2007TORBJORN AKERSTEDT Summary Disturbed or shortened sleep is prospectively related to disease. One might also expect that sickness absence would be another consequence but very little data seem to exist. The present study used 8300 individuals in a national sample to obtain information on reports of disturbed sleep and fatigue 1 year and merged this with data on long-term sickness absence 2 years later. A logistic regression analysis was applied to the data with adjustments for demographic and work environment variables. The results showed that individuals without registered sickness absence at the start had a higher probability of entering a period of long-term (,90 days, odds ratio [OR] = 1.24 with 95% confidence interval [CI] = 1.02,1.51) sickness absence 2 years later if they reported disturbed sleep at the start. The figure for fatigue was OR = 1.35 (CI = 1.14,1.60). When fatigue or disturbed sleep was separately excluded the OR increased to OR = 1.44 and OR = 1.47, respectively. Intermediate sickness absence (14,89 days) showed similar but slightly weaker results. The results indicate that disturbed sleep and fatigue are predictors of long-term absence and it is suggested that impaired sleep may be part of a chain of causation, considering its effects on fatigue. [source] Current topical and systemic approaches to treatment of rosaceaJOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY & VENEREOLOGY, Issue 8 2009HC Korting Abstract Rosacea is a common, often overlooked, chronic facial dermatosis characterized by intermittent periods of exacerbation and remission. Clinical subtypes and grading of the disease have been defined in the literature. On the basis of a genetic predisposition, there are several intrinsic and extrinsic factors possibly correlating with the phenotypic expression of the disease. Although rosacea cannot be cured, there are several recommended treatment strategies appropriate to control the corresponding symptoms/signs. In addition to adequate skin care, these include topical and systemic medications particularly suitable for the papulopustular subtype of rosacea with moderate to severe intensity. The most commonly used and most established therapeutic regimens are topical metronidazole and topical azelaic acid as well as oral doxycycline. Conventionally, 100,200 mg per day have been used. Today also a controlled release formulation is available, delivering 40 mg per day using non-antibiotic, anti-inflammatory activities of the drug. Anti-inflammatory dose doxycycline in particular allows for a safe and effective short- and long-term therapy of rosacea. Topical metronidazole and topical azelaic acid also appear to be safe and effective for short-term use. There are indications that a combined therapy of anti-inflammatory dose doxycycline and topical metronidazole could possibly have synergy effects. Further interesting therapy options for the short- and long-term therapy of rosacea could be low-dose minocycline and isotretinoin; however, too little data are available with regard to the effectiveness, safety, optimal dosage and appropriate length of treatment for these medications to draw final conclusions. Conflicts of interest None declared. [source] Factors Influencing Standard Pretravel Health Advice,A Study in BelgiumJOURNAL OF TRAVEL MEDICINE, Issue 5 2007Kristina Van De Winkel MD Background Travelers with risk factors, medical conditions such as immunosuppression, medication intake, pregnancy, or elderly age, need adaptation or reinforcement of pretravel health advice. The literature provides little data on the frequency of these risk groups in the travel population. This study intended to investigate whether risk factors influencing standard travel advice are common in the population attending our travel clinic. Methods A prospective survey was carried out over a 2-month period in 2004 at the travel clinic of the Institute for Tropical Medicine in Antwerp, Belgium. A list of risk factors focused on the following three important advice categories: malaria prophylaxis, yellow fever vaccination, and travelers' diarrhea or other enteric infections. We counted how frequently a risk factor was observed for each advice category (potential influence) and, after considering the travel characteristics, how often a real adaptation of advice was necessary (actual influence). Results Of 2,227 travelers, 276 were found to have a possible influencing factor (12.4%). The potential influence was 10.9% (243/2,227) for malaria prophylaxis advice, 6.1% (136/2,227) for yellow fever vaccination, and 1.9% (43/2,227) for travelers' diarrhea advice. The actual influence was lower 8% (184/2,227), 5% (109/2,227), and 1.2% (27/2,227), respectively. The main interfering factors were as follows: for influence on malaria advice, age ,60 years (44%) and neuropsychiatric disorders (15.6%); for yellow fever vaccination, age ,60 years (63.2%) and immunosuppression (10.3%); and for influence on travelers' diarrhea advice, decreased gastric acidity (44.2%) and immunosuppression (32.6%). Conclusion Travelers with risk factors are not infrequently seen at our travel clinic. Some groups are more prominently present and could be the focus of travel group,specific instructions. The study suggests that being informed about risk groups is essential for advising travelers. [source] Facial resurfacing in patients with Fitzpatrick skin type IV,LASERS IN SURGERY AND MEDICINE, Issue 2 2002Suchai Sriprachya-anunt MD Abstract Background and Objectives Though post-inflammatory hyperpigmentation (PIH) is probably the most common complication of laser resurfacing and appears to correlate directly with the intensity of the patient's natural pigmentation, there is very little data that specifically addresses the risks of dyspigmentation in more darkly pigmented patients (Fitzpatrick skin types IV and above). The objective of this study was to evaluate the long-term dyspigmentation of patients with skin type IV having radial laser resurfacing. Study Design/Materials and Methods A retrospective review of the clinical efficacy, incidence of dyspigmentation and other adverse effects, as well as the pre/post-operative protocol of 22 patients with Fitzpatrick skin type IV who were a minimum of 1 year post-operative following facial laser resurfacing. Results The average patient achieved greater than 50% improvement, indicating adequate treatment being delivered. PIH occurred in 68% of patients, starting 1 month post-operative and lasting 3.8 months. There was no correlation to pre-treatment or type of laser used as far as incidence of PIH. True hypopigmentation was not seen in this group of 22 patients. Conclusions PIH is the most common complication of facial resurfacing in patients with skin type IV. It is not preventable by choice of laser or skin care regimen pre-operative, but appears to respond to appropriate treatment once it has developed. Lasers Surg. Med. 30:86,92, 2002. © 2002 Wiley-Liss, Inc. [source] | ||||||||||||||||||||||||||||||||||||||||