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Optimal Use (optimal + use)
Selected AbstractsCosmetic Color Improvement of the Nipple-Areola Complex by Optimal Use of Tretinoin and HydroquinoneDERMATOLOGIC SURGERY, Issue 12 2002Kotaro Yoshimura MD background. A successful treatment to improve the color of nipple-areola complex (NAC) has never been reported, although the number of women seeking the more attractively colored NAC is not small. objective. To determine the effectiveness of our bleaching protocol for cosmetic improvement of the NAC. methods. The protocol was composed of two phases: bleaching phase (4,8 weeks) and healing phase (4,6 weeks). 0.2,0.4% tretinoin aqueous gel was applied concomitantly with 5% hydroquinone, 7% lactic acid ointment for bleaching twice a day. Tretinoin was applied to the NAC with a small cotton applicator, while hydroquinone was widely applied beyond the NAC area. After obtaining sufficient improvement in NAC color, the application of tretinoin was discontinued and hydroquinone alone was continually applied in the healing phase until the reactive erythema was eliminated. Fifteen female patients were involved in this study. results. The average treatment period was 16.6 weeks. Improvement of NAC color was obtained in 12 patients (80%) by the physician's estimation, and 11 patients (73%) satisfied with their final results. The treatment was repeated after a 1-month interval of tretinoin application in 4 patients: 2 desired further improvement in color, and 2 had the second course conducted to treat the postinflammatory hyperpigmentation on the surrounding mound induced by the first course. conclusion. This approach appeared to be most effective for cosmetic improvement of NAC color among treatments available so far. [source] Optimal use of high-resolution topographic data in flood inundation modelsHYDROLOGICAL PROCESSES, Issue 3 2003P. D. Bates Abstract In this paper we explore the optimum assimilation of high-resolution data into numerical models using the example of topographic data provision for flood inundation simulation. First, we explore problems with current assimilation methods in which numerical grids are generated independent of topography. These include possible loss of significant length scales of topographic information, poor representation of the original surface and data redundancy. These are resolved through the development of a processing chain consisting of: (i) assessment of significant length scales of variation in the input data sets; (ii) determination of significant points within the data set; (iii) translation of these into a conforming model discretization that preserves solution quality for a given numerical solver; and (iv) incorporation of otherwise redundant sub-grid data into the model in a computationally efficient manner. This processing chain is used to develop an optimal finite element discretization for a 12 km reach of the River Stour in Dorset, UK, for which a high-resolution topographic data set derived from airborne laser altimetry (LiDAR) was available. For this reach, three simulations of a 1 in 4 year flood event were conducted: a control simulation with a mesh developed independent of topography, a simulation with a topographically optimum mesh, and a further simulation with the topographically optimum mesh incorporating the sub-grid topographic data within a correction algorithm for dynamic wetting and drying in fixed grid models. The topographically optimum model is shown to represent better the ,raw' topographic data set and that differences between this surface and the control are hydraulically significant. Incorporation of sub-grid topographic data has a less marked impact than getting the explicit hydraulic calculation correct, but still leads to important differences in model behaviour. The paper highlights the need for better validation data capable of discriminating between these competing approaches and begins to indicate what the characteristics of such a data set should be. More generally, the techniques developed here should prove useful for any data set where the resolution exceeds that of the model in which it is to be used. Copyright © 2002 John Wiley & Sons, Ltd. [source] Optimal use of solar collectors for residential buildingsINTERNATIONAL JOURNAL OF ENERGY RESEARCH, Issue 11 2001Stig-Inge GustafssonArticle first published online: 5 JUN 200 Abstract Solar radiation is an abundant free resource which may be used in the form of solar heated water. This is achieved in solar collectors which, unfortunately, are expensive devices and, further, the warm water must be stored in accumulators,items which also cost money. This paper shows how we have optimized the situation for a block-of-flats in Sweden. In order to find this point we have used the minimum life-cycle cost (LCC) concept as a criterion. The best solution is therefore found when that cost finds its lowest value. It is also examined under which conditions solar collectors are part of the optimal solution and further it is calculated what happens if this optimal point is abandoned, i.e. how much will the LCC increase if other than optimal solutions are chosen. LCC optimization for multi-family buildings almost always results in a heating system with low operating costs such as district heating or dual-fuel systems where a heat pump takes care of the base load and an oil boiler the peak. The installation cost must, however, be kept to a reasonable level. Expensive solar panel systems are therefore normally avoided if the lowest LCC shall be reached, at least for Swedish conditions. This is so even if the solar system has a very low operating cost. For buildings where the only alternative energy source is electricity, solar collectors seem to be on the rim of profitability, i.e. for an energy price of about 0.6 SEK kWh,1. Copyright © 2001 John Wiley & Sons, Ltd. [source] Aminolevulinic acid-loaded Witepsol microparticles manufactured using a spray congealing procedure: implications for topical photodynamic therapyJOURNAL OF PHARMACY AND PHARMACOLOGY: AN INTERNATI ONAL JOURNAL OF PHARMACEUTICAL SCIENCE, Issue 9 2009Rasil Al-Kassas Abstract Objectives The aim was to enhance aminolevulinic acid (ALA) stability by incorporation into low-melting microparticles prepared using a spray congealing procedure and to evaluate temperature-triggered release, allowing topical bioavailability following melting at skin temperature. Methods ALA-loaded Witepsol microparticles were prepared using a novel spray congealing technique. Entrapment efficiency was compared with conventional emulsion-based methods and modelled drug release profiles determined using a membrane separation technique. Raised receiver medium temperature was used to determine triggered release. Bioavailability and lipid-mediated enhancement of ALA penetration were determined in excised murine skin. Key findings ALA-loaded Witepsol microparticles were spherical, with a mean diameter of 20 ,m. Loading and stability studies demonstrated effective encapsulation, ranging from 91% to 100%, with no evidence of degradation to pyrazine derivatives. ALA release correlated with dissolution medium temperature, triggered at temperatures close to that of skin. Results suggested that molten Witepsol enhanced cutaneous permeation, whereas incorporation of microparticles in a semi-solid vehicle attenuated ALA penetration. Optimal use was direct application under occlusion. Conclusions Spray congealing is superior to the emulsion-based procedures with respect to encapsulation efficiency of ALA in Witepsol matrices, providing temperature-triggered release, enhanced stability and improved penetration of ALA through keratinised skin. These features could improve ALA delivery to superficial lesions as part of photodynamic therapy. [source] Pharmacological approaches towards rationalizing the use of endoparasitic drugs in small animalsJOURNAL OF VETERINARY PHARMACOLOGY & THERAPEUTICS, Issue 6 2006S. F. SANCHEZ BRUNI Parasitic diseases are an important health concern to small animal veterinarians worldwide, and their zoonotic potential is also of relevance to human medicine. The treatment and control of such conditions relies heavily on pharmaceutical intervention using a range of antiparasitic drugs and/or their biologically active metabolites. Broad spectrum agents have been produced, although narrow and even monospecific drugs are used in some situations. Their efficacy may depend on dosage, the target pathogen(s), the host species and/or the site of infection. Optimal use of antiparasitics requires a detailed consideration of the pharmacokinetic and pharmacodynamic properties of the drugs in specific clinical contexts. This review summarizes the present status of knowledge on the metabolism, and physicochemical and pharmacological properties of the major antiparasitic drugs currently used in small animal veterinary practice. In addition, data relevant to therapeutic dosage, efficacy and clinical indication/contraindication, particularly in relation to combination drug therapy, are included. [source] Humoral immune responses during a malaria vaccine trial in Tanzanian infantsPARASITE IMMUNOLOGY, Issue 9 2000Galindo The development of a malaria vaccine is a priority for improved and sustained malaria control. Optimal use of a vaccine in Africa will only be achieved if it can be delivered through the Expanded Programme of Immunization (EPI). We have completed a trial of the peptide vaccine SPf66 in Tanzanian infants, given alongside the EPI vaccines. This paper describes the humoral responses to SPf66 and the EPI vaccines. A total of 1207 infants were recruited into a two-arm, double-blind, individually randomized placebo-controlled trial of SPf66. The objectives of the trial were to determine the safety, immunogenicity and efficacy of SPf66 and to assess interactions with EPI vaccines when three doses of SPf66 were delivered alongside the EPI vaccines. Cross-sectional surveys were carried out to asses seroconversion rates to the EPI vaccines and the antibody response to SPf66 (NANP)50 and Plasmodium falciparum lysates. Seroconversion rates to EPI vaccines were high and no statistically significant differences in prevalence or titres were found between SPf66 and placebo recipients. IgG antibodies against SPf66 (NANP)50 and whole P. falciparum lysate were present in high titres in mothers of recruited children at the time of birth. Vaccination with SPf66 stimulated a good anti-SPf66 IgG response which declined to preimmunization levels by 2 years of age and which was not associated with protection against clinical malaria. The vaccine induced no IgG antibodies against (NANP)50 or P. falciparum lysates. SPf66 stimulated a humoral immune response when given to very young infants and did not interfere with seroconversion to EPI vaccines. The response to SPf66 was qualitatively different from that seen in older children, in whom SPf66 has been shown to be moderately efficacious. This difference raises concerns about the difficulties of immunizing very young infants who need to be targeted by antimalarial vaccination programs. [source] A rapid technique for assessing the suitability of areas for invasive species applied to New Zealand's riversDIVERSITY AND DISTRIBUTIONS, Issue 2 2008Cathy Kilroy ABSTRACT Early responses to incursions of non-indigenous species (NIS) into new areas include modelling and surveillance to define the organisms' potential and actual distributions. For well-studied invasive species, predictive models can be developed based on quantitative data describing environmental tolerances. In late 2004, an invasive freshwater diatom Didymosphenia geminata, an NIS for which we had no such quantitative data, was detected in a New Zealand river. We describe a procedure used to rapidly develop a classification of suitability for all New Zealand's rivers, based on two sources of information. First, from a review of the limited available literature and unpublished data, we determined that temperature, hydrological and substrate stability, light availability, and water pH were the most important environmental gradients determining D. geminata's broad-scale distribution and capacity for establishing and forming blooms in rivers. The second information source was a GIS-based river network developed for a national classification of New Zealand's rivers, with associated data describing environmental characteristics of each section of the network. We used six variables that were available for every section of the network as surrogates for the environmental gradients that determine suitability. We then determined the environmental distance of all the river sections in the network from our assessment of the optimal conditions conducive to D. geminata blooms. The analysis suggested that > 70% of New Zealand's river sections (stream order > 3) fell into the two highest suitability categories (on a five-point scale). At the time of writing, D. geminata had spread to 12 catchments, all of which were within these two categories. The technique is applicable in initial responses to incursions of NIS where quantitative information is limited, and makes optimal use of available qualitative information. Our assessment contributed to evaluations of the potential ecological, social, and economic impacts of D. geminata and is currently being used to stratify site selection for ongoing surveillance. [source] Combined Ketogenic Diet and Vagus Nerve Stimulation: Rational Polytherapy?EPILEPSIA, Issue 1 2007Eric H. Kossoff Summary:,Objective: The concept of "rational polypharmacy" has been associated with anticonvulsant management for decades, but the term has not been applied to nonpharmacologic therapies. Methods: We conducted a multicenter, retrospective study of children who received concurrent diet (ketogenic or modified Atkins) and vagus nerve stimulation (VNS) treatment for medically intractable epilepsy. Results: Thirty children in total from six epilepsy centers were treated over a 6-yr period. The median age at the initiation of combination therapy was 10 yr (range, 4,24 yr). Sixteen (53%) received dietary therapy followed by VNS; no differences were noted between centers. After 3 months, 21 (70%) had seizure reduced by >50% over the previous single nonpharmacologic treatment, of whom 13 (62%) had improvement within the first month. A 5-min VNS off-time correlated with >90% seizure reduction (p = 0.02). The median duration of nonpharmacologic polytherapy was 12 months (range, 0.5,96 months); 17 (57%) remain on dual therapy at this time. No side effects were noted. Most patients who discontinued combination therapy did so because of a lack of efficacy rather than restrictiveness. Conclusions: In this small group, the combined use of diet and VNS appeared synergistic and yielded rapid benefits. It may be more effective with longer VNS off-times. Further prospective studies of this combination in refractory pediatric epilepsy are needed to help guide optimal use. [source] Temporal, spatial and biotic variations in extrafloral nectar secretion by Macaranga tanariusFUNCTIONAL ECOLOGY, Issue 6 2000Heil M. Abstract 1Many plants produce extrafloral nectar (EFN) to nourish ants and other animals which defend them against herbivores. We aimed to find reasons for the high variability in amounts of EFN produced by most plant species. We investigated the influence of several biotic and abiotic factors (time of day, leaf age, nectar removal and leaf damage) on secretion rates of EFN in the common south-east Asian pioneer tree species, Macarangatanarius (L.) Muell. Arg. 2In most experiments leaves were washed with pure water and bagged in nets to protect them against nectar-collecting insects, and nectar was collected and quantified 24 h later. Six soluble sugars and up to eight amino acids were detected in nectar samples derived from untreated, field-grown plants. Total amounts of soluble substances varied more than the relative composition of EFN. 3Nectar secretion rates were highest on young, expanded leaves. A diurnal pattern with a secretion peak in the first 2 h after dusk was detected in the field. Nectar removal had a positive effect and its accumulation a negative effect on further EFN production. Artificial leaf damage (punching leaves with a needle or removing parts of the leaf blade with scissors) led to a significant induction of EFN production for the next 3 days. 4Extrafloral nectar of M. tanarius was secreted in complex patterns influenced by different biotic and abiotic factors; its production appeared to be adapted temporally and spatially in order to ensure optimal use of invested resources. [source] Making better biogeographical predictions of species' distributionsJOURNAL OF APPLIED ECOLOGY, Issue 3 2006ANTOINE GUISAN Summary 1Biogeographical models of species' distributions are essential tools for assessing impacts of changing environmental conditions on natural communities and ecosystems. Practitioners need more reliable predictions to integrate into conservation planning (e.g. reserve design and management). 2Most models still largely ignore or inappropriately take into account important features of species' distributions, such as spatial autocorrelation, dispersal and migration, biotic and environmental interactions. Whether distributions of natural communities or ecosystems are better modelled by assembling individual species' predictions in a bottom-up approach or modelled as collective entities is another important issue. An international workshop was organized to address these issues. 3We discuss more specifically six issues in a methodological framework for generalized regression: (i) links with ecological theory; (ii) optimal use of existing data and artificially generated data; (iii) incorporating spatial context; (iv) integrating ecological and environmental interactions; (v) assessing prediction errors and uncertainties; and (vi) predicting distributions of communities or collective properties of biodiversity. 4Synthesis and applications. Better predictions of the effects of impacts on biological communities and ecosystems can emerge only from more robust species' distribution models and better documentation of the uncertainty associated with these models. An improved understanding of causes of species' distributions, especially at their range limits, as well as of ecological assembly rules and ecosystem functioning, is necessary if further progress is to be made. A better collaborative effort between theoretical and functional ecologists, ecological modellers and statisticians is required to reach these goals. [source] Bioethanol: fuel or feedstock?JOURNAL OF CHEMICAL TECHNOLOGY & BIOTECHNOLOGY, Issue 4 2007Jeppe Rass-Hansen Abstract Increasing amounts of bioethanol are being produced from fermentation of biomass, mainly to counteract the continuing depletion of fossil resources and the consequential escalation of oil prices. Today, bioethanol is mainly utilized as a fuel or fuel additive in motor vehicles, but it could also be used as a versatile feedstock in the chemical industry. Currently the production of carbon-containing commodity chemicals is dependent on fossil resources, and more than 95% of these chemicals are produced from non-renewable carbon resources. The question is: what will be the optimal use of bioethanol in a longer perspective? Copyright © 2007 Society of Chemical Industry [source] The science and art of hyaluronic acid dermal filler use in esthetic applicationsJOURNAL OF COSMETIC DERMATOLOGY, Issue 4 2009Michael Gold MD Summary Background, The number of dermal fillers has expanded dramatically; clinicians can benefit from practical information on their optimal use. Aims, To review key determinants of dermal filler performance, to discuss technical considerations, and to illustrate these factors based on the author's clinical experience. Methods, Current literature pertaining to the physicochemical properties of hyaluronic acid (HA) dermal fillers and implications for clinical use was reviewed. The author provides clinical guidelines for optimizing outcomes, illustrated with three case examples. Results, Hyaluronic acids are nonimmunogenic, versatile, reversible, and have excellent benefit,risk profiles, making them near-ideal filling agents. They differ in their manufacturing processes, viscosity, hardness, cohesivity, ease of injection, and ideal uses. Patient counseling and education with individualized selection of the appropriate agent is critical to provide satisfactory outcomes. Conclusions, Clinicians must be technically proficient, balance esthetic need with facial anatomy, and consider HA properties to provide optimal outcomes. [source] How American Children Spend Their TimeJOURNAL OF MARRIAGE AND FAMILY, Issue 2 2001Sandra L. Hofferth The purpose of this article is to examine how American children under age 13 spend their time, sources of variation in time use, and associations with achievement and behavior. Data come from the 1997 Child Development Supplement to the Panel Study of Income Dynamics. The results suggest that parents' characteristics and decisions regarding marriage, family size, and employment affect the time children spend in educational, structured, and family activities, which may affect their school achievement. Learning activities such as reading for pleasure are associated with higher achievement, as is structured time spent playing sports and in social activities. Family time spent at meals and time spent sleeping are linked to fewer behavior problems, as measured by the child's score on the Behavior Problems Index. The results support common language and myth about the optimal use of time for child development. [source] Comparison of plastic films with different optical properties for soil covering in horticulture: test under simulated environmental conditionsJOURNAL OF THE SCIENCE OF FOOD AND AGRICULTURE, Issue 4 2005Adolf Heißner Abstract Covering the soil with plastic film is an important method to modify soil temperature and improve the conditions for plant growth. For the optimal use of films in horticulture, it is necessary to quantify this effect, which depends particularly on the optical properties of the film. Five films, used mainly for soil covering in asparagus cultivation, were tested by measuring the soil temperature as well as the transmittance and reflectance in the short- and long-wavelength bands: ,Taschenfolie schwarz/weiß', a film with black and white surfaces and pockets for fastening; ,Antitaufolie', a film with anti-condensation coating, ,Solartherm plus Folie', a film with black top and transparent sides; ,MaterBi Folie', a biodegradable film; and ,Thermoplus Folie', a black polyethylene with transparent sides. All films were produced in Germany. The temperature measurements were carried out under controlled irradiation (short-wavelength band) and ambient temperature conditions in the laboratory: first, 182 W m,2 and 11 °C at a depth of 0.4 m, and second, 340 W m,2 at 20 °C. A significant relationship between the temperature increase or decrease by covering the soil with the film and the calculated apparent quantities of the reflectance in the short and long-wavelength band was derived (r2 = 0.85, n = 12). Furthermore, first tests with a physical model were carried out to obtain basic information, which should be used in the development of strategies for film management in the field. Copyright © 2004 Society of Chemical Industry [source] Study of bioaccumulation of dalteparin at a prophylactic dose in patients with various degrees of impaired renal functionJOURNAL OF THROMBOSIS AND HAEMOSTASIS, Issue 4 2009P. SCHMID Summary.,Background: Low-molecular-weight heparins (LMWH) have been shown to be effective and safe for prophylaxis of thromboembolic diseases. However, issues regarding safety and optimal use of LMWH arise in patients with renal insufficiency (RI). Objectives: To compare pharmacokinetic data of dalteparin for up to 3 weeks in patients with various degrees of RI. Patients and methods: Patients from general medical and surgical wards were included in this prospective cohort study and divided into three groups according to renal function: A = normal (GFR , 60 mL min,11.73 m,2), B = mild RI (GFR 30,59 mL min,11.73 m,2), C = severe RI (GFR < 30 mL min,11.73 m,2). Dalteparin was injected s.c. once daily at a prophylactic dose. Peak anti-Xa activity levels (anti-Xa) were measured 4 ± 1 h after injection on day 1 and every third day up to 3 weeks. Primary objectives were peak anti-Xa levels and adjusted anti-Xa levels, adjustment being carried out for dose and body weight. Results: A total of 42 patients could be analyzed during a median of 10 days (interquartile range IQR 4,13, range 1,20). In all groups, adjusted peak anti-Xa levels were not different on day 10 compared with day 1. No bioaccumulation >30% could be found up to day 10 even in patients with severe RI. Conclusion: The use of dalteparin at a prophylactic dose was not associated with a bioaccumulation >30% even in patients with severe renal insufficiency during a median follow-up of 10 days (IQR 4,13, range 1,20). [source] Factors that identify survival after liver retransplantation for allograft failure caused by recurrent hepatitis C infectionLIVER TRANSPLANTATION, Issue 12 2004Guy W. Neff Hepatitis C virus (HCV) is becoming the most common indication for liver retransplantation (ReLTx). This study was a retrospective review of the medical records of liver transplant patients at our institution to determine factors that would identify the best candidates for ReLTx resulting from allograft failure because of HCV recurrence. The patients were divided into 2 groups on the basis of indication for initial liver transplant. Group 1 included ReLTx patients whose initial indication for LTx was HCV. Group 2 included patients who received ReLTx who did not have a history of HCV. We defined chronic allograft dysfunction (AD) as patients with persistent jaundice (> 30 days) beginning 6 months after primary liver transplant in the absence of other reasons. HCV was the primary indication for initial orthotopic liver transplantation (OLT) in 491/1114 patients (44%) from July 1996 to February 2004. The number of patients with AD undergoing ReLTx in Groups 1 and 2 was 22 and 12, respectively. The overall patient and allograft survival at 1 year was 50% and 75% in Groups 1 and 2, respectively (P = .04). The rates of primary nonfunction and technical problems after ReLTx were not different between the groups. However, the incidence of recurrent AD was higher in Group 1 at 32% versus 17% in Group 2 (P = .04). Important factors that predicted a successful ReLTx included physical condition at the time of ReLTx (P = .002) and Child-Turcotte-Pugh score (P = .008). In conclusion, HCV is associated with an increased incidence of chronic graft destruction with a negative effect on long-term results after ReLTx. The optimum candidate for ReLTx is a patient who can maintain normal physical activity. As the allograft shortage continues, the optimal use of cadaveric livers continues to be of primary importance. The use of deceased donor livers in patients with allograft failure caused by HCV remains a highly controversial issue. (Liver Transpl 2004;10:1497,1503.) [source] Design principles for virtual patients: a focus group study among studentsMEDICAL EDUCATION, Issue 6 2009Sören Huwendiek Objectives, This study aimed to examine what students perceive as the ideal features of virtual patient (VP) design in order to foster learning with a special focus on clinical reasoning. Methods, A total of 104 Year 5 medical students worked through at least eight VPs representing four different designs during their paediatric clerkship. The VPs were presented in two modes and differed in terms of the authenticity of the user interface (with or without graphics support), predominant question type (long- versus short-menu questions) and freedom of navigation (relatively free versus predetermined). Each mode was presented in a rich and a poor version with regard to the use of different media and questions and explanations explicitly directed at clinical reasoning. Five groups of between four and nine randomly selected students (n = 27) participated in focus group interviews facilitated by a moderator using a questioning route. The interviews were videotaped, transcribed and analysed. Summary reports were approved by the students. Results, Ten principles of VP design emerged from the analysis. A VP should be relevant, of an appropriate level of difficulty, highly interactive, offer specific feedback, make optimal use of media, help students focus on relevant learning points, offer recapitulation of key learning points, provide an authentic web-based interface and student tasks, and contain questions and explanations tailored to the clinical reasoning process. Conclusions, Students perceived the design principles identified as being conducive to their learning. Many of these principles are supported by the results of other published studies. Future studies should address the effects of these principles using quantitative controlled designs. [source] How to use molecular marker data to measure evolutionary parameters in wild populationsMOLECULAR ECOLOGY, Issue 7 2005DANY GARANT Abstract Estimating the genetic basis of phenotypic traits and the selection pressures acting on them are central to our understanding of the evolution and conservation of wild populations. However, obtaining such evolutionary-related parameters is not an easy task as it requires accurate information on both relatedness among individuals and their breeding success. Polymorphic molecular markers are very useful in estimating relatedness between individuals and parentage analyses are now extensively used in most taxa. The next step in the application of molecular data to wild populations is to use them to derive estimates of evolutionary-related parameters for quantitative traits, such as quantitative genetic parameters (e.g. heritability, genetic correlations) and measures of selection (e.g. selection gradients). Despite their great appeal and potential, the optimal use of molecular tools is still debated and it remains unclear how they should best be used to obtain reliable estimates of evolutionary parameters in the wild. Here, we review the methods available for estimating quantitative genetic and selection parameters and discuss their merits and shortcomings, to provide a tool that summarizes the potential uses of molecular data to obtain such parameters in wild populations. [source] Quality of life and use of red cell transfusion in patients with myelodysplastic syndromes.AMERICAN JOURNAL OF HEMATOLOGY, Issue 10 2009A systematic review The main treatment for many patients with Myelodysplastic Syndromes (MDS) remains red cell transfusion to attenuate the symptoms of chronic anemia. Fatigue can reduce a patient's health related quality of life (HRQoL), but there is little understanding of the optimal use of transfusions to improve this. A systematic review was performed to identify and appraise publications reporting the use of HRQoL instruments in patients with MDS. A total of 17 separate studies were identified that used 14 HRQoL instruments, but only one MDS disease specific HRQoL instrument (QOL-E) was reported. Two well established HRQoL instruments were most often used in MDS research (variants of the Functional Assessment of Cancer Therapy (FACT) and the European Organisation for Research and Treatment of Cancer Core Quality of Life Questionnaire (QLQ-C30)). Several common problems were identified in the published literature including a lack of power calculations to detect clinically relevant changes, small sample sizes and significant attrition rates for completion of HRQoL assessments, all of which limit the strength of any conclusions. There is no consensus on the optimal transfusion regimen to improve HRQoL in transfusion-dependent MDS. Future research into HRQoL within MDS is a pressing requirement. Studies should focus on the domains that are of most clinical importance to the patient as well as traditional quantitative changes of hemoglobin concentration. Am. J. Hematol., 2009. © 2009 Wiley-Liss, Inc. [source] Procedural considerations for photographic-based joint angle measurementsPHYSIOTHERAPY RESEARCH INTERNATIONAL, Issue 4 2005Colin Dunlevy Abstract Background and Purpose Measuring static joint angles is important to clinicians involved in assessing, diagnosing and treating musculoskeletal disorders. Ne measurement techniques such as the Uillinn Method © (UM) employ the relatively new technology of digital photography and software to form a virtual goniometer. It is of central importance that the errors associated such new measurement techniques are known. Precision in joint angle measurement is a challenge and errors can arise from three separate categories: equipment error, examiner error or biological error. The aim of the present study was to discover the amount of equipment error associated with the UM and to present guidelines for the optimal use of a photographic based measurement technique Method This was a non-clinical agreement study design that attempted to describe the best possible agreement between a mathematical control dataset and the angles calculated from the virtual goniometer, which in this case was the UM. When this was established, the effect of rotation and placing the angle at the periphery of the camera's field of view were tested. Results The repeatability coefficient (RC) between the UM and the control data under optimal conditions was 0.81°; the typical error (TE) was 0.29° (n = 120). When the angle appeared at the edge of the photograph the RC increased to 2° and the TE to 0.73° (n = 48). When 5° rotation was introduced between the camera and the angle no increase in error was detected. However, increasing amounts of rotation above 5° was proportional to increases in the RC (RC at 10° = 2.3°; 20° = 3.86°; 30° = 14.8°; 40° = 27.27°) and the TE (TE at 10° = 0.83°; 20° = 2.7°; 30° = 5.3°; 40° = 9.8°) scores. Conclusion Photographic-based joint angle measurement techniques are subject to error if careful procedures are not observed. Best procedures include photography from a perpendicular viewpoint and centring the lens on the target angle. Copyright © 2005 John Wiley & Sons, Ltd. [source] Analysis of Cardiac Development in the Turtle Emys orbicularis (Testudines: Emidydae) using 3-D Computer Modeling from Histological SectionsTHE ANATOMICAL RECORD : ADVANCES IN INTEGRATIVE ANATOMY AND EVOLUTIONARY BIOLOGY, Issue 7 2010Laura M.F. Bertens Abstract In this article we present a 3-D modeling study of cardiac development in the European pond turtle, Emys orbicularis (of the reptilian order Testudines). The study is aimed at elucidating the embryonic development of the horizontal septum in the ventricle and underscoring the importance of 3-D reconstructions in studying morphogenesis. Turtles possess one common ventricle, partly divided into three cava by a vertical and a horizontal septum, of which the embryonic origins have so far not been described. We used serial sectioning and computerized high-resolution 3-D reconstructions of different developmental stages to create a chronological overview of cardiogenesis, in order to study this process. This has yielded a new understanding of the development of the horizontal septum and (directly related) the looping of the heart tube. This looping is found to be markedly different from that in the human heart, with the turtle having two clear bends in the part of the heart tube leaving the primitive ventricle, as opposed to one in humans. It is this particular looping that is reponsible for the formation of the horizontal septum. In addition to our findings on the ventricular septation this study has also yielded new insights into the developmental origins of the pulmonary vein. The 3-D reconstructions were built using our platform TDR-3-D base and enabled us to study the developmental processes in specific parts of the turtle heart separately and in three dimensions, over time. The complete 3-D reconstructions have been made available to the reader via internet using our 3-D model browser application, which allows interactive viewing of the models. The browser application can be found on bio-imaging.liacs.nl/galleries/emysorbicularis/TurtleGallery.html, along with additional images of both models and histological sections and animation sequences of the models. By allowing the reader to view the material in such an interactive way, we hope to make optimal use of the new 3-D reconstruction techniques and to engage the reader in a more direct manner. Anat Rec 239:1101,1114, 2010. © 2010 Wiley-Liss, Inc. [source] Innovations in the Assessment of Transplant Center Performance: Implications for Quality ImprovementAMERICAN JOURNAL OF TRANSPLANTATION, Issue 4p2 2009D. A. Axelrod Continuous quality improvement efforts have become a central focus of leading health care organizations. The transplant community has been a pioneer in periodic review of clinical outcomes to ensure the optimal use of limited donor organs. Through data collected from the Organ Procurement and Transplantation Network (OPTN) and analyzed by the Scientific Registry of Transplant Recipients (SRTR), transplantation professionals have intermittent access to specific, accurate and clinically relevant data that provides information to improve transplantation. Statistical process control techniques, including cumulative sum charts (CUSUM), are designed to provide continuous, real-time assessment of clinical outcomes. Through the use of currently collected data, CUSUMs can be constructed that provide risk-adjusted program-specific data to inform quality improvement programs. When retrospectively compared to currently available data reporting, the CUSUM method was found to detect clinically significant changes in center performance more rapidly, which has the potential to inform center leadership and enhance quality improvement efforts. [source] Application of tropical legumes for pig feedANIMAL SCIENCE JOURNAL, Issue 4 2007Apichai MEKBUNGWAN ABSTRACT Raw legume seeds are important source of protein and other nutrients for monogastric animals. However, these legume seeds include many kinds of anti-nutritive factors (ANF) such as trypsin and chymotrypsin inhibitors, lectins and tannins. Although these ANF vary by species, cultivation areas and harvesting methods, they play a role in decreasing the utilization of nutrients. The pig is a monogastric animal which is slightly tolerant to the ANF in raw legume seed. Nevertheless, the optimal use of legume seed as a pig feed necessitates a lowering of the toxicity in the raw seed until it is appropriate for incorporation in the feed. There are many methods to improve the utilization of nutrients in legume seed, such as breeding improvement, physical treatments (decortications, dehulling, milling and others), heat treatments (toasting, boiling, extrusion, streaming or autoclave), chelating substances for binding toxics, radiation and soaking. The choice of the treatment depends on the availability of facilities and economic considerations. This article reviews and discusses the nutrients in legume seeds and might offer an important information on legume seeds for pig feed to nutritionists. [source] Modelling strategic use of the national antiviral stockpile during the CONTAIN and SUSTAIN phases of an Australian pandemic influenza responseAUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 2 2010Jodie McVernon Abstract Objective: To define optimum use of the national antiviral stockpile during the early phases of the response to pandemic influenza in Australia, to inform the 2008 revision of the Australian Health Management Plan for Pandemic Influenza. Methods: A mathematical model was used to compare strategic uses of antiviral agents for treatment and post-exposure prophylaxis to limit transmission until availability of a strain-specific vaccine. The impact of provision of pre-exposure prophylaxis to healthcare workers (HCWs) on the ability to control the epidemic was also assessed. Results: Optimal constraint of epidemic growth was achieved by intensive ascertainment of contacts of cases for post-exposure prophylaxis for as long as feasible. While pre-exposure prophylaxis of healthcare workers utilised a substantial proportion of the stockpile, this did not impede disease control or the ability to treat cases. Absolute delays to outbreak depended on both the intervention strategy and the growth rate of the epidemic. As vaccination was only effective when introduced before explosive growth, this timing was critical to success. Conclusions and implications: Liberal distribution of antiviral drugs to limit disease spread for as long as is feasible represents optimal use of these agents to constrain epidemic growth. In reality, additional non-pharmaceutical control measures are likely to be required to control transmission until vaccines can definitively contain pandemic influenza outbreaks. [source] Clinical assessment and management of the oral environment in the oncology patientAUSTRALIAN DENTAL JOURNAL, Issue 2010LJ Walsh Abstract The dental care of oncology patients is an important component of general dental practice. Oncology patients have additional requirements for their outpatient care in the dental office. Intense involvement of the general dental practitioner in the patient's overall plan of care is essential so that appropriate preventive and therapeutic strategies are followed prior to chemotherapy, radiation and other medical treatments. This paper provides an overview of the role of the dental practitioner in the pre-treatment workup and post-treatment maintenance of oncology patients, and discusses the complications which occur during the intensive and in-hospital phases of care, in the context of approaches that show promise for reducing or preventing these. The role of the general dental practitioner in the maintenance of oral health for the remainder of the patient's life is stressed, with evidence-based recommendations given for optimal use of home care products which support oral health and improve quality-of-life. [source] Teriparatide (Biosynthetic Human Parathyroid Hormone 1,34): A New Paradigm in the Treatment of OsteoporosisBASIC AND CLINICAL PHARMACOLOGY & TOXICOLOGY, Issue 6 2004Kim T. Brixen Biosynthetic human parathyroid hormone 1,34 (teriparatide) was recently approved in the EU and the USA as the first anabolic treatment of osteoporosis. The effects of teriparatide are mediated by the G-protein-dependent, parathyroid hormone receptor-1 in the cell membrane. The binding of the ligand to the receptor activates adenylate cyclase and a number of phospholipases (A, C, and D) and increases intracellular levels of cAMP and calcium. Intermittent teriparatide increases the number of osteoblasts and bone formation by activation of pre-existing osteoblasts, increased differentiation of lining cells, and reduced osteoblast apoptosis. Anabolic effects of teriparatide on bone have been demonstrated in several species. It increases bone mass, structural integrity, bone diameter, and bone strength. Clinical efficacy was demonstrated in a randomized study comprising 1637 post-menopausal women with osteoporosis showing a 65% and 35% reduction of the relative risk of vertebral and appendicular fractures, respectively, during 18 months of treatment. Moreover, bone mineral density in the lumbar spine and hip increased by 9.7% and 2.6%, respectively. Similar effects on bone mineral density have been reported in men with osteoporosis and in glucocorticoid-induced osteoporosis, however, fracture data are limited in these groups. Direct comparison with alendronate revealed that teriparatide has a more pronounced effect on bone mineral density. Teriparatide should be used in combination with calcium plus vitamin D, and may be combined with hormonal replacement therapy. In contrast, alendronate attenuates the effect of teriparatide. The efficacy of other combinations remains uncertain. After termination of teriparatide, bone mineral density of the lumbar spine is reduced by approximately 2,3% after 2 1/2 years. This decrease is prevented by treatment with bisphosphonates. The most frequent adverse effects with teriparatide are nausea, headache, dizziness, and leg cramps, however, only the latter two differed significantly between the groups receiving teriparatide 20 ,g/day and placebo. In the pivotal clinical study, reduced dosage or termination of therapy due to hypercalcaemia was necessary in 3% and 0.2%, respectively. In a rat toxicology study, in which teriparatide was administered in high dosages for an extended period of time, osteosarcoma was seen in a significant number of animals. However, none of the approximately 2800 patients in clinical trials has developed osteosarcoma. Teriparatide constitutes a break-through in the treatment of severe osteoporosis, although a number of issues about the optimal use of teriparatide remains unsettled. The published data provide proof of concept on anabolic therapy which changes several paradigms of bone physiology. Other parathyroid hormone analogues are being investigated in clinical trials and the development of non-peptide, small molecules targeted at the parathyroid hormone receptor may be envisaged. [source] Bisphosphonate therapy for patients with breast carcinomaCANCER, Issue S3 2003Who to treat, when to stop Abstract Bisphosphonates have become well established in the treatment of patients with metastatic bone disease, although the optimal use of these agents has not been defined clearly. Randomized, controlled trials have demonstrated that treatment with intravenous pamidronate can significantly reduce the rate of skeletal-related events in patients with bone metastases from myeloma or advanced breast carcinoma. To date, there are few data from controlled, randomized studies to support the use of bisphosphonates in patients with bone metastases from malignancies other than breast carcinoma and myeloma. The optimal duration of treatment is unknown. Recent data have demonstrated that prolonged treatment is tolerated well, with no obvious toxicity. Generally, treatment is continued irrespective of the development of skeletal-related events and until there is a substantial decline in performance status. The widespread use of bisphosphonates will have major financial implications. Retrospective studies have suggested that the cost-effectiveness ratio is high for patients with advanced breast carcinoma. These ratios may be improved by targeting therapy to patients at high risk of developing complications from skeletal metastatic disease. Among patients with skeletal metastases from breast carcinoma, a recent retrospective analysis demonstrated that patients with disease confined to the skeleton were at greater risk of pathologic fractures compared with patients who had additional extraosseous disease. It is interesting to note that approximately two-thirds of patients with advanced breast carcinoma in the randomized trials of intravenous pamidronate had disease confined to the skeleton. The use of markers of bone turnover to identify patients who are most likely to benefit from bisphosphonate therapy or to identify patients who will respond to such therapy is the subject of further investigation. There are conflicting data on the use of bisphosphonates as an adjuvant therapy. Currently, such treatment should occur only as part of a clinical trial. Bisphosphonates can be used to prevent bone loss as a result of therapy for malignant disease, e.g., premature menopause in patients with early breast carcinoma. Cancer 2003;97(3 Suppl):854,8. © 2003 American Cancer Society. DOI 10.1002/cncr.11146 [source] Trading Land Development Rights under a Planned Land Use System: The "Zhejiang Model"CHINA AND WORLD ECONOMY, Issue 1 2009Hui Wang Q15; Q24; R52; R58 Abstract China's state planned land use system, including regulations such as setting planned quotas for land use, basic cropland preservation, and pursuing a balance between the conversion of arable land into non-agricultural use and the supplement of new agricultural land, has substantially constrained the economic growth of industrial provinces in China. This article explores the innovative reforms adopted by Zhejiang Province through land development rights (LDR) transfer within a locality and LDR trading across localities. We argue that there is a "Zhejiang model of LDR transferring and trading," which, we believe, has significant implications not only for fostering an efficiency-enhancing market for land development rights and agricultural land preservation, but also for optimal use of land and a more balanced regional development. One important policy issue relating to China's rural land system is that under China's land requisition system, farmers are usually under compensated for urban land-taking. [source] Solving multicomponent chiral separation challenges using a new SFC tandem column screening toolCHIRALITY, Issue 3 2007Christopher J. Welch Abstract A tool for improved tandem column chiral supercritical fluid chromatography (SFC) method development screening was prepared by modification of a commercial analytical SFC instrument with two different software-controllable, six position high-pressure column selection valves, each controlling a bank of five different columns and a pass through line. The resulting instrument, which has the ability to screen 10 different individual columns and 25 different tandem column arrangements, is a useful tool for facilitating the screening of tandem column SFC arrangements for separation of complex mixtures of stereoisomers or other multicomponent mixtures. Strategies for optimal use of the instrument are discussed, and several examples of the use of the instrument in developing tandem SFC methods for resolution of multicomponent mixtures are presented. Chirality, 2007. © 2006 Wiley-Liss, Inc. [source] Tumour necrosis factor-alpha (TNF- ,) enhances lymphocyte migration into rheumatoid synovial tissue transplanted into severe combined immunodeficient (SCID) miceCLINICAL & EXPERIMENTAL IMMUNOLOGY, Issue 1 2000S. Wahid Adhesion mechanisms play a major role in the recruitment of peripheral blood lymphocytes (PBL) which characteristically infiltrate rheumatoid arthritis (RA) synovium and other chronically inflamed tissues. Through a sequential series of complex integrated adhesion and signalling events, ,multistep model of migration', specific subsets of PBL are recruited into inflamed tissues. In this process both leucocyte receptors and microvascular endothelial (MVE) counter-receptors play a critical role. The MVE in particular, during an inflammatory state, is the target of various inflammatory mediators that cause the up-regulation of several cell adhesion molecules (CAM). One of the most important factors known to be a powerful inducer of MVE CAM is TNF- ,. Conversely, blocking TNF- , causes a down-modulation of CAM expression. To test directly the capacity of TNF- , to induce cell migration into RA synovium we adapted a model in which synovial grafts were implanted into SCID mice subcutaneously. Using this model we demonstrate that: (i) transplants remain viable and become vascularized and fed by mouse subdermal vessels; (ii) the mouse vasculature connects to the transplant vasculature which maintains the ability to express human CAM; (iii) intragraft injections of TNF- , up-regulate the expression of human CAM, following the down-regulation which occurred 4 weeks post-transplantation; and (iv) the up-regulation of graft CAM is associated with increased human PBL migration into the transplants. This study provides direct evidence in vivo of the capacity of TNF- , to induce cell migration. In addition, it provides the experimental background for the optimal use of this model. [source] | ||||||||||||||||||||||||||||||||||