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Primary Aim (primary + aim)
Selected AbstractsExtended cognitive behavior therapy for cigarette smoking cessationADDICTION, Issue 8 2008Joel D. Killen ABSTRACT Primary aim Examine the effectiveness of extended cognitive behavior therapy (CBT) in promoting longer-term smoking abstinence. Design Open-label treatment phase followed by extended treatment phase. Randomization conducted prior to entry into open-label treatment phase; analysis based on intention-to-treat to avoid threat of selection bias. Setting Community smoking cessation clinic. Participants A total of 304 adult smokers (,18 years of age; ,10 cigarettes/day). Intervention Open-label (8 weeks): all participants received bupropion SR, nicotine patch, CBT. Extended treatment (12 weeks): participants received either CBT + voicemail monitoring and telephone counseling or telephone-based general support. Measurements Seven-day point prevalence abstinence, expired-air carbon monoxide. Results At week 20 follow-up, CBT produced a higher 7-day point prevalence abstinence rate: 45% versus 29%, P = 0.006; at 52 weeks the difference in abstinence rates (31% versus 27%) was not significant. History of depression was a moderator of treatment. Those with a positive history had a better treatment response at 20 weeks when assigned to the less intensive telephone support therapy (P < 0.05). Conclusion The superiority of CBT to 20 weeks suggests that continued emphasis on the development of cognitive and behavioral strategies for maintaining non-smoking during an extended treatment phase may help smokers to maintain abstinence in the longer term. At present, the minimum duration of therapy is unknown. [source] Patient reported and anatomical outcomes after surgery for pelvic organ prolapse,,NEUROUROLOGY AND URODYNAMICS, Issue 3 2009Ahmed S. El-Azab Abstract Aim Primary aim was to modify Pelvic Floor Distress Inventory (PFDI) and Pelvic Floor Impact Questionnaire (PFIQ) to assess pelvic organ prolapse (POP) in Arabic Muslim women. Secondary aim was to compare functional and anatomical outcomes of POP repair. Methods Questionnaire. A characteristic (prayer) was added to PFIQ. Linguistic validation of questionnaires was then done. Twenty cases were enrolled in a pilot study to test internal consistency and reliability. Subsequent study. Prospective study included women with symptomatic POP,,,stage II. History, examination by POP-Q, and administration of PFDI and PFIQ, were done before and 6 months after surgery. Results Questionnaire. Internal consistency of added question was good (Cronbach ,,=,0.78). Test,retest reliability of individual PFIQ items was variable. Subsequent Study. Between September 2004 and February 2007, 78 consecutive women were included. Cystocele, rectocele, and no site predominated in 74.4%, 17.9% and 7.7% of cases, respectively. Preoperatively 19.2%, 15.4% and 47.4% reported stress, urge, and mixed incontinence, respectively. Overall and individual urinary symptoms scores improved significantly after surgery. There were significant improvements in individual symptoms of constipation, splint to defecate and losing not well formed stools. Low self-esteem was most negative impact of prolapse on quality of life (QoL) followed by prayer. After surgery 90% of subjects had anatomical cure. After surgery, QoL issues are significantly related to anatomic location of prolapse as determined by POP-Q. Conclusions Modified PFIQ and PFDI are suitable to assess POP among Muslim women. Postoperatively, many prolapse-related symptoms and QoL significantly improve after surgery on the short term with an anatomic cure rate of 90%. Neurourol. Urodynam. 28:219,224, 2009. © 2008 Wiley-Liss, Inc. [source] Continuous glucose monitoring by intravenous microdialysisACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 7 2010O. ROOYACKERS Background: The conflicting results from studies over tight glucose control in intensive care unit (ICU) patients ask for a continuous on-line real-time glucose monitoring in future. Here, intravenous microdialysis was tested in ICU patients and healthy volunteers. Primary aims were technical feasibility and accuracy. Methods: A microdialysis catheter was inserted into a peripheral vein. ICU patients (n=10) were studied for up to 5 days. Healthy volunteers (n=6) were studied on one occasion. Recordings were monitored during 70 min each 24-h period to allow for an estimate of variability over time. Microdialysis glucose and lactate were compared with plasma glucose and whole blood lactate. Results are presented as medians (quartiles) of the differences between microdialysis and plasma concentrations over each of the 70-min recording periods. Results: Out of the included ICU patients, no exclusions or early terminations were due to failure of the microdialysis catheter. The concordance was highly variable. The difference of medians over the recording periods differed by ,34% (,40, ,16) in patients and ,22% (,31, ,15) for the volunteers. In contrast, the overall variability within the individual measurement periods was low. Conclusion: Technical feasibility was good, but the accuracy was not sufficient and the variability between the recording periods was high without calibrations. The non-availability of suitable peripheral veins was a problem in many patients screened but not included in the study. Intravenous microdialysis to obtain continuous on-line real-time glucose monitoring is technically feasible, but accuracy needs to be improved. [source] Oestrogen receptor , is expressed in adult human skeletal muscle both at the mRNA and protein levelACTA PHYSIOLOGICA, Issue 4 2003A. Wiik Abstract Aim:, There are two known oestrogen receptors (ER), oestrogen receptor , (ER,) and the recently cloned oestrogen receptor , (ER,). ER, mRNA has been detected in mouse, rat, bovine and human skeletal muscle. ER, mRNA has been detected in bovine skeletal muscle. To our knowledge, no study has investigated the expression of oestrogen receptor , in human skeletal muscle. Therefore, the primary aim of the present investigation was to study ER, mRNA and protein expression in human skeletal muscle. In addition the ER, expression was also studied. Methods:, Muscle biopsies were taken from vastus lateralis in six healthy adults (three women and three men). mRNA expression was detected with real-time PCR (TaqMan) and protein localization by immunohistochemistry. Results:, A clear expression of ER, and ER, mRNA was seen in skeletal muscle in all subjects. The ER, mRNA expression was 180 fold higher compared with that of ER, mRNA. Immunohistochemistry demonstrated positive staining for ER,, but not for ER,, with localization to the nuclei of skeletal muscle fibres. On average, 70% of all nuclei were ER, -positive. Conclusion:, The present study shows for the first time ER, mRNA and protein expression in human skeletal muscle tissue in both males and females. [source] Using Evidence to Improve Reproductive Health Quality along the Thailand-Burma BorderDISASTERS, Issue 3 2004Tara M. Sullivan The Mae Tao Clinic, located on the Thailand-Burma border, has provided health services for illegal migrant workers in Thailand and internally displaced people from Burma since 1989. In 2001, the clinic launched a project with the primary aim of improving reproductive health services and the secondary aim of building clinic capacity in monitoring and evaluation (M&E). This paper first presents the project's methods and key results. The team used observation of antenatal care and family-planning sessions and client exit interviews at baseline and follow-up, approximately 13 months apart, to assess performance on six elements of quality of care. Findings indicated that improving programme readiness contributed to some improvement in the quality of services, though inconsistencies in findings across the methods require further research. The paper then identifies lessons learned from introducing M&E in a resource-constrained setting. One key lesson was that a participatory approach to M&E increased people's feelings of ownership of the project and motivated staff to collect and use data for programme decision-making to improve quality. [source] Utility of software analysis of esophageal manometry studies in patients with aperistalsisDISEASES OF THE ESOPHAGUS, Issue 1 2009P. A. Hart SUMMARY Esophageal manometry is the gold standard for the diagnosis of esophageal aperistalsis. There is computer software that analyzes peristalsis on esophageal manometry, but this automated analysis has not been formally evaluated. Our primary aim was to evaluate the software analysis of esophageal aperistalsis by esophageal manometry in patients diagnosed with aperistalsis by an experienced clinician. Esophageal manometry studies from January 2006 to November 2007 were retrospectively reviewed for evidence of aperistalsis by an experienced clinician. All studies demonstrating aperistalsis were selected for further review. The automated analysis performed by our software program for each study was recorded. Agreement between the automated analysis and the clinician was measured by the proportion of agreement on the absence of peristalsis. Eighty-seven of the 962 esophageal manometry studies reviewed demonstrated aperistalsis. The automated analysis reported esophageal body peristalsis with wet swallows in 66 out of 87 patients (75.9%). In these patients, the software analyzed an average of 34.2% of the wet swallows as peristaltic. The agreement between the clinician's review and software analysis of aperistalsis was 24.1%. These data suggest there is poor agreement between the automated analysis of peristalsis and that of an experienced reviewer. Automated analysis cannot be relied upon in the diagnostic evaluation of esophageal aperistalsis as it overestimates the presence of peristalsis and may lead to incorrect diagnoses and management strategies. [source] Estrogen and progesterone receptors in esophageal carcinomaDISEASES OF THE ESOPHAGUS, Issue 4 2008R. Kalayarasan SUMMARY., Information is sparse and contradictory in the literature regarding the role of estrogen receptor (ER) and progesterone receptor (PR) in esophageal carcinoma. This study was conducted over a period of 18 months from September 2004 with the primary aim of determining the PR, ER alpha (ER,) and ER beta (ER,) status of esophageal carcinoma and normal esophageal mucosa (NEM). The receptor status was correlated with tumor type, tumor differentiation and tumor stage. A total of 45 patients with histologically proven squamous cell carcinoma (SCC) (n = 30) and adenocarcinoma (AC) (n = 15) were studied. Receptor status was detected by immunohistochemistry (IHC) and semiquantitative assessment was done by quick score method of endoscopic biopsy specimens. The mean age for SCC and AC were not significantly different. The gender ratio in favor of males was 3 : 2 for SCC and 4 : 1 for AC. None of the specimens from SCC or AC showed positivity for PR both in NEM and tumor tissue. Likewise none of the specimens were positive for ER, by IHC. The mean ER, score for AC was significantly higher than SCC. For SCC it was seen that ER, positivity in tumor cells increases with dedifferentiation and increasing tumor stage. This trend was seen for AC as well. ER, is over-expressed in poorly differentiated SCC and AC compared to NEM. Thus ER, may be a marker for poor biological behavior, that is dedifferentiation or higher stage of disease. In view of these findings we propose a large-scale prospective, longitudinal interventional study using selective estrogen modulators. [source] Pore properties as indicators of breakdown mechanisms in experimentally weathered limestonesEARTH SURFACE PROCESSES AND LANDFORMS, Issue 8 2001Dawn T. Nicholson Abstract The results are reported of four experimental weathering tests , freeze , thaw, wetting and drying, slake durability and salt weathering , on five different types of limestone. Effective porosity, mercury intrusion porosimetry and scanning electron microscopy were used to evaluate changes in pore properties, while weight loss and fracture density were used to assess deterioration severity. A primary aim was to observe modifications in porosity due to weathering and to draw inferences about the internal rock deterioration mechanisms taking place. It is concluded that the five limestones not only show a wide range of resistance to weathering in general but considerable difference in resistance to particular weathering processes. Consequently, when assessing durability it is essential to consider rock properties in the context of the weathering process to which the rock is subject. The type of deterioration indicator used is also important in interpretation of durability. A variety of pore modification mechanisms operate, including changes in pore connectivity, pore infilling, and the introduction of additional void space. There are indications that changes to the internal pore structure of rocks due to weathering may be a precursor to more substantial macrodeterioration. Copyright © 2001 John Wiley & Sons, Ltd. [source] Electrical activation of the orbicularis oculi muscle does not increase the effectiveness of botulinum toxin type A in patients with blepharospasmEUROPEAN JOURNAL OF NEUROLOGY, Issue 3 2010A. Conte Background:, Our primary aim in this study was to determine whether electrically induced activation of the injected muscle increases effectiveness of botulinum type A toxin (BonT-A) in patients with blepharospasm (BPS). The second aim was to assess the safety of BonT-A by investigating whether BonT-A injection alters the excitability of blink reflex circuits in the brainstem. Methods:, Twenty-three patients with BPS received BonT-A (Botox) injected bilaterally into the orbicularis oculi muscle at a standard dose. In 18 patients, electrically induced muscle activation of the orbicularis oculi muscle on one side was performed for 60 min (4 Hz frequency) in a single session, immediately after BonT-A injection and in five patients for 60 min once a day for five consecutive days. The severity of BPS was assessed clinically with the BPS score. Compound muscle action potential (cMAPs) from the orbicularis oculi muscles were measured bilaterally. The blink reflex recovery cycle was studied at interstimulus intervals of 250 and 500 ms. Participants underwent clinical and neurophysiological assessment before BonT-A injection (T0) and 2 weeks thereafter (T1). Results:, Compound muscle action potential amplitude significantly decreased at T1 but did not differ between stimulated and non-stimulated orbicularis oculi in the two groups. BonT-A injection left the blink reflex recovery cycle tested on the stimulated and non-stimulated sides unchanged. Conclusions:, In patients with BPS, the electrically induced muscle activation neither increases the effectiveness of BonT-A nor produces larger electrophysiological peripheral effects. The lack of BonT-A-induced changes in the blink reflex recovery cycle provides evidence that BonT-A therapy is safe in patients with BPS. [source] On the climate and weather of mountain and sub-arctic lakes in Europe and their susceptibility to future climate changeFRESHWATER BIOLOGY, Issue 12 2009R. THOMPSON Summary 1.,The complex terrain and heterogeneous nature of the mountain environment coupled with remoteness from major centres of human activity makes mountains challenging locations for meteorological investigations. Mountainous areas tend to have more varied and more extreme weather than lowlands. 2.,The EMERGE program has the primary aim of assessing the status of remote mountain and sub-arctic lakes throughout Europe for the first time. In this study, we describe the main features of the climate, ice-cover durations and recent temperature trends of these areas. The main weather characteristics of European mountain and sub-arctic lakes are their cold temperatures and year-round precipitation. Mean annual temperatures are generally close to 0 °C, and maximum summer temperatures reasonably close to 10 °C. 3.,Maritime versus continental settings determine the main differences in annual-temperature range among lake districts (10.5 °C in Scotland to 26.7 °C in Northern Finland), and a similar factor for ice-cover duration. Radiation ranges from low (120 W m,2) in the high latitude sub-arctic and high (237 W m,2) in the southern ranges of the Pyrenees and Rila. Similarly, precipitation is high in the main Alpine chain (250 cm year,1 in the Central Southern Alps) and low in the continental sub-arctic (65 cm year,1 in Northern Finland). 4.,The main temporal patterns in air temperature follow those of the adjacent lowlands. All the lake districts warmed during the last century. Spring temperature trends were highest in Finland; summer trends were weak everywhere; autumn trends were strongest in the west, in the Pyrenees and western Alps; while winter trends varied markedly, being high in the Pyrenees and Alps, low in Scotland and Norway and negative in Finland. 5.,Two new, limnological case studies on Lake Redon, in the Pyrenees, highlight the sensitivity of remote lakes to projected changes in the global climate. These two case studies involve close linkages between extreme chemical-precipitation events and synoptic wind-patterns, and between thermocline behaviour and features of the large-scale circulation. 6.,Individual lakes can be ultra-responsive to climate change. Even modest changes in future air temperatures will lead to major changes in lake temperatures and ice-cover duration and hence probably affect their ecological status. [source] Tongue Sandwiches and Bagel Days: Sex, Food and Mind-Body DualismGENDER, WORK & ORGANISATION, Issue 4 2004Lynne Baxter The substantive content of our paper is that of mind-body dualism, which we explore through food metaphors. However, our primary aim is to use these food metaphors to explore the difficulties in going beyond dualistic thinking. We do this by focusing on dualism as a learnt state of being. Accordingly, and using an analysis of pedagogies of the everyday that takes account of particular communities of practice, we seek to demonstrate the (re)production of dualistic frameworks in organizational life. Our conclusion returns to a political agenda that is concerned to go beyond the inevitable hierarchization implicit in dualistic construction. Here we present the case for the retention of the binary and we indicate the work that now needs to take place if we are interested in developing interpretations that express the fluidity of gendered identities. [source] Proton collisions with the water dimer at keV energiesINTERNATIONAL JOURNAL OF QUANTUM CHEMISTRY, Issue 2 2009O. Quinet Abstract Proton collisions with the water dimer are studied using a nonadiabatic, direct, time-dependent approach called electron nuclear dynamics (END). Fragmentation of the water dimer in collisions with protons at energies of 5.0, 1.0 keV and 200 eV is the primary aim of this initial study of water clusters using END. We report on the initial fragmentation dynamic, that is, for times less than 200 fs. © 2008 Wiley Periodicals, Inc. Int J Quantum Chem, 2009 [source] Endotracheal tube size and sore throat following surgery: a randomized-controlled studyACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 2 2010M. JAENSSON Background: Sore throat following endotracheal intubation is a common problem following surgery and one of the factors that affects the quality of recovery. This study was carried out with the primary aim of assessing whether the size of the endotracheal tube (ETT) affects the risk of sore throat in women following anaesthesia. Methods: One hundred healthy adult women undergoing elective surgery were randomly allocated to oral intubation with either ETT size 6.0 or 7.0. Anaesthesia was based on either inhalation or total intravenous anaesthesia according to standardized routines. Pre- and post-operatively, sore throat and discomfort were assessed on a four-graded scale and for hoarseness on a binary scale (yes or no). Post-operatively, the assessments were performed after 1,2 and 24 h, and if there was discomfort at 24 h, a follow-up call was made at 72 and 96 h. Results: After 1,2 h post-operatively, there were a higher proportion of patients with sore throat in ETT 7.0 vs. ETT 6.0 (51.1% vs. 27.1%), P=0.006. This difference between the groups was also evident, P=0.002, when comparing changes between the pre- and the post-operative values. The severity of discomfort from sore throat was also higher in ETT 7.0 (38.8%) compared with ETT 6.0 (18.8%), P=0.02. No differences were found in the incidence of hoarseness between the groups. The remaining symptoms lasted up to 96 h post-operatively in 11%, irrespective of the tube size. Conclusion: Use of a smaller-sized ETT can alleviate sore throat and discomfort in women at the post-anaesthesia care unit. [source] Seroprevalence of hepatitis A virus antibodies in Turkish and Moroccan children in Rotterdam,JOURNAL OF MEDICAL VIROLOGY, Issue 2 2004J.H. Richardus Abstract Seasonal fluctuations in hepatitis A have been observed in the Netherlands related to Turkish and Moroccan children after visiting their home countries. This study determined the prevalence and associated factors of hepatitis A virus (HAV) antibodies in Turkish and Moroccan children in Rotterdam. A random sample was taken of children in Rotterdam, aged 5,16 years, of Turkish and Moroccan origin, together with a random sample of native Dutch children aged 5,7 and 14,16 years. Blood was collected by finger prick on filter paper. IgG and IgM anti-HAV was detected by an enzyme-linked immunoassay (EIA). The 319 Turkish, 329 Moroccan, and 248 native Dutch children participated in the study. In Turkish children, IgG anti-HAV increased from 2.2% to 22.2% over the age groups. In Moroccan children, IgG anti-HAV increased from 10.2% to 57.7%. In native Dutch children, 0.8% had IgG anti-HAV in the youngest and 3.1% in the oldest age group. The percentage IgG-positive also having IgM anti-HAV was 21% in Turkish, and 41% in Moroccan children. No IgG-positive native Dutch children had IgM anti-HAV. The prevalence of IgG anti-HAV was associated with increased age, being Moroccan, longer stay in the country of origin before migrating to the Netherlands, and known contact to HAV. The majority of Turkish and Moroccan children aged 4,16 years in Rotterdam are not protected against HAV, but do have a high risk of becoming infected while visiting their native country. Active vaccination against HAV of these children is indicated, with as primary aim their own protection. Prevention of HAV-transmission in the general community should be seen as a secondary benefit. In addition, possible Dutch contacts of nonvaccinated Turkish and Moroccan children, such as day care workers and teachers, should also be vaccinated against HAV. J. Med. Virol. 72:197,202, 2004. © 2004 Wiley-Liss, Inc. [source] Quality of life in patients with burning mouth syndromeJOURNAL OF ORAL PATHOLOGY & MEDICINE, Issue 7 2008Pía López-Jornet Objective:, To study the quality of life in patients with burning mouth syndrome (BMS), our primary aim was to compare BMS patients with healthy controls and the secondary aim was to compare subgroups of BMS patients on the type of therapy received; using the Medical Outcome Short Form Health Survey Questionnaire (SF-36) and the Oral Health Impact Profile (OHIP-49) as measurement instruments. Method:, Sixty consecutive patients (10 males and 50 females) with BMS were studied in the Department of Oral Medicine (Faculty of Medicine and Dentistry, University of Murcia, Spain), while 60 healthy patients were used as controls. The Spanish version of the SF-36 was used to evaluate general quality of life, together with the OHIP-49 in its Spanish version. Results:, Regarding general quality of life as assessed with the SF-36, and on comparing the BMS vs. the control groups, lower scores were obtained in the former in all domains (P < 0.001). The OHIP-49 in turn yielded significant differences in each of the domains vs. the controls. No significant differences were found between the patients with BMS in any domain regarding parafunctional habits and the presence of dentures. In relation to the different treatments, significant differences were recorded in functional limitation (P = 0.02) and physical pain (P = 0.033). Conclusion:, Patients with BMS yield poorer scores on all scales vs. the healthy controls when applying the SF-36 and OHIP-49. [source] Distribution and abundance of West Greenland humpback whales (Megaptera novaeangliae)JOURNAL OF ZOOLOGY, Issue 4 2004Finn Larsen Abstract Photo-identification surveys of humpback whales Megaptera novaeangliae were conducted at West Greenland during 1988,93, the last 2 years of which were part of the internationally coordinated humpback whale research programme YoNAH, with the primary aim of estimating abundance for the West Greenland feeding aggregation. The area studied stretched from the coast out to the offshore margin of the banks, determined approximately by the 200 m depth contours, between c. 61°70,N and c. 66°N. The surveys were conducted between early July and mid-August and 993 h were expended on searching effort. A total of 670 groups of humpback whales was encountered leading to the identification of 348 individual animals. Three areas of concentration were identified: an area off Nuuk; an area at c. 63°30,N; and an area off Frederikshåb. Sequential Petersen capture,recapture estimates of abundance were calculated for five pairs of years at 357 (1988,89), 355 (1989,90), 566 (1990,91), 376 (1991,92), and 348 (1992,93). Excluding the anomalously high estimate in 1990,91, the simple mean is 359 (se= 27.3, CV = 0.076) and the inverse CV-squared weighted mean is 356 animals (se= 24.9, CV = 0.070). These calculations lead us to conclude that between 1988 and 1993 there were 360 humpbacks (CV = 0.07) in the West Greenland feeding aggregation. Using the Cormack,Jolly,Seber model framework non-calf survival rate was estimated at 0.957 (se= 0.028). Our data have low power (P < 0.3) to detect a trend of 3.1%, assuming the probability of a type I error was 0.05. [source] Does the UKCAT predict Year 1 performance in medical school?MEDICAL EDUCATION, Issue 12 2009Bonnie Lynch Context, The need to identify the best applicants for medicine and to ensure that selection is fair and ethical has led to the development of alternative, or additional, selection tools. One such tool is the United Kingdom Clinical Aptitude Test, or UKCAT. To date there have been no studies of the predictive validity of the UKCAT. Objectives, This study set out to identify whether UKCAT total score and subtest scores predict Year 1 outcomes in medical school. Methods, Year 1 students starting in 2007 at the University of Aberdeen or University of Dundee medical schools were included. Data collected were: UKCAT scores; Universities and Colleges Admissions Service (UCAS) form scores; admission interview scores; final Year 1 degree examination scores, and records of re-sitting examinations and of withdrawing from a course. Correlations were used to select variables for multiple regression analysis to predict examination scores. Results, Data were available for 341 students. Examination scores did not correlate with UKCAT total or subtest scores. Neither UCAS form score nor admission interview score predicted outcomes. None of the UKCAT scores were reliably associated with withdrawals (P -values for all comparisons > 0.05). Only the decision analysis subtest was associated with re-sits of examinations, but the difference in means was contrary to the direction anticipated (P = 0.025, 95% confidence interval = 6.1,89.7). Discussion, UKCAT scores did not predict Year 1 performance at the two medical schools. Although early prediction is arguably not the primary aim of the UKCAT, there is some cause for concern that the test failed to show even the small-to-moderate predictive power demonstrated by similar admissions tools. [source] Towards minimizing immunosuppression in pediatric liver transplant recipientsPEDIATRIC TRANSPLANTATION, Issue 5 2009Yumirle P. Turmelle Abstract:, Immunosuppression regimens after liver transplantation focus mainly on preventing rejection and subsequent graft loss. However, in children, morbidity and mortality rates from infections exceed those from rejection after transplant, and immunosuppression can hinder growth, renal function, and graft tolerance. We hypothesized that early steroid withdrawal, with a primary aim of TAC monotherapy would yield no penalty in terms of rejection and graft loss, while reducing risks of infection and maximizing growth. We prospectively evaluated 64 consecutive pediatric liver transplant recipients. One yr patient/graft survival was 93/90%, respectively. At one yr post-transplant, 75.4% of patients were on TAC monotherapy. No deaths or graft losses were caused by infection. Sixty-one percent of patients had at least one episode of rejection, most within three months following transplant and 3.8% were treated for chronic rejection. One non-compliant adolescent died from chronic rejection. CMV, EBV, and lymphoproliferative disease rates were 3.1%, 5.3%, 1.8%, respectively. Pretransplant and one yr post-transplant glomerular filtration rates were unchanged. One yr improved catch-up growth was observed. We conclude that immunosuppression minimization after pediatric liver transplant yields no serious complications from rejection, and might confer advantages with respect to infection, renal function, growth, and is deserving of wider application and study. [source] Whole-seed development in Sicyos angulatus (Cucurbitaceae, Sicyeae) and a comparison with the development of water-impermeable seeds in five other familiesPLANT SPECIES BIOLOGY, Issue 3 2010XIAOXIA QU Abstract Sicyos is the only member of the Cucurbitaceae known to have water-impermeable seeds, that is, physical dormancy (PY), and development of seeds with PY has not been studied in detail in this family. Our primary aim was to describe seed development in Sicyos angulatus from pollination to seed maturity and to compare it with the development of water-impermeable seeds in other families reported in the literature. Full seed stage (highest moisture content [MC]) occurred 4,6 days after pollination (DAP) and physiological maturity occurred 20 DAP. Seeds became water impermeable 32 DAP, with 14.6% MC. The hilum was the site of water loss during the final stage of maturation drying. Excised embryos could germinate from 20 DAP to 36 DAP, whereas no intact seeds germinated during any stage of seed development. Mechanical scarification did not promote germination of seeds after the seed coat became water impermeable at 32,36 DAP. Based on a previous study of seed dormancy and germination in S. angulatus, we suggest that germination in these scarified seeds may have been prevented by resistance of inner membrane and fruit-seed coat to embryo expansion. The MC when seeds became impermeable (14.6%) is in the range of that reported for seeds of species in five other families with PY. Information on seed development in S. angulatus will be useful in planning the timing of management strategies for this pernicious annual weed. [source] Dihydrotestosterone activates the MAPK pathway and modulates maximum isometric force through the EGF receptor in isolated intact mouse skeletal muscle fibresTHE JOURNAL OF PHYSIOLOGY, Issue 3 2010M. M. Hamdi It is generally believed that steroid hormones have both genomic and non-genomic (rapid) actions. Although the latter form an important component of the physiological response of these hormones, little is known about the cellular signalling pathway(s) mediating these effects and their physiological functions in adult mammalian skeletal muscle fibres. Therefore, the primary aim of this study was to investigate the non-genomic actions of dihydrotestosterone (DHT) and their physiological role in isolated intact mammalian skeletal muscle fibre bundles. Our results show that treating the fibre bundles with physiological concentrations of DHT increases both twitch and tetanic contractions in fast twitch fibres. However, it decreases them in slow twitch fibres. These changes in force are accompanied by an increase in the phosphorylation of MAPK/ERK1/2 in both fibre types and that of regulatory myosin light chains in fast twitch fibres. Both effects were insensitive to inhibitors of Src kinase, androgen receptor, insulin-like growth factor 1 receptor and platelet-derived growth factor receptor. However, they were abolished by the MAPK/ERK1/2 kinase inhibitor PD98059 and the epidermal growth factor (EGF) receptor inhibitor tyrphostin AG 1478. In contrast, testosterone had no effect on force and increased the phosphorylation of ERK1/2 in slow twitch fibres only. From these results we conclude that sex steroids have non-genomic actions in isolated intact mammalian skeletal muscle fibres. These are mediated through the EGF receptor and one of their main physiological functions is the enhancement of force production in fast twitch skeletal muscle fibres. [source] Hospital-Physician Collaboration: Landscape of Economic Integration and Impact on Clinical IntegrationTHE MILBANK QUARTERLY, Issue 3 2008LAWTON ROBERT BURNS Context: Hospital-physician relationships (HPRs) are an important area of academic research, given their impact on hospitals' financial success. HPRs also are at the center of several federal policy proposals such as gain sharing, bundled payments, and pay-for-performance (P4P). Methods: This article analyzes the HPRs that focus on the economic integration of hospitals and physicians and the goals that HPRs are designed to achieve. It then reviews the literature on the impact of HPRs on cost, quality, and clinical integration. Findings: The goals of the two parties in HPRs overlap only partly, and their primary aim is not reducing cost or improving quality. The evidence base for the impact of many models of economic integration is either weak or nonexistent, with only a few models of economic integration having robust effects. The relationship between economic and clinical integration also is weak and inconsistent. There are several possible reasons for this weak linkage and many barriers to further integration between hospitals and physicians. Conclusions: Successful HPRs may require better financial conditions for physicians, internal changes to clinical operations, application of behavioral skills to the management of HPRs, changes in how providers are paid, and systemic changes encompassing several types of integration simultaneously. [source] Sexual dimorphism and seasonal changes of leaf gas exchange in the dioecious tree Ilex paraguariensis grown in two contrasted cultivation typesANNALS OF APPLIED BIOLOGY, Issue 2 2009M. Rakocevic Abstract Yerba maté (Ilex paraguariensis, Aquifoliaceae) is a subtropical, evergreen, dioecious, South American tree. In one preliminary study, it was observed that the functional strategy of yerba mate females, aiming to finish reproductive process, was increased transpiration relative to photosynthetic rates compared with males, on self-shaded leaves. We hypothesised that the long-term gas exchange response of males and females can evolve independently of phenological stage and cultivation type. In this spirit, the primary aim of the study was to analyse the physiological sexual dimorphism of this species, evaluating fluctuations of gas exchanges related to microclimate and phenological stages. A field study was conducted on adult plants of yerba maté cultivated in monoculture (MO) and in forest understorey (FUS), and measurements carried out in situ on microclimate and leaf gas exchange parameters. The photosynthetic photon flux density that was attained at leaf level in FUS was reduced roughly 10-fold compared with that in MO. Various leaf age populations were observed during a 2-year period at 2-month intervals and grouped into four categories: young, young-fully-expanded, fully-expanded and old. Young and young-fully-expanded leaves were the most active in photosynthesis. Leaves of female plants showed greater photosynthetic rate than those of male plants, which was expressed on all leaf age categories in MO, but only during vegetative stages previous to flowering and fruit ripening. The photosynthesis of young-fully-expanded leaves of females grown in FUS was superior to males but only during winter growth pause. The stomatal conductance differed in relation to cultivation type and leaf age but did not show the sexual differentiation. Physiological sexual dimorphism in yerba mate is shown to be plastic, responding to environmental conditions. The cost associated to the reproduction of yerba maté could be most easily met showing physiological differentiation of both sexes. A higher reproductive investment of females might be compensated for by exhibiting greater leaf photosynthesis than males that occurs in vegetative stages that precede flowering and fruit ripening. [source] Workplace-based assessment: assessing technical skill throughout the continuum of surgical trainingANZ JOURNAL OF SURGERY, Issue 3 2009Jonathan Beard Abstract The Royal Colleges of Surgeons and Surgical Specialty Associations in the UK have introduced competence-based syllabi and curricula for surgical training. The syllabi of the Intercollegiate Surgical Curriculum Programme (ISCP) and Orthopaedic Curriculum and Assessment Programme (OCAP) define the core competencies, that is, the observable and measureable behaviours required of a surgical trainee. The curricula define when, where and how these will be assessed. Procedure-based assessment (PBA) has been adopted as the principal method of assessing surgical skills. It combines competencies specific to the procedure with generic competencies such as safe handling of instruments. It covers the entire procedure, including preoperative and postoperative planning. A global summary of the level at which the trainee performed the assessed elements of the procedure is also included. The form has been designed to be completed quickly by the assessor (clinical supervisor) and fed-back to the trainee between operations. PBA forms have been developed for all index procedures in all surgical specialties. The forms are intended to be used as frequently as possible when performing index procedures, as their primary aim is to aid learning. At the end of a training placement the aggregated PBA forms, together with the logbook, enable the Educational Supervisor and/or Programme Director to make a summary judgement about the competence of a trainee to perform index procedures to a given standard. [source] END-OF-LIFE CARE IN THE 21st CENTURY: ADVANCE DIRECTIVES IN UNIVERSAL RIGHTS DISCOURSEBIOETHICS, Issue 3 2010IREVI, VIOLETA BE ABSTRACT This article explores universal normative bases that could help to shape a workable legal construct that would facilitate a global use of advance directives. Although I believe that advance directives are of universal character, my primary aim in approaching this issue is to remain realistic. I will make three claims. First, I will argue that the principles of autonomy, dignity and informed consent, embodied in the Oviedo Convention and the UNESCO Declaration on Bioethics and Human Rights, could arguably be regarded as universal bases for the global use of advance directives. Second, I will demonstrate that, despite the apparent consensus of ethical authorities in support of their global use, it is unlikely, for the time being, that such consensus could lead to unqualified legal recognition of advance directives, because of different understandings of the nature of the international rules, meanings of autonomy and dignity which are context-specific and culture-specific, and existing imperfections that make advance directives either unworkable or hardly applicable in practice. The third claim suggests that the fact that the concept of the advance directive is not universally shared does not mean that it should not become so, but never as the only option in managing incompetent patients. A way to proceed is to prioritize work on developing higher standards in managing incompetent patients and on progressing towards the realization of universal human rights in the sphere of bioethics, by advocating a universal, legally binding international convention that would outlaw human rights violations in end-of-life decision-making. [source] Technoreview: Focusing light on infection in four dimensionsCELLULAR MICROBIOLOGY, Issue 4 2004Pascal Roux Summary The fusion of cell biology with microbiology has bred a new discipline, cellular microbiology, in which the primary aim is to understand host,pathogen interactions at a tissue, cellular and molecular level. In this context, we require techniques allowing us to probe infection in situ and extrapolate quantitative information on its spatiotemporal dynamics. To these ends, fluorescent light-based imaging techniques offer a powerful tool, and the state-of-the-art is defined by paradigms using so-called multidimensional (multi-D) imaging microscopy. Multi-D imaging aims to visualize and quantify biological events through time and space and, more specifically, refers to combinations of: three (3D, volume), four (4D, time) and five (5D, multiwavelength)-dimensional recordings. Successful multi-D imaging depends upon understanding the available technologies and their limitations. This is especially true in the field of microbiology where visualization of infectious/pathogenic activities inside living host systems presents particular technical challenges. Thus, as multi-D imaging rapidly becomes a common bench tool to the cellular microbiologist, this review provides the new user with some of the necessary technical insight required to get the best from these methods. [source] The role and duties of scientific medical societies: The German Society of Dermatology from the member's perspectiveJOURNAL DER DEUTSCHEN DERMATOLOGISCHEN GESELLSCHAFT, Issue 1 2010Peter Hensen Summary Background: The German Society of Dermatology is a scientific medical society that represents the interests of German-speaking dermatology. One recommendation of a strategic planning mission was to increase the involvement of society members. Methods: Based on an empirical approach (questionnaire survey) a systematic member inquiry was performed which focused on the motives for membership, the image of the society,the use of provided services,and expectations and needs. Items regarding profession and health politics, continuous education and specialist training, and scientific representation and research promotion were considered in equal measure. Results: In total, 931 usable questionnaires were available with a response rate of 28.4%. Various single results could be integrated in a subsequent strategic dialogue. The German Society of Dermatology is regarded as active and powerful in scientific issues and promotion of research. However, numerous expectations have been expressed to strengthen future activities in professional and health care related issues. Needs and demands differ if members are scientifically active or rather not. Conclusions: A scientific society in general acts in a permanent area of conflict and has to deal with multiple positions and interests. Thereby members' needs and demands may vary dependent on individual and professional backgrounds. Members who are not scientifically active should be more integrated in the society while at the same time the society's aims should be coordinated with that of the Berufsverband (organization of practicing dermatologists). Better networking is required both within the society and with outside groups. In addition, the primary aims and objectives of the society should be made even clearer to all interested parties. [source] | |||||||||||||||||||