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Little Evidence (little + evidence)
Kinds of Little Evidence Selected AbstractsLittle evidence for different phenomenology in poststroke depressionACTA PSYCHIATRICA SCANDINAVICA, Issue 6 2010T. B. Cumming Cumming TB, Churilov L, Skoog I, Blomstrand C, Linden T. Little evidence for different phenomenology in poststroke depression. Objective:, It remains unclear whether mood depressive disorders after stroke have a distinct phenomenology. We evaluated the symptom profile of poststroke depression (PSD) and assessed whether somatic symptoms were reported disproportionately by stroke patients. Method:, The sample was 149 stroke patients at 18 months poststroke and 745 age- and sex-matched general population controls. A comprehensive psychiatric interview was undertaken and depression was diagnosed according to DSM-III-R criteria. Results:, Depressed controls reported more ,inability to feel' (P = 0.002) and ,disturbed sleep' (P = 0.008) than depressed stroke patients. Factor analysis of the 10 depressive symptoms identified two main factors, which appeared to represent somatic and psychological symptoms. There was no difference in scores on these two factors between stroke patients and controls. Conclusion:, Phenomenology of depression at 18 months poststroke is broadly similar but not the same as that described by controls. Somatic symptoms of depression were not over-reported by stroke patients. [source] Mitochondrial control region variation in bank voles (Clethrionomys glareolus) is not related to Chernobyl radiation exposureENVIRONMENTAL TOXICOLOGY & CHEMISTRY, Issue 2 2007Heather N. Meeks Abstract ,Three previous studies at Chernobyl, Ukraine, documented elevated mitochondrial DNA diversity in bank voles (Clethrionomys glareolus) from radioactively contaminated sites. Little evidence was found to link patterns of diversity in contaminated areas to radiation exposure, but the experimental design precluded discriminating among alternative explanations for elevated diversity in exposed groups. Reference sites selected for the studies were relatively distant from contaminated sites and, additionally, were separated from contaminated sites by large river systems; thus, we hypothesized that differences among sites were correlated with geographic isolation rather than with radiation exposure. For the present study, we added three reference sites, which were selected based on minimal radioactive contamination, proximity to contaminated sites, and absence of obvious barriers to dispersal. We hypothesized that neighboring reference sites should exhibit levels and patterns of diversity similar to those of contaminated sites if the previously detected differences were, in fact, caused by geographic isolation. Indeed, levels of diversity in nearby reference sites are comparable to levels in contaminated sites. Additionally, nearby reference sites contain several haplotypes not observed at other study sites. Our results suggest that levels of diversity in contaminated regions are more plausibly explained by ecological and historical factors than by increased mutational pressure resulting from exposure to Chernobyl radiation. [source] Impact of perfluorooctanoic acid on fathead minnow (Pimephales promelas) fatty acyl-coa oxidase activity, circulating steroids, and reproduction in outdoor microcosmsENVIRONMENTAL TOXICOLOGY & CHEMISTRY, Issue 8 2004Ken D. Oakes Abstract This study investigates reproductive impairment and biochemical changes in fathead minnow (Pimephales promelas) exposed for 39 d to varying concentrations of perfluorooctanoic acid (PFOA) under microcosm conditions. While the concentrations tested in this study were much higher than those normally found in the environment, no mortality was associated with PFOA exposure. Only modest changes were observed in condition factor and in relative liver and gonad size. Significant declines in circulating plasma steroids were observed, but these were accompanied by only limited increases in time to first oviposition and decreases in overall egg production. Peroxisome proliferation, as quantified by fatty acyl-CoA oxidase (FAO) activity, was elevated with low PFOA concentrations but attenuated with exposure to higher PFOA doses. Little evidence was seen of differential induction of peroxisome-associated enzyme activity with sex. Oxidative stress, as quantified by the 2-thiobarbituric acid reactive substances (TBARS) assay, was only modestly influenced by PFOA exposure and is not a significant consequence of FAO activity in fathead minnow. Perfluorooctanoic acid appears to be relatively nontoxic at environmentally relevant concentrations but may impact biochemical and reproductive endpoints under conditions associated with environmental spills. [source] The relationship of emotional intelligence with academic intelligence and the Big FiveEUROPEAN JOURNAL OF PERSONALITY, Issue 2 2002Karen Van der Zee The present study examines the relationship of self- and other ratings of emotional intelligence with academic intelligence and personality, as well as the incremental validity of emotional intelligence beyond academic intelligence and personality in predicting academic and social success. A sample of 116 students filled in measures for emotional and academic intelligence, the Big Five, and indicators of social and academic success. Moreover, other ratings were obtained from four different raters on emotional intelligence and social success. Factor analysis revealed three emotional intelligence dimensions that were labelled as ,Empathy', ,Autonomy', and ,Emotional Control'. Little evidence was found for a relationship between emotional and academic intelligence. Academic intelligence was low and inconsistently related to emotional intelligence, revealing both negative and positive interrelations. Strong relationships were found of the emotional intelligence dimensions with the Big Five, particularly with Extraversion and Emotional Stability. Interestingly, the emotional intelligence dimensions were able to predict both academic and social success above traditional indicators of academic intelligence and personality. Copyright © 2002 John Wiley & Sons, Ltd. [source] An Experimental Study of Auditor Analytical Review JudgementsJOURNAL OF BUSINESS FINANCE & ACCOUNTING, Issue 9-10 2000Kenny Z. Lin This paper provides evidence as to how five factors highlighted in the current UK auditing standard are taken into account by auditors in analytical review (AR) judgements. While the relative importance of particular cues was generally found to be consistent with the standard, certain factors were taken into account only to a marginal extent. Little evidence of configural cue usage was identified. The study also provides evidence of a tendency towards conservatism in the way auditors approach AR. The results suggest both that the potential to substitute AR for other substantive procedures may be realised only imperfectly and that the issue of configural reasoning should be addressed in the auditing standard. [source] An Experimental Study of Auditor Analytical Review JudgementsJOURNAL OF BUSINESS FINANCE & ACCOUNTING, Issue 7-8 2000Kenny Z. Lin This paper provides evidence as to how five factors highlighted in the current UK auditing standard are taken into account by auditors in analytical review (AR) judgements. While the relative importance of particular cues was generally found to be consistent with the standard, certain factors were taken into account only to a marginal extent. Little evidence of configural cue usage was identified. The study also provides evidence of a tendency towards conservatism in the way auditors approach AR. The results suggest both that the potential to substitute AR for other substantive procedures may be realised only imperfectly and that the issue of configural reasoning should be addressed in the auditing standard. [source] Factors affecting the uptake of new medicines in secondary care , a literature reviewJOURNAL OF CLINICAL PHARMACY & THERAPEUTICS, Issue 4 2008D. Chauhan BPharm MRPharmS MSc Summary Background and Objective:, The rate of uptake of new medicines in the UK is slower than in many other OECD countries. The majority of new medicines are introduced initially in secondary care and prescribed by specialists. However, the reasons for relatively low precribing levels are poorly understood. This review explores the determinants of uptake of new medicines in secondary care. Methods:, Nine electronic databases were searched covering the period 1992,2006. Once the searches had been run, records were downloaded and those which evaluated uptake of new medicines in secondary care were identified. UK studies were of primary interest, although research conducted in other countries was also reviewed if relevant. With the exception of ,think pieces', eligibility was not limited by study design. Studies published in languages other than English were excluded from the review. Determinants of uptake in secondary care were classified using Bonair and Persson's typology for determinants of the diffusion of innovation. Results:, Almost 1400 records were screened for eligibility, and 29 studies were included in the review. Prescribing of new medicines in secondary care was found to be subject to a number of interacting influences. The support structures which exist within secondary care facilitate access to other colleagues and shape prescribing practices. Clinical trial investigators and physicians who sit on decision-making bodies such as Drug and Therapeutic Committees (DTCs) appear to have a special influence due to their proximity to their research and understanding of evidence base. Pharmaceutical representatives may also influence prescribing decisions through funding of meetings and academic detailing, but clinicians are wary of potential bias. Little evidence on the influence of patients upon prescribing decisions was identified. The impact of clinical guidelines has been variable. Some guidelines have significantly increased the uptake of new medicines, but others have had little discernible impact despite extensive dissemination. However given the increasing influence of the National Institute for Health and Clinical Excellence, guidelines may become more important. The impact of financial prescribing incentives on secondary care prescribing is unclear. Although cost and budget may influence hospital prescribing of new drugs, they are of secondary importance to the safety and effectiveness profile of the medicine. If a drug has a novel mechanism of action, or belongs to a class with few alternatives, clinicians are more likely to consider it favourably as a prescribing option. Conclusions:, Although price does not appear to be a primary factor behind prescribing decision-making, in secondary care there has long been a historical need for formal purchasing decisions through the DTC, which differentiates it from primary care. This, in addition to increasing pressures for cost-effectiveness within the NHS means that cost will appear more frequently on clinician consciousness. As a result, guidelines are more likely to be implemented using the strong professional networks in existence within secondary care, and although the influence of patients has not been addressed by the literature, they are likely to have an increasing input into the prescribing decision, given the importance of patient involvement in current UK policy. [source] Competition in prescription drug markets: is parallel trade the answer?MANAGERIAL AND DECISION ECONOMICS, Issue 5 2010Panos Kanavos This article uses a price determination model with dynamic panel data estimation to examine the extent to which pharmaceutical parallel trade promotes price competition and leads to downward price convergence. Little evidence of sustainable price competition is found. We find that prices are mainly affected by regulation and by competition in the wholesale distribution chain; that the pricing strategy of parallel distributors resembles that of originator drugs in importing countries; and that there may be upward rather than downward price convergence. Drawing on the European evidence, the findings also indicate that opening the US market to parallel imports will not necessarily lead to competition and enhance pharmaceutical cost containment. Copyright © 2010 John Wiley & Sons, Ltd. [source] Lichen Planus in 24 Children with Review of the LiteraturePEDIATRIC DERMATOLOGY, Issue 4 2005Pilar Luis-Montoya M.D. Our objective was to obtain epidemiologic data retrospectively and determine the clinical characteristics of lichen planus in Mexican children seen in our dermatology department. We found 235 patients with the clinical and histologic diagnosis of lichen planus seen over a period of 22 years and 7 months. Twenty-four (10.2%) of these patients were children (15 years of age or younger). The ratio of male to female was 1 : 1.2. The main clinical pattern was classic lichen planus (43.5%). Mucous membrane and nail involvement were uncommon. No family history of lichen planus or systemic disease was noted. In the international literature, the frequency of lichen planus varied from 2.1% to 11.2% of the pediatric population. In the majority of studies no significant gender predominance was identified. Most patients had the classic variety of lichen planus. Reported mucosal involvement was rare, except in India and Kuwait. Frequency of nail involvement ranged from 0% to 16.6%. Little evidence of systemic disease or family history was found. [source] The effectiveness of a pre-operative home-based physiotherapy programme for chronic anterior cruciate ligament deficiencyPHYSIOTHERAPY RESEARCH INTERNATIONAL, Issue 4 2006SL Keays Abstract Background and Purpose.,Little evidence supports the prescription of pre-operative rehabilitation in the treatment of chronic anterior cruciate ligament-deficient (ACLD) subjects. The aim of the present study was to assess the effectiveness of a specific six-week pre-operative exercise programme on ACLD knees.,Method.,A single, masked, controlled study was designed. This comprised two matched groups of 12 chronically ACLD patients awaiting reconstruction and a group of 12 matched uninjured control subjects. Only one ACLD group received a home-based exercise and educational programme. Assessment before and after the exercise intervention included: knee joint stability (clinical and KT1000 evaluation); muscle strength (Cybex II); standing balance and functional performance (agility, hop and subjective tests).,Results.,At the time of initial assessment there were no statistically significant differences in any measures for the two ACLD groups but both ACLD groups were significantly different from the uninjured control group as regards quadriceps strength and function. Measures taken after six weeks showed no significant improvement in the untreated ACLD group or in the uninjured control group The treated ACLD group showed significant improvement in the following measures: quadriceps strength measured at 60° and 120° per second (p < 0.001); single leg standing balance with eyes closed (p < 0.001); instrumented passive stability at 20,lb (89N) force (p = 0.003); agility and subjective performance (p < 0.001). The incidence of unstable episodes had decreased in the treated ACLD group, reducing further damage to the joint.,Conclusion.,This study leaves little doubt that pre-operative physiotherapy had a positive effect on motor function in ACLD subjects and should be prescribed routinely to maximize muscle stabilizing potential prior to reconstruction. Patients report improved stability and, in certain cases, may avoid surgery. The finding that exercise increased the passive stability of the joint was unexpected and requires further investigation. Copyright © 2006 John Wiley & Sons, Ltd. [source] Is racial prejudice declining in Britain?1THE BRITISH JOURNAL OF SOCIOLOGY, Issue 4 2008Robert Ford Abstract This article employs two previously neglected indicators of racial prejudice from the British Social Attitudes surveys to examine the social distribution of prejudices against black and Asian Britons. Three hypotheses are proposed and tested: that racial prejudice is declining in Britain; that this decline is principally generational in nature; and that greater prejudice is shown towards more culturally distinct Asian minorities than black minorities. Strong evidence is found for the first two hypotheses, with evidence of an overall decline in prejudice and of a sharp decline in prejudices among generations who have grown up since mass black and Asian immigration began in the 1950s. Little evidence is found for the third hypothesis: British reactions towards black and Asian minorities are broadly similar suggesting racial differences may still be the main factor prompting white hostility to British minorities. [source] CT analysis after distraction osteogenesis in Pierre Robin SequenceTHE LARYNGOSCOPE, Issue 2 2009Saswata Roy MD Abstract Objectives/Hypothesis: Early mandibular lengthening by distraction osteogenesis provides an alternative to traditional methods of airway management in infants with Pierre Robin sequence (PRS). Little evidence in the medical literature quantitatively demonstrates the changes in skeletal, soft tissue, and hypopharyngeal spaces with mandibular distraction. Study Design: Prospective analysis of a cohort of three patients with PRS. Methods: We reviewed a series of infants with PRS and severe upper airway obstruction who underwent mandibular distraction. The infants underwent mandibular lengthening with the same internal, unidirectional distraction osteogenesis device. Standardized serial computed tomography (CT) scans were obtained according to established protocol. Computed tomography data were extracted and analyzed with medical image analysis software for mandibulo-maxillary arch harmony, symmetry, hypopharyngeal airway volume, geniohyoid distance, distraction osteogenesis bone volume, and mandibular length. Results: Mandibulo-maxillary alveolar ridge distances were corrected to 0.5 mm after distraction. Clinical examination showed good arch harmony without open-bite or cross-bite deformities. Mandibular ramus was lengthened by 19.5%; the body, 43.4%. After distraction, total mandibular length was increased by 26.2%; hypopharyngeal airway volume, 192%; posterior distance from pharyngeal wall to tongue base, 198.9%; and geniohyoid distance, 14.1%. Conclusions: Unidirectional internal microdistractors can achieve good mandibulo-maxillary arch harmony. Hypopharyngeal airway volume increases substantially, with an even greater increase in distance between tongue base and posterior pharyngeal wall. As the distal mandibular segment is distracted, the hyoid moves anteriorly, with minor increase in geniohyoid relationship. Internal mandibular microdistraction devices represent a substantial advance in airway obstruction management in infants with micrognathia. Laryngoscope, 2009 [source] Prostate-specific antigen levels in relation to cadmium exposure and zinc intake: results from the 2001,2002 national health and nutrition examination surveyTHE PROSTATE, Issue 2 2008Edwin van Wijngaarden Abstract BACKGROUND Cadmium exposure has been suggested as a risk factor for prostate cancer, and experimental literature suggests that the carcinogenic effect of cadmium is modified by the presence of zinc. We evaluated total prostate-specific antigen (PSA) levels in relation to urinary cadmium concentrations and dietary zinc intake. METHODS PSA levels were determined in 1,320 men over the age of 40 in the 2001,2002 National Health and Nutrition Examination Survey (NHANES). Urinary cadmium concentrations were measured in about one-third of the sample population, whereas dietary zinc intake was based on participants' 24-hr recall. Information on all three variables was available for 422 men in the 2001,2002 NHANES survey. We performed linear regressions to evaluate the relationships these factors after accounting for age and other covariates. RESULTS Little evidence for an association between cadmium and elevated PSA level was observed. However, the data provide suggestive evidence for an interaction between zinc intake and cadmium exposure (P for interaction,=,0.09). Among men with zinc intake less than the median level of 12.67 mg/day, an increase in 1 µg/g creatinine cadmium exposure was associated with a 35% increase in PSA level. In contrast, among men with greater than median zinc intake, little evidence for an association between cadmium and PSA was found. CONCLUSIONS These findings suggest a protective effect of zinc intake on cadmium-induced prostatic injury, and may provide further rationale for investigating the impact of these factors individually and jointly on the etiology of prostate cancer. Prostate 68: 122,128, 2008. © 2007 Wiley-Liss, Inc. [source] Electrical stimulation as an adjunct to spinal fusion: A meta-analysis of controlled clinical trialsBIOELECTROMAGNETICS, Issue 7 2002Masami Akai Abstract This study was a meta-analysis to examine whether electrical stimulation has a specific effect on spinal fusion. Little evidence exists on the efficacy of electrical stimulation for improving fusion rate of spinal fusion surgery. Using MEDLINE (1966,2000) and EMBASE (1985,1999), a search for articles was carried out using the Medical Subject Headings: (1) electric stimulation or electromagnetic fields, (2) spinal fusion, (3) controlled or clinical trial, and (4) human. Data were extracted from all the hit articles and additionally collected from appropriate journal lists. A total of five randomized controlled trials (RCT) on bones assessing healing of spinal fusion were identified and scored on methodological quality. All the identified studies reported positive findings, but the quality score of each trial showed wide flaws. Because of relatively homogenous subjects who had spine fusion and radiographic assessment from these studies, pooling of the data was able to be performed. Excluding one trial with the lowest score, the combined results of four trials, whose major endpoints were the success rate of the fusion, revealed a statistically significant effect of electrical stimulation with various techniques, but the selected trials still showed wide variation in view of stimulation modalities and treatment protocol. The pooled result of the studies in this review revealed the efficacy of electrical stimulation based on proved methodological quality. As problems on therapeutic modality and protocol remain, there is a further need for improvement in design to constitute acceptable proof and to establish treatment programs that better demonstrate electrical stimulation effects on spinal fusion. Bioelectromagnetics 23:496,504, 2002. © 2002 Wiley-Liss, Inc. [source] Industry responses to EU WEEE and ROHS Directives: perspectives from ChinaCORPORATE SOCIAL RESPONSIBILITY AND ENVIRONMENTAL MANAGEMENT, Issue 5 2006Jieqiong Yu Abstract The electrical and electronics (EE) industry has come under increasing pressure to adopt extended producer responsibility (EPR) policies through the introduction of the European Union's Directives on Waste Electrical and Electronic Equipment (WEEE) and the Restriction of Use of Certain Hazardous Substances (ROHS). Based on the findings of 50 questionnaires and in-depth interviews with China's EE manufacturers, this paper investigates the perception of and readiness of companies for implementation of WEEE and ROHS in China. It identifies key difficulties encountered by manufacturers in fulfilling the requirements and evaluates the effectiveness of these two directives in promoting environmental reform. The findings indicate that the extent of companies' responses largely depends on their market structure and client requirements. Supply chain management, raw material testing and cost implications appear to be key challenges in addressing issues surrounding the directives. There is little evidence to suggest that these directives have effectively driven China's EE manufacturers towards systematic eco-design. Copyright © 2006 John Wiley & Sons, Ltd and ERP Environment. [source] Family factors in the intergenerational transmission of offendingCRIMINAL BEHAVIOUR AND MENTAL HEALTH, Issue 2 2009David P. Farrington Background,Convicted parents tend to have convicted children, but there have been few previous studies of transmission between three generations, especially including both records and interviews for hundreds of people. Method,In the Cambridge Study in Delinquent Development (CSDD), 411 south London males have been followed up from age 8 to age 48. These males (generation 2, G2) are compared with their fathers and mothers (generation 1, G1), and with their biological sons and daughters (generation 3, G3). Results,There was significant intergenerational transmission of convictions from G1 males to G2 males, and from G2 males to G3 males. Convictions of fathers still predicted convictions of sons after controlling for risk factors, but the predictive efficiency was reduced. Transmission was less from G1 females to G2 males, and from G2 males to G3 females. There was little evidence of intergenerational transmission from G1 to G3, except from grandmothers to granddaughters. Conclusions,The intergenerational transmission of offending may be mediated by family, socio-economic and individual risk factors. Intervention to reduce intergenerational transmission could target these risk factors. Copyright © 2009 John Wiley & Sons, Ltd. [source] Outcome measures used in forensic mental health research: a structured reviewCRIMINAL BEHAVIOUR AND MENTAL HEALTH, Issue 1 2009Jemma C. Chambers Background,The evidence base for forensic mental health (FMH) services has been developing since the late 1990s. Are outcome measures sound enough for the evaluation tasks? Aims,To identify, from published literature, outcome measures used in FMH research and, where feasible, assess their quality. Method,A structured review was undertaken of trials and intervention studies published between 1990 and 2006. Details of outcome variables and measures were abstracted. Evidence regarding most frequently occurring outcome measures was assessed. Results,Four hundred and fifty different instruments were used to assess outcomes, incorporating 1038 distinct variables. Very little evidence could be found to support the measurement properties of commonly used instruments. Conclusions and implications for practice,There is little consistency in the use of outcome measure in FMH research. Effort is required to reach consensus on validated outcome measures in this field in order to better inform practice. Copyright © 2009 John Wiley & Sons, Ltd. [source] Levels of literacy among juvenile offenders: the incidence of specific reading difficultiesCRIMINAL BEHAVIOUR AND MENTAL HEALTH, Issue 4 2000Margaret J. Snowling Introduction Academic achievement is low among offenders. Yet there is little evidence that prisoners are less literate than the general population. Do they have more dyslexia? This paper considers three definitions of dyslexia to see whether they relate to young offenders' literacy difficulties. Method The reading and spelling skills of 91 15- to 17-year-old male juvenile offenders who were incarcerated are reported, together with assessments of their vocabulary and non-verbal (spatial) skills. Estimates of the prevalence of reading disability are considered in relation to different definitions of dyslexia. Results The regression of literacy skills on non-verbal ability yielded an estimated prevalence of 57% while a more conservative estimate of 43% followed from the regression of literacy skill on verbal ability, and 38% of the sample had specific phonological deficits. Many of the offenders had experienced social and family adversity and reported poor school attendance. Discussion It is proposed that as a group, juvenile offenders are best described as having general verbal deficits encompassing problems of language and literacy. Copyright © 2000 Whurr Publishers Ltd. [source] A CROSS-CULTURAL EXAMINATION OF THE LINK BETWEEN CORPORAL PUNISHMENT AND ADOLESCENT ANTISOCIAL BEHAVIOR,CRIMINOLOGY, Issue 1 2000RONALD L. SIMONS Several studies with older children have reported a positive relationship between parental use of corporal punishment and child conduct problems. This has lead some social scientists to conclude that physical discipline fosters antisocial behavior. In an attempt to avoid the methodological difficulties that have plagued past research on this issue, the present study used a proportional measure of corporal punishment, controlled for earlier behavior problems and other dimensions of parenting, and tested for interaction and curvilinear effects. The analyses were performed using a sample of Iowa families that displayed moderate use of corporal punishment and a Taiwanese sample that demonstrated more frequent and severe use of physical discipline, especially by fathers. For both samples, level of parental warmth/control (i.e., support, monitoring, and inductive reasoning) was the strongest predictor of adolescent conduct problems. There was little evidence of a relationship between corporal punishment and conduct problems for the Iowa sample. For the Taiwanese families, corporal punishment was unrelated to conduct problems when mothers were high on warmth/control, but positively associated with conduct problems when they were low on warmtwcontrol, An interaction between corporal punishment and warmth/Wcontro1 was found for Taiwanese fathers as well. For these fathers, there was also evidence of a curvilinear relationship, with the association between corporal punishment and conduct problems becoming much stronger at extreme levels of corporal punishment. Overall, the results are consistent with the hypothesis that it is when parents engage in severe forms of corporal punishment, or administer physical discipline in the absence of parental warmth and involvement, that children feel angry and unjustly treated, defy parental authority, and engage in antisocial behavior. [source] Understanding Surge Capacity: Essential ElementsACADEMIC EMERGENCY MEDICINE, Issue 11 2006Donna F. Barbisch RN As economic forces have reduced immediately available resources, the need to surge to meet patient care needs that exceed expectations has become an increasing challenge to the health care community. The potential patient care needs projected by pandemic influenza and bioterrorism catapulted medical surge to a critical capability in the list of national priorities, making it front-page news. Proposals to improve surge capacity are abundant; however, surge capacity is poorly defined and there is little evidence-based comprehensive planning. There are no validated measures of effectiveness to assess the efficacy of interventions. Before implementing programs and processes to manage surge capacity, it is imperative to validate assumptions and define the underlying components of surge. The functional components of health care and what is needed to rapidly increase capacity must be identified by all involved. Appropriate resources must be put into place to support planning factors. Using well-grounded scientific principles, the health care community can develop comprehensive programs to prioritize activities and link the necessary resources. Building seamless surge capacity will minimize loss and optimize outcomes regardless of the degree to which patient care needs exceed capability. [source] RIGHT-TO-CARRY CONCEALED HANDGUNS AND VIOLENT CRIME: CRIME CONTROL THROUGH GUN DECONTROL?,CRIMINOLOGY AND PUBLIC POLICY, Issue 3 2003TOMISLAV V. KOVANDZIC Research Summary: "Right-to-Carry" (RTC) concealed-handgun laws mandate that authorities issue concealed handgun permits to qualified applicants. The supposition by those supporting the laws is that allowing private citizens to carry concealed handguns in public can reduce violent crime by deterring prospective criminals afraid of encountering armed civilians. Critics of the laws argue that violent altercations are more likely to turn deadly when more people carry guns. Whether the laws cause violent crime to increase or to decrease has become an important public policy question, as most states have now adopted such legislation. The present study evaluates Florida's 1987 RTC law, which prior research suggests plays a key role in the RTC debate. Specifically, we use panel data for 58 Florida counties from 1980 to 2000 to examine the effects on violent crime from increases in the number of people with concealed-carry permits, rather than before-after dummy and time-trend variables used in prior research. We also address many of the methodological problems encountered in earlier RTC studies. We present numerous model specifications, and we find little evidence that increases in the number of citizens with concealed-handgun permits reduce or increase rates of violent crime. Policy Implications: The main policy implication of this research is that there appears to be little gained in the way of crime prevention by converting restrictive gun carrying laws to "shall-issue" laws, although the laws might still prove beneficial by (1) eliminating arbitrary decisions on gun permit applications, (2) encouraging gun safety, (3) making permit holders feel safer when out in public, (4) providing permit holders with a more effective means of self-defense, and (5) reducing the costs to police departments of enforcing laws prohibiting unlicensed gun carrying. [source] Effects of right and left vagal stimulation on left ventricular acetylcholine levels in the catACTA PHYSIOLOGICA, Issue 1 2001T. Akiyama To test the effectiveness of, and the interactions between, right and left vagal stimulation on left ventricular acetylcholine (ACh) levels, we applied the dialysis technique to the heart of anaesthetized cats. Dialysis probes were implanted in the left ventricular myocardium and perfused with Krebs,Henseleit buffer containing eserine. Dialysate ACh content was measured as an index of ACh release from post-ganglionic vagal nerve terminals in the left ventricular myocardium. We electrically stimulated the right and left cervical vagal nerves separately or together and investigated the dialysate ACh response. In two different regions of the left ventricle, substantial dialysate ACh responses were observed by the stimulation (20 Hz) of both right and left cervical vagal nerves. At stimulation frequencies of both 10 and 20 Hz, the dialysate ACh response to the bilateral vagal stimulation was almost algebraically the calculated sum of the individual dialysate ACh responses to unilateral vagal stimulation. In conclusion, ACh levels in the left ventricle are affected by both right and left vagal nerves and show little evidence of interactions between right and left vagal nerves at the level of the cardiac ganglia. [source] Comparison of the Medical Priority Dispatch System to an Out-of-hospital Patient Acuity ScoreACADEMIC EMERGENCY MEDICINE, Issue 9 2006Michael J. Feldman MD Abstract Background: Although the Medical Priority Dispatch System (MPDS) is widely used by emergency medical services (EMS) dispatchers to determine dispatch priority, there is little evidence that it reflects patient acuity. The Canadian Triage and Acuity Scale (CTAS) is a standard patient acuity scale widely used by Canadian emergency departments and EMS systems to prioritize patient care requirements. Objectives: To determine the relationship between MPDS dispatch priority and out-of-hospital CTAS. Methods: All emergency calls on a large urban EMS communications database for a one-year period were obtained. Duplicate calls, nonemergency transfers, and canceled calls were excluded. Sensitivity and specificity to detect high-acuity illness, as well as positive predictive value (PPV) and negative predictive value (NPV), were calculated for all protocols. Results: Of 197,882 calls, 102,582 met inclusion criteria. The overall sensitivity of MPDS was 68.2% (95% confidence interval [CI] = 67.8% to 68.5%), with a specificity of 66.2% (95% CI = 65.7% to 66.7%). The most sensitive protocol for detecting high acuity of illness was the breathing-problem protocol, with a sensitivity of 100.0% (95% CI = 99.9% to 100.0%), whereas the most specific protocol was the one for psychiatric problems, with a specificity of 98.1% (95% CI = 97.5% to 98.7%). The cardiac-arrest protocol had the highest PPV (92.6%, 95% CI = 90.3% to 94.3%), whereas the convulsions protocol had the highest NPV (85.9%, 95% CI = 84.5% to 87.2%). The best-performing protocol overall was the cardiac-arrest protocol, and the protocol with the overall poorest performance was the one for unknown problems. Sixteen of the 32 protocols performed no better than chance alone at identifying high-acuity patients. Conclusions: The Medical Priority Dispatch System exhibits at least moderate sensitivity and specificity for detecting high acuity of illness or injury. This performance analysis may be used to identify target protocols for future improvements. [source] Findings from a multidisciplinary clinical case series of females with Rett syndromeDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 5 2003Hilary Cass BSc FRCPCH Systematic data from a multidisciplinary clinical assessment of a large series of females with Rett syndrome (RS; n=87) is presented. Participants' ages ranged from 2 years 1 month to 44 years 10 months. Areas assessed included oromotor skills, feeding problems, growth, breathing abnormalities, mobility, postural abnormalities and joint deformities, epilepsy, hand use and stereotypies, self-care, and cognitive and communication skills. Many previously reported trends in the presentation of RS over time were confirmed, notably the increasingly poor growth and near pervasiveness of fixed joint deformities and scoliosis in adulthood. In contrast, there was a slight trend towards improved autonomic function in adulthood, whereas feeding difficulties increased into middle childhood and then reached a plateau. Improvements in mobility into adolescence were followed by a decline in those skills in adulthood. Levels of dependency were high, confirming findings from previous studies. Despite the presence of repetitive hand movements, a range of hand-use skills was seen in individuals of all ages. Cognitive and communication skills were limited, but there was little evidence of deterioration of these abilities with age. These findings confirm that RS is not a degenerative condition and indicate that intervention and support to maintain and increase motor skills, daily living skills, and cognitive and communicative functioning are appropriate targets for individuals with RS. [source] The role of sensorimotor impairments in dyslexia: a multiple case study of dyslexic childrenDEVELOPMENTAL SCIENCE, Issue 3 2006Sarah White This study attempts to investigate the role of sensorimotor impairments in the reading disability that characterizes dyslexia. Twenty-three children with dyslexia were compared to 22 control children, matched for age and non-verbal intelligence, on tasks assessing literacy as well as phonological, visual, auditory and motor abilities. The dyslexic group as a whole were significantly impaired on phonological, but not sensorimotor, tasks. Analysis of individual data suggests that the most common impairments were on phonological and visual stress tasks and the vast majority of dyslexics had one of these two impairments. Furthermore, phonological skill was able to account for variation in literacy skill, to the exclusion of all sensorimotor factors, while neither auditory nor motor skill predicted any variance in phonological skill. Visual stress seems to account for a small proportion of dyslexics, independently of the commonly reported phonological deficit. However, there is little evidence for a causal role of auditory, motor or other visual impairments. [source] The therapeutics of lifestyle management on obesityDIABETES OBESITY & METABOLISM, Issue 11 2010P. A. Dyson The global incidence and prevalence of obesity continue to increase, with the fastest rate of increase in the developing world. Obesity is associated with many chronic diseases including type 2 diabetes, cardiovascular disease and some cancers. Weight loss can reduce the risk of developing these diseases and can be achieved by means of surgery, pharmacotherapy and lifestyle interventions. Lifestyle interventions for prevention and treatment of obesity include diet, exercise and psychological interventions. All lifestyle interventions have a modest but significant effect on weight loss, but there is little evidence to indicate that any one intervention is more effective. There is evidence of an additive effect for adjunct therapy, and the combination of diet, exercise and behavioural interventions appears to be most effective for both the prevention and treatment of obesity. [source] Mid- and high-ratio premix insulin analogues: potential treatment options for patients with type 2 diabetes in need of greater postprandial blood glucose controlDIABETES OBESITY & METABOLISM, Issue 2 2010J. S. Christiansen Some patients with type 2 diabetes continue to have high postprandial blood glucose levels on twice-daily regimens of ,low-ratio' premix insulin formulations (up to 30% rapid-acting, with 70% protracted insulin). These patients require intensified insulin therapy, which can be provided by a twice- or thrice-daily regimen of mid-ratio (50% rapid-acting and 50% protaminated intermediate-acting insulin , human or analogue) or high-ratio (70% rapid-acting and 30% protaminated insulin , analogue only) premix insulin. Alternatively, a third daily injection of low-ratio premix insulin can be added to the regimen, with the option of incorporating one or more injections of mid- or high-ratio premix as required, and as an alternative to basal,bolus therapy. How these mid- and high-ratio formulations differ from the low-ratio premix insulins is reviewed here, with the aim of identifying the role of these formulations in diabetes management. Glucose clamp studies have shown that premix analogues give serum insulin levels proportional to their percentage of rapid-acting uncomplexed insulin: the higher the proportion, the greater the maximum level reached. Other pharmacokinetic parameters were not always significantly different between the mid- and high-ratio formulations. In clinical trials, postprandial plasma glucose and glycated haemoglobin A1c (HbA1c) levels were significantly reduced with thrice-daily mid- /high-ratio premix analogue when compared with twice-daily low-ratio biphasic human insulin (BHI) 30/70 or once-daily insulin glargine. Moreover, glycaemic control with mid-/high-ratio premix analogue was found to be similar to that with a basal,bolus therapy. Mid- and high-ratio premix regimens are generally well tolerated. The frequency of minor hypoglycaemia was reportedly higher with mid- /high-ratio premix analogues than with BHI 30, but nocturnal hypoglycaemia was less frequent. Although there is little evidence that clinical outcomes with mid-ratio premix analogues are different from those with high-ratio, they are useful additions to the low-ratio formulations for the management of diabetes, and addressing postprandial hyperglycaemia in particular. [source] The global challenge of type 2 diabetes and the strategies for response in ethnic minority groupsDIABETES/METABOLISM: RESEARCH AND REVIEWS, Issue 6 2010Flavio Lirussi Abstract Ethnic minorities living in high-income countries usually exhibit a greater risk of developing diabetes along with higher morbidity and mortality rates. We evaluated the effectiveness of interventions to improve glycaemic control in ethnic minority groups. Results of major controlled trials, systematic reviews and meta-analyses were included in the review. Only 1/47 studies addressing diet and exercise interventions reported details on the ethnicity of the studied population. Self-management education was successful if associated with increased self-efficacy; delivered over a longer period; of high intensity; culturally tailored; and when using community educators. Strategies adopted in community-gathering places, family-based, multifaceted, and those tackling the social context were likely to be more effective. A positive relationship was found between social support and self-management behaviour as well as quality of life, but there is little evidence about the impact of organizational changes within health-care services on diabetes control. More research is needed to strengthen the evidence on effective strategies for response to diabetes in ethnic minorities. Also, there is a need to take into account diabetes beliefs and communication difficulties, as well as potential protective factors. Globally, many health-care systems are inadequately equipped to improve diabetes prevention and disease outcomes in these communities. Copyright © 2010 John Wiley & Sons, Ltd. [source] Targeted group antenatal prevention of postnatal depression: a reviewACTA PSYCHIATRICA SCANDINAVICA, Issue 4 2003M.-P. Austin Objective:, To review the efficacy of antenatal group interventions aimed at reducing postnatal depression (PND) in ,at risk' women. Method:, Medline, Psyclit, HEALTHSTAR, EMBASE, Cochrane library, UK National Research Register and CINHAL searches were performed from 1960 to December 2001 focussing on randomized controlled trials (RCTs). Results:, As statistical synthesis of the studies was not feasible, a qualitative review is provided. All five studies reviewed suffer from substantial limitations including small numbers; unrealistic effect sizes; large attrition rates; lack of a systematic approach in identifying those ,at risk' and thus clinically heterogenous samples. Three of the studies used unvalidated interventions that were educational or supportive in approach. While one such study reported a benefit of intervention, the largest study using a structured intervention, reported no effect. A very small study using interpersonal therapy, was promising but needs replication with an adequate sample size. Conclusion:, There is currently little evidence from RCTs to support the implementation of antenatal group interventions to reduce PND in ,at risk' women. Further studies addressing the significant methodological limitations are recommended before concluding that antenatal targeted interventions have no place in maternity care. [source] Longitudinal study of urinary albumin excretion in young diabetic patients,-Wessex Diabetic Nephropathy ProjectDIABETIC MEDICINE, Issue 5 2001S. Twyman Summary Aims This study was established to follow changes in albumin/creatinine ratio (ACR) and to determine the prevalence and degree of progression of microalbuminuria (MA) or of clinical proteinuria (CP) in children with Type 1 diabetes. The study has investigated subjects for up to 12 years in establishing the correlation between MA and gender, age, duration of diabetes and glycated haemoglobin (HbA1c). The study has defined clinical cut-offs for MA in daytime clinic urine samples in young diabetic subjects. Methods Three hundred and sixty-one patients were involved in the study, with 221 (61.2%) having over six sets of data. Urine samples were collected at routine annual clinic visits and analysed without prior freezing for ACR. Blood samples were taken for HbA1c measurement. Data including sex, age and duration of diabetes were recorded. Results A random clinic ACR of <,4.5 mg/mmol (males) and 5.2 mg/mmol (females) creatinine was used as the ,clinical cut-off' to define the presence of MA. The presence of MA was independent of HbA1c and duration of diabetes but appeared be associated with the adolescent years (> 10 years). There was little evidence of progression from normoalbuminuria to MA, or from MA to CP. Of patients aged 10,18 years, 30.9% of males and 40.4% of females had one or more episodes of MA. Conclusions Persistent MA and random episodes of MA or CP may be associated with the adolescent years but not with duration of diabetes. Further study will reveal if the substantial increases in ACR sometimes seen during adolescence are predictive of diabetic nephropathy. Clinical cut-offs of <,4.5 and <,5.2 mg/mmol creatinine for males and females, respectively, are suggested for the interpretation of changes in ACR in random urine samples in young people with Type 1 diabetes. [source] | |||||||||||||||||||||||||||||||||||||||||||