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Selected AbstractsSingle-port laparoscopic surgery, the new evolution of endoscopic surgeryASIAN JOURNAL OF ENDOSCOPIC SURGERY, Issue 3 2009H. Rivas Abstract Introduction: Laparoscopic surgery through a single port is gaining great interest throughout the world. Our group has pioneered and been a leader on these novel techniques. Here we describe our experience based on a model of single-port laparoscopic cholecystectomy. Materials and Methods: From January 2008 until August 2009, over 200 patients have undergone single-port laparoscopic surgery at our institution. Here, we analyze a cohort of the initial 100 cholecystectomies in order to evaluate a proposed technique, common challenges, the learning curve and potential solutions. Results: Single-port laparoscopic surgery was feasible in all patients from this cohort. Patients were strictly selected. Operating times similar to those of conventional laparoscopy were only achieved after completing 50 cases. Common technical challenges included clashing instruments, deflection of laparoscope due to conflict with light source, and organ retraction. Acceptance by surgeons and lack of patience and time may become significant obstacles that prevent the procedure's widespread adoption. The excellent aesthetic results are superior to laparoscopy. Other benefits of laparoscopy are preserved and may prove to be superior on clinical trials. Discussion: Single-port laparoscopic surgery is becoming popular worldwide. Safe and successful adoption requires learning the basic concepts of this method, identifying challenges, and implementing solutions. Once these essentials are mastered, the learning curve may be shortened, especially for experienced laparoscopic surgeons, and this technique may then be used to replicate many abdominal operations. Transparency with patients and team building are essential requirements for a successful adoption. Clinical trials are ideal before universal adoption. [source] Public employment and labour market performanceECONOMIC POLICY, Issue 34 2002Yann Algan Summary We explore the consequences of public employment for labour market performance. Theory suggests that public employment may not only crowd out private employment, but also increase overall unemployment if, by offering attractive working conditions, it draws additional individuals into the labour force. Empirical evidence from a sample of OECD countries in the 1960,2000 period suggests that, on average, creation of 100 public jobs may have eliminated about 150 private sector jobs, slightly decreased labour market participation, and increased by about 33 the number of unemployed workers. Theoretical considerations and empirical evidence, however, suggest that the crowding out effect of public jobs on private jobs is only significant in countries where public production is highly substitutable to private activities and the public sector offers more attractive wages and/or other benefits than the private labour market. [source] Rehabilitation for community-dwelling people with stroke: home or centre based?INTERNATIONAL JOURNAL OF STROKE, Issue 3 2010A systematic review Stroke rehabilitation for people living in the community is commonly delivered either in a centre, outpatient or day hospital setting. More recently, services may be offered in the actual home of the person as home-based or domiciliary rehabilitation. There are differing reports of the benefits and barriers of home-based vs. centre-based community rehabilitation. This systematic review sought to pool data from all retrieved studies that compared the functional benefits of home-based vs. centre for community-dwelling people with stroke. A comprehensive search strategy was implemented in all major databases (Cochrane library, Medline, AMED, Embase, Ageline, Cinahl, PEDro) for randomised controlled trials investigating this question in relation to functional benefits as a primary outcome and carer, cost or other benefits as secondary outcomes. There were no language or date limits. Eleven trials were found and results pooled for the Barthel Index, the measure of functional independence used consistently across the majority of retrieved studies. There was a significant effect in favour of home-based rehabilitation at 6 weeks (P=0·03) and 3,6 months (P=0·01). The effects were less clear at 6 months, although this was using the less sensitive version of the Barthel Index (P=0·27 or adjusted P=0·04). Individual studies reported cost benefits and increased carer satisfaction in favour of home-based rehabilitation. The provision of rehabilitation for people living in the community should trend towards home-based. Further research is required into adverse events and the experiences of all stakeholders. [source] Lecturer practitioners in UK nursing and midwifery: what is the evidence?JOURNAL OF CLINICAL NURSING, Issue 7 2004A systematic review of the research literature Background., Lecturer practitioner roles have been widely established in the UK, and are seen as having the ability to overcome the theory,practice gap in nursing, as well as offering other benefits including functioning as a link between education and practice. Aims and objectives., This article systematically reviews the research literature on UK lecturer practitioner roles in nursing and midwifery, in order to construct a picture of the themes that emerge from their national implementation. Conclusions., Only eight published research studies meeting the inclusion criteria were identified in journals, and five more included from the ,grey literature', totalling 13 suitable research reports. Of these 13 papers, six involved nurses and midwives. Key themes from the literature are outlined and discussed. There is an overwhelming preference for qualitative methodologies, although there is a strong argument for quantitative work in mixed-methods studies. Relevance to clinical practice. Lecturer practitioner roles can make an important contribution to nursing and midwifery education, but this is problematic. It is essential that managers clarify the purpose, responsibilities, support and review of lecturer practitioner roles if they are to be successful. [source] Individual patient data meta-analysis of randomized anti-epileptic drug monotherapy trialsJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 2 2000Paula R. Williamson PhD Abstract Meta-analysis may be based on either aggregate data or individual patient data (IPD). Three reasons why IPD are desirable for the meta-analysis of anti-epileptic drug (AED) monotherapy trials are: (1) to undertake a more complete analysis of time-to-event outcomes; (2) to investigate the interaction between AED and type of epilepsy; and (3) to undertake re-analysis of the trial to obtain results for all relevant outcomes. We demonstrate that IPD meta-analysis is possible in AED research. Problems arose from missing data at four levels: (1) unknown trials; (2) known trials but no IPD supplied; (3) known trials but missing outcome data for some individuals within trials; and (4) known trials but missing covariate data for some individuals within trials. Empirical evidence of the reliability of meta-analyses based on aggregate rather than individual patient data is still lacking. Examples of other benefits such projects may bring include improvements to the design of a new trial in the area, in terms of the sample size considerations, the definition of outcomes and data collection. [source] Home haemodialysis: ,home, home, sweet, sweet home!' (Review Article)NEPHROLOGY, Issue 3 2005CHRISTOPHER R BLAGG SUMMARY: Home haemodialysis was first developed 40 years ago as a means of treating more patients with the limited funds then available. It soon became obvious that the treatment worked well and subsequent studies and experience have confirmed that it improves both mortality and morbidity and provides the best quality of life and other benefits for dialysis patients. The present review describes the history of the development of home haemodialysis in Seattle and elsewhere and the lessons learned about its benefits in the early days, which are just as relevant today. The advantages and disadvantages are discussed, as are the issues of which patients are candidates for this treatment and what is required of a home haemodialysis training and support programme. The decline in use of home haemodialysis in the USA and elsewhere is described and the actions that may already be beginning to reverse this trend. The role of home haemodialysis in giving the opportunity for longer hours of dialysis three times a week or on alternate nights is important. There is discussion of the relationship of home haemodialysis and peritoneal dialysis and its important future role as the means to enable treatment with more frequent short daily and long nightly haemodialysis. [source] A new dawn , the ecological genetics of mycorrhizal fungiNEW PHYTOLOGIST, Issue 2 2000D. LEE TAYLOR Many human activities, such as ore mining and smeltering, sewage sludge treatment and fossil fuel consumption, result in toxic soil concentrations of ,heavy metals' (Al, Cd, Co, Cr, Cu, Hg, Mn, Ni, Pb, Ti, Zn and others) (Gadd, 1993). There are also natural soils, such as serpentine, with levels of heavy metals that inhibit or preclude the growth of many plants and soil micro-organisms. However, certain plants and microorganisms do grow in these metalliferous sites. Understanding the physiology, ecology and evolution of tolerance to elevated soil metal concentrations is important in an applied setting, and is also of interest in theoretical biology. Applied importance relates to the improvement of forest health in areas subject to increasing pollution, rehabilitation of severely polluted sites by phytostabilization of metals, and metal removal using hyperaccumulating plants (Krämer, 2000; Ernst, 2000). Areas of theoretical interest include the evolution of local adaptation (Sork et al., 1993) and how it is shaped by the combined influences of natural selection, gene flow and genetic architecture, as well as metal influences on various species interactions (Pollard, 2000). A paper appears on pages 367,379 in this issue by Jan Colpaert and coworkers which adroitly combines the disparate fields of physiology, genetics and ecology to answer several outstanding questions concerning heavy metal tolerance in mycorrhizal fungi. Mycorrhizal fungi, which interact mutualistically with the majority of plant species, are well known for improving the P status of their hosts (Smith & Read, 1997). Some mycorrhizal fungi are also able to mobilize N and P from organic substrates and to provide plants with improved micronutrient and water acquisition, pathogen resistance, and a variety of other benefits (Smith & Read, 1997). One of these additional benefits is the amelioration of toxicity in metalliferous soils. [source] Glyphosate: a once-in-a-century herbicidePEST MANAGEMENT SCIENCE (FORMERLY: PESTICIDE SCIENCE), Issue 4 2008Stephen O Duke Abstract Since its commercial introduction in 1974, glyphosate [N -(phosphonomethyl)glycine] has become the dominant herbicide worldwide. There are several reasons for its success. Glyphosate is a highly effective broad-spectrum herbicide, yet it is very toxicologically and environmentally safe. Glyphosate translocates well, and its action is slow enough to take advantage of this. Glyphosate is the only herbicide that targets 5-enolpyruvyl-shikimate-3-phosphate synthase (EPSPS), so there are no competing herbicide analogs or classes. Since glyphosate became a generic compound, its cost has dropped dramatically. Perhaps the most important aspect of the success of glyphosate has been the introduction of transgenic, glyphosate-resistant crops in 1996. Almost 90% of all transgenic crops grown worldwide are glyphosate resistant, and the adoption of these crops is increasing at a steady pace. Glyphosate/glyphosate-resistant crop weed management offers significant environmental and other benefits over the technologies that it replaces. The use of this virtually ideal herbicide is now being threatened by the evolution of glyphosate-resistant weeds. Adoption of resistance management practices will be required to maintain the benefits of glyphosate technologies for future generations. Copyright © 2008 Society of Chemical Industry [source] A survey of the mycorrhization of Southeast Asian ferns and lycophytesPLANT BIOLOGY, Issue 5 2010M. Kessler Abstract The colonisation of land by plants may not have been possible without mycorrhizae, which supply the majority of land plants with nutrients, water and other benefits. In this sense, the mycorrhization of basal groups of land plants such as ferns and lycophytes is of particular interest, yet only about 9% of fern and lycophyte species have been sampled for their mycorrhization status, and no community-level analyses exist for tropical fern communities. In the present study, we screened 170 specimens of ferns and lycophytes from Malaysia and Sulawesi (Indonesia), representing 126 species, and report the mycorrhization status for 109 species and 19 genera for the first time. Mycorrhizal colonisations were detected in 96 (56.5%) of the specimens, 85 of which corresponded to arbuscular mycorrhizae (AMF), three to dark-septate endophytes (DSE) and four to mixed colonisations (AMF + DSE). DSE colonisations were lower than in comparable samples of ferns from the Andes, suggesting a geographical or taxonomic pattern in this type of colonisation. Epiphytes had significantly lower levels of colonisation (26.1%) than terrestrial plants (70.7%), probably due to the difficulty of establishment of mycorrhizal fungi in the canopy habitat. [source] Using measured performance as a process safety leading indicatorPROCESS SAFETY PROGRESS, Issue 2 2009Kenneth H. Harrington Abstract Periodic demands on layers of protection (i.e., prealarms, safety instrumented functions, relief devices, emergency response systems, etc.) are precursors to more serious incidents. The failure of one or more layers of protection is always part of an accident sequence. When they occur documenting these demands and the associated consequences in a way to facilitate analysis, provides a means to measure process safety management performance. Although process safety metrics are still in their adolescence, this article reviews experiences of development and implementation of a "Challenges to Safety Systems" process safety performance indicator. This article includes a discussion of automating significant portions of the data collection process based on the technical work documented by the CCPS PERD (Process Equipment Reliability Database) initiative. The article also recommends various metrics that can be calculated and describes how the initial foundation developed to support improved process safety can be leveraged to achieve other benefits, such as design improvements and improvements in the reliability, operation, and maintenance of the facility. © 2009 American Institute of Chemical Engineers Process Saf Prog, 2009 [source] Foraging ecology of howler monkeys in a cacao (Theobroma cacao) plantation in Comalcalco, MexicoAMERICAN JOURNAL OF PRIMATOLOGY, Issue 2 2006David Muñoz Abstract Recent evidence indicates that primate populations may persist in neotropical fragmented landscapes by using arboreal agroecosystems, which may provide temporary habitats, increased areas of vegetation, and connectivity, among other benefits. However, limited data are available on how primates are able to sustain themselves in such manmade habitats. We report the results of a 9-month-long investigation of the feeding ecology of a troop of howler monkeys (n=24) that have lived for the past 25 years in a 12-ha cacao plantation in the lowlands of Tabasco, Mexico. A vegetation census indicated the presence of 630 trees (,20 cm diameter at breast height (DBH)) of 32 shade species in the plantation. The howlers used 16 plant species (13 of which were trees) as sources of leaves, fruits, and flowers. Five shade tree species (Ficus cotinifolia, Pithecellobium saman, Gliricidia sepium, F. obtusifolia, and Ficus sp.) accounted for slightly over 80% of the total feeding time and 78% of the total number trees (n=139) used by the howlers, and were consistently used by the howlers from month to month. The howlers spent an average of 51% of their monthly feeding time exploiting young leaves, 29% exploiting mature fruit, and 20% exploiting flowers and other plant items. Monthly consumption of young leaves varied from 23% to 67%, and monthly consumption of ripe fruit varied from 12% to 64%. Differences in the protein-to-fiber ratio of young vs. mature leaves influenced diet selection by the monkeys. The howlers used 8.3 ha of the plantation area, and on average traveled 388 m per day in each month. The howlers preferred tree species whose contribution to the total tree biomass and density was above average for the shade-tree population in the plantation. Given the right conditions of management and protection, shaded arboreal plantations in fragmented landscapes can sustain segments of howler monkey populations for many decades. Am. J. Primatol. 68:127,142, 2006. © 2006 Wiley-Liss, Inc. [source] Assessing ecological changes in and around marine reserves using community perceptions and biological surveysAQUATIC CONSERVATION: MARINE AND FRESHWATER ECOSYSTEMS, Issue 4 2010M. Yasué Abstract 1. Well-enforced partial or total no-fishing zones (collectively known as marine protected areas, or MPAs) can help restore degraded coral reefs and enhance fish populations. 2. A comparison was made of community perceptions of ecological changes in an MPA with concurrent scientific data on these changes in the same MPA. Such analyses are particularly important in community-based MPAs where local support is a key determinant of ecological success. 3. The no-take MPA in question was initially launched in partnership with the community in 1995 and formalized in 1998. The perceptions data come from interviews with community members in 1999 and 2004, the biological data come from underwater visual censuses of the MPA from 1998 to 2004. 4. Community members perceived more fish within the MPA and slight increases in catch outside the MPA. In contrast, fish censuses showed a high degree of stochastic variation and only minor increases in fish abundance, size and diversity in and around the MPA between 1998 and 2004. 5. Possible explanations for these discrepancies include different temporal, spatial or species frames of reference and/or limitations to the biological survey technique. Other options include wishful thinking, external influences, a desire to please, or confounding with other benefits. 6. This study demonstrates some of the strengths and weaknesses of community perceptions and biological data. In order to improve our understanding about the changes that occur over time in an MPA and engender community support for the long-term viability of MPAs, it is important to develop diverse and efficient monitoring schemes. Copyright © 2010 John Wiley & Sons, Ltd. [source] A collaborative approach to the environmental assessment process prior to oil exploration activities offshore the Falkland IslandsAQUATIC CONSERVATION: MARINE AND FRESHWATER ECOSYSTEMS, Issue 1 2002Liz Hopkins Abstract 1.Operating Companies awarded acreage in the Falkland Islands First Offshore Licensing Round began exploration for oil and gas in 1996. Appropriate environmental management is an important aspect of exploration activities in any new frontier area and the Falklands Islands were no exception. Operators with drilling commitments established the Falklands Operators Sharing Agreement (FOSA), which included an Environmental Workgroup (EWG) to take responsibility for the environmental issues associated with exploration activities. 2.The EWG was established early in the exploration programme and commissioned a number of specific environmental studies relating to the offshore environment of the Islands. The data made available by this research provided a valuable input to the assessment of potential environmental impacts from the planned exploration activities. By undertaking environmental impact assessments prior to exploration activities FOSA were able to identify and adopt operational and management controls to ensure potential environmental impacts were, where possible, minimized or avoided. 3.The EWG also provided the main point of contact with the regulators on environmental matters and through the Falkland Islands Exploration & Production Environmental Forum facilitated consultation with government departments such as Fisheries, and other stakeholders such as Falklands Conservation. 4.The co-operative approach taken by the operators with regard to the environmental management of the exploration activities offshore the Falkland Islands is considered to have been very successful. The most obvious benefits were through the shared resources resulting in financial savings, however, other benefits have included, avoiding duplication of effort, the promoting of ,working togetherness' and a reduced burden on consultees. Copyright © 2002 John Wiley & Sons, Ltd. [source] Home safety assessment in the prevention of falls among older peopleAUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 5 2000Nancye Peel Objective:Home safety assessment was examined as part of a randomised trial of falls prevention interventions among older community dwellers. Method:Falls prevention strategies, including education and awareness-raising, exercise, home modifications and medical assessment, were trialled with 252 members of the National Seniors Association. Falls outcomes were monitored using a daily calendar diary during intervention and follow-up periods. Results:The home assessment group was significantly more likely to modify their home environment than the controls (p<0.0001). Participants, regardless of group allocation, reported a significant reduction in concern about falling (p<0.0001). During the intervention, the home assessment group had lower incidence rates for falls and injuries than the control group, although differences were not significant. The lowered rates were sustained post-intervention. Conclusions:While the effect on falls incidence of a home safety intervention on its own could not be demonstrated, other benefits, including improved confidence attributable to awareness of such falls prevention measures, were recorded. Implication:The null effects of home modifications on falls prevention in this study may indicate that the program is more appropriate for the frail aged. [source] IMS network signaling peering: Challenges and proposalBELL LABS TECHNICAL JOURNAL, Issue 4 2008Jean-Philippe Joseph IP Multimedia Subsystem (IMS) network peering is a key enabler that will help accelerate deployment of next-generation IMS-based networks. Today's early deployments of dispersed IMS networks require public switched telephone network (PSTN)/public land mobile network (PLMN) bridges for network interconnection between IMS islands. The PSTN/PLMN bridging arrangement is inefficient, however, in that it results in unnecessary settlements for the carriers. It further impedes the implementation of rich multimedia and Voice over IP (VoIP)-related services that require end-to-end Internet Protocol (IP) connectivity. Last, it perpetuates the reliance on the existing PSTN/PLMN network for voice calls among subscribers served by different IMS-based carriers. This paper analyzes in detail the IMS peering challenges from the perspective of Session Initiation Protocol (SIP) signaling peering. It discusses issues related to the routing of SIP messages, and addressing, address resolution, and discovery of peering points for IMS signaling peering. It further establishes that a new routing algorithm is needed that will allow signaling peering points to dynamically discover the "best" transit network among others for reaching a destination. In closing, it presents a high-level IMS signaling routing process that includes, among other benefits, support for number portability as a key function for inter-carrier IMS peering. © 2008 Alcatel-Lucent. [source] Treatment of hepatitis C virus infection in intravenous drug usersACTA NEUROPSYCHIATRICA, Issue 5 2006Matthew L Cowan Background:, Hepatitis C virus (HCV) infection is common among intravenous drug users, and because of the long latent period, HCV liver disease is set to increase. Objectives:, We sought to examine practice guidelines regarding treatment of HCV in drug users and to review the evidence for current practices. Methods:, A structured search of the Pubmed database, websites of the National Institute for Clinical Excellence and national and international expert groups and opinion of independent experts in the field. Results and Conclusions:, All those infected with HCV need to be assessed to ascertain whether they have active ongoing viral replication and the extent of liver damage. HCV-infected individuals should be educated about the modes of transmission and means of reducing the risk of infecting others. They should also be advised to avoid cofactors (especially alcohol) that accelerate the progression of liver disease. Specific treatment with antivirals can cause viral clearance and prevent the progression of liver disease. Therapy is effective in those on opiate-replacement treatments and also in motivated individuals who continue to use intravenous drugs. The decision whether to treat drug users should be made jointly by specialists in the management of viral hepatitis and addiction on a case-by-case basis. Current combination drug regimens are expensive but are claimed to be cost-effective, and are certainly much less costly than managing end-stage liver disease. In addition to satisfactory sustained viral response rates, other benefits such as a beneficial effect on drug habit, self-esteem and rehabilitation have been reported. Encouraging suitable drug users to take-up and comply with treatment seems to be more easily achieved in supportive drug dependency unit settings (rather than the more formal surroundings of a hospital clinic). [source] Nitrilase and Its Application as a ,Green' CatalystCHEMISTRY & BIODIVERSITY, Issue 12 2006Ram Singh Abstract Hydrolase-catalyzed reactions have been widely applied in organic synthesis. Nitrilases are an important class of hydrolase that converts naturally occurring, as well as xenobiotically derived, nitriles to the corresponding carboxylic acids and ammonia. Because of their inherent enantio- and regioselectivities and other benefits, nitrilases are attractive as ,green', mild, and selective catalysts for setting stereogenic centers in fine-chemical synthesis and enantiospecific synthesis of a variety of carboxylic acid derivatives. In this review, the literature has been surveyed to provide a comprehensive coverage of the application of nitrilases in organic synthesis. Literature has also been cited to describe the isolation and/or characterization of nitrilases and related enzymes. [source] | ||||||||||||||||