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Selected AbstractsThe Prevalence of Valvular Abnormalities in Patients Who Were Referred for Echocardiographic Examination With a Primary Diagnosis of "Heart Murmur"ECHOCARDIOGRAPHY, Issue 5 2007Mohammad-Reza Movahed M.D., Ph.D. Introduction: The prevalence of valvular abnormality and innocent murmur in patients who are referred for echocardiographic evaluation with the diagnosis of "murmur" is not known. The goal of this study was to evaluate the prevalence of valvular abnormalities in such patients. Methods: We retrospectively reviewed the echocardiograms that were referred with the primary ordering diagnosis of "murmur," for the presence of valvular abnormalities. For comparison, we used other documented primary reasons for echocardiographic referral, such as chest pain, shortness of breath, etc. Results: In this cohort, 7,684 echocardiogram reports documented primary diagnostic reasons for echocardiographic referral. A total of 3,460 echocardiogram reports (45%) were coded "murmur" as the primary reason for the study referral. There was a higher prevalence of female patient referrals for heart murmur evaluation (61.8% vs. 38.2%). Although, patients with murmur had a higher prevalence of valvular abnormalities, compared to other reasons for echocardiographic examination, the prevalence of valvular abnormality was less than 50% (48.6% vs. 35.5%) in both groups. Despite the higher number of female patients referred with the diagnosis of murmur, the percentage of abnormal valves was lower in women (45.6% vs. 53.4% in men). Conclusion: The prevalence of valvular abnormalities in patients who were referred with the diagnosis of murmur for echocardiographic examination was less than 50%, with a lesser degree found in women. Routine utilization of echocardiography for evaluation of all murmurs may be unwarranted. [source] The Impact of Cerebral Source Area and Synchrony on Recording Scalp Electroencephalography Ictal PatternsEPILEPSIA, Issue 11 2007James X. Tao Summary Purpose: To determine the cerebral electroencephalography (EEG) substrates of scalp EEG seizure patterns, such as source area and synchrony, and in so doing assess the limitations of scalp seizure recording in the localization of seizure onset zones in patients with temporal lobe epilepsy. Methods: We recorded simultaneously 26 channels of scalp EEG with subtemporal supplementary electrodes and 46,98 channels of intracranial EEG in presurgical candidates with temporal lobe epilepsy. We correlated intracranial EEG source area and synchrony at seizure onset with the corresponding scalp EEG. Eighty-six simultaneous intracranial- and scalp-recorded seizures from 23 patients were evaluated. Results: Thirty-four intracranial ictal discharges (40%) from 9 patients (39%) had sufficient cortical source area (namely > 10 cm2) and synchrony at seizure onset to produce a simultaneous or nearly simultaneous focal scalp EEG ictal pattern. Forty-one intracranial ictal discharges (48%) from 10 patients (43%) gradually achieved the necessary source area and synchrony over several seconds to generate a scalp EEG ictal pattern. These scalp rhythms were lateralized, but not localizable as to seizure origin. Eleven intracranial ictal discharges (13%) from 4 patients (17%) recruited the necessary source area, but lacked sufficient synchrony to result in a clearly localized or lateralized scalp ictal pattern. Conclusions: Sufficient source area and synchrony are mandatory cerebral EEG requirements for generating scalp-recordable ictal EEG patterns. The dynamic interaction of cortical source area and synchrony at the onset and during a seizure is a primary reason for heterogeneous scalp ictal EEG patterns. [source] Origin of Radiation-Induced Degradation in Polymer Solar CellsADVANCED FUNCTIONAL MATERIALS, Issue 16 2010Ankit Kumar Abstract Polymer solar cells have been shown to degrade under X-rays. Here, in situ polymer photovoltaic performance and recombination lifetimes are measured and it is found that charge accumulation is the primary reason for degradation of solar cells. This is affected by the mixing ratio of donor and acceptor in the bulk heterojunction. Both a quantitative understanding and the physical model of the degradation mechanism are presented. Understanding of the degradation mechanism is extended in polymer donor,acceptor bulk heterojunction systems to propose a material combination for making radiation hard diodes that can find important application in fields ranging from memory arrays to organic X-ray detectors for medical imaging. [source] Analysis of free flap viability based on recipient vein selectionHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 10 2009David O. Francis MD Abstract Background. Venous anastomotic failure is the primary reason for microvascular free tissue transfer failure. Donor and recipient veins can be oriented in the same longitudinal axis (end-to-end anastomosis), or the donor vein can be anastomosed to the internal jugular vein in an end-to-side configuration. No consensus on the optimal anastomosis configuration exists. We sought to evaluate whether type of venous anastomosis impacts flap survival rate. Methods. Data were collected on all patients undergoing microvascular free flap reconstruction of head and neck defects at the University of Washington between August 1993 and April 2007. Flaps with a single venous anastomosis were analyzed. Flaps were stratified into those with end-to-end and end-to-side anastomoses. Survival rates were compared between groups using bivariate and multivariate techniques. Results. Inclusion criteria were met by 786 free flaps; 87% performed in an end-to-end and 13% in an end-to-side configuration. Flap re-exploration and failure rate were 4.3% and 1.1%, respectively. In multivariate analysis, there was no difference in odds of flap re-exploration (OR .70, 95% CI .23,2.18) or flap failure whether or not an end-to-end or end-to-side anastomosis was performed (OR 2.09, 95% CI .38,11.5). Conclusions. In this large cohort of patients, we found no difference in the odds of flap re-exploration or failure based on venous anastomotic configuration. Reconstructive surgeons should have both anastomotic techniques in their repertoire to optimize the success of every flap. © 2009 Wiley Periodicals, Inc. Head Neck, 2009 [source] Physiological Responses of Krishum (Iris lactea Pall. var. chinensis Koidz) to Neutral and Alkaline SaltsJOURNAL OF AGRONOMY AND CROP SCIENCE, Issue 6 2008Y. Wang Abstract The aims of this study were to compare the physiological responses of krishum (Iris lactea Pall. var. chinensis Koidz) to neutral and alkaline salt stress and identify and examine the mechanisms involved in plant response to salt treatments. In this study, biomass, ion accumulation (Na+, K+, Ca2+, Mg2+), organic solute (proline) concentration, rate of membrane electrolyte leakage (REL) and antioxidase activities including those of superoxide dismutase (SOD, EC 1.15.1.1), catalase (CAT, EC 1.11.1.6) and peroxidase (POD, EC 1.11.1.7) were investigated in krishum under different concentrations of NaCl, Na2CO3 and the mixture of the two salts in the same volume. All three treatments caused increases in Na+ concentration, proline content and REL and decreases in root Mg2+ and K+ content. Increased Ca2+ and antioxidase activities were observed at lower external Na+ concentrations. However, at higher external Na+ levels, decreased Ca2+ and antioxidase activities were detected. Alkaline salt resulted in more damage to krishum than neutral salt including lower SOD, POD and CAT activities and decreased proline content, relative to neutral salt. High Na+ and low K+ in krishum intensified ion toxicity under alkaline condition. Alkaline salt caused greater harm to plants than neutral salt, the primary reason of which might be the lower Ca2+ content in the plant under alkaline salt stress. [source] Diet reconstruction and historic population dynamics in a threatened seabirdJOURNAL OF APPLIED ECOLOGY, Issue 4 2007D. RYAN NORRIS Summary 1For the overwhelming majority of species, we lack long-term information on the dynamics of populations. As a consequence, we face considerable uncertainty about how to discriminate among competing hypotheses of population decline and design conservation plans. 2The marbled murrelet Brachyramphus marmoratus is a small seabird that nests in coastal old-growth forest but feeds year-round in near-shore waters of the north-eastern Pacific. Although a decline in nesting habitat is the primary reason why marbled murrelets are listed as threatened in Canada, nest predation and food availability may also influence population abundance. To examine the hypothesis that murrelet populations are influenced by variation in diet quality, we analysed stable-carbon and -nitrogen isotopes in feathers of museum specimens collected in the Georgia Basin, British Columbia. 3Between 1889 and 1996, we found a decline in stable isotopic signatures that was approximately equal to a 62% drop in trophic feeding level. We also found that the estimated proportion of fish in murrelet diet was related closely to murrelet abundance over the past 40 years, as estimated from volunteer surveys. Using these isotopic data, we modelled population size as a function of variation in reproductive rate due to changes in diet quality and found that our model matched closely the 40-year field estimates. We then applied our 107-year isotopic record to the model to back-cast estimates of population growth rate to 1889. 4Our results suggest that, up to the 1950s, murrelet populations in the Georgia Basin were capable of growing and were probably limited by factors other than diet quality. After this period, however, our results imply that murrelets were often, but not solely, limited by diet quality. 5Synthesis and applications. Protecting nesting habitat may not be sufficient to rebuild populations of this highly secretive and threatened seabird and recovery might also require the restoration of marine habitat quality, as well as a better understanding of how ocean climate affects prey abundance and reproductive rate. Combined with contemporary demographic data, stable isotope analysis of historic samples provides a unique opportunity to reconstruct population histories for species where we lack long-term information. [source] Financial Restatements, Cost of Debt and Information Spillover: Evidence From the Secondary Loan MarketJOURNAL OF BUSINESS FINANCE & ACCOUNTING, Issue 9-10 2009Jong Chool Park Abstract:, In this paper, we investigate the effect of financial restatements on the debt market. Specifically, we focus on the secondary loan market, which has become one of the largest capital markets in the US, and ask the following: (1) whether financial restatements increase restating firm's cost of debt financing and (2) whether the information about restatements arrives at the secondary loan market earlier than at the stock market? Using 176 restatement data, we find significant negative abnormal loan returns and increased bid-ask spreads around restatement announcements. Furthermore, this negative loan market reaction is more pronounced when the restatement is initiated by either the SEC or auditors, and when the primary reason for restatement is related to revenue recognition issues. Additionally, we find restatement information arrives at the secondary loan market earlier than at the equity market, and that such private information quickly flows into the equity market. We also show that stock prices begin to decline approximately 30 days prior to the restatement announcements for firms with traded loans. However, we do not find such informational leakage for firms without traded loans. Collectively, the results of this paper suggest: (1) increased cost of debt financing after restatements and (2) superior informational efficiency of the secondary loan market to the stock market. [source] A3 domain residue Glu1829 contributes to A2 subunit retention in factor VIIIaJOURNAL OF THROMBOSIS AND HAEMOSTASIS, Issue 5 2007H. WAKABAYASHI Summary.,Background:,Factor VIII (FVIII) is activated by thrombin to the labile FVIIIa, a heterotrimer of A1, A2 and A3C1C2 subunits, which serves as a cofactor for FIXa. A primary reason for the instability of FVIIIa is the tendency for the A2 subunit to dissociate from FVIIIa leading to an inactive cofactor and consequent loss of FXase activity. Objective:,Based on our finding of low-specific activity and a fast decay rate for a FVIII point mutation of Glu1829 to Ala (E1829A), we examined whether residue Glu1829 in the A3 subunit is important for A2 subunit retention. Results:,The rate of activity decay of E1829A was ,fourteenfold faster than wild-type (wt) FVIIIa and this rate was reduced in the presence of added A2 subunit. Specific activity values for E1829A measured by one-stage and two-stage assays were ,14% and ,11%, respectively, compared with wt FVIII. Binding affinity for the A1 subunit to E1829A-A3C1C2 was comparable to wt A3C1C2 (Kd = 20.1 ± 3.4 nm for E1829A, 15.3 ± 3.7 nm for wt), whereas A2 subunit affinity for the A1/A3C1C2 dimer forms was reduced by ,3.6-fold as a result of the mutation (Kd = 526 ± 107 nm for E1829A, 144 ± 21 nm for wt). Conclusion:,As modeling data suggest that Glu1829 is located at the A2-A3 domain interface these results are consistent with Glu1829 contributing to the interactions involved with A2 subunit retention in FVIIIa. [source] Plot shape effects on plant species diversity measurementsJOURNAL OF VEGETATION SCIENCE, Issue 2 2005Jon E. Keeley Abstract. Question: Do rectangular sample plots record more plant species than square plots as suggested by both empirical and theoretical studies? Location: Grasslands, shrublands and forests in the Mediterranean-climate region of California, USA. Methods: We compared three 0.1-ha sampling designs that differed in the shape and dispersion of 1-m2 and 100-m2 nested subplots. We duplicated an earlier study that compared the Whittaker sample design, which had square clustered subplots, with the modified Whittaker design, which had dispersed rectangular subplots. To sort out effects of dispersion from shape we used a third design that overlaid square subplots on the modified Whittaker design. Also, using data from published studies we extracted species richness values for 400-m2 subplots that were either square or 1:4 rectangles partially overlaid on each other from desert scrub in high and low rainfall years, chaparral, sage scrub, oak savanna and coniferous forests with and without fire. Results: We found that earlier empirical reports of more than 30% greater richness with rectangles were due to the confusion of shape effects with spatial effects, coupled with the use of cumulative number of species as the metric for comparison. Average species richness was not significantly different between square and 1:4 rectangular sample plots at either 1- or 100-m2. Pairwise comparisons showed no significant difference between square and rectangular samples in all but one vegetation type, and that one exhibited significantly greater richness with squares. Our three intensive study sites appear to exhibit some level of self-similarity at the scale of 400 m2, but, contrary to theoretical expectations, we could not detect plot shape effects on species richness at this scale. Conclusions: At the 0.1-ha scale or lower there is no evidence that plot shape has predictable effects on number of species recorded from sample plots. We hypothesize that for the mediterranean-climate vegetation types studied here, the primary reason that 1:4 rectangles do not sample greater species richness than squares is because species turnover varies along complex environmental gradients that are both parallel and perpendicular to the long axis of rectangular plots. Reports in the literature of much greater species richness recorded for highly elongated rectangular strips than for squares of the same area are not likely to be fair comparisons because of the dramatically different periphery/area ratio, which includes a much greater proportion of species that are using both above and below-ground niche space outside the sample area. [source] A Subaru/Suprime-Cam wide-field survey of globular cluster populations around M87 , II.MONTHLY NOTICES OF THE ROYAL ASTRONOMICAL SOCIETY, Issue 2 2006Colour, spatial distribution ABSTRACT We have performed a wide-field imaging survey of the globular cluster (GC) populations around M87 with Suprime-Cam on the 8.2-m Subaru Telescope. A field extending from the centre of M87 out to a radius of ,0.5 Mpc was observed through the BVI filters. By investigating the GC colour distribution as a function of distance from M87 and NGC 4552, another luminous Virgo elliptical in our survey field, it is found that clear bimodality [(V,I)peak, 1.0 and 1.2] is seen only in the inner regions (,10 kpc) of the host galaxies and that it becomes weaker with radius due to the decreasing contribution of the red GC (V,I > 1.1) subpopulation. It is also found (both around M87 and around NGC 4552) that while the spatial distribution of the red GCs is as centrally concentrated as the host galaxy halo light distribution, the distribution of the blue GCs (V,I, 1.1) tends to be more extended. However, the blue GC distribution around M87 is not as extended as the Virgo cluster mass density profile. Based on these facts, we argue that the contribution of GCs associated with the Virgo cluster [e.g. intergalactic GCs (i-GCs)] is not significant around M87 and is not the primary reason for the high SN value of M87. Instead, most of the blue GCs around luminous ellipticals, as well as the red GCs, are presumed to be associated with the host galaxy. We model the radial profile of GC surface densities out to ,0.5 Mpc from M87 by a superposition of the GC populations associated with M87 and with NGC 4552. It is found that there are some regions where the GC surface densities are larger than that which is expected from this model, suggesting the existence of an additional i-GC population independent of the luminous ellipticals. By comparing the estimated i-GC surface density with the luminosity density of the intracluster stellar population inferred from the intergalactic planetary nebulae in the Virgo cluster, we obtain a crude estimate of i-GC specific frequency SN= 2.9+4.2,1.5. If this SN value represents the stellar population tidally stripped by a massive central galaxy from other (less-luminous) galaxies, the contribution of tidally captured GCs in the GC population of M87 would need to be low to be consistent with the high SN value of M87. [source] Unresolved issues relating to the Shaking Palsy on the celebration of James Parkinson's 250th birthdayMOVEMENT DISORDERS, Issue S17 2007Andrew J. Lees MD Abstract James Parkinson's Essay on the Shaking Palsy published in 1817 provided the first clear clinical description for the disorder now known throughout the world by his name. His primary reason for publishing his monograph shortly before his retirement from medical practice was to draw the medical profession's attention to a malady, which had not yet been defined as a nosological entity. He also hoped that the eminent anatomists of the day would be stimulated to elucidate the pathological lesion responsible for the clinical picture and that this in turn might lead to a rational cure. The concept of Parkinson's disease remains clinically based and successive generations of neurologists have refined and embellished Parkinson's seminal descriptions. Narrative accounts by affected individuals have also helped physicians understand what it is like to live with Parkinson's disease. For many years, the pathological hallmarks of Parkinson's disease were disputed and there were few clinico-pathological reports with adequate clinical description. However, most neurologists now link severe loss of nigral cells in the ventrolateral tier of the pars compacta of the substantia nigra with bradykinesia and the presence of Lewy bodies in a number of discrete brain stem and cortical regions with Parkinson's disease. There are many unanswered clinical questions relating to Parkinson's disease including the striking heterogeneity and frequent limb asymmetry. It also remains somewhat uncertain whether Parkinson's disease is ever truly unilateral by the time of clinical presentation and whether the hand rather than the foot is the most common site of onset. Hyposmia and visual hallucinations are helpful pointers in distinguishing Parkinson's disease from atypical Parkinsonism and should be specifically enquired about in the history. Simple reliable cultural-specific smell identification batteries are an urgent need and target of clinical research. It remains to be determined whether Alzheimer type dementia as opposed to a dysexecutive syndrome should be considered a part of Parkinson's disease and further detailed clinico-pathological correlative studies are needed. It is also unclear whether autosomal dominant monogenetic Parkinsonism due to synuclein or LRRK-2 mutations will prove to be identical clinically with Parkinson's disease and for the present it is wiser to regard Parkinson's disease as a sporadic disorder. Parkinson was an active political reformer and if alive today would certainly be campaigning to translate more effectively the rich seam of neuroscientific research of the last decade into therapeutic benefits for the rising number of people who are developing the shaking palsy as a result of increasing longevity in the developed world. © 2007 Movement Disorder Society [source] Improved pain management in pediatric postoperative liver transplant patients using parental education and non-pharmacologic interventionsPEDIATRIC TRANSPLANTATION, Issue 2 2006Paul J. Sharek Abstract:, A pain management intervention, consisting of pretransplant parental education and support, pre- and postoperative behavioral pediatrics consultation, postoperative physical and occupational therapy consultation, and implementation of non-pharmacologic pain management strategies, was introduced to all pediatrics patients receiving liver transplants at Lucile Packard Children's Hospital beginning August 2001. Children receiving transplants pre-intervention (May, 2000 to February, 2001) and post-intervention (August, 2001 to March, 2002) were compared using pain scores, parent perception of pain ratings, length of stay, ventilator days, total cost, and opioid use. A total of 27 children were evaluated (13 historical control, 14 intervention). The two populations did not differ on age at transplant (mean age 53.8 vs. 63.6 months), sex (46.1% vs. 50% male), ethnicity (53.8% vs. 57.1% white, non-Hispanic) weight at transplant (17.5 vs. 24.7 kg), percent with biliary atresia as the primary reason for transplant (42.9% vs. 69.2%), percent with status 1 transplant listing score (38.5% vs. 50.0%), or public insurance status (30.8 vs. 57.2% with Medicaid). No differences were found in mean pediatric intensive care unit (PICU) postoperative length of stay (6.7 vs. 5.3 days), total postoperative length of stay (17.5 vs. 17.5 days), total inpatient length of stay (27.0 vs. 24.4 days), time to extubation (30 vs. 24.3 h), total cost ($147 983 vs. $157 882) or opioid use through postoperative day (POD) 6 (0.24 vs. 0.25 mg/kg/day morphine equivalent). A decrease in mean pain score between POD 0 and 6 (2.82 vs. 2.12; p = 0.047), a decrease in mean parental pain perception score (3.1 vs. 2.1; p = 0.001), and an increase in number of pain assessments per 12 h shift (3.43 vs. 6.79; p < 0.005) were seen. A comprehensive non-pharmacologic postoperative pain management program in children receiving a liver transplant was associated with decreased pain scores, improved parent perception of pain, and an increased number of pain assessments per 12 h shift. No increases in lengths of stay (PICU, postoperative, total), time to extubation, or total cost were found. [source] ORIGINAL RESEARCH,ED PHARMACOTHERAPY: Post-Radical Prostatectomy Pharmacological Penile Rehabilitation: Practice Patterns Among the International Society for Sexual Medicine PractitionersTHE JOURNAL OF SEXUAL MEDICINE, Issue 7 2009Patrick Teloken MD ABSTRACT Introduction., Despite the fact that there is minimal evidence-based data supporting it, the concept of pharmacological penile rehabilitation following radical prostatectomy (RP) is receiving great attention. Aim., To define attitudes and practice patterns of clinicians who were members of the International Society for Sexual Medicine (ISSM) and/or its affiliated societies. Methods., Members of the ISSM and its regional affiliates were invited to participate in a web-based survey. Main Outcome Measures., Demographic factors, current practice status, and opinions regarding post-RP erectile dysfunction and penile rehabilitation. The statistical methods used included chi-square, Student's t -tests, and logistic regression analysis. Results., Three hundred-one physicians from 41 countries completed the questionnaire (82% were urologists). Sixty-five percent of the responders had formal sexual medicine specialty training, 44% had uro-oncology specialty training, and 60% performed RPs. Eighty-seven percent performed some form of rehabilitation. As part of the primary rehabilitation strategy, 95% used phosphodiesterase type 5 inhibitors (PDE5), 30% used vacuum device, 75% used intracavernosal injections, and 9.9% used intraurethral prostaglandin. Fifty-four percent commenced rehabilitation immediately/just after urethral catheter removal, and 37% within the first 4 months after RP. Neither the number of years in medical practice, clinician age, nor country/region of practice differed between rehabilitation performers and nonperformers. With regard to the primary reason for avoiding rehabilitation: 50% responded said it is the cost; 25% said the fact that it is not evidence-based; and 25% said they were not familiar with the concept. Performing rehabilitation was positively associated with urologic oncology training (P = 0.03), performing RP (P < 0.001), and seeing over 50 post-RP patients per year (P = 0.011). Conclusions., Among ISSM members post-RP penile rehabilitation is widely practiced, commenced early, and based predominantly on PDE5 inhibitors and intracavernosal injections. Clinicians who perform RP or see over 50 such patients per year are the most likely to perform rehabilitation. Cost represents the most common reason for rehabilitation neglect. Teloken P, Mesquita G, Montorsi F, and Mulhall J. Post-radical prostatectomy pharmacological penile rehabilitation: Practice patterns among ISSM practitioners. J Sex Med 2009;6:2032,2038. [source] A comparison of the impact of TOVS arid ATOVS satellite sounding data on the accuracy of numerical weather forecastsTHE QUARTERLY JOURNAL OF THE ROYAL METEOROLOGICAL SOCIETY, Issue 569 2000S. J. English Abstract The Advanced TIROS Operational Vertical Sounder (ATOVS) was launched on the NOAA-15 satellite in May 1998. This provided a very significant improvement in the information available from meteorological polar-orbiting satellites compared with the previous TIROS Operational Vertical Sounder system, particularly for humidity and vertical resolution of temperature in cloudy areas. In preparation for assimilation of the observations into a three-dimensional analysis of atmospheric temperature and humidity, the observations have been compared with calculated top-of-atmosphere brightness temperatures computed from numerical weather prediction model profiles of temperature and humidity. Differences between observed and modelled brightness temperature are small. In some parts of the tropics and northern hemisphere the standard deviation of these differences for the tropospheric Advanced Microwave Sounding Unit sounding channels is only marginally higher than the radiometric noise of the observations. Early in 1999 a series of observation-system experiments were completed in which ATOVS observations were assimilated using a one-dimensional variational analysis. No use of the new humidity information could be made because of interference problems experienced by the microwave humidity sounder on ATOVS. Nonetheless, these experiments showed that the assimilation of the new temperature information provided by the radiance observations reduces forecast errors by as much as 20% in the southern hemisphere and 5% in the northern hemisphere. Further improvements have been found by assimilating more data over land. The major impact arises from the microwave channels. Whilst forward-model errors may be slightly lower for the microwave channels than the infrared channels the primary reason is the provision of sounding information in active weather systems, which are usually cloudy. [source] Penile rehabilitation protocol after robot-assisted radical prostatectomy: assessment of compliance with phosphodiesterase type 5 inhibitor therapy and effect on early potencyBJU INTERNATIONAL, Issue 3 2010Daniel J. Lee Study Type , Therapy (case series) Level of Evidence 4 OBJECTIVE To evaluate factors that affect compliance in men who enrol in a phosphodiesterase type 5 inhibitor (PDE5I) protocol after nerve-sparing robot-assisted prostatectomy (RAP), and report on short-term outcomes, as PDE5Is may help restore erectile function after RAP and patient adherence to the regimen is a factor that potentially can affect outcome. PATIENT AND METHODS We prospectively followed 77 men who had nerve-sparing RAP and enrolled in a postoperative penile rehabilitation protocol. The men received either sildenafil citrate or tadalafil three times weekly. The minimum follow-up was 8 weeks. Potency was defined as erection adequate for penetration and complete intercourse. Compliance was defined as men adhering to the regimen for ,2 months. RESULTS The mean age of the cohort was 57.8 years and the median follow-up was 8 months. In all, 32% of the men discontinued the therapy <2 months after RAP and were deemed noncompliant with an additional 39% discontinuing therapy by 6 months, with the high cost of medication being the primary reason (65%). Long-term compliance and preoperative erectile dysfunction were independent predictors of potency return after adjusting for age and nerve sparing. CONCLUSIONS The high cost of medication remains a significant barrier to maintaining therapy. Noncompliance to PDE5I therapy in a tertiary care centre was much higher than reported in clinical trial settings. With longer-term follow-up, we need to further define the factors that improve overall recovery of sexual function after RAP. [source] Why primiparous mothers do not breastfeed in the United States: a national surveyACTA PAEDIATRICA, Issue 11 2003JS Taylor Aim: To investigate primiparous women's primary reason for not breastfeeding. Methods: We used the 1995 National Survey of Family Growth to analyze the breastfeeding behaviors of a national probability sample of 6733 first-time US mothers, aged 15 to 44 y. Main outcome measures in this cross-sectional study were the reasons for never breastfeeding and reasons for stopping breastfeeding using closed-ended, multiple choice questions. Results: Most commonly, women did not breastfeed because they "preferred to bottle feed" (66.3%). The most common reason for stopping breastfeeding was that the child was "old enough to wean" (35.7%), although 15%, 34%, 54%, and 78% of those women had stopped breastfeeding by 3, 6, 9, and 12 mo, respectively. "Physical or medical problem" was reported by 14.9% of women who did not breastfeed and 26.9% of women who had stopped breastfeeding, making it the second most common reason for not breastfeeding in each group. There were significant differences across racial and ethnic groups. Conclusion: Additional studies are needed to better understand why women "prefer to bottle feed", especially black women. Increasingly effective programs and policies to promote breastfeeding will logically follow. Since physical and medical problems are such common reasons both for never breastfeeding and for stopping breastfeeding, individual healthcare providers can have a significant impact on breastfeeding rates and duration. [source] Determinants of coverage in Community-based Therapeutic Care programmes: towards a joint quantitative and qualitative analysisDISASTERS, Issue 2 2010Saśl Guerrero One of the most important elements behind the success of Community-based Therapeutic Care (CTC) programmes for the treatment of severe acute malnutrition has been their ability to achieve high levels of coverage. In CTC, coverage is measured using the Centric System Area Sampling (CSAS) method, which provides accurate and reliable estimates of programme coverage as well as information on the primary reasons for non-attendance. Another important feature of CTC programmes is their use of socio-cultural assessments to determine potential barriers to access and to develop context-specific responses. By analysing data on non-attendance provided by CSAS surveys, in conjunction with data from socio-cultural assessments, it is possible to identify common factors responsible for failures in programme coverage. This paper focuses on an analysis of data from 12 CTC programmes across five African countries. It pinpoints three common factors (distance to sites, community awareness of the programme, and the way in which rejections are handled at the sites) that, together, account for approximately 75 per cent of non-attendance. [source] The Prevalence of Valvular Abnormalities in Patients Who Were Referred for Echocardiographic Examination With a Primary Diagnosis of "Heart Murmur"ECHOCARDIOGRAPHY, Issue 5 2007Mohammad-Reza Movahed M.D., Ph.D. Introduction: The prevalence of valvular abnormality and innocent murmur in patients who are referred for echocardiographic evaluation with the diagnosis of "murmur" is not known. The goal of this study was to evaluate the prevalence of valvular abnormalities in such patients. Methods: We retrospectively reviewed the echocardiograms that were referred with the primary ordering diagnosis of "murmur," for the presence of valvular abnormalities. For comparison, we used other documented primary reasons for echocardiographic referral, such as chest pain, shortness of breath, etc. Results: In this cohort, 7,684 echocardiogram reports documented primary diagnostic reasons for echocardiographic referral. A total of 3,460 echocardiogram reports (45%) were coded "murmur" as the primary reason for the study referral. There was a higher prevalence of female patient referrals for heart murmur evaluation (61.8% vs. 38.2%). Although, patients with murmur had a higher prevalence of valvular abnormalities, compared to other reasons for echocardiographic examination, the prevalence of valvular abnormality was less than 50% (48.6% vs. 35.5%) in both groups. Despite the higher number of female patients referred with the diagnosis of murmur, the percentage of abnormal valves was lower in women (45.6% vs. 53.4% in men). Conclusion: The prevalence of valvular abnormalities in patients who were referred with the diagnosis of murmur for echocardiographic examination was less than 50%, with a lesser degree found in women. Routine utilization of echocardiography for evaluation of all murmurs may be unwarranted. [source] A Fearsome Trap: The will to know, the obligation to confess, and the Freudian subject of desireEDUCATIONAL PHILOSOPHY AND THEORY, Issue 7 2010John Ambrosio Abstract The author examines the relation between Michel Foucault's corpus and Freudian psychoanalysis. He argues that Foucault had a complex and changing relationship to psychoanalysis for two primary reasons: his own psychopathology, personal experience, and expressed desire, and due to an ineluctable contradiction at the heart of psychoanalysis itself. The author examines the history of Foucault's personal and scholarly interest in psychology and psychiatry, tracing the emergence, development, and shift in his thought and work. He then argues that Foucault's critique of psychoanalysis can be extended to the constitution of the Western educated subject, and that Foucault ultimately resolved his personal dilemma in relation to psychoanalysis by rejecting the ,will to knowledge' and refusing the notion of a stable and fixed identity. [source] Initial Public Offerings: CFO PerceptionsFINANCIAL REVIEW, Issue 4 2006James C. Brau G14; G24; G32; G34 Abstract We examine four issues pertaining to initial public offerings (IPOs) using a survey of 438 chief financial officers (CFOs). First, why do firms go public? Second, is CFO sentiment stationary across bear and bull markets? Third, what concerns CFOs about going public? Fourth, do CFO perceptions correlate with returns? Results support funding for growth and liquidity as the primary reasons for IPOs. CFO sentiment is generally stationary in pre- and post-bubble years. Managers are concerned with the direct costs of going public, such as underwriting fees, as well as indirect costs. We find a negative relation between a focus on immediate growth and long-term abnormal returns. [source] Registered nurse incentives to return to practice in the United StatesINTERNATIONAL JOURNAL OF NURSING PRACTICE, Issue 5 2009Joanne C Langan PhD RN This US study uniquely listened to registered nurses with current licenses who do not work as nurses or are unemployed. An electronic survey was advertised in 13 Boards of Nursing newsletters. Investigated was why nurses left nursing, what would entice them to return to nursing, and what skill review is essential to competent and confident return to nursing practice. Herzberg's theory was used to study factors affecting registered nurses' decision to practise nursing. Data were analysed using SPSS and manifest content analysis. Nurses (n = 127) identified various work conditions as the primary reasons for leaving nursing. Work condition improvement, recognition of one's work, opportunities for professional growth and family needs consideration were identified as key enticing factors for returning to nursing. Many respondents identified needing review of medicines, intravenous skills, new technologies and a refresher course. Acting on their voiced concerns will enhance nurse recruitment and retention. [source] Management of a cadaveric orthotopic liver transplantation in a pediatric patient with complex congenital heart diseasePEDIATRIC ANESTHESIA, Issue 6 2006DENNIS E. FEIERMAN MD PhD Summary Pediatric orthotopic liver transplantations (OLT) are commonly performed nowadays. Two primary reasons for OLT in children are complications from either extrahepatic biliary atresia (EHBA) or inborn errors of metabolism. However, congenital liver disease may be associated with significant other congenital abnormalities. We present a case of a successful OLT in a pediatric patient with a history of EHBA, situs inversus, and complex congenital heart disease. The cardiac anomalies include dextrocardia, absence of the atrial septum (single atrium), single atrioventricular valve (a-v canal), and an incomplete ventricular septum. Prior surgery include a Kasai procedure for EHBA, banding of the proximal main pulmonary artery, and Broviac catheter placement. We present the anesthesia concerns and management for this complicated case. [source] ORIGINAL RESEARCH,PSYCHOLOGY: Sexual Motivation in Women as a Function of AgeTHE JOURNAL OF SEXUAL MEDICINE, Issue 12 2009Cindy M. Meston PhD ABSTRACT Introduction., Women's motivations to engage in sex are likely influenced by their past sexual experiences, the type of relationship in which they are involved in, and numerous lifestyle factors such as career and family demands. The influences of these factors undoubtedly change as women age. Aim., This study aimed to examine potential differences in sexual motivation between three distinct age groups of premenopausal women. Methods., Women aged 18,22 years (N = 137), 23,30 years (N = 103), and 31,45 years (N = 87) completed an online survey that assessed the proportion with which they had engaged in sexual intercourse for each of 140 distinct reasons. Main Outcome Measures., The YSEX? Questionnaire by Meston and Buss [1] was used to measure sexual motivation. The items of this questionnaire were composed of four primary sexual motivation factors (physical, goal attainment, emotional, insecurity), and 13 subfactors. Results., Women aged 31,45 years reported a higher proportion of engaging in sex compared with one or both of the younger age groups of women for nine of the 13 YSEX? subfactors: stress reduction, physical desirability, experience seeking, resources, social status, revenge, expression, self-esteem boost, and mate guarding. At an item level, the top 25 reasons for having sex were virtually identical across age groups. Conclusion., Women aged 31,45 have more motives for engaging in sex than do women aged 18,30, but the primary reasons for engaging in sex do not differ within this age range. Women aged 18,45 have sex primarily for pleasure, and love and commitment. The implications for diagnosis and treatment of women with sexual dysfunctions were discussed. Meston CM, Hamilton LD, and Harte CB. Sexual motivation in women as a function of age. J Sex Med 2009;6:3305,3319. [source] Formation of Human Telomeric G-quadruplex Structures Induced by the Quaternary Benzophenanthridine Alkaloids: Sanguinarine, Nitidine, and ChelerythrineCHINESE JOURNAL OF CHEMISTRY, Issue 5 2010Shu Yang Abstract The ligands which can facilitate the formation and stabilize G-quadruplex structures have attracted enormous attention due to their potential ability of inhibiting the telomerase activity and halting tumor cell proliferation. It is noteworthy that the abilities of the quaternary benzophenanthridine alkaloids (QBAs), the very important G-quadruplex binders, in inducing the formation of human telomeric DNA G-quadruplex structures, have not been reported. Herein, the interaction between single-strand human telomeric DNA and three QBAs: Sanguinarine (San), Nitidine (Nit) and Chelerythrine (Che), has been investigated. Although these molecules are very similar in structure, they exhibit significantly different abilities in inducing oligonucleotide d(TTAGGG)4 (HT4) to specific G-quadruplex structures. Our experimental results indicated that the best ligand San could convert HT4 into antiparallel G-quadruplex structure completely, followed by Nit, which could transform to mixed-type or hybrid G-quadruplex structure partially, whereas Che could only transform to antiparallel G-quadruplex structure in small quantities. The relative QBAs' inducing abilities as indicated by the CD data are in the order of San>Nit>Che. Further investigation revealed that the G-quadruplex structures from HT4 induced by QBAs are of intramolecular motif. And only sequences with certain length could be induced by QBAs because of their positive charges which could not attract short chain DNA molecules to close to each other and form intermolecular G-quadruplex. In addition, the factors that affect the interaction between HT4 and QBAs were discussed. It is proposed that the thickness of the molecular frame and the steric hindrance are the primary reasons why the subtle differences in QBAs' structure lead to their remarkable differences in inducing the formation of the G-quadruplex structures. [source] | |||||||||||||||||||