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Severe Consequences (severe + consequence)
Selected AbstractsKey issues with implementing LOPAPROCESS SAFETY PROGRESS, Issue 2 2010William Bill Bridges Abstract This article writen by one of the originators of LOPA, focuses on problems observed with LOPA. One the biggest issues is that organizations use LOPA without following the rules for LOPA, especially the rules related to maintaining, testing, and record-keeping for each independent protection layer (IPL) and for each "optimized" initiating event (IE). Another issue is that many companies and analysts overuse LOPA. The LOPA book authors expected the number of scenarios going to LOPA (after a HAZOP/PHA) would be 1 to 10% (max) of those uncovered in a qualitative analysis (maybe after 100 HAZOP nodes, you would do 1,10 LOPA). A PHA team would recommend (or use) LOPA only if the scenario was too complex for the PHA/HAZOP team. It appears that most companies are using LOPA for every scenario that has a severe consequence; this result in doing LOPA on much more than 10% of the scenarios. Many times, there is weak definition of the consequence that is being avoided, so an independent layer of protection does not always match up well with the consequence. LOPA is also overworked when it is used. Many of us on the original LOPA book authorship considered LOPA a single analyst job, after a PHA/HAZOP. Instead, the trend appears to be that companies (or perhaps their consultants) make LOPA part of the PHA (in situ), therefore involving the whole PHA team. LOPA is used in PHA team settings, which distracts PHA teams from their primary task of brainstorming to identify the accident scenarios that can occur. This article focuses on preventing these problems and also summarizes the many benefits LOPA has produced for the industry. © 2010 American Institute of Chemical Engineers Process Saf Prog, 2010 [source] Regulation of STARS and its downstream targets suggest a novel pathway involved in human skeletal muscle hypertrophy and atrophyTHE JOURNAL OF PHYSIOLOGY, Issue 8 2009Séverine Lamon Skeletal muscle atrophy is a severe consequence of ageing, neurological disorders and chronic disease. Identifying the intracellular signalling pathways controlling changes in skeletal muscle size and function is vital for the future development of potential therapeutic interventions. Striated activator of Rho signalling (STARS), an actin-binding protein, has been implicated in rodent cardiac hypertrophy; however its role in human skeletal muscle has not been determined. This study aimed to establish if STARS, as well as its downstream signalling targets, RhoA, myocardin-related transcription factors A and B (MRTF-A/B) and serum response factor (SRF), were increased and decreased respectively, in human quadriceps muscle biopsies taken after 8 weeks of both hypertrophy-stimulating resistance training and atrophy-stimulating de-training. The mRNA levels of the SRF target genes involved in muscle structure, function and growth, such as ,-actin, myosin heavy chain IIa (MHCIIa) and insulin-like growth factor-1 (IGF-1), were also measured. Following resistance training, STARS, MRTF-A, MRTF-B, SRF, ,-actin, MHCIIa and IGF-1 mRNA, as well as RhoA and nuclear SRF protein levels were all significantly increased by between 1.25- and 3.6-fold. Following the de-training period all measured targets, except for RhoA, which remained elevated, returned to base-line. Our results show that the STARS signalling pathway is responsive to changes in skeletal muscle loading and appears to play a role in both human skeletal muscle hypertrophy and atrophy. [source] Fetal alcohol syndrome (FAS) in C57BL/6 mice detected through proteomics screening of the amniotic fluid,BIRTH DEFECTS RESEARCH, Issue 4 2008Susmita Datta Abstract BACKGROUND: Fetal Alcohol Syndrome (FAS), a severe consequence of the Fetal Alcohol Spectrum Disorders, is associated with craniofacial defects, mental retardation, and stunted growth. Previous studies in C57BL/6J and C57BL/6N mice provide evidence that alcohol-induced pathogenesis follows early changes in gene expression within specific molecular pathways in the embryonic headfold. Whereas the former (B6J) pregnancies carry a high-risk for dysmorphogenesis following maternal exposure to 2.9 g/kg alcohol (two injections spaced 4.0 h apart on gestation day 8), the latter (B6N) pregnancies carry a low-risk for malformations. The present study used this murine model to screen amniotic fluid for biomarkers that could potentially discriminate between FAS-positive and FAS-negative pregnancies. METHODS: B6J and B6N litters were treated with alcohol (exposed) or saline (control) on day 8 of gestation. Amniotic fluid aspirated on day 17 (n = 6 replicate litters per group) was subjected to trypsin digestion for analysis by matrix-assisted laser desorption,time of flight mass spectrometry with the aid of denoising algorithms, statistical testing, and classification methods. RESULTS: We identified several peaks in the proteomics screen that were reduced consistently and specifically in exposed B6J litters. Preliminary characterization by liquid chromatography tandem mass spectrometry and multidimensional protein identification mapped the reduced peaks to alpha fetoprotein (AFP). The predictive strength of AFP deficiency as a biomarker for FAS-positive litters was confirmed by area under the receiver operating characteristic curve. CONCLUSIONS: These findings in genetically susceptible mice support clinical observations in maternal serum that implicate a decrease in AFP levels following prenatal alcohol damage. Birth Defects Research (Part A), 2008. © 2008 Wiley-Liss, Inc. [source] Ethanol neurotoxicity and dentate gyrus developmentCONGENITAL ANOMALIES, Issue 3 2008Takanori Miki ABSTRACT Maternal alcohol ingestion during pregnancy adversely affects the developing fetus, often leading to fetal alcohol syndrome (FAS). One of the most severe consequences of FAS is brain damage that is manifested as cognitive, learning, and behavioral deficits. The hippocampus plays a crucial role in such abilities; it is also known as one of the brain regions most vulnerable to ethanol-induced neurotoxicity. Our recent studies using morphometric techniques have further shown that ethanol neurotoxicity appears to affect the development of the dentate gyrus in a region-specific manner; it was found that early postnatal ethanol exposure causes a transitory deficit in the hilus volume of the dentate gyrus. It is strongly speculated that such structural modifications, even transitory ones, appear to result in developmental abnormalities in the brain circuitry and lead to the learning disabilities observed in FAS children. Based on reports on possible factors deciding ethanol neurotoxicity to the brain, we review developmental neurotoxicity to the dentate gyrus of the hippocampal formation. [source] Organ-specific lymphangiectasia, arrested lymphatic sprouting, and maturation defects resulting from gene-targeting of the PI3K regulatory isoforms p85,, p55,, and p50,DEVELOPMENTAL DYNAMICS, Issue 10 2009Carla Mouta-Bellum Abstract The phosphoinositide 3-kinase (PI3K) family has multiple vascular functions, but the specific regulatory isoform supporting lymphangiogenesis remains unidentified. Here, we report that deletion of the Pik3r1 gene, encoding the regulatory subunits p85,, p55,, and p50, impairs lymphatic sprouting and maturation, and causes abnormal lymphatic morphology, without major impact on blood vessels. Pik3r1 deletion had the most severe consequences among gut and diaphragm lymphatics, which share the retroperitoneal anlage, initially suggesting that the Pik3r1 role in this vasculature is anlage-dependent. However, whereas lymphatic sprouting toward the diaphragm was arrested, lymphatics invaded the gut, where remodeling and valve formation were impaired. Thus, cell-origin fails to explain the phenotype. Only the gut showed lymphangiectasia, lymphatic up-regulation of the transforming growth factor-, co-receptor endoglin, and reduced levels of mature vascular endothelial growth factor-C protein. Our data suggest that Pik3r1 isoforms are required for distinct steps of embryonic lymphangiogenesis in different organ microenvironments, whereas they are largely dispensable for hemangiogenesis. Developmental Dynamics 238:2670,2679, 2009. © 2009 Wiley-Liss, Inc. [source] A case of late-onset dependence on cocaine and crackADDICTION, Issue 4 2007Christos Kouimtsidis ABSTRACT Aims To raise awareness among the professional clinical and research community of the risk of cocaine misuse among elderly patients. Methods Case report of a male patient, aged 72 years, who presented to a community substance misuse service with cocaine use disorder (hydrochloride and base form). Results The development of the disorder was marked by high levels of cocaine (and later crack cocaine use), repeated periods of abstinence followed by relapse in the past 4 years, with severe consequences to the patient and his family. Treatment involved a close collaboration between several specialist addictions and old-age psychiatry teams in National Health Service. Implications Although dependence on cocaine among the elderly is considered very rare, clinical management can be challenging and is likely to require the involvement of several specialist and general health services. [source] Human haptoglobin structure and function , a molecular modelling studyFEBS JOURNAL, Issue 22 2008F. Polticelli Hemoglobin is the most prominent protein in blood, transporting O2 and facilitating reactive oxygen and nitrogen species detoxification. Hemoglobin metabolism leads to the release of extra-erythrocytic hemoglobin, with potentially severe consequences for health. Extra-erythrocytic hemoglobin is complexed to haptoglobin for clearance by tissue macrophages. The human gene for haptoglobin consists of three structural alleles: Hp1F, Hp1S and Hp2. The products of the Hp1F and Hp1S alleles differ by only one amino acid, whereas the Hp2 allele is the result of a fusion of the Hp1F and Hp1S alleles, is present only in humans and gives rise to a longer ,-chain. Haptoglobin consists of a dimer of ,,-chains covalently linked by a disulphide bond between the Cys15 residue of each ,-chain. However, the presence of the Hp1 and Hp2 alleles in humans gives rise to HPT1-1 dimers (covalently linked by Cys15 residues), HPT1-2 hetero-oligomers and HPT2-2 oligomers. In fact, the HPT2 variant displays two free Cys residues (Cys15 and Cys74) whose participation in intermolecular disulphide bonds gives rise to higher-order covalent multimers. Here, the complete modelling of both haptoglobin variants, together with their basic quaternary structure arrangements (i.e. HPT1 dimer and HPT2 trimer), is reported. The structural details of the models, which represent the first complete view of the molecular details of human haptoglobin variants, are discussed in relation to the known haptoglobin function(s). [source] Intraseasonal climate and habitat-specific variability controls the flowering phenology of high alpine plant speciesFUNCTIONAL ECOLOGY, Issue 2 2010Karl Hülber Summary 1. ,High alpine plants endure a cold climate with short growing seasons entailing severe consequences of an improper timing of development. Hence, their flowering phenology is expected to be rigorously controlled by climatic factors. 2. ,We studied ten alpine plant species from habitats with early and late melting snow cover for 2 years and compared the synchronizing effect of temperature sums (TS), time of snowmelt (SM) and photoperiod (PH) on their flowering phenology. Intraseasonal and habitat-specific variation in the impact of these factors was analysed by comparing predictions of time-to-event models using linear mixed-effects models. 3. ,Temperature was the overwhelming trigger of flowering phenology for all species. Its synchronizing effect was strongest at or shortly after flowering indicating the particular importance of phenological control of pollination. To some extent, this pattern masks the common trend of decreasing phenological responses to climatic changes from the beginning to the end of the growing season for lowland species. No carry-over effects were detected. 4. ,As expected, the impact of photoperiod was weaker for snowbed species than for species inhabiting sites with early melting snow cover, while for temperature the reverse pattern was observed. 5. ,Our findings provide strong evidence that alpine plants will respond quickly and directly to increasing temperature without considerable compensation due to photoperiodic control of phenology. [source] Peripheral tolerance limits CNS accumulation of CD8 T cells specific for an antigen shared by tumor cells and normal astrocytesGLIA, Issue 15 2008Thomas Calzascia Abstract T cell mediated immunotherapies are proposed for many cancers including malignant astrocytoma. As such therapies become more potent, but not necessarily more tumor-specific, the risk of collateral autoimmune damage to normal tissue increases. Tumors of the brain present significant challenges in this respect, as autoimmune destruction of brain tissue could have severe consequences. To investigate local immune reactivity toward a tumor-associated antigen in the brain, transgenic mice were generated that express a defined antigen (CW3170,179) in astroglial cells. The resulting six transgenic mouse lines expressed the transgenic self-antigen in cells of the gastrointestinal tract and CNS compartments, or in the CNS alone. By challenging transgenic mice with tumor cells that express CW3, self/tumor-specific immune responses were visualized within a normal polyclonal T cell repertoire. A large expansion of the endogenous CW3170,179 -specific CD8 T cell population was observed in nontransgenic mice after both subcutaneous and intracerebral implantation of tumor cells. In contrast, CW3170,179 -specific immune responses were not observed in transgenic mice that exhibited extracerebral transgene expression. Importantly, in certain groups of mice in which transgene expression was restricted to the CNS, antigen-specific immune responses occurred when tumor was implanted subcutaneously, but not intracerebrally. This local immune tolerance in the brain was induced via peripheral (extrathymic) rather than central (thymic) tolerance mechanisms. Thus, this study highlights the role of regional immune regulation in the prevention of autoimmunity in the brain, and the potential impact of these mechanisms for brain tumor immunotherapy. © 2008 Wiley-Liss, Inc. [source] Use of quantitative real-time polymerase chain reaction to estimate the size of the house-fly Musca domestica genomeINSECT MOLECULAR BIOLOGY, Issue 6 2006J. Gao Abstract House-flies, Musca domestica, are carriers of more than 100 devastating diseases that have severe consequences for human and animal health. A key bottleneck to progress in controlling the devastating human diseases transmitted by house-flies is lack of knowledge of the basic molecular biology of this species. However, before sequencing of the house-fly genome can be seriously considered it is important to know the size of the genome. In this paper, we used quantitative real-time polymerase chain reaction to calculate genome size of the house-fly in side-by-side experiments with Drosophila melanogaster (known genome size of 180 Mb). Our results indicate the size of the house-fly genome is 295 ± 10 Mb and that of D. melanogaster is 184 Mb. Thus, the house-fly genome is only about 1.6-fold larger than the genome of D. melanogaster. This indicates that the size of the house-fly genome makes it an excellent candidate for whole genome sequencing and that quantitative real-time polymerase chain reaction is an accurate method for the estimation of the size of insect genomes. [source] The direct simulation Monte Carlo method using unstructured adaptive mesh and its applicationINTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN FLUIDS, Issue 4 2002J.-S. Wu Abstract The implementation of an adaptive mesh-embedding (h-refinement) scheme using unstructured grid in two-dimensional direct simulation Monte Carlo (DSMC) method is reported. In this technique, local isotropic refinement is used to introduce new mesh where the local cell Knudsen number is less than some preset value. This simple scheme, however, has several severe consequences affecting the performance of the DSMC method. Thus, we have applied a technique to remove the hanging node, by introducing the an-isotropic refinement in the interfacial cells between refined and non-refined cells. Not only does this remedy increase a negligible amount of work, but it also removes all the difficulties presented in the originals scheme. We have tested the proposed scheme for argon gas in a high-speed driven cavity flow. The results show an improved flow resolution as compared with that of un-adaptive mesh. Finally, we have used triangular adaptive mesh to compute a near-continuum gas flow, a hypersonic flow over a cylinder. The results show fairly good agreement with previous studies. In summary, the proposed simple mesh adaptation is very useful in computing rarefied gas flows, which involve both complicated geometry and highly non-uniform density variations throughout the flow field. Copyright © 2002 John Wiley & Sons, Ltd. [source] Openness, Uncertainty, and Social Spending: Implications for the Globalization, Welfare State DebateINTERNATIONAL STUDIES QUARTERLY, Issue 3 2009Irfan Nooruddin We extend the literature on openness and spending in developing countries arguing that the effect of increasing openness depends on both regime type and the level of openness. Democracies respond to increases in openness by increasing spending while dictatorships respond by decreasing spending. However, the degree to which countries pursue the strategy of choice depends on the level of openness. In autarkic countries, an increase in import competition has more severe consequences for perceptions of job insecurity and dislocation. In response, government management of openness will be more vigorous under these conditions regardless of whether the leader increases or decreases spending. Economic selection mechanisms at work will produce an outcome wherein, at higher levels of openness, further import liberalization has smaller effects on perceptions of job insecurity and dislocation. Hence, both the demand and the supply of government management of openness will be lower. [source] A Nursing Home in Arab-Israeli Society: Targeting Utilization in a Changing Social and Economic EnvironmentJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 1 2005Khalid Suleiman MD This article is a case study of the first 10 years of operation (1992,2002) of the Dabouriya Home for the Aged, the first publicly funded culturally adapted nursing home for Israeli citizens of Arab descent. Although 44% of Arab Israelis and 26% of Jewish Israelis aged 65 and older are disabled, in 1999, 4.3% of the Jewish population but only 0.7% of the Arab-Israeli population aged 65 or older lived in long-term care institutions; disabled Arab-Israeli elderly were mainly cared for by families. As Arab-Israeli society modernizes and traditional caregiving is reduced, alternatives must be found for this growing, disabled population. Medical and administrative records of 404 people admitted consecutively to a 136-bed facility over 10 years were analyzed. Two distinct segments of the needy population were served: people with independent activity of daily living (ADL) function but little or no family to provide help with intermediate ADLs and those dependent in ADLs and with health problems, especially dementia. Economic, demographic, and social changes in Arab-Israeli society may mean that traditional caregivers will not be able to adequately care for this highly disabled population. Administrators of the public health system in Israel should be aware of the underutilization of publicly funded long-term care by disabled Arab Israelis and the lack of care alternatives for the population that does use nursing homes, because there may be severe consequences in terms of caregiver burden and social stress when disabled elderly people remain in unsuitable environments. [source] Carry-over effects in a Pacific seabird: stable isotope evidence that pre-breeding diet quality influences reproductive successJOURNAL OF ANIMAL ECOLOGY, Issue 2 2009Marjorie C. Sorensen Summary 1Understanding the interactions between different periods of the annual cycle in migratory animals has been constrained by our inability to track individuals across seasons. In seabirds, virtually nothing is known about how diet quality during the non-breeding period, away from the breeding grounds, might influence subsequent reproductive success. 2We used stable nitrogen (,15N) and carbon (,13C) isotopes to evaluate the effects of non-breeding diet quality on the timing of breeding and egg size in a population of Cassin's auklets (Ptychoramphus aleuticus) breeding on Triangle Island, British Columbia. Adult feathers are grown during two different periods of the annual cycle, which allowed us to estimate diet quality from the previous fall (October,November) and pre-breeding (February,March) period. 3We found that the estimated proportion of energetically superior copepods (Neocalanus spp.) in the pre-breeding diet tended to be higher in females that bred earlier and laid larger eggs, whereas energetically poor juvenile rockfish (Sebastes spp.) were dominant in the pre-breeding diets of females that bred later and laid smaller eggs. We detected no effect of fall diet quality on breeding date or egg size, and no effect of pre-breeding diet quality on breeding date in males. 4Pre-breeding diet quality was not related to body condition measured 1,2 days after laying, which suggests that females may need to attain a threshold condition before they initiate breeding and successfully rear young. 5Our results suggest that changes in climatic conditions during the pre-breeding period may have severe consequences for reproductive success by influencing breeding date and egg size. Our work emphasizes the importance of determining how events are linked throughout the annual cycle for understanding the fitness and population dynamics of migratory animals. [source] Lived experiences of eating problems for patients with head and neck cancer during radiotherapyJOURNAL OF CLINICAL NURSING, Issue 4 2003Maria Larsson MNSc Summary ,,Only a small proportion of cancer patients undergo radical radiotherapy to the head and neck, but their needs are particularly complex. Although extensive research describes the side-effects of radiotherapy to the head and neck, few studies focus on patients' subjective experiences of eating problems and the impact these have on the patients' daily life. ,,In this study a phenomenological approach was used, as the purpose was to acquire deeper understanding of head and neck cancer patients' lived experiences of eating problems, their consequences in daily life and patients' strategies of coping with these problems. ,,Eight patients from two radiation therapy departments in mid-Sweden were interviewed in an open dialogue. Data analysis was based on Colaizzi's method. ,,Eating problems experienced were captured in two interrelated main themes: ,Ability to chew and swallow' and ,Will and desire to eat'. The eating problems were found to cause a number of severe consequences in daily life. These are incorporated into one main theme: ,The way of life is disturbed'. Ways to cope with this disturbance were captured in one main theme: ,Trying to see the end , To survive'. ,,This study identifies the need to view eating problems as a complex phenomenon in a specific context including the individual patient's life situation. The findings create the opportunity to develop nursing interventions based on patients' own needs. To facilitate this, a specialist nurse should be responsible for reviewing patients regularly throughout radiation therapy. Intervention studies are needed to provide optimal clinical guidelines. [source] Stress and well-being in the aftermath of the World Trade Center attack: The continuing effects of a communitywide disasterJOURNAL OF COMMUNITY PSYCHOLOGY, Issue 2 2005Richard E. Adams In this study, we examine the relationship between exposure to the World Trade Center disaster (WTCD) and the well-being of adults living in New York City (NYC) at the time of the attacks by using a stress process model. One year after the attacks, we conducted a telephone survey of a cross-sectional random sample of city residents with an oversample of residents who had received mental health treatment since the attacks (N = 2,368). The survey gathered information about respondents' demographic characteristics, exposure to the WTCD, other stressful events, and social psychological resources. The dependent variable (health status) was measured by using the Short Form-12 (SF-12) mental health and physical health scales. Overall, the greater the exposure to the events surrounding the WTCD, the poorer the person's psychological well-being, even after controlling for demographic characteristics, other stressors, and social psychological resources. Exposure was only weakly related to physical well-being, once other factors were taken into account. The findings clearly show that individuals who experienced greater exposure to the WTCD have more psychological problems than those who had less exposure 1 year after the attacks. Exposure did not seem to have such severe consequences for physical well-being. Thus, our study supports the continuation of mental health services to survivors of a community disaster well beyond the first year post disaster. © 2005 Wiley Periodicals, Inc. J Comm Psychol 33: 175,190, 2005. [source] A randomised, controlled trial of the effects of an energy-dense supplement on energy intake, appetite and blood lipids in malnourished community-based elderly patientsJOURNAL OF HUMAN NUTRITION & DIETETICS, Issue 4 2008G.P. Hubbard Background:, Disease-related malnutrition is common in the elderly and if left untreated may have severe consequences (Stratton & Elia, 2003). One of the strategies used to combat malnutrition is the use of high-energy, low-volume [18.8 kJ mL,1 (4.5 kcal ml,1)] nutritional supplements. This study aimed to investigate the effects of an energy dense supplement on energy intake, appetite and blood lipids in elderly patients at risk of malnutrition. Methods:, In this randomised, controlled, parallel study, 42 community-based patients (mean (SD) age: 84 (7.0) years, mean body mass index (BMI): 20.9 (3.5) kg m,2), identified as being at medium or high risk of malnutrition [Malnutrition Universal Screening Tool (MUST) (Elia, 2003)] were randomised (using standard randomisation methods) to receive either; (i) 1674 kJ day,1 (400 kcal day,1) (in 3 × 30 mL doses) of an energy-dense supplement (Calogen, Nutricia®) (n = 19) or (ii) dietary advice in the form of a standardised dietary advice sheet (n = 23), for 4 weeks. Energy intake, appetite, blood lipids [i.e. total cholesterol, low density lipoprotein (LDL) cholesterol (subset analysis only)], body weight, gastro-intestinal tolerance, product compliance and product acceptability were assessed during the 4 week study. Results are presented as mean (SD). Paired t -test and one way anova statistical analyses were undertaken using SPSS v15. Ethical approval for this study was obtained from the appropriate committee. Results:, Supplementation with the energy dense supplement significantly increased mean total daily energy intake by +1736 kJ (+415 kcal, P = 0.009) from 6456 (2330) kJ [1543 (557) kcal] to 8192 (1477) kJ [1958 (353) kcal], with no significant effect on voluntary food intake or appetite scores (for hunger, fullness and desire to eat). In the dietary advice group, although mean total daily energy intake was also significantly increased by +1105 kJ (+264 kcal, P = 0.026) from 5623 (2107) kJ [1344 (503) kcal] to 6728 (2029) kJ [1608 (485) kcal], it was significantly lower than in the energy dense group [-1464 kJ (-350 kcal), P = 0.012] at week 4. Both energy-dense and dietary advice groups maintained weight during the study. No significant adverse effects on blood lipid concentrations were observed in either group, with a significant decrease in total cholesterol concentrations [from 4.26 (1.0) mM to 3.96 (0.8) mM, P = 0.03] and LDL cholesterol concentrations [from 2.32 (0.6) mM to 2.06 (0.5) mM, P = 0.03] in the energy dense group (subset analysis, n = 9). Both supplementation with energy dense supplement and dietary advice were well tolerated with no gastro-intestinal side effects. The energy dense supplement was well accepted with >80% of patients rating it as pleasant and convenient, with an enjoyable taste. Compliance with the energy dense supplement was high, with 95% of patients consuming the recommended dose of 3 × 30 mL throughout the study. Discussion:, This study in elderly patients with or at risk of malnutrition suggests that the energy dense supplement is effective in significantly improving total intakes of energy with no suppression of appetite or voluntary dietary intake, enabling patients to maintain weight and that the energy dense supplement is well tolerated and accepted, with excellent compliance and no adverse effects on blood lipids. Conclusions:, This randomised controlled trial suggests that an energy-dense supplement is an effective, well tolerated and safe method of providing energy supplementation for the management of elderly patients with or at risk of malnutrition in clinical practice. References, Elia, M. (2003) The "MUST" report. Nutritional screening for adults: a multidisciplinary responsibility. Redditch, UK: BAPEN. Available at http://www.bapen.org.uk (accessed on 15 March 2008). Stratton, R.J., Green, C.J. & Elia, M. (2003) Disease-related malnutrition: an evidence-based approach. Oxford: CABI publishing. [source] Families in Poverty in the 1990s: Trends, Causes, Consequences, and Lessons LearnedJOURNAL OF MARRIAGE AND FAMILY, Issue 4 2000Karen Seccombe During the 1990s, poverty rates in the United States remained relatively stable despite a robust economy in which unemployment and inflation were at their lowest points in many years. Approximately 13% of individuals, 11% of families, and 19% of children lived below the poverty line in 1998, a decline of only 1% or less for each of these categories since 1990. These high rates of poverty result in many severe consequences. This essay reviews the research and theoretical and conceptual developments during the past decade, including: (a) a background on how the poverty line was developed; (b) general research themes in the 1990s; (c) the causes of the virtually unchanged poverty rate; (d) the consequences of poverty, particularly for children; and (e) the lessons we have learned from research over the past decade, with some directions for the future. [source] Peptides derived from the solvent-exposed loops 3 and 4 of BDNF bind TrkB and p75NTR receptors and stimulate neurite outgrowth and survivalJOURNAL OF NEUROSCIENCE RESEARCH, Issue 6 2010Kristina Fobian Abstract Brain-derived neurotrophic factor (BDNF) is critically involved in modeling the developing nervous system and is an important regulator of a variety of crucial functions in the mature CNS. BDNF exerts its action through interactions with two transmembrane receptors, either separately or in concert. BDNF has been implicated in several neurological disorders, and irregularities in BDNF function may have severe consequences. Administration of BDNF as a drug has thus far yielded few practicable results, and the potential side effects when using a multifunctional protein are substantial. In an effort to produce more specific compounds without side effects, small peptides mimicking protein function have been developed. The present study characterized two mimetic peptides, Betrofin 3 and Betrofin 4, derived from the BDNF sequence. Both Betrofins bound the cognate BDNF receptors, TrkB and p75NTR, and induced neurite outgrowth and enhanced neuronal survival, probably by inducing signaling through tha Akt and MAPK pathways. Distinct, charged residues within the Betrofin sequences were identified as important for generating the neuritogenic response, which was also inhibited when BDNF was added together with either Betrofin, indicating partial agonistic effects of the peptides. Thus, two peptides derived from BDNF induced neurite outgrowth and enhanced neuronal survival, probably through binding to BDNF receptors. © 2009 Wiley-Liss, Inc. [source] To Hedge or Not to Hedge: Managing Demographic Risk in Life Insurance CompaniesJOURNAL OF RISK AND INSURANCE, Issue 1 2006Helmut Gründl Demographic risk, i.e., the risk that life tables change in a nondeterministic way, is a serious threat to the financial stability of an insurance company having underwritten life insurance and annuity business. The inverse influence of changes in mortality laws on the market value of life insurance and annuity liabilities creates natural hedging opportunities. Within a realistically calibrated shareholder value (SHV) maximization framework, we analyze the implications of demographic risk on the optimal risk management mix (equity capital, asset allocation, and product policy) for a limited liability insurance company operating in a market with insolvency-averse insurance buyers. Our results show that the utilization of natural hedging is optimal only if equity is scarce. Otherwise, hedging can even destroy SHV. A sensitivity analysis shows that a misspecification of demographic risk has severe consequences for both the insurer and the insured. This result highlights the importance of further research in the field of demographic risk. [source] Pregnancy after liver transplantationLIVER TRANSPLANTATION, Issue 6 2000Vincent T. Armenti The first known posttransplantation pregnancy was in 1958 in a renal transplant recipient who had received a kidney from her identical twin sister. The first known posttransplantation pregnancy in a liver transplant recipient was in 1978. Information available from female kidney transplant recipients helped in the decision making involved in the management of this case, as well as those that followed. Over the last 20 years, issues specific to liver transplantation and pregnancy have been identified. Similar to the kidney transplant recipient population, when prepregnancy recipient graft function is stable and adequate, pregnancy appears to be well tolerated. Also similar to kidney transplant recipients, there has been no evidence of a specific malformation pattern among the children, and although prematurity and low birth weight occur, overall newborn outcomes have been favorable. Pregnancy in the setting of recurrent liver disease, such as recurrent hepatitis C, poses a potential problem among liver transplant recipients, as well as the possible adverse effects of immunosuppression on maternal kidney function. Also of significance, peripartum graft deterioration has more severe consequences in this transplant recipient population. Therefore, pregnancy must be considered carefully in this transplant recipient group. Since 1991, the National Transplantation Pregnancy Registry (NTPR) has studied the safety of pregnancy outcomes in solid-organ transplant recipients. The purpose of this review is to catalog studies in the literature, as well as to present current data from the registry with management guidelines. [source] A critical analysis of UK public health policies in relation to diet and nutrition in low-income householdsMATERNAL & CHILD NUTRITION, Issue 2 2006Pamela Attree phd Abstract Diet and nutrition, particularly among low-income groups, is a key public health concern in the UK. Low levels of fruit and vegetable consumption, and obesity, especially among children, have potentially severe consequences for the future health of the nation. From a public health perspective, the UK government's role is to help poorer families make informed choices within healthy frameworks for living. However, the question is , to what extent are such policies in accordance with lay experiences of managing diet and nutrition on a low-income? This paper critically examines contemporary public health policies aimed at improving diet and nutrition, identifying the underlying theories about the influences on healthy eating in poor families, and exploring the extent to which these assumptions are based on experiential accounts. It draws on two qualitative systematic reviews , one prioritizing low-income mothers' accounts of ,managing' in poverty; and the other focusing on children's perspectives. The paper finds some common ground between policies and lay experiences, but also key divergencies. Arguably, the emphasis of public health policy on individual behaviour, coupled with an ethos of empowered consumerism, underplays material limitations on ,healthy eating' for low-income mothers and children. Health policies fail to take into account the full impact of structural influences on food choices, or recognize the social and emotional factors that influence diet and nutrition. In conclusion, it is argued that while health promotion campaigns to improve low-income families' diets do have advantages, these are insufficient to outweigh the negative effects of poverty on nutrition. [source] Factors influencing treatment for depression among medical students: a nationwide sample in South KoreaMEDICAL EDUCATION, Issue 2 2009Myoung-Sun Roh Objectives, Depression is more frequently experienced and induces more severe consequences in medical students than in the general population. However, treatment rates for depression in medical students are still low. In this study, the authors investigated factors that affect treatment for depression and dispositions towards treating depression among South Korean medical students. Methods, A nationwide, cross-sectional survey was administered to medical students attending all 41 medical schools in South Korea (14 095 students). The questionnaire included the Beck Depression Inventory (BDI) and asked for data on socio-demographic variables, history of diagnosis or treatment for depression, knowledge of mental health problems and disposition to use mental health care. Results, A total of 7357 students (52.2%) from 36 schools responded to the survey. Of these, 689 (9.4%) were identified as being depressed via a BDI score higher than 16. Of the depressed respondents, only 61 (8.9%) had been diagnosed with depression and 67 (9.7%) had been treated for depression. Age was significantly associated with treatment behaviour for depression. Correct knowledge about the aetiology of depression and psychiatric medicine was significantly related to students' disposition to use psychiatric services and to receive psychopharmacotherapy as an option to resolve depression. Conclusions, Accurate knowledge of depression and appropriate medication seems to be relevant to students seeking appropriate treatment for depression. The development of education programmes designed to improve medical students' knowledge of mental health problems and treatments would facilitate treatment seeking in medical students. [source] Role of tumor cell immune escape mechanisms in cytomegalovirus-mediated oncomodulationMEDICINAL RESEARCH REVIEWS, Issue 2 2005Jindrich Cinatl Jr. Abstract It has been known for a long time that cytomegalovirus (CMV) has evolved mechanisms that allow the escape from the host immune surveillance. In the past, many efforts have been done to elucidate the molecular mechanisms underlying this virus-mediated immune escape and thus virus persistence. However, it is unknown, whether CMV may also impair immune responses directed against tumor cells. This might have severe consequences on tumor progression and may explain the growing evidence for CMV-mediated oncomodulation. This review summarizes recent work on CMV-mediated immune escape mechanisms of tumor cells and oncomodulation and proposes novel aspects that may be important for understanding the CMV-associated tumor progression. © 2004 Wiley Periodicals, Inc. [source] Characteristics of glycemic control in young children with type 1 diabetesPEDIATRIC DIABETES, Issue 4 2002Francine Ratner Kaufman Abtract: Background: The Diabetes Control and Complications Trial (DCCT) demonstrated that the rate-limiting step to the intensification of diabetes management in adolescents and adults was hypoglycemia. Young children were presumed to be at even greater risk for hypoglycemia with severe consequences, particularly if they had HbA1c levels < 8%. Subjects: A retrospective chart review was performed on 148 patients with type 1 diabetes on insulin injection therapy who were < 8 yr of age (mean age 5.7 ± 1.5, mean diabetes duration 3.0 ± 1.4 yr) followed quarterly from July 1999 to June 2001. Methods:, The subjects were divided into two groups based on their mean HbA1c values (< 8 vs. , 8%) averaged over the 2-yr time period. The following variables were analyzed comparing the two groups: age, duration of diabetes, insulin dose, severe hypoglycemic episodes, episodes of diabetic ketoacidosis (DKA), percentage of glucose levels above, within, and below the target range, and number of diabetes home-management competencies obtained. Results:, Patients with HbA1c < 8% spent more time within target range (40.0 vs. 29.5%, p = 0.0001) and less time above their target range (36.9 vs. 51.2%, p = 0.0003). There was no difference in the percentage of glucose levels below target (23.2 vs. 19.4%, p = NS), percentage of severe hypoglycemic episodes (3 vs. 7 episodes per 100 patient-yr, p = NS), or episodes of DKA (1 vs. 3 episodes per 100 patient-yr, p = NS) between the two groups. Subjects with lower HbA1c levels had acquired more home-management competencies (4.0 vs. 3.5, p = 0.01). Conclusions:, If families are competent in fundamental diabetes management, young children can achieve HbA1c levels < 8.0% without increasing the risk of hypoglycemia. [source] Knowledge about hepatitis and previous exposure to hepatitis viruses in immigrants and refugees from the Mekong RegionAUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 1 2005Sonia R. Caruana Objective: Infection with hepatitis B (HBV) and hepatitis C (HCV) viruses is relatively common throughout South-East Asia and chronic infection can lead to severe consequences. This study assesses knowledge about HBV and HCV and estimates the seroprevalence of markers for these viruses in immigrants from Laos and Cambodia. Methods: Ninety-five Laotian (aged 18,82 years) and 234 Cambodian (15,92 years) immigrants participated in separate community-based surveys conducted during 1998 and 2002, respectively. Participants completed a questionnaire on health status and level of knowledge about viral hepatitis. Blood samples were collected and tested for the presence of HBV and HCV markers. Results: Nine per cent of Laotian and 8% of Cambodian participants were infected with HBV. While 49% of Laotian and 64% of Cambodian participants showed evidence of previous exposure to HBV, 30% and 9%, respectively, were vulnerable to infection. The seroprevalence of antibodies to HCV was 3% in the Laotian and 8% in the Cambodian participants. Between one-fifth and one-third of the Laotians and Cambodians who had heard of HBV and HCV knew of possible transmission routes for the viruses. Most of those with HBV or HCV infection were unaware they were infected. Conclusions: These findings indicate a significant prevalence of undetected HBV and HCV infections and an urgent need for the provision of culturally relevant information about viral hepatitis in immigrants of South-East Asian origin. [source] Sickle cell leg ulcers: a frequently disabling complication and a marker of severityBRITISH JOURNAL OF DERMATOLOGY, Issue 2 2008M. Halabi-Tawil Summary Background, Leg ulcers are a poorly known and underestimated complication of sickle cell disease (SCD), but in our experience they often appear as a severely disabling condition, associated with the most severe forms of the disease. Objectives, To assess the characteristics, complications, repercussion on quality of life and associations of SCD ulcers. Methods, Case series of 20 patients followed in a French referral centre for SCD and who had previous/present leg ulcers. Results, Median ulcerated area was 12 cm² and median time spent with ulcers was 29·5 months. Locoregional infections developed in 85%, ankle stiffness in 50% and mood disorders in 85%. Ninety per cent of patients needed analgesics, 20% being opioids. Median loss of time from work was 12·5 months. The Short Form 36 Health Survey showed physical and mental component summary scores of 41·5 and 40·7, respectively, indicating severe alteration close to that found in lung cancer or haemodialysis. Two categories of SCD leg ulcers were distinguished, defined by a 1-year duration cut off. The ,prolonged' ulcers had larger surfaces, tended to recur more frequently and led to more infection and depression. Several SCD complications were associated with leg ulcers, notably priapism, pulmonary hypertension, stroke and acute chest syndrome. Conclusions, Leg ulcers are a major complication of SCD, given their severe consequences and frequent association with other specific organ damage, and they constitute in their ,prolonged' form a severely disabling condition that remains an important therapeutic challenge. [source] Of old and new diseases: genetics of pituitary ACTH excess (Cushing) and deficiencyCLINICAL GENETICS, Issue 3 2007J Drouin The pituitary gland orchestrates our endocrine environment: it produces hormones in response to hypothalamic factors that integrate neural inputs and its activity is balanced by the feedback action of peripheral hormones. Disruption of this equilibrium has severe consequences that affect multiple systems and may be fatal. Genetic analysis of pituitary function led to discovery of critical transcription factors that cause hormone deficiencies when mis-expressed. This review will summarize recent findings that led to the first complete clinical description of inherited, isolated corticotropin (ACTH) deficiency (IAD) and to the first molecular mechanism for excessive ACTH production in Cushing's disease. Indeed, mutations in TPIT, a positive or negative regulator of cell fates for different pituitary lineages, cause neonatal IAD, a condition considered anecdotic before discovery of this transcription factor. Cushing's disease is caused by corticotroph adenomas that produce excess ACTH as a result of resistance to glucocorticoids (Gc). Molecular investigation of the normal mechanism of Gc feedback led to identification of two essential proteins for pro-opiomelanocortin repression that are often mis-expressed in corticotroph adenomas thus providing a molecular explanation for Gc resistance. These two proteins, Brg1 and histone deacetylase 2 (HDAC2), are involved in chromatin remodeling and may also participate in the tumorigenic process, as Brg1 is a tumor suppressor. These recent advances have provided improved diagnosis and opened new perspectives for patient management and therapies. [source] | ||||||||||||||||||||||