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Selected AbstractsThe Effect of Changing Practice on Fall Prevention in a Rehabilitative Hospital: The Hospital Injury Prevention StudyJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 3 2004Michael Vassallo FRCP Objectives: To determine whether a change in practice to introduce a multidisciplinary fall-prevention program can reduce falls and injury in nonacute patients in a rehabilitation hospital. Design: A quasi-experimental study. Setting: Three geriatric wards with a similar design, equipment, staffing levels, and skill mix. Participants: Eight hundred twenty-five consecutive patients. Intervention: The patients' fall-risk status was assessed using the Downton Score. Current practice was maintained on the two control wards (n=550). On the experimental ward (n=275), a fall-prevention program was introduced. A multidisciplinary team met weekly specifically to discuss patients' fall risk and formulate a targeted plan. Patients at risk were identified using wristbands; risk factors were corrected or environmental changes made to enhance safety. Measurements: Primary outcomes were number of fallers, recurrent fallers, total falls, patients sustaining injury, and falls per occupied bed days. Secondary outcomes were place of discharge and mortality. Results: Patients were matched for age and risk status. Control wards had proportionally more fallers (20.2% vs 14.2%: P=.033), patients sustaining injury (8.2% vs 4%: P=.025), and total number of falls (170 vs 72: P=.045). These results did not remain significant after controlling for differing length of stay. There was no reduction in recurrent fallers (6.4% vs 4.7%: P=.43) and no effect on place of discharge (home discharges; 57.5% vs 60.7%: P=.41) or mortality (15.3% vs 13.8%: P=.60). Conclusion: This study shows that falls might be reduced in a multidisciplinary fall-prevention program, but the results are not definitive because of the borderline significance achieved and the variable length of stay. More research on fall prevention in hospital is required, particularly as to what interventions, if any, are effective at reducing falls in this group of patients. [source] Logic of experiments in ecology: is pseudoreplication a pseudoissue?OIKOS, Issue 1 2001Lauri Oksanen Hurlbert divides experimental ecologist into ,those who do not see any need for dispersion (of replicated treatments and controls), and those who do recognize its importance and take whatever measures are necessary to achieve a good dose of it'. Experimental ecologists could also be divided into those who do not see any problems with sacrificing spatial and temporal scales in order to obtain replication, and those who understand that appropriate scale must always have priority over replication. If an experiment is conducted in a spatial or temporal scale, where the predictions of contesting hypotheses are convergent or ambiguous, no amount of technical impeccability can make the work instructive. Conversely, replication can always be obtained afterwards, by conducting more experiments with basically similar design in different areas and by using meta-analysis. This approach even reduces the sampling bias obtained if resources are allocated to a small number of well-replicated experiments. For a strict advocate of the hypothetico-deductive method, replication is unnecessary even as a matter of principle, unless the predicted response is so weak that random background noise is a plausible excuse for a discrepancy between predictions and results. By definition, a prediction is an ,all-statement', referring to all systems within a well-defined category. What applies to all must apply to any. Hence, choosing two systems and assigning them randomly to a treatment and a control is normally an adequate design for a deductive experiment. The strength of such experiments depends on the firmness of the predictions and their a priori probability of corroboration. Replication is but one of many ways of reducing this probability. Whether the experiment is replicated or not, inferential statistics should always be used, to enable the reader to judge how well the apparent patterns in samples reflect real patterns in statistical populations. The concept ,pseudoreplication' amounts to entirely unwarranted stigmatization of a reasonable way to test predictions referring to large-scale systems. [source] Mycobacterial infection and atopy in childhood: A systematic reviewPEDIATRIC ALLERGY AND IMMUNOLOGY, Issue 7 2007Charles C. Obihara The epidemiological relation between mycobacterial infection and the prevalence of atopic disease in humans is still unclear. This is in contrast to studies in murine models in which a clear suppression of atopic symptoms was observed after exposure to mycobacteria or mycobacterial products. We therefore wanted to provide a systematic overview of the published literature on the relationship between mycobacterial infection and atopic disease and to evaluate the causal relationship in a meta-analysis. The EMBASE and MEDLINE databases were searched systematically for papers published in the English literature (1966,2005) on the relation between mycobacterial infection and atopic disease. Original observational or interventional studies involving the paediatric population were included. Two authors independently reviewed articles for data on mycobacterial exposure and atopic disease outcome. Any differences were resolved by discussion. Of a total of 1201 hits, 23 studies (19 cross-sectionals, three case,controls and one prospective cohort) met the inclusion criteria. Only a minority of studies (40%) observed an association between mycobacterial infection and the prevalence of atopic disease outcome. In the meta-analysis, only studies containing data on mycobacterial exposure and atopic disease outcome variables were included. Only cross-sectional studies, in which the relation between a positive tuberculin skin test and allergic symptoms was studied, observed statistically significant negative correlation (odds ratio 0.63; 95% confidence interval: 0.51,0.79). The results of this review show that the evidence of the relationship of mycobacterial infection and atopic disease is based on observations of cross-sectional studies. In a meta-analysis, calculations showed a high level of heterogeneity (I2) within studies with similar design making it difficult to pool effects. This may partly be explained by differences in the type and definition of mycobacterial infection and lack of uniformity in the definition of atopy. The results show that only a minority of studies in the literature shows any evidence of inverse relationship between mycobacterial exposure and atopic disease outcome. The fact that the present epidemiological evidence on the relationship between mycobacterial infection and the development of atopic disease is based mainly on cross-sectional observational studies indicates the need for population-based prospective studies to address this issue. This issue needs to be addressed in view of recent suggestions to developing mycobacterial-based vaccines against atopic disease in the future. [source] Effects of nicotine and chlorisondamine on cerebral glucose utilization in immobilized and freely-moving ratsBRITISH JOURNAL OF PHARMACOLOGY, Issue 1 2000T Marenco Chlorisondamine blocks central nicotinic receptors for many weeks via an unknown mechanism. Intracerebroventricular administration of [3H]-chlorisondamine in rats results in an anatomically restricted and persistent intracellular accumulation of radioactivity. The initial aim of the present study was to test whether nicotinic receptor antagonism by chlorisondamine is also anatomically restricted. Male adult rats were pretreated several times with nicotine to avoid the disruptive effects of the drug seen in drug-naïve animals. They then received chlorisondamine (10 ,g i.c.v.) or saline, and local cerebral glucose utilization (LCGU) was measured 4 weeks later after acute nicotine (0.4 mg kg,1 s.c.) or saline administration. During testing, rats were partially immobilized. Nicotine significantly increased LCGU in the anteroventral thalamus and in superior colliculus. Chlorisondamine completely blocked the first of these effects. Chlorisondamine significantly reduced LCGU in the lateral habenula, substantia nigra pars compacta, ventral tegmental area, and cerebellar granular layer. The second experiment was of similar design, but the rats were not pre-exposed to nicotine, and were tested whilst freely-moving. Acute nicotine significantly increased LCGU in anteroventral thalamus, superior colliculus, medial habenula and dorsal lateral geniculate. Overall, however, nicotine significantly decreased LCGU. Most or all of the central effects of nicotine on LCGU were reversed by chlorisondamine given 4 weeks beforehand. These findings suggest that chlorisondamine blocks nicotinic effects widely within the brain. They also indicate that in freely-moving rats, nicotine can reduce or stimulate cerebral glucose utilization, depending on the brain area. British Journal of Pharmacology (2000) 129, 147,155; doi:10.1038/sj.bjp.0703005 [source] Effect of nonionic radiocontrast agents on the occurrence of contrast-induced nephropathy in patients with mild-moderate chronic renal insufficiency: Pooled analysis of the randomized trialsCATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 3 2005Samin K. Sharma MD Abstract Contrast-induced nephropathy (CIN) is associated with high morbidity and mortality. The recent literature contains numerous clinical trials with similar design, endpoints, and patient populations, describing the nephrotoxic effects of various contrast agents, which are higher with ionic vs. nonionic contrast agents. The difference in the incidence of CIN with nonionic contrast agents may be due to the number of benzene rings (monomer vs. dimer), iodine content, osmolality, and viscosity of the individual contrast agents. We evaluated the recently published data from clinical studies with nonionic iodinated contrast agents in patients with preexisting chronic renal insufficiency (CRI) and report the results of pooled analysis of data from recent prospective independent studies of CIN with various nonionic contrast agents. Review of the recent literature revealed that the CIN incidence varies across the studies reviewed and the contrast agents used. The highest incidence of CIN was observed in studies using iohexol or ioxilan. Results of the pooled analysis of nonionic contrast agents (with more than one randomized study) showed a similar incidence of CIN after iodixanol and iopamidol in patients with preexisting CRI, while both agents showed a significantly lower incidence of CIN compared to iohexol. Since iodixanol is more expensive than iopamidol, this observation may be clinically relevant. © 2005 Wiley-Liss, Inc. [source] Seismic design of RC structures: A critical assessment in the framework of multi-objective optimizationEARTHQUAKE ENGINEERING AND STRUCTURAL DYNAMICS, Issue 12 2007Nikos D. Lagaros Abstract The assessment of seismic design codes has been the subject of intensive research work in an effort to reveal weak points that originated from the limitations in predicting with acceptable precision the response of the structures under moderate or severe earthquakes. The objective of this work is to evaluate the European seismic design code, i.e. the Eurocode 8 (EC8), when used for the design of 3D reinforced concrete buildings, versus a performance-based design (PBD) procedure, in the framework of a multi-objective optimization concept. The initial construction cost and the maximum interstorey drift for the 10/50 hazard level are the two objectives considered for the formulation of the multi-objective optimization problem. The solution of such optimization problems is represented by the Pareto front curve which is the geometric locus of all Pareto optimum solutions. Limit-state fragility curves for selected designs, taken from the Pareto front curves of the EC8 and PBD formulations, are developed for assessing the two seismic design procedures. Through this comparison it was found that a linear analysis in conjunction with the behaviour factor q of EC8 cannot capture the nonlinear behaviour of an RC structure. Consequently the corrected EC8 Pareto front curve, using the nonlinear static procedure, differs significantly with regard to the corresponding Pareto front obtained according to EC8. Furthermore, similar designs, with respect to the initial construction cost, obtained through the EC8 and PBD formulations were found to exhibit different maximum interstorey drift and limit-state fragility curves. Copyright © 2007 John Wiley & Sons, Ltd. [source] Rules, Red Tape, and Paperwork: The Archeology of State Control over MigrantsJOURNAL OF HISTORICAL SOCIOLOGY, Issue 1 2008DAVID COOK MARTÍN How and with what consequences did state control over migration become acceptable and possible after the Great War? Existing studies have centered on core countries of immigration and thus underestimate the degree to which legitimate state capacities have developed in a political field spanning sending and receiving countries with similar designs on the same international migrants. Relying on archival research, and an examination of the migratory field constituted by two quintessential emigration countries (Italy and Spain), and a traditional immigration country (Argentina) since the mid-nineteenth century, this article argues that widespread acceptance of migration control as an administrative domain rightfully under states' purview, and the development of attendant capacities have derived from legal, organizational, and administrative mechanisms crafted by state actors in response to the challenges posed by mass migration. Concretely, these countries codified migration and nationality laws, built, took over, and revamped migration-related organizations, and administratively encaged mobile people through official paperwork. The nature of efforts to evade official checks on mobility implicitly signaled the acceptance of migration control as a bona fide administrative domain. In more routine migration management, states legitimate capacity has had unforeseen intermediate- and long-term consequences such as the subjection of migrants (and, because of ius sanguinis nationality laws, sometimes their descendants) to other states' administrative influence and the generation of conditions for dual citizenship. Study findings challenge scholarship that implicitly views states as constant factors conditioning migration flows, rather than as developing institutions with historically variable regulatory abilities and legitimacy. It extends current work by specifying mechanism used by state actors to establish migration as an accepted administrative domain. [source] Increase in the prevalence of rhinitis among Danish children from 1986 to 2001PEDIATRIC ALLERGY AND IMMUNOLOGY, Issue 2 2007Kåre Håkansson In recent decades, there has been a worldwide increase in the prevalence of atopic diseases. The aim of this study was to investigate whether there has been a change in the prevalence of rhinitis among children in Denmark from 1986 to 2001. We compared data from two random population-based samples of Danish children, aged 7,17 yr, who were examined in 1986 (n = 527) and 2001 (n = 480) using similar designs. Symptoms of rhinitis, skin test reactivity, and bronchial responsiveness to inhaled histamine were assessed. The prevalence of rhinitis increased from 11.8% in 1986 to 23.3% in 2001 (p < 0.001). The increase was most pronounced among subjects who suffered from non-allergic rhinitis (p < 0.001), and among subjects with severe symptoms (p < 0.001). The prevalence of asymptomatic positive skin prick test (SPT) decreased substantially (p < 0.001). A history of asthma and parental atopic disease were strong predictors of non-allergic rhinitis, whereas a history of asthma, parental atopic disease, bronchial hyperresponsiveness, eczema, and age at examination were statistically significant predictors of allergic rhinitis. The prevalence of non-allergic rhinitis among Danish children has increased substantially from 1986 to 2001. Furthermore, in general more severe symptoms of rhinitis were observed in 2001 compared with 1986. These results underline the importance of using objective measurements such as skin test reactivity when estimating time trends in the prevalence of allergic airways disease, as clinical interviews alone can be misleading. [source] | ||||||||||