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Selected AbstractsLate free-flap salvage with catheter-directed thrombolysisMICROSURGERY, Issue 4 2008Andrew P. Trussler M.D. Introduction: Despite high success rates with free-tissue transfer, flap loss continues to be a devastating event. Flap salvage is often successful if vascular complications are recognized and treated early. However, delayed presentation of flap compromise is an ominous predictor of flap loss. Late free-flap salvage has been described with poor long-term results. Catheter-directed thrombolysis (CDT) has only been described in context with free-tissue transfer in a case of distal bypass salvage. Objectives: The authors examined the efficacy of highly selective CDT in late salvage of free-flaps with vascular compromise. Methods: Two patients underwent highly selective CDT after delayed presentation (>5 days) of flap compromise. Patient 1 is a 59-year-old woman who underwent delayed breast reconstruction with a free TRAM flap and presented with arterial thrombosis 12 days postoperatively. Patient 2 is a 53-year-old man who underwent fibular osteocutaneous free-flap reconstruction of a floor of mouth defect who developed venous thrombosis 6 days postoperatively. Patient 2 underwent two attempted operative anastamotic revisions with thrombectomies and local thrombolysis prior to CDT. Results: The average time of presentation was 9 days, with the average time to CDT being 9.5 days. Patient 1 had an arterial thrombosis, whereas Patient 2 had a venous thrombosis. Both patients underwent successful thrombolysis after super-selective angiograms. Continuous infusions of thrombolytic agents were used in both patients for ,24 h. Average length of stay postCDT was 7 days with no perioperative complications. Long-term follow-up demonstrated complete flap salvage with no soft tissue loss. Conclusion: Despite extremely delayed presentation, aggressive CDT was successful in both breast, and head and neck reconstructions with excellent long-term flap results. CDT appears to be a useful modality in managing difficult cases of free-flap salvage. © 2008 Wiley-Liss, Inc. Microsurgery, 2008. [source] Periodontal condition of the mandibular anterior dentition in patients with conventional and self-ligating bracketsORTHODONTICS & CRANIOFACIAL RESEARCH, Issue 4 2008N Pandis Structured Abstract Authors,,, Pandis N, Vlachopoulos K, Polychronopoulou A, Madianos P, Eliades T Objectives,,, To explore whether the use of self-ligating brackets is associated with better values for periodontal indices because of the lack of elastomeric modules and concomitantly, reduced availability of retentive sites for microbial colonization and plaque accumulation. Setting and Sample Population,,, Private practice of the first author. Patients were selected using the following inclusion criteria: age range 12,17 years, fixed appliances on both arches, aligned mandibular arch, and absence of oral habits and anterior crossbites. Materials and Methods,,, Prospective cohort investigation. Participants were grouped for bracket type, thus 50 patients formed the conventional bracket cohort and 50 patients the self-ligating bracket cohort. Both cohorts were followed with the purpose to examine periodontal status. Average length of follow-up was 18 months. This time period was considered adequate for a proportion of study participants to experience the outcome of interest. Outcome variables were plaque index, gingival index, calculus index, and probing depth for the two bracket cohorts. Results,,, No difference was found in the indices recorded between the two bracket cohorts studied. Conclusion,,, Under the conditions as applied in this study, the self-ligating brackets do not have an advantage over conventional brackets with respect to the periodontal status of the mandibular anterior teeth. [source] HP10 LAPAROSCOPIC RESECTION OF SUBMUCOSAL GASTRIC LESIONS , THE WHANGAREI EXPERIENCEANZ JOURNAL OF SURGERY, Issue 2007J. Y. Yang Purpose To evaluate safety of laparoscopic resection of submucosal gastric lesions performed in Whangarei Based Hospital. Methodology From November 2002 to December 2006, 8 consecutive patients underwent the above mention surgery. (M : F = 5 : 3; Average age 63 [range, 43,83]). All patients underwent pre-operative gastroscopy. Wedge resections were performed for anterior wall lesions. (n = 3). Posterior wall lesions were resected via transgastric approach. (n = 4). Retroperitoneal resection was performed for the foregut duplication cyst. (n = 1). All except one lesion were resected using endoscopic GIA stapler. The medical records of the patients were reviewed retrospectively. Results All patients were successfully treated laparoscopically. No conversion to open surgery. Pathology included: Gastrointestinal-stromal tumor (GIST) (n = 5), Malignant leiomyosarcoma (n = 1), Ectopic pancreas (n = 1), and Foregut duplication cysts (n = 1). All achieved adequate negative surgical margin. Average operation time was 106.14 minutes. [Range, 75,150]. Average length of hospital stay was 3.42 days [range, 1,5]. Complication included one wound infection, and one pyloric stenosis. Average length of follow up was 10.96 months [range, 0.46,31.73]. No recurrence detected and all are still alive till date. Conclusion Laparoscopic resection of submucosal gastric lesions is a safe and appropriate alternative to open surgery. Its main advantage over open technique includes shorter length of hospital stay, lower recurrence rate and lower mortality rates. Surgical technique depends very much on tumor size and location. Outcome of the patients described from our centre is comparable to the others published till date. [source] Impact of laparoscopic cholecystectomy on hospital utilizationANZ JOURNAL OF SURGERY, Issue 4 2004Michael S. Hobbs Objective: The objective of the present study was to assess the impact of laparoscopic cholecystectomy (LC) and associated endoscopic retrograde pancreatography (ERCP) on hospital utilization. Background: Laparoscopic cholecystectomy (LC) has resulted in marked reductions in average length of hospital stay; but population-based studies of hospital utilization have generally not taken into account increased cholecystectomy rates or associated increases in pre and postoperative admissions. Methods: We conducted a population-based study of all residents of Western Australia who underwent cholecystectomy in the period 1980,2000. Record linkage was used to identify pre and postoperative admissions, and to estimate aggregate length of stay per case based on all relevant admissions. We estimated trends in cholecystectomy rates, proportions of cases with related pre and postoperative hospital admissions, average aggregate length of stay per case and total bed utilization per unit of population. Results: The introduction of LC was associated with a sustained increase in rates of cholecystectomy of 25%. Similar increases occurred in the percentage of cases with related preoperative and postoperative admissions. Average length of stay for index admissions declined by nearly 60% compared with 50% for all related admissions. Per capita hospital utilization for index admissions decreased by 45% compared with 38% for index and associated admissions combined, and 32% for all admissions for biliary disease. Conclusions: Reduced hospital utilization associated with LC was partly offset by increases in pre and postoperative admissions and a sustained increase in cholecystectomy rates. Record linkage is required to assess the true impact of new technologies on hospital utilization. [source] 47 Comparison between open and laparoscopic live donor nephrectomyBJU INTERNATIONAL, Issue 2006S. KALOUCAVA Introduction:, Renal replacement therapy is the best management for end stage renal failure. Laparoscopic Donor Nephrectomy (LDN), which is considered safe and effective, began in our unit in July 2003 with an average transplant rate of 12 per year. The aim of this study is to compare the donor morbidity, recovery and costs between Open Donor Nephrectomy (ODN) and LDN. Method:, A retrospective consecutive series of all Donor Nephrectomies since June 2002 were included in this study. Operative details, postoperative donor recovery, donor and recipients renal functions were reviewed. The total costs will also be calculated and compared. Results:, There were 18 LDN and 18 ODN (Total 36 cases) included in this series and equal number of male to female cases. Average operative time for ODN was 2.07 h and LDN was 3.36 h. There was no intra-operative conversion from LDN to ODN and no peri-operative morbidities in either group. The transplanted renal vessel lengths were also compared which showed an average artery length of 40 mm and vein length of 50 mm in the LDN group versus an average of 35 mm artery length and 30 mm vein length in the ODN group. The outcome of the recipient's renal function was not affected whether the donor had OPD or LDN. Average length of hospital stay was 6 days in ODN and 4.5 days in LDN. Costs data to follow. Conclusion:, Laparoscopic Donor Nephrectomy (LDN) is safe and effective in a smaller renal transplant unit. [source] Documenting Loss of Large Trophy Fish from the Florida Keys with Historical PhotographsCONSERVATION BIOLOGY, Issue 3 2009LOREN McCLENACHAN arrecifes de coral; ecología histórica; directrices cambiantes; peces de arrecife; sobrepesca Abstract:,A loss of large vertebrates has occurred in aquatic and terrestrial ecosystems, but data to measure long-term population changes are sparse. Historical photographs provide visual and quantitative evidence of changes in mean individual size and species composition for groups of marine fish that have been targeted by sport fishing. I measured such trends for 13 groups of recreationally caught "trophy" reef fish with photographs taken in Key West, Florida, from 1956 to 2007. The mean fish size declined from an estimated 19.9 kg (SE 1.5) to 2.3 kg (SE 0.3), and there was a major shift in species composition. Landings from 1956 to 1960 were dominated by large groupers (Epinephelus spp.), and other large predatory fish were commonly caught, including sharks with an average length of just <2 m. In contrast, landings in 2007 were composed of small snappers (Lutjanus spp. and Ocyurus chrysurus) with an average length of 34.4 cm (SE 0.62), and the average length of sharks declined by more than 50% over 50 years. Major declines in the size of fish caught were not reflected in the price of fishing trips, so customers paid the same amount for a less-valuable product. Historical photographs provide a window into a more pristine coral reef ecosystem that existed a half a century ago and lend support to current observations that unfished reef communities are able to support large numbers of large-bodied fish. Resumen:,Una pérdida de vertebrados mayores ha ocurrido en ecosistemas acuáticos y terrestres, pero los datos para medir los cambios poblaciones a largo plazo son escasos. Las fotografías históricas proporcionan evidencia visual y cuantitativa de cambios en el tamaño individual promedio y de la composición de especies en grupos de peces marinos que han sido blanco de la pesca deportiva. Medí esas tendencias en 13 grupos de peces de arrecife capturados recreativamente como "trofeos" mediante fotografías tomadas en Key West, Florida, desde 1956 a 2007. El peso promedio de los peces declinó de unos 19.9 kg (ES 1.5) a 2.3 kg (ES 0.3), y hubo un cambio mayor en la composición de especies. Las capturas entre 1956 y 1960 estuvieron dominadas por meros (Epinephelus spp.) grandes, y otros peces depredadores eran capturados comúnmente, incluyendo tiburones con una longitud promedio de poco menos de 2m. En contraste, las capturas en 2007 fueron compuestas de pargos (Lutjanus spp. y Ocyurus chrysurus) pequeños con una longitud promedio de 34.4 cm (ES 0.62), y la longitud promedio de los tiburones declinó más de 50% en 50 años. La gran declinación en el tamaño de los peces capturados no se reflejó en los precios de los viajes de pesca, así que los clientes pagaron la misma cantidad por un producto menos valioso. Las fotografías históricas proporcionan una visión de un ecosistema arrecifal coralino prístino que existió hace medio siglo y proporcionan soporte a los comentarios actuales de que las comunidades arrecifales no explotadas son capaces de soportar numerosos peces de talla grande. [source] Interaction between a dislocation and monovalent anion in various alkali halide crystalsCRYSTAL RESEARCH AND TECHNOLOGY, Issue 10 2010Y. KohzukiArticle first published online: 30 AUG 2010 Abstract It was investigated from (L0/L)2 versus ,0 curve that the Friedel relation between the effective stress and the average length of dislocation segments, L, is appropriate for the interaction between a dislocation and the monovalent anion in various alkali halides single crystals (NaCl: Br - , NaBr: Cl - or I - , KCl: Br - or I - , and RbCl: Br - or I - ). Here, L0 represents the average spacing of monovalent anions on a slip plane and ,0 is the bending angle at which the dislocation breaks away from the anion at the temperature of 0 K. This is because the anions are the weak obstacles such as impede the dislocation at ,0 above about 150 degrees, where the Friedel relation agrees with the Fleischer one (L02 = L2(,,,0)/2). Furthermore, the values of (L /L0) were found to be within 4.05 to 5.87 for the crystals. (© 2010 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim) [source] Growth of children on the ketogenic dietDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 12 2002Eileen P G Vining MD This is a prospective cohort study of 237 children (130 males, 107 females) placed on the ketogenic diet for control of intractable epilepsy (mean age at starting diet 3 years 8 months; age range 2 months to 9 years 10 months); average length of follow-up was 308 days. There were 133 children on the diet at 1 year and 76 at 2 years. Height and weight measurements were converted into age- and sex-appropriate z scores. There was a rapid drop in weight z scores in the first 3 months. After this initial period, the weight z score remained constant in children who started the diet below the median weight for their age and sex, although z scores continued to decrease in children starting above the median. There was a small decrease in height z scores in the first 6 months (<0.5); however, there were larger changes by 2 years. There was no difference based on sex for either height or weight. The ketogenic diet generally provides sufficient nutrition to maintain growth within normal parameters over a defined period. Very young children grow poorly on the diet and should be followed-up carefully over long periods of use. [source] Ambient temperature and risk of death from accidental drug overdose in New York City, 1990,2006ADDICTION, Issue 6 2010Amy S. B. Bohnert ABSTRACT Background Mortality increases as ambient temperature increases. Because cocaine affects core body temperature, ambient temperature may play a role in cocaine-related mortality in particular. The present study examined the association between ambient temperature and fatal overdoses over time in New York City. Methods Mortality data were obtained from the Office of the Chief Medical Examiner for 1990 to 2006, and temperature data from the National Oceanic and Atmospheric Association. We used generalized additive models to test the relationship between weekly average temperatures and counts of accidental overdose deaths in New York City, controlling for year and average length of daylight hours. Results We found a significant relation between ambient temperature and accidental overdose fatality for all models where the overdoses were due in whole or in part to cocaine (all P < 0.05), but not for non-cocaine overdoses. Risk of accidental overdose deaths increased for weeks when the average temperature was above 24°Celsius. Conclusions These results suggest a strong relation between temperature and accidental overdose mortality that is driven by cocaine-related overdoses rising at temperatures above 24°Celsius; this is a substantially lower temperature than prior estimates. To put this into perspective, approximately 7 weeks a year between 1990 and 2006 had an average weekly temperature of 24 or above in New York City. Heat-related mortality presents a considerable public health concern, and cocaine users constitute a high-risk group. [source] Some biophysical properties of castor oil esterified with some acid anhydridesEUROPEAN JOURNAL OF LIPID SCIENCE AND TECHNOLOGY, Issue 10 2008Mona A. Saied Abstract A series of castor oil adducts were synthesized by esterification of castor oil with acid anhydrides: phthalic, maleic and succinic anhydrides. The chemical structure of castor oil and the prepared adducts were characterized by means of IR and 1H,NMR spectroscopy. The number-average and weight-average molecular weights were measured by gel permeation chromatography. The electrical properties were studied through the permittivity, dielectric loss and conductivity measurements, which are considered to be in the range of electrical insulation. The electrical conductivity, which describes the ionic mobility of the systems, was found to be in the range of 10,9 to 10,12,S/cm. This indicates that castor oil and its esters could be used for antistatic applications. The viscosity,, and the activation energy,E,, obtained from the dependency of viscosity on temperature using the Arrhenius equation, were found to increase with increasing molecular weight of the system. The effect of different concentrations of castor oil and its esters on the growth activities of the sugar beet pathogens R.,solani and S.,rolfsii was studied through the determination of percent germination, average length of hyphal extensions, dry mass yield and the production of sclerotia. The obtained data indicate that the esterification of castor oil with anhydrides improves the antifungal activity. [source] Convergence of excitatory and inhibitory inputs onto CCK-containing basket cells in the CA1 area of the rat hippocampusEUROPEAN JOURNAL OF NEUROSCIENCE, Issue 5 2004Ferenc Mátyás Abstract The number and distribution of excitatory and inhibitory inputs affect the integrative properties of neurons. These parameters have been studied recently for several hippocampal neuron populations. Besides parvalbumin- (PV) containing cells that include basket and axo-axonic cells, cholecystokinin (CCK)-containing interneurons also form a basket cell population with several properties distinct from PV cells. Here, at the light microscopic level, we reconstructed the entire dendritic tree of CCK-immunoreactive (IR) basket cells to describe their geometry, the total length and laminar distribution of their dendrites. This was followed by an electron microscopic analysis of serial ultrathin sections immunostained against ,-aminobutyric acid, to estimate the density of excitatory and inhibitory synapses on their somata, axon initial segments and different subclasses of dendrites. The dendritic tree of CCK-IR basket cells has an average length of 6300 µm and penetrates all layers. At the electron microscopic level, CCK basket cells receive dendritic inputs with a density of 80,230 per 100 µm. The ratio of inhibitory inputs is relatively high (35%) and increases towards the soma (83%). The total numbers of excitatory and inhibitory synapses converging onto CCK-IR cells are ,,8200. Comparison of the two, neurochemically distinct basket cells reveals that CCK-containing basket cells receive much less synaptic input than PV cells; however, the relative weight of inhibition is higher on CCK cells. Additional differences in their anatomical and physiological properties predict that CCK basket cells are under a more diverse, elaborate control than PV basket cells, and thus the function of the two populations must be different. [source] Daily jaw muscle activity in freely moving rats measured with radio-telemetryEUROPEAN JOURNAL OF ORAL SCIENCES, Issue 1 2007Nobuhiko Kawai The jaw muscle activity of rats has been investigated for specific tasks. However, the daily jaw muscle use remains unclear. The purpose of the present study was to examine daily jaw muscle activity, and its variability over time, in the rat (n = 12) by the use of radio-telemetry. A telemetric device was implanted for the continuous recording of masseter muscle and digastric muscle activity. Daily muscle use was characterized by calculating the total time that each muscle was active (duty time), the number of bursts, and the average length of bursts. All parameters were estimated for activities exceeding various levels (5,90%) of the day's peak activity. Daily muscle use remained constant for 4 wk. At the low-activity level, the duty time and burst number of the digastric muscle were significantly (P < 0.01) higher than those of the masseter muscle, whereas the opposite was true at the high-activity level (P < 0.05). No significant intermuscular correlation was observed between the number of bursts of the masseter and digastric muscles, but the interindividual variation of both muscles changed, depending on the level of activation. These findings suggest that the masseter muscle and the digastric muscle show a differential active pattern, depending on the activity level. [source] Folding of epidermal growth factor-like repeats from human tenascin studied through a sequence frame-shift approachFEBS JOURNAL, Issue 21 2004Francesco Zanuttin In order to investigate the factors that determine the correct folding of epidermal growth factor-like (EGF) repeats within a multidomain protein, we prepared a series of six peptides that, taken together, span the sequence of two EGF repeats of human tenascin, a large protein from the extracellular matrix. The peptides were selected by sliding a window of the average length of tenascin EGF repeats over the sequence of EGF repeats 13 and 14. We thus obtained six peptides, EGF-f1 to EGF-f6, that are 33 residues long, contain six cysteines each, and bear a partial overlap in the sequence. While EGF-f1 corresponds to the native EGF-14 repeat, the others are frame-shifted EGF repeats. We carried out the oxidative folding of these peptides in vitro, analyzed the reaction mixtures by acid trapping followed by LC-MS, and isolated some of the resulting products. The oxidative folding of the native EGF-14 peptide is fast, produces a single three-disulfide species with an EGF-like disulfide topology and a marked difference in the RP-HPLC retention time compared with the starting product. On the contrary, frame-shifted peptides fold more slowly and give mixtures of three-disulfide species displaying RP-HPLC retention times that are closer to those of the reduced peptides. In contrast to the native EGF-14, the three-disulfide products that could be isolated are mainly unstructured, as determined by CD and NMR spectroscopy. We conclude that both kinetics and thermodynamics drive the correct pairing of cysteines, and speculate about how cysteine mispairing could trigger disulfide reshuffling in vivo. [source] Changes in spawning stock structure strengthen the link between climate and recruitment in a heavily fished cod (Gadus morhua) stockFISHERIES OCEANOGRAPHY, Issue 3 2006GEIR OTTERSEN Abstract Atlantic cod (Gadus morhua) is one of the commercially most important fish species in the North Atlantic and plays a central role in several ecosystems. Fishing pressure has been heavy over a prolonged period and the recent decades have shown dramatic decline in abundance of many stocks. The Arcto-Norwegian (or North-east Arctic) cod stock in the Barents Sea is now the largest stock of Atlantic cod. Recruitment to this stock has varied extensively during the last 60 yr. There is evidence for fluctuations in climate, particularly sea temperature, being a main cause for this variability, higher temperatures being favourable for survival throughout the critical early life stages. Our studies of time series present compelling evidence for a strengthening of the climate,cod recruitment link during the last decades. We suggest this is an effect of the age and length composition of the spawning stock having changed distinctly. The age of the average spawner has decreased by more than 3 yr from between 10 and 11 in the late 1940s to 7,8 in the 1990s, average length from just above 90 cm to around 80 cm. The number of age classes contributing to the spawning stock has also decreased, while the number of length groups present increased slightly. Significant decrease in age of spawners has frequently been described for other heavily fished stocks worldwide. We therefore find it likely that the proposed mechanism of increased influence of climate on recruitment through changes in the spawning stock age and size composition is of a general nature and might be found in other systems. [source] Have newer cardiovascular drugs reduced hospitalization?HEALTH ECONOMICS, Issue 5 2009Evidence from longitudinal country-level data on 20 OECD countries Abstract This study examines the effect of changes in the vintage distribution of cardiovascular system drugs on hospitalization and mortality due to cardiovascular disease using longitudinal country-level data. The vintage of a drug is the first year in which it was marketed anywhere in the world. We use annual data on the utilization of over 1100 cardiovascular drugs (active ingredients) in 20 OECD countries during the period 1995,2003. Countries with larger increases in the share of cardiovascular drug doses that contained post-1995 ingredients had smaller increases in the cardiovascular disease hospital discharge rate, controlling for the quantity of cardiovascular medications consumed per person, the use of other medical innovations (computed tomography scanners and magnetic resonance imaging units), potential risk factors (average consumption of calories, tobacco, and alcohol), and demographic variables (population size and age structure, income, and educational attainment). The estimates also indicate that the use of newer cardiovascular drugs has reduced the average length of stay and the age-adjusted cardiovascular mortality rate, but not the number of potential years of life lost due to cardiovascular disease before age 70 per 100,000 population. The estimates indicate that if drug vintage had not increased during 1995,2004, hospitalization and mortality would have been higher in 2004. We estimate that per capita expenditure on cardiovascular hospital stays would have been 70% ($89) higher in 2004 had drug vintage not increased during 1995,2004. Per capita expenditure on cardiovascular drugs would have been lower in 2004 had drug vintage not increased during 1995,2004. However, our estimate of the increase in expenditure on cardiovascular hospital stays is about 3.7 times as large as our estimate of the reduction in per capita expenditure for cardiovascular drugs that would have occurred ($24). Copyright © 2008 John Wiley & Sons, Ltd. [source] Risk Segmentation Related to the Offering of a Consumer-Directed Health Plan: A Case Study of Humana Inc.HEALTH SERVICES RESEARCH, Issue 4p2 2004Laura A. Tollen Objective. To determine whether the offering of a consumer-directed health plan (CDHP) is likely to cause risk segmentation in an employer group. Study Setting and Data Source. The study population comprises the approximately 10,000 people (employees and dependents) enrolled as members of the employee health benefit program of Humana Inc. at its headquarters in Louisville, Kentucky, during the benefit years starting July 1, 2000, and July 1, 2001. This analysis is based on primary collection of claims, enrollment, and employment data for those employees and dependents. Study Design. This is a case study of the experience of a single employer in offering two consumer-directed health plan options ("Coverage First 1" and "Coverage First 2") to its employees. We assessed the risk profile of those choosing the Coverage First plans and those remaining in more traditional health maintenance organization (HMO) and preferred provider organization (PPO) coverage. Risk was measured using prior claims (in dollars per member per month), prior utilization (admissions/1,000; average length of stay; prescriptions/1,000; physician office visit services/1,000), a pharmacy-based risk assessment tool (developed by Ingenix), and demographics. Data Collection/Extraction Methods. Complete claims and administrative data were provided by Humana Inc. for the two-year study period. Unique identifiers enabled us to track subscribers' individual enrollment and utilization over this period. Principal Findings. Based on demographic data alone, there did not appear to be a difference in the risk profiles of those choosing versus not choosing Coverage First. However, based on prior claims and prior use data, it appeared that those who chose Coverage First were healthier than those electing to remain in more traditional coverage. For each of five services, prior-year usage by people who subsequently enrolled in Coverage First 1 (CF1) was below 60 percent of the average for the whole group. Hospital and maternity admissions per thousand were less than 30 percent of the overall average; length of stay per hospital admission, physician office services per thousand, and prescriptions per thousand were all between 50 and 60 percent of the overall average. Coverage First 2 (CF2) subscribers' prior use of services was somewhat higher than CF1 subscribers', but it was still below average in every category. As with prior use, prior claims data indicated that Coverage First subscribers were healthier than average, with prior total claims less than 50 percent of average. Conclusions. In this case, the offering of high-deductible or consumer-directed health plan options alongside more traditional options caused risk segmentation within an employer group. The extent to which these findings are applicable to other cases will depend on many factors, including the employer premium contribution policies and employees' perception of the value of the various plan options. Further research is needed to determine whether risk segmentation will worsen in future years for this employer and if so, whether it will cause premiums for more traditional health plans to increase. [source] Rising hospitalization rates for inflammatory bowel disease in the United States between 1998 and 2004,INFLAMMATORY BOWEL DISEASES, Issue 12 2007Geoffrey C. Nguyen MD Abstract Background: Recent epidemiological studies suggest that the prevalences of Crohn's disease (CD) and ulcerative colitis (UC) are increasing in the United States. We sought to determine whether nationwide rates of inflammatory bowel disease (IBD) hospitalizations have increased in response to temporal trends in prevalence. Methods: We identified all admissions with a primary diagnosis of CD or UC, or 1 of their complications in the Nationwide Inpatient Sample between 1998 and 2004. National estimates of hospitalization rates and rates of surgery were determined using the U.S. Census population as the denominator. Results: There were an estimated 359,124 and 214,498 admissions for CD and UC, respectively. The overall hospitalization rate for CD was 18.0 per 100,000 and that for UC was 10.8 per 100,000. There was a 4.3% annual relative increase in hospitalization rate for CD (P < 0.0001) and a 3.0% annual increase for UC (P < 0.0001). Surgery rates were 3.4 bowel resections per 100,000 for CD and 1.2 colectomies per 100,000 for UC and remained stable. There were no temporal patterns for average length of stay for CD (5.8 days) or for UC (6.8 days). The national estimate of total inpatient charges attributable to CD increased from $762 million to $1,330 million between 1998 and 2004, and that for UC increased from $592 million to $945 million. Conclusions: Hospitalization rates for IBD, particularly CD, have increased within a 7-year period, incurring a substantial rise in inflation-adjusted economic burden. The findings reinforce the need for effective treatment strategies to reduce IBD complications. (Inflamm Bowel Dis 2007) [source] The effects of telomerase inhibition on prostate tumor-initiating cellsINTERNATIONAL JOURNAL OF CANCER, Issue 2 2010Calin O. Marian Abstract Prostate cancer is the most common malignancy in men, and patients with metastatic disease have poor outcome even with the most advanced therapeutic approaches. Most cancer therapies target the bulk tumor cells, but may leave intact a small population of tumor-initiating cells (TICs), which are believed to be responsible for the subsequent relapse and metastasis. Using specific surface markers (CD44, integrin ,2,1 and CD133), Hoechst 33342 dye exclusion, and holoclone formation, we isolated TICs from a panel of prostate cancer cell lines (DU145, C4-2 and LNCaP). We have found that prostate TICs have significant telomerase activity which is inhibited by imetelstat sodium (GRN163L), a new telomerase antagonist that is currently in Phase I/II clinical trials for several hematological and solid tumor malignancies. Prostate TICs telomeres were of similar average length to the telomeres of the main population of cells and significant telomere shortening was detected in prostate TICs as a result of imetelstat treatment. These findings suggest that telomerase inhibition therapy may be able to efficiently target the prostate TICs in addition to the bulk tumor cells, providing new opportunities for combination therapies. [source] Effect of Temperature on Fecundity, Life Span and Morphology of Long- and Short-Spined Clones of Brachionus caudatus f. apsteini (Rotifera)INTERNATIONAL REVIEW OF HYDROBIOLOGY, Issue 6 2008Sujiporn Athibai Abstract We investigated the effect of temperature (20, 25 and 30 °C) on fecundity, life span and morphology of the rotifer Brachionus caudatus f. apsteini. For each temperature, short posterior-spined and long posterior-spined clones of B. caudatus f. apsteini were individually cultured for up to six generations. The rotifers were fed Chlorella sp. at a density of 1 × 106 cells ml,1. Morphometric data (body size and spine length) were collected. Total number of offspring producing by a single female per life cycle at high temperature was higher than at low temperature. The duration of juvenile period, reproductive period, post-reproductive period and life span of both clones of B. caudatus f. apsteini decreased with increasing temperature. All offspring of short posterior-spined clone produce posterior spines at 20 and 25 °C, with an average length of 19.8 ± 6.6 and 11.9 ± 2.6 ,m, respectively. In contrast, they cannot develop posterior spines at 30 °C, at which the average length of the posterior spine remnant was 6.4 ± 1.3 ,m. On the other hand, all offspring of long posterior-spined clone have long posterior spines with average lengths of 36.8 ± 6.1, 36.3 ± 5.2 and 36.6 ± 6.2 ,m at 20, 25 and 30 °C, respectively. This study indicated that the production of posterior spines can be induced by low temperature and that short posterior-spined and long posterior-spined clones are genetically different. (© 2008 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim) [source] Feeling at home in nursing homesJOURNAL OF ADVANCED NURSING, Issue 3 2001Anke J.E. De Veer PhD Feeling at home in nursing homes Aim.,The purpose of this study was to examine determinants of feeling at home and in particular the privacy in nursing homes in The Netherlands. The first question was to what extent nursing homes differed in the degree residents feel at home and experience privacy. The second question was whether feeling at home is related to privacy in the nursing homes. Background.,Feeling at home is of particular importance to residents of nursing homes because the average length of stay in The Netherlands is about 16 months. A growing number of people are of the opinion that the privacy of the residents has to be improved. Privacy in nursing homes, therefore, has been high on the political agenda over the last few years. Four aspects of privacy were distinguished: privacy related to the characteristics of the building, privacy as a consequence of the attitude of nurses towards residents, privacy in terms of choice and control over time schedules and activities, and privacy related to the amount of disturbance caused by other residents. Design.,The data were collected from individual interviews with 686 residents and family-members in 36 nursing homes in The Netherlands. Results.,Following quantitative data analysis, it was found that nursing homes differed in the proportion of residents feeling at home as well as in three aspects of privacy. Differences in feeling at home were found to be related to privacy, especially to the perceived attitudes of nurses and perceived disturbance caused by other residents. A weak relationship was found between residents and their perceived privacy of the building. Conclusions.,A significant amount of variation in privacy was found at the nursing home level. This implies that feeling at home is not only individually determined but can be influenced by the nursing home's management policy. [source] Long-Term Acute Care: A Review of the LiteratureJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 5 2007Manuel A. Eskildsen MD Long-term acute care (LTAC) represents a rapidly growing category of Medicare providers, but little is known about its quality, outcomes, and cost-effectiveness. Its defining characteristic, as set by Medicare, is an average length of stay of greater than 25 days. Modern LTAC emerged in the early 1980s as a setting for the weaning of ventilator-dependent patients. The industry has developed greatly in the last few years, with for-profit corporations dominating the field, and as Medicare expenditures have grown, new payment systems have emerged to limit spiraling costs. Although LTAC is mainly known for providing chronic ventilator weaning, the case mix is varied. The majority of outcome studies in this setting have been done on pulmonary patients, with fewer data available on nonventilator patients. This article analyzes studies of LTAC that are currently available, discusses some of the public policy issues surrounding this level of care, and suggests a research agenda, including a role for the field of geriatrics. [source] Age, growth, mortality and population structure of the oyster, Crassostrea madrasensis, in the Moheskhali Channel (southeastern coast of Bangladesh)JOURNAL OF APPLIED ICHTHYOLOGY, Issue 1 2008S. M. Nurul Amin Summary The population structure, age, growth, mortality and harvest intensity of the oyster Crassostrea madrasensis were examined in the Moheskhali Channel, Bangladesh between June 2003 and May 2004. The channel is a representative habitat for the area. C. madrasensis monthly length frequency data were analyzed using FiSAT software for estimating population parameters, including asymptotic length (L), growth co-efficient (K) and recruitment pattern to assess the status of the stock. Asymptotic length (L,) and growth co-efficient (K) were 20.88 cm and 0.35 year,1, respectively. The growth performance index (,,) was calculated with 2.18. The growth pattern showed negative allometric growth (b < 3), with an asymptotic weight (W) of about 1124.6 g. The oyster attained an average length of 6.17 cm at the end of 1 year. Total mortality (Z) by length-converted catch curve was estimated at 1.78 year,1, fishing mortality (F) at 0.77 year,1, and natural mortality (M) at 1.01 year,1. The exploitation level (E) of C. madrasensis was 0.43, while the maximum allowable limit of exploitation (Emax) was 0.45 for the highest yield. The recruitment pattern was continuous, displaying a single major peak event per year. Habitat temperatures were 25.5,31.0°C (mean ± SD, 29 ± 1.62°C); salinity range was from 12.36 to 26.0 ppt (mean ± SD, 19.6 ± 4.7 ppt). The exploitation level (0.43) indicated that the oyster stock was exploited at almost maximum yield in this channel. [source] Postpartum plasma exchange as adjunctive therapy for severe acute fatty liver of pregnancyJOURNAL OF CLINICAL APHERESIS, Issue 4 2008James N. Martin Jr. Abstract Acute fatty liver of pregnancy (AFLP) is a rare disease of progressive hepatic insufficiency and secondary systemic compromise that poses significant fetal-maternal risk. Plasma exchange (PEX) is an effective bridge therapy to sustain liver function and enable hepatocellular regeneration to occur in nonpregnant patients following acute decompensation of a chronic liver disease or while awaiting liver transplantation. The application of PEX for patients with AFLP is a novel concept; since 1988 we have utilized postpartum PEX (PPEX) as adjunctive medical therapy for six patients with severe AFLP. Before PPEX initiation, four patients had signs and symptoms of encephalopathy, three required ventilatory support, five had advanced liver insufficiency, and all six were developing renal failure. PPEX was initiated 2,8 days following delivery and repeated (two to four times, mean = 3) at 24,48-h intervals thereafter. All patients responded with composite clinical (symptoms/signs) and laboratory improvement; the average length of hospitalization following final PPEX for five of six patients was 7 days. No significant PPEX-related complications occurred. PPEX utilization in patients with severe AFLP may enhance maternal recovery by preventing secondary sequelae from hepatic insufficiency until spontaneous healing can occur. Further study appears to be indicated to validate a role for PPEX as supportive therapy for puerperal patients with AFLP suffering multiorgan failure. J. Clin. Apheresis, 2008. © 2008 Wiley-Liss, Inc. [source] Nurse discharge planning in the emergency department: a Toowoomba, Australia, studyJOURNAL OF CLINICAL NURSING, Issue 8 2006Desley Hegney BA Aim., This study aimed to ascertain whether a model of risk screening carried out by an experienced community nurse was effective in decreasing re-presentations and readmissions and the length of stay of older people presenting to an Australian emergency department. Objectives., The objectives of the study were to (i) identify all older people who presented to the emergency department of an Australian regional hospital; (ii) identify the proportion of re-presentations and readmissions within this cohort of patients; and (iii) risk-screen all older patients and provide referrals when necessary to community services. Design., The study involved the application of a risk screening tool to 2139 men and women over 70 years of age from October 2002 to June 2003. Of these, 1102 (51·5%) were admitted and 246 (11·5%) were re-presentations with the same illness. Patients presenting from Monday to Friday from 08:00 to 16:00 hours were risk-screened face to face in the emergency department. Outside of these hours, but within 72 hours of presentation, risk screening was carried out by telephone if the patient was discharged or within the ward if the patient had been admitted. Results., There was a 16% decrease in the re-presentation rate of people over 70 years of age to the emergency department. Additionally during this time there was a 5·5% decrease in the readmission rate (this decrease did not reach significance). There was a decrease in the average length of stay in hospital from 6·17 days per patient in October 2002 to 5·37 days per patient in June 2003. An unexpected finding was the decrease in re-presentations in people who represented to the emergency department three or more times per month (known as ,frequent flyers'). Conclusions., Risk screening of older people in the emergency department by a specialist community nurse resulted in a decrease of re-presentations to the emergency department. There was some evidence of a decreased length of stay. It is suggested that the decrease in re-presentations was the result of increased referral and use of community services. It appears that the use of a specialist community nurse to undertake risk screening rather than the triage nurse may impact on service utilization. Relevance to clinical practice., It is apparent that older people presenting to the emergency department have complex care needs. Undertaking risk screening using an experienced community nurse to ascertain the correct level of community assistance required and ensuring speedy referral to appropriate community services has positive outcomes for both the hospital and the patient. [source] Effects of Larval Stocking Density on Laboratory-Scale and Commercial-Scale Production of Summer Flounder Paraliehthys dentatusJOURNAL OF THE WORLD AQUACULTURE SOCIETY, Issue 3 2000Nicholas J. King Experiments 1 and 2 at commercial scale tested the densities of 10 and 60 larvae/L, and 10, 20, and 30/L, respectively. The laboratory scale experiment tested the densities of 10, 20, 30, and 40 larvae/L. Experiments were carried out in two separate filtered, flow-through seawater systems at URI Narragansett Bay Campus (laboratory-scale), and at GreatBay Aquafarms, Inc. (commercial-scale). At both locations, the larvae were raised in a "greenwater" culture environment, and fed rotifers and brine shrimp nauplii according to feeding regimes established for each location. Water temperature was maintained at 21C (± 2) and 19C (± 1) for the duration of laboratory and commercial experiments, respectively. Experiments 1 and 2 at the commercial location were terminated at 42 and 37 d post hatch (dph), respectively, and the laboratory experiment lasted 34 DPH. Larvae initially stocked at 10/L grew to an average length of 14.3 and 14.4 mm, and were significantly larger (P < 0.05) than those stocked at 30/L (13.1 mm) and 60/L (11.7 mm) in commercial scale experiments I and 2, respectively. At laboratory scale, no significant differences in length were detected, although mean total length tended to decrease with increasing stocking density (average length of 14.2, 13.3, 12.7, and 12.7 mm for treatments of 10, 20, 30, and 40/L, respectively). Final survival percentage was not affected by stocking density in either commercial experiment, and was 61 and 40% for treatments of 10 and 60/L in Experiment 1, respectively, and 62, 59, and 56% for Experiment 2, respectively. Similarly, there was no significant difference in final survival percentage among treatments in the laboratory experiment, which averaged 59, 55, 56, and 37% for treatments of 10, 20, 30, and 40L. respectively. Since larval length was not different between the intermediate densities (20 and 30 Iarvae/L), and because high-density rearing can produce a much greater numerical yield per tank, we recommend a density of 30 larvaen as an optimal stocking density for the hatchery production of summer flounder. [source] Cross-Linked Poly(, -caprolactone/D,L -lactide) Copolymers with Elastic PropertiesMACROMOLECULAR CHEMISTRY AND PHYSICS, Issue 18 2002Antti O. Helminen Abstract Cross-linked , -caprolactone (CL) and D,L -lactide (DLLA) copolymers with elastic properties were synthesized in three steps. First, the monomers were copolymerized in ring-opening polymerization to obtain telechelic star-shaped oligomers with almost completely random monomer distribution. The oligomers were methacrylated with methacrylic anhydride in the second step and cured in a third. Molar CL/DLLA compositions of 30/70, 50/50, 70/30, 90/10, and 100/0 were used to obtain elastic structures with a wide range of properties. The effect of the average length of the copolymer block on the properties of the networks was evaluated with three different co-initiator contents (0.5, 1.0, and 2.0/100) in the oligomer synthesis. The oligomers were characterized by 13C NMR spectroscopy, size-exclusion chromatography (SEC), and differential-scanning calorimetry (DSC). The formation of elastic networks was confirmed by the absence of a flow region in dynamic mechanical analysis (DMA), the increase in Tg in DSC, and the full recovery of the sample dimensions after tensile testing. In addition, gel contents were high and the samples swelled in CH2Cl2. The networks possessed break stresses from 0.7,9.7 MPa with elongations from 80,350%. Networks with 100 or 90% of , -caprolactone retained their form in vitro for 12 weeks, but an increase in lactide content made the networks more vulnerable to hydrolysis. Water absorption of the polymers during hydrolysis. [source] Efficacy of enteric-coated mycophenolate sodium in patients with active lupus nephritisNEPHROLOGY, Issue 4 2008SIU-KA MAK SUMMARY: Background: The ideal treatment of lupus nephritis has yet to be defined. Both cyclophosphamide and mycophenolate mofetil have been used with encouraging results, but adverse events are frequently seen. There are no data on the use of enteric-coated mycophenolate sodium. Methods: We retrospectively reviewed 12 patients with active forms of lupus nephritis (1 class III, 7 class IV and 4 class V) treated with enteric-coated mycophenolate sodium combined with corticosteroids. Results: The mean age of the patients was 32.3 ± 11.2 years and the average length of follow up was 25.9 ± 8.9 months. The mean serum creatinine clearance was 93 ± 30.1 mL/min per 1.73 m2 and the mean proteinuria level was 4.5 ± 3.6 g/day. All had features that warranted aggressive treatment. Mycophenolate sodium was given for 12.9 ± 9.7 months with an averaged starting dose of 1350 ± 163 mg/day. Six patients attained complete remission and six attained partial remission with treatment. The mean interval to attain first remission (complete or partial) was 8.3 ± 5.7 weeks. At last follow up, all patients were in complete or partial remission. Apart from herpes zoster that developed in one patient, no other significant side-effects were encountered. Conclusion: Enteric-coated mycophenolate sodium was effective and well-tolerated in the treatment of active lupus nephritis. [source] Cost and mortality associated with hospitalizations in patients with immune thrombocytopenic purpura,AMERICAN JOURNAL OF HEMATOLOGY, Issue 10 2009Mark D. Danese Immune thrombocytopenic purpura (ITP) is associated with low platelet counts and, consequently, a high risk of adverse events leading to hospitalization. However, there are few data on the clinical and economic burden of hospitalizations for ITP. The Nationwide Inpatient Sample (NIS) database of discharges, a stratified 20% sample of all United States (US) community hospitals across all payers, was used to evaluate discharges in ITP patients. We developed nationally representative numbers of discharges in ITP patients from 2003 to 2006 based on diagnosis codes. Using appropriate weights for each NIS discharge, we created national estimates of average cost, length of stay, and in-hospital mortality for specific groups of ITP-related hospitalizations. Approximately 129,000 discharges occurred between 2003 and 2006 in ITP patients. The average cost associated with all discharges in 2008 dollars was 16,476, with a 6.4-day length of stay and in-hospital mortality of 3.8%. In contrast, the average cost of all hospitalizations in the US population during the same period was 10,039, the average length of stay was 4.8 days, and in-hospital mortality was 2.5%. Mortality risk was higher for ITP patients than for the standard US population adjusted for age and gender, with a relative mortality ratio of 1.5 (95% CI: 1.4,1.6). On the basis of a nationally representative sample of US discharge records from 2003 to 2006, hospitalization with ITP represents an economically and clinically important event. ITP was associated with higher costs, longer stays, and more in-hospital deaths on average than all other hospitalized patients combined. Am. J. Hematol. 2009. © 2009 Wiley-Liss, Inc. [source] Clinical experience with a new specimen capturing bone marrow biopsy needleAMERICAN JOURNAL OF HEMATOLOGY, Issue 3 2001Alec S. Goldenberg Abstract The SNARECOILÔ needle is a specimen capturing bone marrow biopsy needle that incorporates a tiny internal capturing coil. It was developed to minimize postinsertion needle manipulation and to facilitate specimen recovery. Forty-four patients underwent 50 bone marrow biopsy procedures with the SNARECOIL needle for a variety of hematologic indications. Second and third procedures were done for follow-up or staging. Each procedure retrieved a specimen with an average length of 2.1 cm. Fifty-two percent of the specimens were ,2.0 cm in length. The majority of specimens demonstrated intact marrow architecture enabling a pathologic diagnosis in every case. Delicate cores of nontrabeculated marrow were recovered in three cases. The SNARECOIL bone marrow biopsy needle reliably retrieves intact bone marrow core specimens for pathologic interpretation. Am. J. Hematol. 68:189,193, 2001 © 2001 Wiley-Liss, Inc. [source] Lumbar ontogenetic growth and sexual dimorphism in modern humansAMERICAN JOURNAL OF HUMAN BIOLOGY, Issue 5 2010Elías Valverde To detect and differentiate between possible heterochronic processes in the ontogenetic growth pattern of the human lumbar region, in relationship with sexual dimorphism. We measured the growth trajectories of average length and width, length/width ratio, posterior projected surface area, and bone mineral density using dual energy X-ray absorptiometry, in a sample group of 1718 modern humans. These growth patterns were analyzed using the Gompertz model. In adult lumbar region, only surface area and width were significantly higher in men. Regarding the ontogenetic growth pattern leading to the dimorphic states, all values obtained for women were significantly higher than those obtained for men. Maximum initial growth rates occurred for surface area and density in women. Width scaled faster than length in both sexes. The lumbar region followed patterns similar to those of other skeletal elements when compared with a previous classification of growth patterns in the human skeleton; however, in this study, the growth rate was slower. With regard to the effect of dimorphism, sexual differences in growth rate accounted for only a small proportion of the variation in lumbar length, mineral density, and surface area. Nevertheless, these sexual differences played an important role in the increase of the length/width ratio, which was reflected in the ages at which sexual dimorphism developed. The sexual dimorphism found in the lumbar region of human adults is not caused by any heterochronic process. The lower values of bone mineral density in adult women could explain the origin of some pathologies related. Am. J. Hum. Biol. 22:596,603, 2010. © 2010 Wiley-Liss, Inc. [source] | |||||||||||||||||||||||||