Home About us Contact
|
Home About us Contact | ||
|
|
||
Mention
Selected AbstractsMOSHER AWARD HONORABLE MENTION,THE LARYNGOSCOPE, Issue 4 2000Natural History of Acoustic Neuromas Abstract Objectives/Hypothesis 1) Develop a computerized technique to accurately compare acoustic neuroma size on routine computed tomography and magnetic resonance imaging (MRI) scans; 2) use this technique to determine the growth pattern in a large series of patients with acoustic neuroma who were conservatively managed; 3) describe the natural history of patients with acoustic neuromas who did not receive surgical intervention and those who underwent subtotal resection; 4) correlate the size and growth rate of acoustic neuromas to clinical presentation and auditory and vestibular testing; and 5) recommend guidelines for the management of patients with acoustic neuromas. Study Design A retrospective study from 1974 to 1999 of patients with unilateral acoustic neuromas who had conservative treatment by serial imaging studies (80 patients) or subtotal resection (49 patients). Methods All patient charts were evaluated for presenting symptoms, reasons for the type of management given, and clinical outcome. Charts were also reviewed with respect to serial audiological assessment, electronystagmography, and brainstem auditory evoked response. Imaging studies were analyzed using a computer technique so that serial studies could be compared to determine growth rates. Results Rigorous computer analysis of tumor size and growth rate was statistically the same as the radiologist's description of the tumor size and growth rate. Of 70 patients who were older than 65 years of age old at the time their tumor was discovered, 4 (5.7%) required intervention and 18 (26%) were dead of unrelated causes. These patients had a mean follow-up of 4.8 years (range, 0.01,17.2 y). Overall, growth rate for nonsurgical patients was 0.91 mm per year. Nonsurgical tumors did not grow or regressed in 42.3%. Overall postoperative growth rate for surgical subtotal resection patients was 0.35 mm per year. Surgical tumors did not grow or regressed after subtotal resection of acoustic neuroma in 68.5% of patients. Three patients (6.1%) required revision surgery because of tumor growth or the development of symptoms. Neither auditory nor vestibular testing was a reliable measure for determining tumor growth. Conclusion Measurement of the maximal tumor diameter on MRI scans is a reliable method for following acoustic neuroma growth. There is no need to perform a rigorous analysis of tumor size to determine whether the tumor is growing significantly. The vast majority of patients older than 65 years with acoustic neuromas do not require intervention. The indications for intervention should be based on a combination of rapid tumor growth with the development of symptoms. [source] What imaging tells us about violence in anti-social menCRIMINAL BEHAVIOUR AND MENTAL HEALTH, Issue 3 2010Mairead C. DolanArticle first published online: 8 JUN 2010 This paper provides an overview of imaging studies in samples of men with personality disorder (PD) who have been violent. Mention is also made of the work of two groups that have looked at the neural correlates of violence across diagnostic categories, including schizophrenia and anti-social PD given their relevance in the field. The paper focuses on the notion that aggressive behaviour can be conceptualised in terms of at least two types, reactive and pro-active, and that few studies separate them. The neuro-anatomical basis of aggression and associated neurobehavioural theories are discussed in relation to clinical disorders (mainly anti-social personality pathology) associated with these different types of aggressive behaviour. Structural (computed tomography, magnetic resonance imaging) and functional (positron emission tomography, fMRI, single-photon emission tomography) studies with violent people variously characterised as anti-social or having psychopathy will be critically reviewed. Copyright © 2010 John Wiley & Sons, Ltd. [source] Stroke secondary prevention and blood pressure reduction: an observational study of the use of PROGRESS therapyFUNDAMENTAL & CLINICAL PHARMACOLOGY, Issue 2 2008Jean-Marc Bugnicourt Abstract The Perindopril pROtection aGainst REcurrent Stroke Study (PROGRESS) showed the efficacy of blood pressure reduction in secondary stroke prevention. This anti-hypertensive treatment (perindopril 4 mg daily plus indapamide 1.5 mg daily) is now routinely proposed to patients referred to our department for stroke or transient ischaemic attack (TIA). The aim of this study was to evaluate the prescription of PROGRESS therapy during hospitalization and to identify the predictors of therapy discontinuation after discharge. Eligible patients admitted to the Amiens University hospital for acute stroke or TIA from January to April 2003 were included (n = 101). At 1 year, the use of PROGRESS therapy was evaluated by structured phone interviews. In addition, each patient's general practitioner (GP) was also contacted to provide information. PROGRESS therapy was mentioned on the hospital discharge summary significantly less frequently after cardioembolic stroke (OR: 0.15; 95% CI: 0.05,0.5; P = 0.001) and TIA (OR: 0.12; 95% CI: 0.02,0.7; P = 0.02). At 1 year, only 25.7% of patients were treated with optimal PROGRESS therapy (perindopril 4 mg daily plus indapamide 1.5 mg daily). Mention of PROGRESS therapy in the discharge summary was the main predictor of optimal PROGRESS therapy at 1 year (OR: 10.8; 95% CI: 1.3,88.3; P = 0.03). This study shows that mention of PROGRESS therapy in the discharge summary must be improved as it is associated with a higher use of these anti-hypertensive agents 1 year after stroke/TIA. [source] An object relations approach to studying prejudice with specific reference to anti-semitism: the long-term use of a lethal apocalyptic projectionINTERNATIONAL JOURNAL OF APPLIED PSYCHOANALYTIC STUDIES, Issue 1 2007Clyde Friedman Abstract Prejudice seems to be part of the human condition. The specific prejudice of anti-Semitism has affected Jews for at least 2300 years with, at times, horrendous consequences. What psychodynamics are operating in prejudice in general, and in the specific prejudice of antisemitism? What has caused such a small group to be targeted by such long-standing enmity? Will prejudice or antisemitism ever end or do groups need scapegoats and do the Jewish people fit the scapegoat profile? This article reviews some of the psychodynamics as described by Freud, Klein, Fairbairn, Bion, and others that make people susceptible to fear and prejudice, and to the particular prejudice of antisemitism. Mention will be made of some of the historical, religious, and sociological dynamics that contribute to antisemitism. With reference to Object Relations theory and the Apocalyptic-Messianic myth present in monotheistic religions, an explanation is suggested as to how prejudice and antisemitism become lethal on an individual and large-group scale. Hitler is referred to as a specific illustration of this phenomenon. Some case examples from the writer's clinical practice are also utilized to further illustrate the psychodynamics presented. Copyright © 2006 John Wiley & Sons, Ltd. [source] Duels, Doctors And DeathANZ JOURNAL OF SURGERY, Issue 8 2000Reginald Magee Duelling as a method of settling disputes between gentlemen was practised in the British Isles and on the Continent from the 16th to the beginning of the 20th century. In early duels the victory would go to the better swordsman, but the use of pistols not only made the contest more deadly, but also more democratic. The social aspects, the indications for a challenge, the material and methods and the mortality and morbidity of the contest are considered. Mention is made of a case in which John Hunter was consulted. Its management, progress and autopsy findings are described together with Hunter's thoughts about it and the management of similar wounds. [source] Predictors of early rescreening in the National Cervical Screening Program, AustraliaAUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 4 2001Heather Mitchell Objective: To identify variables that predict early rescreening after a negative Pap smear report. Methods: Cohort study using the records of a statewide Cervical Cytology Registry in Victoria, Australia. The cohort comprised 31,082 women who had a negative Pap smear report during the first half of 1996 and who were rescreened within the subsequent 36 months. Early rescreening was defined as a further Pap smear within 21 months. Results: The strongest predictor of early rescreening was a recommendation at the time of issuing the negative Pap smear report by the laboratory for retesting before two years (adjusted odds ratio = 3.81, 95% confidence interval (Cl) 3.58,4.05). Mention of reactive or inflammatory change as part of the negative Pap smear report was also a powerful predictor (adjusted odds ratio = 1.67, 95% Cl 1.50,1.85). Significant predictors associated with the women were young age, high socio-economic status and residence in the capital city. Significant predictors associated with the practitioner were if either the index or subsequent smear was collected by an obstetrician/gynaecologist or a hospital-based clinic, or if the practitioner collecting the index smear was a female. The population-attributable risk per cent associated with the laboratory recommendation was 27%. Conclusions: This data suggests that a multi-faceted strategy targeting pathology laboratories, practitioners and women may be needed to reduce early rescreening. Implications: Early rescreening is wasteful of health resources. New screening programs should be designed to avoid this problem [source] Welding Automation in Space-Frame Bridge ConstructionCOMPUTER-AIDED CIVIL AND INFRASTRUCTURE ENGINEERING, Issue 3 2001Alistair Greig The SPACES system has been proposed as an alternative for long-span bridge construction. Tubular space frames offer a structurally more efficient solution for bridges, but they have been considered too expensive because the joints at the nodal intersections of the tubular members are difficult and expensive to weld. The benefits of the SPACES system can only be realized by using a computer-integrated construction system to drive down the fabrication costs. A key component of the computer-integrated construction is the robotic welding system. This article describes the development of a lightweight automated welding system for the joining of tubular members. It addresses the geometry of intersecting cylinders and the kinematics and design of a 5-degree-of-freedom manipulator. Summary solutions are given for both. The control software is described briefly, and mention of the welding tests and overall business process is also made. A consortium of U.K. industry and universities is conducting the work. [source] Does PTSD occur in sentenced prison populations?CRIMINAL BEHAVIOUR AND MENTAL HEALTH, Issue 3 2007A systematic literature review Background,A systematic review of the literature on mental disorder in prisoners, published in 2002, made no mention of post-traumatic stress disorder (PTSD), but indicators from other studies suggest that a history of serious and chronic trauma is common among offenders. Aims,To conduct a systematic review of the literature with the specific questions: does any epidemiological study of sentenced prisoners include data on prevalence of PTSD while in prison? If so, what is the prevalence in this group? Method,Literature databases EMBASE, Medline, PsychInfo, PILOTS and SIGLE were searched. The Journal of Traumatic Stress was searched manually. Preliminary screening was conducted by reading abstracts of hundreds of papers. Ten exclusion criteria were then applied to the screened selection. Reference sections of all accessed papers were searched for any further studies. Results,One hundred and three potentially relevant papers were identified after preliminary screening. Four met all criteria for inclusion and suffered none of the exclusion criteria. PTSD rates ranged from 4% of the sample to 21%. Women were disproportionately affected. Conclusions and implications for practice,All four papers suggested that the prevalence of PTSD among sentenced prisoners is higher than that in the general population, as reported elsewhere. Overall the findings suggest a likely need for PTSD treatment services for sentenced prisoners. Copyright © 2007 John Wiley & Sons, Ltd. [source] Use of topical immunomodulators in organ transplant recipientsDERMATOLOGIC THERAPY, Issue 1 2005Bradley T. Kovach ABSTRACT:, Solid organ transplant recipients are a growing population at increased risk for the development of cutaneous premalignant and malignant lesions, resulting in significant morbidity and mortality. Topical immunomodulators, in particular imiquimod, have shown efficacy in the management of multiple malignant, precancerous, and viral conditions. The ability to locally induce an immune response, presumably against tumor and viral antigens, and induce apoptosis makes topical immunomodulators a promising therapeutic option in organ transplant recipients. Although limited, data have begun to accumulate on the use of imiquimod in transplant patients for the management of superficial, nodular, and infiltrative basal cell carcinomas; in situ and invasive squamous cell carcinomas; condyloma acuminata; and common warts. As more experience is gathered, the role of imiquimod and other topical immunomodulators in the care of OTRs will be clarified. The authors reviewed the existing data on the use of topical imiquimod in OTRs with mention of its presumed mechanisms of action and other immunomodulators with potential efficacy against cancerous and precancerous lesions. [source] Towards an understanding of the high death rate among young people with diabetes in UkraineDIABETIC MEDICINE, Issue 1 2001M. Telishevka SUMMARY Aims Published rates of deaths attributed to diabetes mellitus among those aged under 50 have risen substantially in several former Soviet republics since the late 1980s. The reasons for this increase, and the situation facing patients with diabetes in these countries are poorly understood. The aim of this study was to describe the circumstances leading up to the death of individuals dying under the age of 50 years with mention of diabetes on their death certificate. Methods Interviews with surviving relatives or neighbours, combining elements of verbal autopsy and confidential enquiry. For those who had lived in the city of Lviv a random sample was taken. For those in rural areas a purposive sample was used to ensure coverage of more and less remote areas. Results Key informants were identified and agreed to be interviewed for 64 individuals out of a possible 79 with insulin-treated diabetes identified from their death certificates. The main immediate causes of death were renal failure (69%), ischaemic heart disease (9%), ketoacidosis (6%) and hypoglycaemia (3%). Over a third of men, but no women, were reported to have been heavy drinkers. Informants described many difficulties in obtaining regular supplies of insulin and related supplies since 1990. Although insulin is officially available free of charge, most had retained supplies for use in an emergency. More than half had, at some time, purchased supplies. The large number of deaths from renal failure reflects the effective absence of renal replacement therapy for patients with diabetes. Conclusions Individuals with diabetes in Ukraine face profound challenges involving access to necessary care. Their needs require significantly more attention from policy makers. [source] Misunderstanding Gödel: New Arguments about Wittgenstein and New Remarks by WittgensteinDIALECTICA, Issue 3 2003Victor Rodych The long-standing issue of Wittgenstein's controversial remarks on Gödel's Theorem has recently heated up in a number of different and interesting directions [(Floyd and Putnam. 2000), (Steiner, 2001), (Floyd, 2001)]. In their (2000), Juliet Floyd and Hilary Putnam purport to argue that Wittgenstein's,notorious'(RFM App. III, §8) "Contains a philosophical claim of great interest," namely, "if one assumed. that ,P is provable in Russell's system one should, give up the "translation" of P by the English sentence ,P is not provable'," because if ,P is provable in PM, PM is , -inconsistent, and if PM is ,-inconsistent, we cannot translate ,P'as 'P is not provable in PM'because the predicate,NaturalNo.(x)'in ,P'"cannot be,interpreted" as "x is a natural number." Though Floyd and Putnam do not clearly distinguish the two tasks, they also argue for "The Floyd-Putnam Thesis," namely, that in the 1930's Wittgenstein had a particular (correct) understanding of Gödel's First Incompleteness Theorem. In this paper, I endeavour to show, first, that the most natural and most defensible interpretation of Wittgenstein's (RFM App. III, §8) and the rest of (RFM App. III) is incompatible with the Floyd-Putnam attribution and, second, that evidence from Wittgenstein's Nachla (i.e., a hitherto unknown "proof sketch" of Gödel's reasoning, Wittgenstein's only mention of ,-inconsistency, and Wittgenstein's only mention of "K provable") strongly indicates that the Floyd- Putnam attribution and the Floyd-Putnam Thesis are false. By way of this examination, we shall see that despite a failure to properly understand Gödel's proof,perhaps because, as Kreisel says, Wittgenstein did not read Gödel's 1931 paper prior to 1942-Wittgenstein's 1937,38, 1941 and 1944 remarks indicate that Gödel's result makes no sense from Wittgenstein's own (idiosyncratic) perspective. [source] Alcohol consumption and liver cirrhosis mortality with and without mention of alcohol,the case of CanadaADDICTION, Issue 9 2003Mats Ramstedt ABSTRACT Aims, To analyse post-war variations in per capita alcohol consumption in relation to gender-specific liver cirrhosis mortality in Canadian provinces and to assess the extent to which alcohol bears a different relation to cirrhosis deaths with mention of alcohol (alcoholic cirrhosis) compared to cirrhosis deaths without mention of alcohol (non-alcoholic cirrhosis). Data and method, Annual liver cirrhosis mortality rates by 5-year age groups were converted into gender-specific and age-adjusted mortality rates. Outcome measures included total cirrhosis,the conventional measure of liver cirrhosis,alcoholic cirrhosis and non-alcoholic cirrhosis. Per capita alcohol consumption was measured by alcohol sales and weighted with a 10-year distributed lag model. A graphical analysis was used to examine the regional relationship and the Box,Jenkins technique for time-series analysis was used to estimate the temporal relationship. Findings, Geographical variations in alcohol consumption corresponded to variations in total liver cirrhosis and particularly alcoholic cirrhosis, whereas non-alcoholic cirrhosis rates were not associated geographically with alcohol consumption. In general, for all provinces, time-series analyses revealed positive and statistically significant effects of changes in alcohol consumption on cirrhosis mortality. In Canada at large, a 1-litre increase in per capita consumption was associated with a 17% increase in male total cirrhosis rates and a 13% increase in female total cirrhosis rates. Alcohol consumption had a stronger impact on alcoholic cirrhosis, which increased by fully 30% per litre increase in alcohol per capita for men and women. Although the effect on the non-alcoholic cirrhosis rate was weaker (12% for men and 7% for women) it was nevertheless statistically significant and suggests that a large proportion of these deaths may actually be alcohol-related. Conclusions, Some well-established findings in alcohol research were confirmed by the Canadian experience: per capita alcohol consumption is related closely to death rates from liver cirrhosis and alcohol-related deaths tend to be under-reported in mortality statistics. [source] Trends in Parkinson's disease related mortality in England and Wales, 1993,2006EUROPEAN JOURNAL OF NEUROLOGY, Issue 9 2009A. Q. N. Mylne Background:, This paper describes changes in Parkinson's disease (PD) mortality in England and Wales between 1993 and 2006 using all information on death certificates. Methods:, Information on deaths was obtained from the Office for National Statistics. Mortality rates for any mention of PD on death certificates were directly age-standardized using the European standard population. Average yearly changes in mortality rates were estimated using linear regression. The underlying cause of death on death certificates where PD was mentioned was examined by sex and calendar period. Results:, Male PD age-standardized mortality rates for any mention of PD decreased from 15.0 to 11.7 per 100 000 between 1993 and 2006. Female PD mortality rates fell from 6.3 to 4.9 per 100 000. Decreases were greater for older age-groups. The proportion of deaths with PD recorded as the underlying cause increased by 50% in 2001 following implementation of the 10th revision of the International Classification of Diseases (ICD). Conclusion:, Parkinson's disease mortality rates in England and Wales are decreasing, especially for men and for older age-groups. Because of data limitations we are unable to ascertain whether the decrease of PD recorded on death certificates is because of a reduction in PD incidence, or to improved survival for PD patients resulting from advancements in PD treatments or to improvements in general medical care. The dramatic increase in PD as the underlying cause of death following ICD revision in 2001 demonstrates the dangers of using underlying cause of death to investigate mortality trends without being aware of the potential for artifacts. [source] Modularity, evolvability, and adaptive radiations: a comparison of the hemi- and holometabolous insectsEVOLUTION AND DEVELOPMENT, Issue 2 2001Andrew S. Yang SUMMARY Despite recent attention given to the concept of modularity and its potential contribution to the evolvability of organisms, there has been little mention of how such a contribution may affect rates of diversification or how this would be assessed. A first key prediction is that lineages with relatively greater degrees of modularity in given traits should exhibit higher rates of diversification. Four general conditions for testing this prediction of the modular evolvability hypothesis are outlined here. The potential role of modularity as a deterministic factor in adaptive radiations is best examined by looking at historic patterns of diversification rather than just levels of extant diversity, the focus of most analyses of key innovations. Recent developmental evidence supports the notion that phenotypes of juvenile and adult stages of insects with "complete" metamorphosis (Holometabola) are distinct developmental and evolvable modules compared to the highly correlated life stages of insects with "incomplete" metamorphosis (Hemimetabola). Family-level rates of diversification for these two groups were calculated from the fossil record. The Holometabola was found to have a significantly and characteristically higher rate of diversification compared to the less modular Hemimetabola, consistent with the idea that intrinsic differences in modularity can influence the long-term evolvability of organisms. The modular evolvability hypothesis also makes a second key prediction: that characters in more modular clades will exhibit greater levels of variation due to their independence. This provides an independent, phenotypically based test of the hypothesis. We discuss here how this second prediction may be tested in the case of the Hemi- and Holometabola. [source] Stroke secondary prevention and blood pressure reduction: an observational study of the use of PROGRESS therapyFUNDAMENTAL & CLINICAL PHARMACOLOGY, Issue 2 2008Jean-Marc Bugnicourt Abstract The Perindopril pROtection aGainst REcurrent Stroke Study (PROGRESS) showed the efficacy of blood pressure reduction in secondary stroke prevention. This anti-hypertensive treatment (perindopril 4 mg daily plus indapamide 1.5 mg daily) is now routinely proposed to patients referred to our department for stroke or transient ischaemic attack (TIA). The aim of this study was to evaluate the prescription of PROGRESS therapy during hospitalization and to identify the predictors of therapy discontinuation after discharge. Eligible patients admitted to the Amiens University hospital for acute stroke or TIA from January to April 2003 were included (n = 101). At 1 year, the use of PROGRESS therapy was evaluated by structured phone interviews. In addition, each patient's general practitioner (GP) was also contacted to provide information. PROGRESS therapy was mentioned on the hospital discharge summary significantly less frequently after cardioembolic stroke (OR: 0.15; 95% CI: 0.05,0.5; P = 0.001) and TIA (OR: 0.12; 95% CI: 0.02,0.7; P = 0.02). At 1 year, only 25.7% of patients were treated with optimal PROGRESS therapy (perindopril 4 mg daily plus indapamide 1.5 mg daily). Mention of PROGRESS therapy in the discharge summary was the main predictor of optimal PROGRESS therapy at 1 year (OR: 10.8; 95% CI: 1.3,88.3; P = 0.03). This study shows that mention of PROGRESS therapy in the discharge summary must be improved as it is associated with a higher use of these anti-hypertensive agents 1 year after stroke/TIA. [source] Faith, hope and money: the Jesuits and the genesis of fundraising for education, 1550,1650*HISTORICAL RESEARCH, Issue 214 2008Dame Olwen Hufton The Society of Jesus in the early modern period produced the largest network of schools the world had known and left an indelible mark on the structures of schooling in Europe into modern times. The distinctive schools were substantial and offered a mixture of civic humanism based on classical texts and theological studies but also, according to place, languages and mathematics, all offered without cost to parents. How was the money raised to build and sustain these institutions by a mendicant order? It is here argued that we see the first indications of the kind of fundraising activities practised by modern front-rank American universities, including building up significant friends, producing newsletters and publications, suppressing mention of failures and accentuating successes and involving a broad spectrum of influential people of both sexes in the expansion process. The author's intent is to argue for a more nuanced approach to the motives of donors than that current in recent historiography. [source] Valuation of biodiversity effects from reduced pesticide useINTEGRATED ENVIRONMENTAL ASSESSMENT AND MANAGEMENT, Issue 2 2006Jesper S. Schou Abstract This study deals with the effects on biodiversity of pesticide-free buffer zones along field margins. Using choice modeling, the majority of respondents to a survey on pesticide use in the environment are willing to accept an increase in the price of bread if the survival of partridge chicks and the number of wild plants increase. The study identifies the need for further empirical work with respect to methodological validation, price estimation, and the use of survey results in policy analysis. In particular, the environmental effects of pesticide use are complex and, therefore, present difficult challenges when presenting information to lay people. Forty-one percent of respondents changed their responses regarding willingness to pay more for bread when references to pesticide use were introduced in the questionnaire. This indicates that scenarios depicting changes in pesticide use can be difficult to present to lay people in an economically rational and well-defined context. Thus, in the study of valuation related to changes in pesticide use, much attention should be devoted to the design and definition of the context. Furthermore, the effects of providing different background information, e.g., with or without the mention of pesticides, should be tested. [source] Concurrent and retrospective verbal reports as tools to better understand the role of attention in second language tasksINTERNATIONAL JOURNAL OF APPLIED LINGUISTICS, Issue 2 2003Joaquim Camps This study investigates how the use of think-aloud protocols, both concurrent and retrospective, can contribute to the study of the role of attention in second language acquisition. It is based on the analysis of think-aloud protocols produced by 74 first-year learners of Spanish during and immediately after a reading and multiple-choice activity. The activity consisted of a text with direct object pronouns and 16 blanks for which a choice of three possible antecedents was given. The key to making the right choice was attending to both form and meaning in the input. The data in the think-aloud protocols was classified into mentions of the pronouns in the text as well as references to gender and number agreement. The results showed that mention of the targeted structure in the think-aloud protocols was related to better performance on the task for second-semester students, but not for first-semester students. There was some difference in the results for the concurrent and retrospective protocols. The possible complementary nature of these two sources of data is discussed. [source] Implementation of oral health recommendations into two residential aged care facilities in a regional Australian cityINTERNATIONAL JOURNAL OF EVIDENCE BASED HEALTHCARE, Issue 3 2006Tony Fallon BAppSc(Hons) PhD Abstract Background, Residents of aged care facilities usually have a large number of oral health problems. Residents who suffer from dementia are at particular risk. A systematic review of the best available evidence with regard to maintaining the oral health of older people with dementia in residential aged care facilities provided a number of recommendations. Objectives, The aim of the implementation project was to introduce evidence-based oral hygiene practices for patients with dementia in two publicly funded residential aged care facilities and monitor for changes in nursing awareness, knowledge, documentation and practice to improve patient outcomes and ensure appropriate accreditation standards were met. An additional aim was to identify barriers and strategies to overcome barriers to implementation of evidence-based recommendations. Methods, Two facilities, a 40-bed facility and a 71-bed facility in the health service district of the regional Australian city of Toowoomba, provided the setting. A quality improvement approach was taken, using a number of strategies from the National Health and Medical Research Council guidelines for implementation studies. The implementation involved a number of stages, including project development, interactive oral health education, oral audits of residents, changes to oral hygiene practice via care plans and critical reflection. Results, The multidisciplinary approach to improving oral healthcare appeared to improve knowledge and awareness and move oral health practices in facilities closer to best practice. Specialised training in oral health was provided to a Clinical Nurse Consultant. Regular oral audits were introduced and facility staff were trained in the use of the oral audit tool. Care plans at one facility were of better quality and more comprehensive than before the intervention. Comments made during critical reflection suggested improvements in the oral health of residents, increased use of oral swabs and saliva substitutes, improved care of dentures and mention of the use of mouth props in resident care plans. There was also some evidence that changes brought about by the implementation are sustainable. Conclusion, The majority of recommendations provided in the systematic review of oral healthcare for dementia patients were applicable to the applied context. The importance of day-to-day leaders was highlighted by the apparently varied outcomes across target facilities. The quality improvement approach would appear to have considerable advantages when applied to improving practice in residential aged care. [source] A fearful child attends: a psychoanalytic explanation of children's responses to dental treatmentINTERNATIONAL JOURNAL OF PAEDIATRIC DENTISTRY, Issue 6 2007RUTH FREEMAN Background., At the mention of dental treatment some children become overwhelmed by anxiety whereas others appear to take the news in their stride. Sometimes when anxious children attend dental treatment, they appear to cope, contain their fears, and passively submit to treatment, whereas others angrily refuse to open their mouths and a third group of children exist who seem to just ,tough it out' no matter how disagreeable or frightening dental treatment becomes. The question remains: why do children react so differently to dental treatment? Aim., This paper aims to provide a psychoanalytic explanation as to why children react and respond differently to dental treatment. Results., This paper proposes a psychoanalytic formulation based on the functionality of the family, parent,child dyads, child psychological development, and the child's emotional and actual life experiences. Conclusions., There is a need to understand the dynamic nature of child dental anxiety and to appreciate the hidden factors and underlying complexities associated with the anxious child who attends for dental treatment. [source] Measuring Consumer Perceptions of Procedural Justice in a Complaint ContextJOURNAL OF CONSUMER AFFAIRS, Issue 2 2000CARL L. SAXBY The idea of procedural justice as perceived by consumers has not been explored in the consumer behavior literature, although there has been some mention of consumer perceptions of fair treatment. This article describes the development of a scale using procedural justice as its theoretic base to measure consumers' perceptions of fair treatment when they complain. Results indicate that consumers make a distinction between the complaint process and the outcome of their complaint, indicating that procedural justice has further research potential. In addition, the proposed scale possesses the psychometric properties of an acceptable scale. [source] Esophageal Causes of Sudden and Unexpected DeathJOURNAL OF FORENSIC SCIENCES, Issue 2 2006Roger W. Byard M.D. ABSTRACT: Gastrointestinal conditions are uncommon causes of sudden and/or unexpected death as compared to cardiovascular diseases, motor vehicle trauma, or suicide, and may involve an array of fatal mechanisms. Lethal esophageal conditions are encountered even less often, the manifestations of which include acute upper airway occlusion from tumors or foreign material, intraluminal hemorrhage from vascular abnormalities, or perforation with fistula formation resulting in hemorrhage and sepsis. When encountered at autopsy, a particular condition may also be a manifestation of a disease that does not primarily involve the esophagus. For this reason, a detailed autopsy investigation is required for evidence of systemic or remote disease when lesions are found within the esophagus. In this report, possible life-threatening esophageal conditions are reviewed with a description of lethal mechanisms, mention of rare associated diseases, and comment on difficulties that may arise at autopsy in the evaluation of such cases. [source] Cause-specific mortality and death certificate reporting in adults with moderate to profound intellectual disabilityJOURNAL OF INTELLECTUAL DISABILITY RESEARCH, Issue 11 2009F. Tyrer Abstract Background The study of premature deaths in people with intellectual disability (ID) has become the focus of recent policy initiatives in England. This is the first UK population-based study to explore cause-specific mortality in adults with ID compared with the general population. Methods Cause-specific standardised mortality ratios (SMRs) and exact 95% confidence intervals were calculated by age and sex for adults with moderate to profound ID living in the unitary authorities of Leicester, Leicestershire and Rutland, UK, between 1993 and 2006. Causes of death were also studied to determine how often ID and associated conditions, such as Down syndrome, were mentioned. Results A total of 503 (17% of population) adults with ID died during the 14-year study period (30 144 person-years). Relatively high cause-specific mortality was seen for deaths caused by congenital abnormalities (SMR = 8560), diseases of the nervous system and sense organs (SMR = 1630), mental disorders (other than dementia) (SMR = 1141) and bronchopneumonia (SMR = 647). Excess deaths were also seen for diseases of the genitourinary system or digestive system, cerebrovascular disease, other respiratory infections, dementia (in men only), other circulatory system diseases (in women only) and accidental deaths (in women only). Two-fifths (n = 204; 41%) of deaths recorded in adults with ID mentioned ID or an associated condition as a contributing cause of death. Conclusions Strategies to reduce inequalities in people with ID need to focus on decreasing mortality from potentially preventable causes, such as respiratory infections, circulatory system diseases and accidental deaths. The lack of mention of ID on death certificates highlights the importance of effective record linkage and ID reporting in health and social care settings to facilitate the government's confidential inquiry into causes of death in this population. [source] ,Learning hospitals' and qualityKNOWLEDGE AND PROCESS MANAGEMENT: THE JOURNAL OF CORPORATE TRANSFORMATION, Issue 4 2003Anastasius Moumtzoglou In the next generation of management thinking, we must go beyond TQM and on to Deming's theory of profound knowledge, much of which is embodied in the field of organizational learning and in particular, in Senge's ,Fifth Discipline' or systems thinking. In this framework there is no explicit mention of quality but the goal is still a process of ongoing improvement, that is, quality is implicitly treated. Hospitals are thought to be pretty complex organizations to implement Senge's theory because they are hierarchical, skills intensive and most health care workers deal with their emotions, patient's emotions, doctor's emotions and fellow employee's emotions in highly intense situations. However, Senge's five ,component technologies' provide an excellent framework to begin with. Copyright © 2003 John Wiley & Sons, Ltd. [source] Ernst Florens Friedrich Chladni (1756,1827) and the origins of modern meteorite researchMETEORITICS & PLANETARY SCIENCE, Issue S9 2007Ursula B. Marvin These ideas violated two strongly held contemporary beliefs: 1) fragments of rock and metal do not fall from the sky, and 2) no small bodies exist in space beyond the Moon. From the beginning, Chladni was severely criticized for basing his hypotheses on historical eyewitness reports of falls, which others regarded as folk tales, and for taking gross liberties with the laws of physics. Ten years later, the study of fallen stones and irons was established as a valid field of investigation. Today, some scholars credit Chladni with founding meteoritics as a science; others regard his contributions as scarcely worthy of mention. Writings by his contemporaries suggest that Chladni's book alone would not have led to changes of prevailing theories; thus, he narrowly escaped the fate of those scientists who propose valid hypotheses prematurely. However, between 1794 and 1798, four falls of stones were witnessed and widely publicized. There followed a series of epoch-making analyses of fallen stones and "native irons" by the chemist Edward C. Howard and the mineralogist Jacques-Louis de Bournon. They showed that all the stones were much alike in texture and composition but significantly different from the Earth's known crustal rocks. Of primary importance was Howard's discovery of nickel in the irons and the metal grains of the stones. This linked the two as belonging to the same natural phenomenon. These chemical results, published in February 1802, persuaded some of the leading scientists in England, France, and Germany that bodies do fall from the sky. Within a few months, chemists in France reported similar results and a new field of study was inaugurated internationally, although opposition lingered on until April 1803, when nearly 3,000 stones fell at L'Aigle in Normandy and transformed the last skeptics into believers. Chladni immediately received full credit for his hypothesis of falls, but decades passed before his linking of falling bodies with fireballs received general acceptance. His hypothesis of their origin in cosmic space met with strong resistance from those who argued that stones formed within the Earth's atmosphere or were ejected by lunar volcanoes. After 1860, when both of these hypotheses were abandoned, there followed a century of debate between proponents of an interstellar versus a planetary origin. Not until the 1950s did conclusive evidence of their elliptical orbits establish meteorite parent bodies as members of the solar system. Thus, nearly 200 years passed before the questions of origin that Chladni raised finally were resolved. [source] Inaugural diversity award winner is announced; law firm award, honorable mention go to two U.K. firmsALTERNATIVES TO THE HIGH COST OF LITIGATION, Issue 2 2009Russ Bleemer The CPR Institute presents its first Award for Outstanding Contribution to Diversity in ADR, and its second set of honorees for the Law Firm Award for Excellence in ADR. Also, CPR offers mediation space, and more. [source] RESEARCH ARTICLES: Traces of a Lost Language and Number System Discovered on the North Coast of PeruAMERICAN ANTHROPOLOGIST, Issue 3 2010Jeffrey Quilter ABSTRACT, Sometime in the early 17th century, at Magdalena de Cao, a community of resettled native peoples in the Chicama Valley on the North Coast of Peru, a Spaniard used the back of a letter to jot down the terms for numbers in a local language. Four hundred years later, the authors of this article were able to recover and study this piece of paper. We present information on this otherwise unknown language, on numeracy, and on cultural relations of ethnolinguistic groups in pre- and early-post-Conquest northern Peru. Our investigations have determined that, while several of the Magadalena number terms were likely borrowed from a Quechuan language, the remainder record a decimal number system in an otherwise unknown language. Historical sources of the region mention at least two potential candidate languages, Pescadora and Quingnam; however, because neither is documented beyond its name, a definite connection remains impossible to establish. RESUMEN, En los inicios del siglo diecisiete, en el sitio de Magdalena de Cao, una comunidad de indígenas reducidos en el valle de Chicama en la costa norte del Perú, un español usó el reverso de una carta para anotar las palabras que traducían números en un idioma local. Cuatrocientos años después, la carta fue recuperada y estudiada por los autores de este artículo. Presentamos información acerca de este idioma desconocido, tanto como sobre los conceptos numéricos, y sobre las relaciones culturales de grupos etnolinguísticos en la costa norte del Perú antes y después de la conquista español. Nuestras investigaciones habían determinado que, mientras algunas de las palabras numéricas son probablemente prestadas de un idioma quechua, los demás vienen de un sistema numérico decimal de un idioma hasta ahora desconocido. Las fuentes históricas en la región mencionan al menos dos idiomas como candidatos potenciales, o sea Pescadora y Quingnam, pero como no sabemos sino esos dos nombres, es imposible identificar a que idiomas pertenecieron. [source] Parkinson's disease mortality among male anesthesiologists and internistsMOVEMENT DISORDERS, Issue 12 2005Chava Peretz PhD Abstract Clusters of Parkinson's disease (PD) among healthcare professionals have been interpreted as evidence of an infectious etiology. Anesthetic gases have also been associated with parkinsonism symptoms and PD among patients undergoing general anesthesia. We investigated PD mortality among large cohorts of male U.S. anesthesiologists (n = 33,040) and internal medicine physicians (n = 33,044). PD mortality for any mention on a death certificate was lower than rates in U.S. men during 1979,1995 for both groups, although anesthesiologists had a significantly elevated risk for PD as underlying cause of death for 10-year follow-up. Direct comparisons of mortality between the two cohorts indicated excess PD mortality in anesthesiologists for >10-year follow-up for any mention and for underlying cause of death. These findings lend some support to the hypothesis that infectious agents or anesthetic gases may be associated etiologically with PD. © 2005 Movement Disorder Society [source] Anesthetic experience of 100 pediatric tracheostomiesPEDIATRIC ANESTHESIA, Issue 7 2009FIONA WRIGHTSON MB ChB FRCA Summary Background:, Tracheostomy is more hazardous in the pediatric population than in adults (Paediatr Nurs, 17, 2005, 38; Int J Pediatr Otorhinolaryngol, 67, 2003, 7; J R Soc Med, 89, 1996, 188). Airway management in these children and infants is potentially challenging. Previous case series of pediatric tracheostomy published in the surgical journals make little mention of anesthetic techniques used and do not describe airway management. The aim of this study was to review the anesthetic, and in particular the airway management of children undergoing tracheostomy at Great Ormond Street Hospital (GOSH). Methods:, Between September 2004 and December 2007, the ENT surgical database showed that 109 children had a surgical tracheostomy performed at GOSH. We were only able to locate the notes of 100 of these cases. The anesthetic records of these 100 patients undergoing tracheostomy were analyzed retrospectively. Results:, Ninety-four percent (94/100) of tracheostomies were elective, and 6% (6/100) were emergency. In this study, 26% (26/100) of children were recorded as difficult to intubate. These difficult airways were managed as follows: 10/26 used a laryngeal mask airway (LMA), 5/26 were managed with facemask alone, 3/26 had fiber-optic intubation, 5/26 had surgical intubation and 2/26 were intubated with the aid of a bougie and cricoid pressure. Conclusions:, This case series demonstrates that intubation is difficult in up to 26% of children presenting for tracheostomy. While intubation of the trachea remains the preferred option when anesthetizing children for tracheostomy, the LMA or facemask can provide a successful airway where intubation is not possible. The use of the LMA or facemask may therefore be life saving in the unintubatable child. [source] Mass spectrometric study of peptides secreted by the skin glands of the brown frog Rana arvalis from the Moscow regionRAPID COMMUNICATIONS IN MASS SPECTROMETRY, Issue 9 2009T. Yu. A high-performance liquid chromatography nano-electrospray ionization Fourier transform mass spectrometry (HPLC/nanoESI-FTMS) approach involving recording of collision-activated dissociation (CAD) and electron-capture dissociation (ECD) spectra of an intact sample and two its modifications after performic oxidation and reduction followed by carboxamidomethylation helps to establish peptide profiles in the crude secretion of frog species at mid-throughput level, including de novo sequencing. The proposed derivatization procedures allow increasing of the general sequence coverage in the backbone, providing complementary information and, what is more important, reveal the amino acid sequence in the cystine ring (,rana box'). Thus purely mass spectrometric efficient sequencing becomes possible for longer than usual proteolytic peptides. Seventeen peptides belonging to four known families were identified in the secretion of the European brown frog Rana arvalis inhabiting the Moscow region in Russia. Ranatuerins, considered previously a unique feature of the North American species, as well as a new melittin-related peptide, are worth special mention. The developed approach was previously successfully used for the identification of peptides in the skin secretion of the Caucasian green frog Rana ridibunda. Copyright © 2009 John Wiley & Sons, Ltd. [source] | |||||||||||||||||||||||||||||||||||||||||||