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Selected AbstractsNutritional problems in children treated for medulloblastoma: Implications for enteral nutrition supportPEDIATRIC BLOOD & CANCER, Issue 4 2009Evelyn Ward BSc Abstract Background The aim of this study was to identify the nature and severity of nutritional problems associated with the current treatment of medulloblastoma and to identify any risk factors for nutritional morbidity during treatment. Procedure A multicentre retrospective audit of medical and dietetic notes of 41 children treated for medulloblastoma in three UK paediatric oncology centres was undertaken. Data on nutritional status, nutritional support, mutism, swallowing and common toxicity criteria (CTC) scores for vomiting, constipation and mobility were collected at defined points in treatment from diagnosis until 12 months post-treatment. Results Significant problems including weight loss, vomiting and constipation were highlighted early on in treatment. The majority of patients were well nourished at diagnosis with a mean percentage weight: height of 99.8%, however nutritional status started to decline early in treatment during radiotherapy, coinciding with 49% of patients having grade 1 or above CTC score for vomiting and constipation. The decline in nutritional status continued, peaking by course 2 of chemotherapy with a mean weight loss of 8.2% since diagnosis. Proactive supplementary feeding early in treatment by one of the three centres demonstrated a superior nutritional outcome when compared statistically to the two centres that fed only as a response to nutritional decline. Conclusion The study highlighted significant morbidity associated with the current treatment of medulloblastoma. Findings suggest the need to consider earlier proactive nutritional intervention to prevent nutritional decline during treatment. These early nutritional problems may be related to toxicities of radiotherapy and concomitant vincristine. Pediatr Blood Cancer 2009;53:570,575. © 2009 Wiley-Liss, Inc. [source] The effectiveness of psychological treatments for treatment-resistant depression: a systematic reviewACTA PSYCHIATRICA SCANDINAVICA, Issue 5 2005S. McPherson Objective:, A systematic review of all studies (controlled and uncontrolled) to evaluate psychological interventions with treatment-resistant depression. Method:, A systematic search to identify studies evaluating a psychological intervention with adults with a diagnosis of major depressive disorder who had not responded to at least one course of antidepressant medication. Results:, Twelve studies met inclusion criteria, of which four were controlled and eight uncontrolled. Treatment effect sizes were computable for four studies and ranged from 1.23 to 3.10 with a number of better quality studies demonstrating some improvements in patients following a psychological intervention. Conclusion:, Psychological treatments for depression are commonly delivered and often recommended following the failure of medication. The paucity of evidence for their effectiveness in these situations is a significant problem. There is a need for studies with a strong controlled design investigating the effectiveness of psychological treatments for patients with treatment-resistant depression. [source] Plantar pressures in diabetic patients with foot ulcers which have remained healedDIABETIC MEDICINE, Issue 11 2009T. M. Owings Abstract Aims, The recurrence of foot ulcers is a significant problem in people with diabetic neuropathy. The purpose of this study was to measure in-shoe plantar pressures and other characteristics in a group of neuropathic patients with diabetes who had prior foot ulcers which had remained healed. Methods, This was an epidemiological cohort study of patients from diabetes clinics of two Swedish hospitals. From a database of 2625 eligible patients, 190 surviving patients with prior plantar ulcers of the forefoot (hallux or metatarsal heads) caused by repetitive stress were identified and 49 patients agreed to participate. Barefoot and in-shoe plantar pressures were measured during walking. Data on foot deformity, activity profiles and self-reported behaviour were also collected. Results, Mean barefoot plantar peak pressure at the prior ulcer site (556 kPa) was lower than in other published series, although the range was large (107,1192 kPa). Mean in-shoe peak pressure at this location averaged 207 kPa when measured with an insole sensor. Barefoot peak pressure only predicted ,35% of the variance of in-shoe peak pressure, indicating variation in the efficacy of the individual footwear prescriptions (primarily extra-depth shoes with custom insoles). Conclusions, We propose that the mean value for in-shoe pressures reported in these patients be used as a target in footwear prescription for patients with prior ulcers. Although plantar pressure is only one factor in a multifaceted strategy to prevent ulcer recurrence, the quantitative focus on pressure reduction in footwear is likely to have beneficial effects. [source] Lower levels of circulating IGF-I in Type 1 diabetic women with frequent severe hypoglycaemia during pregnancyDIABETIC MEDICINE, Issue 7 2008L. Ringholm Nielsen Abstract Aims Severe hypoglycaemia is a significant problem in pregnant women with Type 1 diabetes. We explored whether frequent severe hypoglycaemia during pregnancy in women with Type 1 diabetes is related to placental growth hormone (GH) and insulin-like growth factor I (IGF-I) levels. Methods A prospective, observational study of 107 consecutive pregnant women with Type 1 diabetes. Blood samples were drawn for IGF-I and placental GH analyses at 8, 14, 21, 27 and 33 weeks. Severe hypoglycaemic events were reported within 24 h. Results Eleven women (10%) experienced frequent severe hypoglycaemia (, 5 events), accounting for 60% of all events. Throughout pregnancy, IGF-I levels were 25% lower in these women (P < 0.005) compared with the remaining women, despite similar placental GH levels. Eighty per cent of the severe hypoglycaemic events occurred before 20 weeks when IGF-I levels were at their lowest. This finding was not explained by differences in insulin dose, median plasma glucose levels or glycated haemoglobin. History of severe hypoglycaemia the year preceding pregnancy and impaired hypoglycaemia awareness,being the only predictors of frequent severe hypoglycaemia in a logistic regression analysis,were not associated with IGF-I or placental GH levels at 8 weeks. Conclusions In women with Type 1 diabetes experiencing frequent severe hypoglycaemia during pregnancy, IGF-I levels are significantly lower compared with the remaining women despite similar placental GH levels. IGF-I levels are lowest in early pregnancy where the incidence of severe hypoglycaemia is highest. IGF-I may be a novel factor of interest in the investigation of severe hypoglycaemia in patients with Type 1 diabetes. [source] Responsible alcohol service: lessons from evaluations of server training and policing initiativesDRUG AND ALCOHOL REVIEW, Issue 3 2001TIM STOCKWELL Abstract Responsible alcohol service programmes have evolved in many countries alongside a general increase in the availability of alcohol and a greater focus on the prevention of alcohol-related road crashes. They also recognize the reality that a great deal of high-risk drinking and preventable harm occurs in and around licensed premises or as drinkers make their way home. Early US efficacy studies of programmes which trained managers and barstaff to limit customers' levels of intoxication and prevent drink driving showed promise. Studies of effectiveness of these programmes in the wider community, and in the absence of the enforcement of liquor laws, found little benefit. The data will be interpreted as suggesting that, in reality, skills deficits in the serving of alcohol are not a significant problem compared with the motivational issue for a commercial operation of abiding by laws that are rarely enforced and which are perceived as risking the goodwill of their best customers. Australian, UK and US experiences with liquor law enforcement by police will be discussed along with outcomes from the Australian invention of Alcohol Accords, informal agreements between police, licensees and local councils to trade responsibly. It will be concluded that the major task involved in lifting standards of service and preventing harm is to institutionalize legal and regulatory procedures which impact most on licensed premises. A number of strategies are suggested also for creating a political and social climate which supports the responsible service of alcohol and thereby supports the enactment and enforcement of appropriate liquor laws. [source] Recanting of life-time inhalant use: how big a problem and what to make of itADDICTION, Issue 8 2009Steven C. Martino ABSTRACT Aims To establish the prevalence of recanting of life-time inhalant use, identify correlates of recanting to gain insight to its causes and develop a method for distinguishing recanters who truly are versus are not life-time users of inhalants. Design and setting Longitudinal survey data from students in 62 South Dakota middle schools who were participating in a field trial to evaluate a school-based drug prevention program. Measurements At grades 7,8, participants reported on their life-time inhalant use, other drug use and drug-related beliefs, attitudes and behaviors. Findings Forty-nine per cent of students who reported life-time inhalant use at grade 7 recanted their reports a year later. Comparison of students who recanted inhalant use with those who did or did not report inhalant use consistently on drug-related beliefs, attitudes and behaviors at grades 7 and 8 suggested that, whereas some inhalant use recanting reflects denial of past behavior, some reflects erroneous initial reporting. Based on a latent mixture model fitted to the multivariate distribution of grade 7 and grade 8 responses of recanters and consistent reporters, we calculated the probability that each recanter was, in fact, a life-time inhalant user. An estimated 67% of the recanters in our sample appear to be life-time inhalant users who admitted use in grade 7 and then denied that use at grade 8; 33% appear to be students who reported use incorrectly at grade 7 and then corrected that error at grade 8. Conclusions Inhalant use recanting is a significant problem that, if not handled carefully, is likely to have a considerable impact on our understanding of the etiology of inhalant use and efforts to prevent it. [source] The epidemiology of depression in diabetesEUROPEAN DIABETES NURSING, Issue 3 2008K Winkley BSc, PhD Lecturer in Diabetes, Psychology Abstract Depression is characterised by a period of low mood and loss of interest in everyday activities, and its prevalence in people with diabetes is thought to be twice as high as for those without the condition. Depression in diabetes is associated with a number of adverse outcomes such as increased morbidity, mortality and poor quality of life. As diabetes is increasingly common amongst the economically active, this has serious implications for health services and in the UK, the National Health Service (NHS) has recognised that depression in people with diabetes is a significant problem and recommends screening for depression in this group. Risk factors for depression in diabetes are almost identical to those in people without diabetes, but less is known about its course when people have diabetes, although the available evidence suggests it is more chronic. Research into the mechanisms by which depression is bad for people with diabetes suggests that biological, psychological and social factors play a part but the inter-relationships between these factors are likely to be complex and are not yet fully understood. Depression in people with diabetes can be treated successfully with pharmacological and psychological treatments at least in the short-term, but we do not yet know which treatments are successful in the long-term. Further research into the pathological mechanisms of depression and its treatment are needed if we are to continue to improve the health and lives of people with diabetes. Copyright © 2008 FEND [source] Effect of seed coating on plant growth and soil conditions: A preliminary study for restoration of degraded rangeland in the Qinghai,Tibetan Plateau, ChinaGRASSLAND SCIENCE, Issue 3 2010Yingchun Liu Abstract Rangeland degradation is a significant problem in the Qinghai,Tibetan Plateau, China. Restoration of the degraded rangelands through reseeding is being undermined by poor seedling growth under adverse soil moisture and nutrition conditions. Accordingly, seeds of Italian ryegrass (Lolium multiflorum) and Chinese milk vetch (Astragalus sinicus) were coated with a mixture of hygroscopic and plant-derived polysaccharide gums and alga powder (Phaeocystis sp. necolon-1), and inoculated with spores of microorganisms (Aspergillus sp. and Streptomyces sp.), serving as coating mixture decomposers, in order to improve rhizosphere moisture and nutrition. In a growth chamber simulating spring climate on the Plateau, seedling emergence of the coated seeds was 60,80 and 48,82%, respectively, for the two plant species in comparison to 38 and 24% for the uncoated seeds, which was due to moisture being supplied by the coat. In the outdoor pots with soil texture and moisture conditions similar to those of the degraded rangelands on the Plateau, dry weight of the plants from the coated seeds was 109,184 and 118,156 mg plant,1 for the respective plant species, while that of the plants from uncoated seeds was 18,20 and 10,11 mg plant,1. The number of Rhizobium sp. nodules on Chinese milk vetch plants from the coated seeds was 21,25 plant,1 while 0,2 in plants from uncoated seeds. Enhancement of plant growth was caused by increased activity of soil microbes. Plant growth on the soil after sampling plants from the coated seeds was also enhanced, indicating sustainability of improvement of soil conditions. Thus seed coating with hygroscopic nutrient-source materials and inoculation with microorganism spores as slow decomposers of the coating materials is a promising method for restoring degraded rangelands. [source] The role of algorithm and result comprehensibility of automated scheduling on complacencyHUMAN FACTORS AND ERGONOMICS IN MANUFACTURING & SERVICE INDUSTRIES, Issue 6 2008Julien Cegarra Several studies have stressed that even expert operators who are aware of a machine's limits could adopt its proposals without questioning them (i.e., the complacency phenomenon). In production scheduling for manufacturing, this is a significant problem, as it is often suggested that the machine be allowed to build the production schedule, confining the human role to that of rescheduling. This article evaluates the characteristics of scheduling algorithms on human rescheduling performance, the quality of which was related to complacency. It is suggested that scheduling algorithms be characterized as having result comprehensibility (the result respects the scheduler's expectations in terms of the discourse rules of the information display) or algorithm comprehensibility (the complexity of the algorithm hides some important constraints). The findings stress, on the one hand, that result comprehensibility is necessary to achieve good production performance and to limit complacency. On the other hand, algorithm comprehensibility leads to poor performance due to the very high cost of understanding the algorithm. © 2008 Wiley Periodicals, Inc. [source] Mentors, supervisors and role models: do they reduce the effects of psychological contract breach?HUMAN RESOURCE MANAGEMENT JOURNAL, Issue 3 2009Thomas J. Zagenczyk Psychological contract breach has become a significant problem for many organisations in today's business environment because it fosters a belief within employees that the organisation does not support them. Accordingly, we examine whether organisations can diminish the negative impact of psychological contract breach on perceived organisational support (POS) by providing employees with mentors, supportive supervisors and role models. In Study 1, we found that mentor relationships moderated the relationship between psychological contract breach and POS six months later. In Study 2, we showed that mentor relationships and supervisor support reduced the negative impact of contract breach on POS. Contrary to expectations, employees who maintained relationships with role models reported lower levels of POS in response to psychological contract breach than those employees who reported that they did not have role models in their organisations. Implications for research and practice are discussed. [source] Enhancing the effectiveness of residential treatment for substance abusing pregnant and parenting women: Focus on maternal reflective functioning and mother-child relationshipINFANT MENTAL HEALTH JOURNAL, Issue 5 2006Marjukka Pajulo Substance abuse during early motherhood has become a significant problem and has led to accelerated efforts to develop specific treatment facilities for these mothers and children. Despite the often intensive treatment efforts in residential settings, there is surprisingly little evidence of their efficacy for enhancing the quality of caregiving. The situation of these mother-child pairs is exceptionally complex and multilevel, and has to be taken into account in the content and structuring of treatment. Intensive work in the "here and now" focusing on the mother-child relationship from pregnancy onwards in an effort to enhance maternal reflective capacity and mindedness is considered a key element for better treatment prognosis, in terms of both abstinence and quality of parenting. Pioneering work with such a focus is described in this article. [source] Human immunodeficiency virus,hepatitis C coinfection: swapping new problems for newer onesINTERNAL MEDICINE JOURNAL, Issue 7 2001J. Sasadeusz Abstract Recent successes in HIV therapy have uncovered other health problems for HIV-infected individuals. Hepatitis C has become an especially significant problem, partly due to its faster progression in an immunocompromised setting. In addition, the higher viral loads in coinfected patients likely result in more efficient perinatal and perhaps even sexual transmission. Therapy has largely been neglected, despite data suggesting its efficacy in HIV,HCV coinfected patients. Studies of combination interferon and ribavirin studies are lacking, although underway. A major concern is the potential inactivation of certain thymidine analogues by ribavirin. Some antiretroviral therapies, such as ritonavir, indinavir and nevirapine, may enhance liver toxicity in coinfected patients and should be avoided if possible. The role of chronic low-grade liver function abnormalities remains uncertain and requires further investigation. (Intern Med J 2001; 31: 418,421) [source] Parameter identification with weightless regularization,INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN ENGINEERING, Issue 3 2001Tomonari Furukawa Although the regularization increased the popularity of parameter identification due to its capability of deriving a stable solution, the significant problem is that the solution depends upon the regularization parameters chosen. This paper presents a technique for deriving solutions without the use of the parameters and, further, an optimization method, which can work efficiently for problems of concern. Numerical examples show that the technique can efficiently search for appropriate solutions. Copyright © 2001 John Wiley & Sons, Ltd. [source] New insights into the pathophysiology of postoperative cognitive dysfunctionACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 8 2010L. KRENK There is evidence that postoperative cognitive dysfunction (POCD) is a significant problem after major surgery, but the pathophysiology has not been fully elucidated. The interpretation of available studies is difficult due to differences in neuropsychological test batteries as well as the lack of appropriate controls. Furthermore, there are no internationally accepted criteria for defining POCD. This article aims to provide an update of current knowledge of the pathogenesis of POCD with a focus on perioperative pathophysiology and possible benefits achieved from an enhanced postoperative recovery using a fast-track methodology. It is concluded that the pathogenesis of POCD is multifactorial and future studies should focus on evaluating the role of postoperative sleep disturbances, inflammatory stress responses, pain and environmental factors. Potential prophylactic intervention may include minimal invasive surgery, multi-modal non-opioid pain management and pharmacological manipulation of the inflammatory response and sleep architecture. [source] The economic consequences of noncompliance in cardiovascular disease and related conditions: a literature reviewINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 2 2008N. Muszbek Summary Objectives:, To review studies on the cost consequences of compliance and/or persistence in cardiovascular disease (CVD) and related conditions (hypertension, dyslipidaemia, diabetes and heart failure) published since 1995, and to evaluate the effects of noncompliance on healthcare expenditure and the cost-effectiveness of pharmaceutical interventions. Methods:, English language papers published between January 1995 and February 2007 that examined compliance/persistence with medication for CVD or related conditions, provided an economic evaluation of pharmacological interventions or cost analysis, and quantified the cost consequences of noncompliance, were identified through database searches. The cost consequences of noncompliance were compared across studies descriptively. Results:, Of the 23 studies identified, 10 focused on hypertension, seven on diabetes, one on dyslipidaemia, one on coronary heart disease, one on heart failure and three covered multiple diseases. In studies assessing drug costs only, increased compliance/persistence led to increased drug costs. However, increased compliance/persistence increased the effectiveness of treatment, leading to a decrease in medical events and non-drug costs. This offset the higher drug costs, leading to savings in overall treatment costs. In studies evaluating the effect of compliance/persistence on the cost-effectiveness of pharmacological interventions, increased compliance/persistence appeared to reduce cost-effectiveness ratios, but the extent of this effect was not quantified. Conclusions:, Noncompliance with cardiovascular and antidiabetic medication is a significant problem. Increased compliance/persistence leads to increased drug costs, but these are offset by reduced non-drug costs, leading to overall cost savings. The effect of noncompliance on the cost-effectiveness of pharmacological interventions is inconclusive and further research is needed to resolve the issue. [source] Quality of life in patients with atopic dermatitis: Impact of tacrolimus ointmentINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 6 2006Makoto Kawashima MD Background, Atopic dermatitis (AD), a significant problem in Japan, has a major impact on health-related quality of life (QOL). The development of steroid phobia in patients with AD may restrict the therapeutic options available to these patients. Tacrolimus ointment is a safe and effective nonsteroid treatment for AD. It may be an appropriate alternative for patients with AD and steroid phobia. The aim of this study was to determine the impact of AD on QOL and to investigate the effect of tacrolimus ointment on QOL in patients with steroid phobia. Methods, Firstly, QOL scores were investigated in patients with AD and steroid phobia using the World Health Organization Quality of Life instrument, WHOQOL-26, and were compared with QOL scores from a previous study in volunteers from Tokyo, Japan. Secondly, patients with steroid phobia received tacrolimus ointment treatment for 12 weeks. Quality of life scores were assessed using WHOQOL-26 at baseline and study end. Results, The overall mean QOL score of 106 patients with AD was significantly lower than that of 708 volunteers (3.1 ± 0.5 vs. 3.3 ± 0.5, P < 0.001). The overall QOL score improved from 2.9 ± 0.4 at baseline to 3.3 ± 0.4 following 12 weeks' tacrolimus ointment treatment in 35 patients with AD and steroid phobia (P < 0.001). Conclusions, Atopic dermatitis significantly lowers QOL. Tacrolimus ointment is associated with a significant improvement in QOL in patients with steroid phobia, indicating that it is an effective alternative to topical corticosteroids in these patients. [source] Absconding: A review of the literature 1996,2008INTERNATIONAL JOURNAL OF MENTAL HEALTH NURSING, Issue 5 2008Eimear Muir-Cochrane ABSTRACT:, Absconding is a significant problem with potential for harm to patients or the general public. The consequences of absconding include physical harm, prolonged treatment time, and substantial economic costs. The aim of this systematic literature review is to synthesize quality literature about absconding from psychiatric facilities, identify gaps in knowledge, and make recommendations for practice. An electronic search yielded 39 journal articles that met the review criteria. Findings demonstrate that a single definition of absconding remains elusive, making the prevalence of absconding difficult to establish. Absconding events are multifactorial, with environmental, psychosocial, and organic aspects. Negative consequences exist including violence, aggression, and self-neglect and harm to self and others. Papers are clustered around the following themes: harm and risk, absconder profiles, absconding rates, and perceptions of nurses and patients. Nursing interventions designed to decrease absconding have been implemented with success, but only in a few studies and in Australia, none have been reported in the literature to date. Further research is required to identify appropriate nursing-based interventions that may prove useful in reducing the risk of absconding. [source] An alternative response to "The best interests of the child thesis: some thoughts from Australia"INTERNATIONAL JOURNAL OF SOCIAL WELFARE, Issue 4 2009Richard P. BarthArticle first published online: 10 SEP 200 Many of the concerns about recent changes in child welfare services practice in Australia have also been raised in the USA. Although it certainly may be the case that mandatory reporting is causing a broadening of child welfare services in Australia, close data-informed scrutiny suggests that this is not the case in the USA. Further, there are positive alternatives to overly intrusive child welfare service interventions that are arising in the USA. There is reasonable evidence to suggest that too little protection rather than too much intrusion remains the more significant problem in the USA; this may also be true elsewhere. The quality and range of services certainly determines whether intrusion is helpful to children and families. In some cases, for example life-threatening health problems that parents will not or cannot treat, engaging the assistance of child welfare services should not be ruled out for ideological reasons. [source] Insights on Immunizations From Caregivers of Children Receiving Medicaid-Funded ServicesJOURNAL FOR SPECIALISTS IN PEDIATRIC NURSING, Issue 4 2000Deborah B. Evers ISSUES AND PURPOSE. Despite numerous programs aimed at improving immunization rates among American children, under-immunization remains a significant problem. This study was conducted to gain insight into parents' /guardians' knowledge and attitudes regarding childhood immunizations. DESIGN AND METHODS. Thirteen African-American mothers and grandmothers participated in semistructured, audiotaped focus-group interviews. RESULTS. Four major themes emerged: health knowledge and beliefs about immunizations, system barriers that impede obtaining immunizations, facilitators that enhance obtaining immunizations, and suggestions for change. PRACTICE IMPLICATIONS. Immunizations are one of the most important health advantages available to children. Therefore, nurses must become aware of the problem of underimmunization and work to address some of the concerns caregivers have identified in this study. The health and lives of the nation's children depend on it. [source] Stability of poly(3,4-ethylene dioxythiophene) materials intended for implants,JOURNAL OF BIOMEDICAL MATERIALS RESEARCH, Issue 2 2010Elin M. Thaning Abstract This study presents experiments designed to study the stability of the conducting polymer poly(3,4-ethylene dioxythiophene) (PEDOT), under simulated physiological conditions using phosphate-buffered saline (PBS) and hydrogen peroxide (H2O2) (0.01M) at 37°C over a 5- to 6-week period. Voltage pulsing in PBS was used as an additional test environment. The influence of switching the counter ion used in electropolymerization from polystyrene sulphonate (PSS) to heparin was investigated. Absorbance spectroscopy and cyclic voltammetry were used to evaluate the material properties. Most of the samples in H2O2 lost both electroactivity and optical absorbance within the study period, but PEDOT:PSS was found slightly more stable than PEDOT:heparin. Polymers were relatively stable in PBS throughout the study period, with around 80% of electroactivity remaining after 5 weeks, disregarding delamination, which was a significant problem especially for polymer on indium tin oxide substrates. Voltage pulsing in PBS did not increase degradation. The counter ion influenced the time course of degradation in oxidizing agents. © 2010 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 2010 [source] Risk factors for drug-induced gingival overgrowthJOURNAL OF CLINICAL PERIODONTOLOGY, Issue 4 2000R. A. Seymour Abstract Background/Aims: Drug-induced gingival overgrowth remains a significant problem for the periodontologist. Many patients medicated with the drugs implicated in this unwanted effect experience significant, recurrent gingival problems that require repeated surgical excisions. In this review, we attempt to identify and quantify the various "risk factors" associated with both the development and expression of the drug-induced gingival changes. Method: The risk factors appraised include age, sex, drug variables, concomitant medication, periodontal variables and genetic factors. Elucidation of such factors may help to identify "at risk patients" and then develop appropriate treatment strategies. Results: Of the factors identified, the only one that can be affected by the periodontologist is the patents' periodontal condition. However, drug variables and concomitant medication do impact upon the expression of gingival overgrowth. Conclusion: The identificatioin of risk factors associated with both the prevalence and severity of drug-induced gingival overgrowth is important for all parties involved with this unwanted effect. Both periodontologist and patient have an important rôle to play in improving oral hygiene and gingival health. Likewise, there is always an opportinity to establish a close liaison between the patient's physician and the periodontologist to try and identify alternative drug regimens that can help reduce the impact of this unwanted effect. [source] Lawyers at Mid-Career: A 20-Year Longitudinal Study of Job and Life SatisfactionJOURNAL OF EMPIRICAL LEGAL STUDIES, Issue 3 2009John Monahan This study is the first to our knowledge to simultaneously measure the predictors of lawyers' satisfaction with their careers and the predictors of lawyers' satisfaction with their lives more broadly. One class of the University of Virginia School of Law was studied between their matriculation in 1987 and their graduation in 1990. All 360 living graduates of this class were contacted in 2007, with a response rate of 72.2 percent. Descriptive information was obtained and empirically validated measures of both career satisfaction and life satisfaction were administered. Respondents were found to have taken many diverse career paths, with most (85 percent) having changed jobs at least once, and half having changed jobs at least twice. Gender differences in the personal and professional lives of respondents were pervasive. Women graduates were far more likely than men to interrupt or forego full-time employment (39 percent vs. 1 percent), mainly in order to care for children, and were also more likely to have a spouse or partner employed full time outside the home (77 percent vs. 24 percent). Working conditions at large private law firms emerged as a significant problem for many respondents; half of those who started their careers in large firms left to go to a different type of employer. Finally, both career satisfaction and life satisfaction were found to be high, with 81 percent of the respondents satisfied with their decision to become a lawyer, and 86 percent satisfied with their lives more broadly. [source] EFFECT OF STORAGE TEMPERATURE AND TIME ON QUALITY IN MINIMALLY PROCESSED LITCHI FRUIT (LITCHI CHINENSIS SONN.)JOURNAL OF FOOD QUALITY, Issue 3 2010ELIA NORA AQUINO BOLAÑOS ABSTRACT Rind browning is the most serious marketing problem for litchi (Litchi chinensis Sonn.) fruit, although it has no effect on the quality of the edible aril portion. Physicochemical, biochemical and subjective quality evaluations were done in minimally processed (peeled and vacuum-packed) litchi cv. Racimo Rojo fruit stored 18 days at 2, 5 or 10C. Little change was observed in total soluble solids, titratable acidity and pH, independent of storage temperature. Polyphenol oxidase (PPO) activity decreased, total phenolic compound content remained unchanged and peroxidase (POD) activity increased during storage. Correlation was low (<0.63) between color parameters (L*, a*and b*) and PPO and POD activities, and phenolic compounds. The minimally processed fruit stored at 2C exhibited characteristics similar to fresh fruit, whereas those stored at 5 and 10C emitted disagreeable odors that lowered their subjective quality. PRACTICAL APPLICATIONS The insignificant physicochemical changes observed here suggest that when stored at 2C, litchi fruit can be offered as a minimally processed product with characteristics similar to fresh fruit. Unlike most other minimally processed fruit products and other litchi varieties, pulp browning was not a significant problem in litchi cv. Racimo Rojo after peeling, providing it a potential commercial advantage. [source] Intestinal metaplasia: A premalignant lesion involved in gastric carcinogenesisJOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 2 2009Rita A Busuttil Abstract Despite a plateau in incidence, gastric cancer remains a significant problem globally. The majority of gastric cancer is associated with histologically recognizable premalignant stages as first described by Pelayo Correa in the mid-1970s. The mortality from gastric cancer remains high especially in Western countries where, arguably, the index of suspicion of gastric cancer in patients presenting with upper abdominal symptoms is lower than in high prevalence countries. What is the evidence that intestinal metaplasia (IM) is a premalignant condition? What should the clinician know about IM and the relative risks of progression to gastric cancer? Finally, what are the current and future strategies that may help stratify patients into high risk and low risk for the development of gastric cancer? This review focuses on gastric IM and outlines some of the literature that discusses it as a premalignant condition. It also reviews the issue of surveillance of patients with IM in order to attempt to reduce the significant mortality of gastric cancer by detection of earlier stages of disease which are eminently treatable. [source] Palliative management of cancer of the oesophagus , opportunities for dietetic interventionJOURNAL OF HUMAN NUTRITION & DIETETICS, Issue 5 2003A. Holdoway Introduction: Cancer of the oesophagus develops insidiously and when patients present with symptoms such as dysphagia to solids/semi-solids and in some cases liquids, the disease is often advanced and patients are frequently poorly nourished and cachectic (Angorn, 1981; Larrea, 1992). In our own unit we were aware that patients were only referred to the dietitian once an oesophageal stent was inserted or radiotherapy commenced, thereby possibly missing opportunities to treat or prevent malnutrition earlier. We therefore evaluated the nutritional status and care pathways of patients diagnosed with cancer of the oesophagus in whom palliative treatment was the only option, with the aim of assessing the extent of malnutrition and identifying opportunities for earlier dietetic intervention to prevent or slow the development of malnutrition. Method: Data were collated on all patients referred to the hospital's dysphagia clinic and diagnosed with inoperable cancer of the oesophagus. Height, weight, body mass index, degree of dysphagia, period of dysphagia, percentage weight loss (data collected as standard practice in the dysphagia clinic) and time to stent insertion/radiotherapy and survival time was collected from the medical notes. Results: Data were available on 58 patients, 33 male, 25 female, mean age 75 years (range 49,92 years). The mean length of survival was 10.2 months (0,24 months). At diagnosis, 47% experienced dysphagia with solids, 33% with semi-solids and 16% experienced a degree of dysphagia with liquids. The period of dysphagia was 1 month to 2 years. Eighty-three per cent of patients had lost weight at diagnosis. Mean percentage weight loss per individual was 13% (range 0,45%). Thirty-five per cent had a BMI <20 kg/m2. Median time from diagnosis to radiotherapy (n = 8) was 2 months with range, 1,6 months. Median time from diagnosis to the placement of the oesophageal stent (n = 12) was 1 month with range, 0,7 months. Discussion: These data illustrate that malnutrition remains a significant problem in this patient group. These results demonstrate that dysphagia and malnutrition, as indicated by weight loss, is developing in the community before diagnosis. Opportunities for earlier dietetic intervention exist between diagnosis and date at which other treatments commence, i.e. stent insertion. Further opportunities exist to educate community health professionals on treating and preventing malnutrition when dysphagia presents. Survival times support the need for dietetic follow-up. In our unit the results of this audit helped to improve care pathways for patients with cancer of the oesophagus. In response to the above findings, a nutritional screening tool is now completed by a nurse specialist at the first clinic attended. This has enabled appropriate and timely advice to be given on modified texture and fortification of food to optimize nutritional intake at diagnosis. [source] Why do some hospital leaders "speak no evil" about their organizations' medical errors?JOURNAL OF LEADERSHIP STUDIES, Issue 3 2008Ruby A. Rouse Sentinel events, preventable medical errors resulting in serious disability or death, are a significant problem for hospital leaders. Accreditation agencies, such as the Joint Commission, urge hospitals to voluntarily disclose information about medical errors. However, some healthcare leaders "speak no evil" by choosing not to release sentinel-event data. In an effort to increase the reporting of medical errors, several states passed laws mandating disclosure of sentinel events to the government. The state-reported medical error rates of Indiana hospitals were compared with their leaders' perceptions of quality of care. Regardless of the number of sentinel events occurring at their hospitals, leaders consistently claimed their organizations provided high-quality care. Two theories, rationalization and gaming, are presented to explain why leaders do not acknowledge the presence of serious quality-management problems in their organizations. [source] A prospective analysis of incidence and severity of quadriceps inhibition in a consecutive sample of 100 patients with complete acute anterior cruciate ligament ruptureJOURNAL OF ORTHOPAEDIC RESEARCH, Issue 5 2004Terese L. Chmielewski Background: Weakness of the quadriceps femoris muscle after anterior cruciate ligament injury and reconstruction has been attributed to incomplete voluntary activation of the muscle. The literature is conflicting on the incidence of incomplete voluntary quadriceps activation after anterior cruciate ligament injury because of differences in testing methods and population biases. The purpose of this study was to systematically examine the incidence and severity of quadriceps voluntary activation failure in both lower extremities after acute anterior cruciate ligament injury. We hypothesized that the incidence of quadriceps inhibition would be higher in the anterior cruciate ligament injured limbs than the uninvolved limbs, that the incidence of inhibition in the anterior cruciate ligament deficient limbs would be larger than in our historical sample of healthy young individuals tested in the same manner and that there would be no difference in inhibition by gender. Study design: Prospective, descriptive. Methods: One hundred consecutive patients with acute anterior cruciate ligament rupture (39 women and 61 men) were tested when range of motion was restored and effusion resolved, an average of 6 weeks after injury. A burst superimposition technique was used to assess quadriceps muscle activation and strength in all patients. Dependent t -tests were used to compare side-to-side differences in quadriceps strength. Independent t -tests were used to compare incidence of activation failure by gender and make comparisons to historical data on young, active individuals. Results: The average involved side quadriceps activation was 0.92, and ranged from 0.60 to 1.00. The incidence of incomplete activation in the involved side quadriceps was 33 per cent and uninvolved side quadriceps was 31 per cent after acute anterior cruciate ligament rupture. The incidence of incomplete activation bilaterally was 21 per cent. There was no difference in incidence of quadriceps inhibition by gender. Conclusion: The incidence of voluntary quadriceps inhibition on the involved side was three times that of uninjured, active young subjects, but the magnitude was not large. The incidence of quadriceps inhibition on the uninjured side was similar to the injured side. Clinical relevance: Both the incidence and magnitude of quadriceps inhibition after ACL rupture are lower than have previously been reported. The conventional wisdom, therefore, that quadriceps inhibition is a significant problem in this population is challenged by the results of this study. Differences between this study and others include sufficient practice to ensure a maximal effort contraction and rigorous inclusion criteria. The findings have implications for strength testing as well as rehabilitation. The quadriceps index, an assessment of the injured side quadriceps strength deficit may be affected by the presence of voluntary activation failure in the uninvolved side. © 2004 Orthopaedic Research Society. Published by Elsevier Ltd. All rights reserved. [source] Salvage of pelvic recurrence of colorectal cancerJOURNAL OF SURGICAL ONCOLOGY, Issue 8 2010Kimberly A. Varker MD Abstract Although the incidence of locally recurrent colorectal cancer has been reduced by improved surgical techniques and the frequent use of multimodality therapy, pelvic recurrence remains a significant problem. Radiation or chemotherapy may provide palliation but it is often short-lived. For fit candidates without evidence of extrapelvic disease, surgical resection (anterior resection, abdominoperineal resection, pelvic exenteration, or abdominosacral resection) may be the most appropriate treatment. For patients with unresectable disease, isolated pelvic perfusion may provide effective palliation. J. Surg. Oncol. 2010; 101:649-660. © 2010 Wiley-Liss, Inc. [source] Prediction of post-operative pain by an electrical pain stimulusACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 5 2007P. R. Nielsen Background:, Treatment of post-operative pain is still a significant problem. Recently, interest has focused on pre-operative identification of patients who may experience severe post-operative pain in order to offer a more aggressive analgesic treatment. The nociceptive stimulation methods have included heat injury and pressure algometry. A simple method, Pain Matcher® (PM), using electrical stimulation, is validated for pain assessment, but has not been evaluated as a tool for prediction of post-operative pain. Our aim was to assess the predictive value of pre-caesarean section pain threshold on intensity of post-caesarean section pain using the PM. Patients and methods:, Thirty-nine healthy women scheduled for elective caesarean section were studied. The anaesthetic/analgesic procedures included spinal anaesthesia, paracetamol, diclofenac, controlled-release (CR) oxycodone and morphine on request. Pre-operatively, the sensory and pain thresholds were measured using the PM. Post-operatively, a midwife, blinded for pre-caesarean pain threshold assessments, assessed the pain at rest and during mobilization every 12 h for 2 days. Consumption of analgesics was also recorded. Results:, Pre-operative pain threshold correlated significantly with post-caesarean pain score (VAS) at rest and mobilization: [Spearman's rho =,0.65 (,0.30 to ,0.75), P < 0.01] and [Spearman's rho =,0.52 (,0.23 to ,0.72), P < 0.01], respectively. There was no significant correlation between pre-operative PM assessment of sensory threshold and post-operative pain. Conclusion:, Electrical pain threshold before caesarean section seems to predict the intensity of post-operative pain. This method may be used as a screening tool to identify patients at high risk of post-operative pain. [source] Helicobacter pylori vaccines,the current statusALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 9 2000Sutton In this review, we take a look at the current status in the development of a vaccine against the human pathogenic bacterium, Helicobacter pylori, a major aetiological factor in peptic ulcer disease and gastric adenocarcinoma. Various animal models are now in use from mice infected with H. pylori, through gnotobiotic pigs and primates to ferrets naturally infected with their own Helicobacter, H. mustelae. A significant problem remains the requirement for a suitable mucosal adjuvant. Detoxification or the use of low doses of adjuvants already available may provide a solution and new immune stimulating compounds have been tested with some success. New approaches include the delivery of Helicobacter antigens by DNA immunization, microparticles or live vectors such as attenuated salmonella and the examination of alternative routes of vaccine administration. The phenomenon of post-immunization gastritis and improvements in vaccine efficacy are also discussed. A major area of interest is the mechanism by which immunization actually influences Helicobacter colonization. This remains a mystery: antibodies appear to be unimportant whereas CD4+ T-cells essential. Finally, a viewpoint is given on whom should be immunized when a final vaccine becomes available. [source] | ||||||||||||||||||||||||||||||||||||||||||||||||||||