Home About us Contact
|
Home About us Contact | ||
|
|
||
Treatment Time (treatment + time)
Kinds of Treatment Time Selected AbstractsCharacterizing Waiting Room Time, Treatment Time, and Boarding Time in the Emergency Department Using Quantile RegressionACADEMIC EMERGENCY MEDICINE, Issue 8 2010Ru Ding MS ACADEMIC EMERGENCY MEDICINE 2010; 17:813,823 © 2010 by the Society for Academic Emergency Medicine Abstract Objectives:, The objective was to characterize service completion times by patient, clinical, temporal, and crowding factors for different phases of emergency care using quantile regression (QR). Methods:, A retrospective cohort study was conducted on 1-year visit data from four academic emergency departments (EDs; N = 48,896,58,316). From each ED's clinical information system, the authors extracted electronic service information (date and time of registration; bed placement, initial contact with physician, disposition decision, ED discharge, and disposition status; inpatient medicine bed occupancy rate); patient demographics (age, sex, insurance status, and mode of arrival); and clinical characteristics (acuity level and chief complaint) and then used the service information to calculate patients' waiting room time, treatment time, and boarding time, as well as the ED occupancy rate. The 10th, 50th, and 90th percentiles of each phase of care were estimated as a function of patient, clinical, temporal, and crowding factors using multivariate QR. Accuracy of models was assessed by comparing observed and predicted service completion times and the proportion of observations that fell below the predicted 10th, 50th, and 90th percentiles. Results:, At the 90th percentile, patients experienced long waiting room times (105,222 minutes), treatment times (393,616 minutes), and boarding times (381,1,228 minutes) across the EDs. We observed a strong interaction effect between acuity level and temporal factors (i.e., time of day and day of week) on waiting room time at all four sites. Acuity level 3 patients waited the longest across the four sites, and their waiting room times were most influenced by temporal factors compared to other acuity level patients. Acuity level and chief complaint were important predictors of all phases of care, and there was a significant interaction effect between acuity and chief complaint. Patients with a psychiatric problem experienced the longest treatment times, regardless of acuity level. Patients who presented with an injury did not wait as long for an ED or inpatient bed. Temporal factors were strong predictors of service completion time, particularly waiting room time. Mode of arrival was the only patient characteristic that substantially affected waiting room time and treatment time. Patients who arrived by ambulance had shorter wait times but longer treatment times compared to those who did not arrive by ambulance. There was close agreement between observed and predicted service completion times at the 10th, 50th, and 90th percentile distributions across the four EDs. Conclusions:, Service completion times varied significantly across the four academic EDs. QR proved to be a useful method for estimating the service completion experience of not only typical ED patients, but also the experience of those who waited much shorter or longer. Building accurate models of ED service completion times is a critical first step needed to identify barriers to patient flow, begin the process of reengineering the system to reduce variability, and improve the timeliness of care provided. [source] The Effect of Emergency Department Crowding on Length of Stay and Medication Treatment Times in Discharged Patients With Acute AsthmaACADEMIC EMERGENCY MEDICINE, Issue 8 2010Jesse M. Pines MD ACADEMIC EMERGENCY MEDICINE 2010; 17:834,839 © 2010 by the Society for Academic Emergency Medicine Abstract Objectives:, This study sought to determine if emergency department (ED) crowding was associated with longer ED length of stay (LOS) and time to ordering medications (nebulizers and steroids) in patients treated and discharged with acute asthma and to study how delays in ordering may affect the relationship between ED crowding and ED LOS. Methods:, A retrospective cohort study was performed in adult ED patients aged 18 years and older with a primary International Classification of Diseases, 9th Revision (ICD-9), diagnosis of asthma who were treated and discharged from two EDs from January 1, 2007, to January 1, 2009. Four validated measures of ED crowding (ED occupancy, waiting patients, admitted patients, and patient-hours) were assigned at the time of triage. The associations between the level of ED crowding and overall LOS and time to treatment orders were tested by analyzing trends across crowding quartiles, testing differences between the highest and lowest quartiles using Hodges-Lehmann distances, and using relative risk (RR) regression for multivariable analysis. Results:, A total of 1,716 patients were discharged with asthma over the study period (932 at the academic site and 734 at the community site). LOS was longer at the academic site than the community site for asthma patients by 90 minutes (95% confidence interval [CI] = 79 to 101 minutes). All four measures of ED crowding were associated with longer LOS and time to treatment order at both sites (p < 0.001). At the highest level of ED occupancy, patients spent 75 minutes (95% CI = 58 to 93 minutes) longer in the ED compared to the lowest quartile of ED occupancy. In addition, comparing the highest and lowest quartiles of ED occupancy, time to nebulizer order was 6 minutes longer (95% CI = 1 to 13 minutes), and time to steroid order was 16 minutes longer (95% CI = 0 to 38 minutes). In the multivariable analysis, the association between ED crowding and LOS remained significant. Delays in nebulizer and steroid orders explained some, but not all, of the relationship between ED crowding and ED LOS. Conclusions:, Emergency department crowding is associated with longer ED LOS (by more than 1 hour) in patients who ultimately get discharged with asthma flares. Some but not all of longer LOS during crowded times is explained by delays in ordering asthma medications. [source] 4361: Management of orbital tumours with adjuvant iodine brachytherapy using "inverted" plaquesACTA OPHTHALMOLOGICA, Issue 2010T KIVELÄArticle first published online: 23 SEP 2010 Purpose To describe our experience in using "inverted" iodine plaques as adjuvant treatment after resection of orbital tumours. Methods Between 1999 and 2007, three patients (ages 17-48 years) underwent resection of an lacrimal gland tumour followed by application of an "inverted" iodine plaque manage any microscopic infiltration, i.e. a gold plaque carrying iodine-125 seeds on its convex rather than concave surface. In a fourth instance, the seeds were placed on the convex surface of a ruthenium rather than a gold plaque to manage an eye with a late extraocular recurrence of an irradiated uveal melanoma following resection of the extension. Results The diameter of the plaque was 20 mm. It was sutured to the sclera so that when the eye was in primary position the lacrimal fossa was targeted. When the eye moved, the irradiated volume naturally enlarged. A 40-56 Gy dose was calculated to the depth of 10 mm, and the dose at 5 mm was then calculated as 80-134 Gy. Treatment time was 59-154 hours. In one case, the iodine seeds were placed asymmetrically to limit radiation damage to the eyelid skin. In two patients, transient erythema of the upper eyelid developed, which resolved in a few months time. In case of the extraocular melanoma, dose was the same. Recurrent tumours have not developed. Conclusion An "inverted" iodine plaque is one option for adjuvant irradiation of the orbit which shields the eye from radiation damage. [source] Behavioural treatment of urinary incontinence and encopresis in children with learning disabilities: transfer of stimulus controlDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 4 2000Linda Smith MAMSc Clinical Psychologist Urinary and faecal incontinence present a considerable problem in people with learning disabilities, despite the general effectiveness of behavioural techniques in continence training. Children with learning disabilities and obsessional behaviour may be particularly resistant to toilet training, even where relatively cognitively able, and often despite a substantial degree of control over their eliminatory functions. Their resistance may be more appropriately regarded as a challenging behaviour and their incontinence better explained by factors other than a simple failure to learn. A 'stimulus-control'hypothesis proposes that the child's nappy (diaper) /potty/underwear has developed strong stimulus control over the elimination response. This report describes three case studies in which treatment-resistant children, aged between 8 and 12 years, with mild or moderate learning disabilities, were successfully treated for nappy-dependent nocturnal encopresis or diurnal urinary incontinence. The children were routine case referrals for whom previous attempts to train bowel or bladder control had failed. Behavioural techniques, such as 'shaping'(gradually increasing the proximity to the toilet),,fading'(reducing the presence of the nappy), and rewards for eliminating, effected successful transfer of stimulus control over elimination from nappy to toilet. Treatment times varied, depending on the degree of the child's obsession and resistance to change. [source] Efficacy and safety of DALI LDL-apheresis at high blood flow rates: A prospective multicenter studyJOURNAL OF CLINICAL APHERESIS, Issue 4 2003T. Wendler Abstract Direct adsorption of lipids (DALI) is the first LDL-apheresis method compatible with whole blood. Usually, the blood flow rate is adjusted at 60,80 ml/min, which results in session times of about 2 hr. The present study was performed to test the safety and efficacy of low-density lipoprotein cholesterol (LDL-C) and lipoprotein (a) [Lp(a)] removal by DALI at high blood flow rates in order to reduce treatment time. Thirteen chronic DALI patients in seven centers suffering from hypercholesterolemia (LDL-C 162 ± 42 mg/dl at baseline) and coronary artery disease were treated on a weekly or biweekly basis by DALI apheresis. The blood flow rate QB was held constant for at least two sessions, respectively, and was increased from 60 to 80, 120, 160, 200, and 240 ml/min. All patients had pre-existing av-fistulas. The anticoagulation was performed by a heparin bolus plus ACD-A at a ratio of citrate: blood ranging from 1:20 to 1:90. Clinically, the sessions were well tolerated and only 26/201 sessions (12%) of the treatments were fraught with minor adverse events. Acute LDL-C reductions (derived from LDL-C levels determined by lipoprotein electrophoresis) averaged 72/66/60/53/50/48% for QB = 60/80/120/160/200/240 ml/min. Lp(a) reductions were 68/67/62/60/58/56%, whereas HDL-C losses were ,10%. Routine blood chemistries and blood cell counts remained in the normal range. Treatment times averaged 142/83/45 min at Qb = 60/120/240 ml/min. On average, DALI LDL-apheresis could be performed safely and effectively at high blood flow rates up to at least 120 ml/min in patients with good blood access, which significantly reduced treatment time from 142 to 83 min (,42%). J. Clin. Apheresis 18:157,166, 2003. © 2003 Wiley-Liss, Inc. [source] Capillary electrochromatography with monolithic silica column:,I.ELECTROPHORESIS, Issue 3 2003Preparation of silica monoliths having surface-bound octadecyl moieties, applications to the separation of neutral, charged species, their chromatographic characterization Abstract Monolithic silica columns with surface-bound octadecyl (C18) moieties have been prepared by a sol-gel process in 100 ,m ID fused-silica capillaries for reversed-phase capillary electrochromatography of neutral and charged species. The reaction conditions for the preparation of the C18-silica monoliths were optimized for maximum surface coverage with octadecyl moieties in order to maximize retention and selectivity toward neutral and charged solutes with a sufficiently strong electroosmotic flow (>,2 mm/s) to yield rapid analysis time. Furthermore, the effect of the pore-tailoring process on the silica monoliths was performed over a wide range of treatment time with 0.010 M ammonium hydroxide solution in order to determine the optimum time and conditions that yield mesopores of narrow pore size distribution that result in high separation efficiency. Under optimum column fabrication conditions and optimum mobile phase composition and flow velocity, the average separation efficiency reached 160,000 plates/m, a value comparable to that obtained on columns packed with 3 ,m C18-silica particles with the advantages of high permeability and virtually no bubble formation. The optimized monolithic C18-silica columns were evaluated for their retention properties toward neutral and charged analytes over a wide range of mobile phase compositions. A series of dimensionless retention parameters were evaluated and correlated to solute polarity and electromigration property. A dimensionless mobility modulus was introduced to describe charged solute migration and interaction behavior with the monolithic C18-silica in a counterflow regime during capillary electrochromatography (CEC )separations. The mobility moduli correlated well with the solute hydrophobic character and its charge-to-mass ratio. [source] Benzydamine for prophylaxis of radiation-induced oral mucositis in head and neck cancers: a double-blind placebo-controlled randomized clinical trialEUROPEAN JOURNAL OF CANCER CARE, Issue 2 2009A. KAZEMIAN md, assistant professor We evaluated the efficacy of benzydamine oral rinse for prevention of radiation-induced mucositis. Patients with head and neck cancers, who were referred in 2004,2005, received an oral rinse of either benzydamine or placebo. One hundred patients were randomized in this trial. At the end of the study, 19 patients were excluded from the analysis because they did not use the medication for the assigned period. In the benzydamine group, the frequency of mucositis grade ,3 was 43.6% in contrast to 78.6% in other group (P = 0.001). Grade ,3 mucositis was 2.6 times more frequent in the placebo group. Intensity of mucositis increased up to fourth week of treatment in both groups to grade 2. In the treated group the grade of mucositis was approximately constant to the end of therapy; but in the control group it raised to grade 3 (P < 0.001). The highest grade of mucositis during the treatment time was significantly different between two groups (P = 0.049). The median interval to observation of grade ,2 mucositis was 24 days in the placebo group and 28 days in the benzydamine group (P = 0.12). Benzydamine oral rinse seems to be effective, safe, and well tolerated for prophylactic treatment of radiation-induced oral mucositis in head and neck tumours. [source] Surface Structures and Osteoblast Activity on Biomedical Polytetrafluoroethylene Treated by Long-Pulse, High-Frequency Oxygen Plasma Immersion Ion ImplantationADVANCED ENGINEERING MATERIALS, Issue 5 2010Liping Tong Abstract Polytetrafluoroethylene (PTFE) is a biologically safe polymer used widely in clinical medicine including oral and orthopedic surgery. However, the high bio-inertness of PTFE has hampered wider applications in the biomedical fields. In this work, we extend the treatment time in long-pulse, high-frequency oxygen plasma immersion ion implantation of PTFE and a more superhydrophobic surface with a water contact angle of 160° is created. X-ray photoelectron spectroscopy (XPS) and atomic force microscopy (AFM) reveal that the optimized long-pulse, high-frequency oxygen plasma immersion ion implantation process induces a rougher surface and to a lesser extent alters the surface oxygen concentration on the PTFE. Our data, especially long-term contact angles, suggest that the superhydrophobility stems from surface roughness alteration. Furthermore, the activity of MC3T3-E1 osteoblasts cultured on the treated surfaces is promoted in terms of quantities and morphology. [source] Fluorescence-controlled Er:YAG laser for caries removal in permanent teeth: a randomized clinical trialEUROPEAN JOURNAL OF ORAL SCIENCES, Issue 2 2008Henrik Dommisch The aim of this randomized clinical study was to compare the efficacy of a fluorescence-controlled erbium-loaded yttrium aluminum garnet (Er:YAG) laser with conventional bur treatment for caries therapy in adults. Twenty-six patients with 102 carious lesions were treated using either the Er:YAG laser, at threshold levels of 7, 8, 9, and 10 [U], or rotary burs. Both techniques were applied to each lesion at separate locations. After treatment, dentine samples were obtained using a carbide bur. The viable counts of Streptococcus mutans (SM) and lactobacilli (LB) [expressed as colony-forming units (log10 CFUs)], treatment time, pain, vibration, and sound intensity were determined. The median numbers of CFUs for SM and LB were not statistically different between laser and bur treatment at threshold levels 7 and 8 [U]. At threshold levels 9 and 10 [U], the median number of CFUs for LB [1.11 (range: 0.00,2.04)] were significantly higher following laser treatment than following bur treatment [0.30 (range: 0.00,0.60)]. The results indicate that treatment with a fluorescence-controlled Er:YAG laser at threshold levels of 7 and 8 removed caries to a level similar to that achieved using conventional bur treatment, with clinically irrelevant amounts of remaining bacteria. Although more time consuming, laser treatment provided higher patient comfort than bur treatment. [source] Influence of Treatment Conditions on the Chemical Oxidative Activity of H2SO4/H2O2 Mixtures for Modulating the Topography of Titanium,ADVANCED ENGINEERING MATERIALS, Issue 12 2009Fabio Variola Abstract Host-tissue integration of medical implants is governed by their surface properties. The capacity to rationally design the surface physico-chemical cues of implantable materials is thus a fundamental prerequisite to confer enhanced biocompatibility. Our previous work demonstrated that different cellular processes are elicited by the nanotexture generated on titanium (cpTi) and Ti6Al4V alloy by chemical oxidation with a H2SO4/H2O2 mixture. Here, we illustrate that by varying the etching parameters such as temperature, concentration, and treatment time, we can create a variety of surface features on titanium which are expected to impact its biological response. The modified submicron and nanotextured surfaces were characterized by scanning electron (SEM) and atomic force (AFM) microscopies. Contact angle measurements revealed the higher hydrophilicity of the modified surfaces compared to untreated samples and Fourier transform infrared spectroscopy (FT-IR) established that the etching generated a TiO2 layer with a thickness in the 40,60,nm range. [source] Tailoring Titanium Hydride Decomposition Kinetics by Annealing in Various AtmospheresADVANCED ENGINEERING MATERIALS, Issue 5 2004D. Lehmhus With series production of aluminium foams according to the Fraunhofer process a reality, further improvement of structural homogeneity has gained interest. Since this characteristic is strongly influenced by blowing agent decomposition, means to adapt the latter have been investigated: The paper concentrates on thermal treatment of TiH2, comparing effects induced by treatment time, temperature and atmosphere variation. Structural characteristics of AlSi7 foams using TiH2 variants as foaming agent are evaluated. [source] Salvage laryngectomy and pharyngocutaneous fistulae after primary radiotherapy for head and neck cancer: A national survey from DAHANCAHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 9 2003Cai Grau MD, DMSc Objective. In 1998, the Danish Society for Head and Neck Oncology decided to conduct a nationwide survey at the five head and neck oncology centers with the aim of evaluating the surgical outcome of salvage laryngectomy after radiotherapy with special emphasis on identifying factors that could contribute to the development of pharyngocutaneous fistulae. Patients. A total of 472 consecutive patients undergoing postirradiation salvage laryngectomy in the period July 1, 1987,June 30, 1997 were recorded at the five head and neck oncology centers in Denmark. Age ranged from 36 to 84 years, median 63 years, 405 men and 67 women. Primary tumor site was glottic larynx (n = 242), supraglottic larynx (n = 149), other larynx (n = 45), pharynx (n = 27), and other (n = 9). All patients had received prior radiotherapy. Results. Median time between radiotherapy and laryngectomy was 10 months (range, 1,348 months). A total of 89 fistulae lasting at least 2 weeks were observed, corresponding to an overall average fistulae risk of 19%. The number of performed laryngectomies per year decreased linearly (from 58 to 37), whereas the annual number of fistulae increased slightly (from 7 to 11), which meant that the corresponding estimated fistulae risk increased significantly from 12% in 1987 to 30% in 1997. Other significant risk factors for fistulae in univariate analysis included younger patient age, primary advanced T and N stage, nonglottic primary site, resection of hyoid bone, high total radiation dose, and large radiation fields. Multiple logistic regression analysis of these parameters suggested that nonglottic tumor site, late laryngectomy period (1987,1992 vs 1993,1997), and advanced initial T stage were independent prognostic factors for fistulae risk. Surgical parameters like resection of thyroid/tongue base/trachea or radiotherapy parameters like overall treatment time or fractions per week did not influence fistulae risk. Conclusions. The risk of fistulae is especially high in patients initially treated with radiotherapy for nonglottic advanced stage tumors. A significant decrease in the number of performed salvage laryngectomies over the 10 years was seen. Over the same time period, the annual number of fistulae remained almost constant. The resulting more than doubling of fistulae rate could thus in part be explained by less surgical routine. © 2003 Wiley Periodicals, Inc. Head Neck 25: 711,716, 2003 [source] Long slow night hemodialysis and quality of lifeHEMODIALYSIS INTERNATIONAL, Issue 1 2005P. Hakkarainen Background:,Long slow hemodialysis (LS-HD) improves many biochemical parameters compared with conventional HD. However, its influences on quality of life are less well known. Aims:,The objective of this study was to examine the quality of life of patients on LS-HD performed overnight compared to the patients on standard hemodialysis. This extends the previous study, conducted in 2001, which examined the LS-HD patients, quality of life. Patients and methods:,We sent questionnaires to 12 LS-HD (overnight, treatment time 8 h × 3/wk) patients and 15 day HD (4.5 h × 3/wk) patients, all being treated using the limited care method. Data was collected using two different structured questionnaires. One was constructed for a previous study (2001) and the other one was a standardized set of questionnaires (RAND-36). Research material was collected from patient documents, such as the essential biochemical parameters, blood pressure, weight gain, and weekly EPO doses were recorded. Ten of the LS-HD patients (83%) and 13/15 (87%) of day HD patients returned the questionnaires. Three day hemodialysis patients returned empty questionnaires, which were disqualified. Results:,Based on the medical facts, the results showed that the patients of LS-HD felt better than the patients in another group. Patients on the LS-HD had higher Kt/V (2.623 vs. 1.577) and Hb (118 vs. 111) and lower Pi (1.36 vs. 1.63) and EPO dose (epoietin-beta 2667 ky/week vs. 5833 ky/week; darbepoetin 16 ky/week vs. 37 ky/week). However, their predialysis BP as well as the weight gain between treatments and salt and fluid balances caused problems furthermore. The experiences of the therapy of the LS-HD patients were more positive than of the control group: they felt their medical condition was better than of the patients on day HD. However we didn't observe significant differences in the replies showing physical or psychosocial conditions between the two groups. Conclusions:,The study suggests that when patients can themselves make the choice between treatment modalities, it improves the quality of life of the patients. Control of anemia is improved in LS-HD overnight patients with lower doses of EPO. The LS-HD gives the patients more freedom of diet. However, more attention must be paid to salt and fluid restriction. The LS-HD makes it possible for many patients to work normally. [source] Genetic association between TNF-, ,308 G>A polymorphism and longitudinal weight change during clozapine treatmentHUMAN PSYCHOPHARMACOLOGY: CLINICAL AND EXPERIMENTAL, Issue 4 2010Ying-Chieh Wang Abstract Objective The aim of the study was to investigate the association between genetic variation in the tumor necrosis factor-alpha (TNF-,) gene and longitudinal weight change during long-term clozapine treatment. Methods Fifty-five patients with refractory schizophrenia treated with clozapine for 8 years were recruited. Gender, age, treatment response to clozapine in the first 14 months, baseline BMI, clozapine dose, concomitant use of mood stabilizers and other antipsychotics, and ,308 G,>,A polymorphism in the human TNF-, gene were analyzed using generalized estimating equations. Results In addition to having a lower baseline BMI (p,=,0.0013) and a longer treatment time (p,=,0.050), the ,308 GG carriers gained significantly more weight than the ,308 A allele carriers (p,=,0.0084) during 8 years of clozapine treatment, after controlling for other non-genetic factors. Conclusions The ,308 G,>,A genetic variant of the TNF-, gene is associated with longitudinal weight change during clozapine treatment. Follow-up duration is an important factor to consider when performing pharmacogenetic study of clozapine-induced weight gain. Copyright © 2010 John Wiley & Sons, Ltd. [source] Supercritical CO2 and N2O pasteurisation of peach and kiwi juiceINTERNATIONAL JOURNAL OF FOOD SCIENCE & TECHNOLOGY, Issue 8 2010Sara Spilimbergo Summary The microbial inactivation and qualitative parameters (pH, sugar content, titratable acidity, absorbance at 420 nm and turbidity) of peach and kiwi juices treated at 35 °C with supercritical carbon dioxide (SC-CO2) and nitrous oxide (SC-N2O) were determined as a function of pressure and treatment time. Total inactivation of both naturally occurring microorganisms and Saccharomyces cerevisiae strain (105 cfu mL,1) was obtained after 15 min of SC-CO2/N2O treatment, 10 MPa and 35 °C, for both juices. No significant changes in chemical-physical or in sensorial characteristics between untreated and treated juice were detected. The results obtained demonstrate the feasibility and the potential of SC-CO2/N2O treatment as an alternative low temperature pasteurisation process for peach and kiwi juices. [source] The effect of high pressure treatment on rheological characteristics and colour of mango pulpINTERNATIONAL JOURNAL OF FOOD SCIENCE & TECHNOLOGY, Issue 8 2005Jasim Ahmed Summary The effect of high-pressure (HP) treatment (100,400 MPa for 15 or 30 min at 20 °C) on the rheological characteristics and colour of fresh and canned mango pulps was evaluated. Differences were observed in the rheological behaviour of fresh and canned mango pulps treated with HP. Shear stress,shear rate data of pulps were well described by the Herschel,Bulkley model. The consistency index (K) of fresh pulp increased with pressure level from 100 to 200 MPa while a steady decrease was noticed for canned pulp. For fresh pulp the flow behaviour index decreased with pressure treatment whereas an increasing trend was observed with canned pulp. Storage and loss moduli of treated fresh pulp with HP increased linearly with angular frequency up to 200 MPa for a treatment time of 30 min while a steady decreasing trend was found for processed pulp. No significant variation in colour was observed during pressure treatment. [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] Room temperature photoluminescence of the Li2ZnTi3O8 spinel: Experimental and theoretical studyINTERNATIONAL JOURNAL OF QUANTUM CHEMISTRY, Issue 5 2005M. S. C. Câmara Abstract This article describes the characterization of intense photoluminescence observed at room temperature of the Li2ZnTi3O8 spinel phase, obtained by the polymeric precursor method. The evolution of visible photoluminescence is demonstrated by measurement of the photoluminescence signal as a function of the annealing treatment time. The evolution indicates that PL can be attributed to the presence of an inorganic disordered phase. In addition, increased annealing treatment times cause not only a decrease in the total residual content of organic material in the samples, but also an intensified photoluminescence. We discuss the nature of visible photoluminescence at room temperature of the Li2ZnTi3O8 spinel phase in the light of results of both recent experimental and quantum mechanical theoretical studies. © 2005 Wiley Periodicals, Inc. Int J Quantum Chem, 2005 [source] Selecting for development of fluoroquinolone resistance in a Campylobacter jejuni strain 81116 in chickens using various enrofloxacin treatment protocolsJOURNAL OF APPLIED MICROBIOLOGY, Issue 4 2010K. Stapleton Abstract Aims:, To determine the effect of various enrofloxacin dose regimes on the colonization and selection of resistance in Campylobacter jejuni strain 81116P in experimentally colonized chickens. Methods and Results:, Two experiments were undertaken, in which 14-day-old chickens were colonized with 1 × 107,1 × 109 CFU g,1Camp. jejuni strain 81116P and then treated with enrofloxacin at 12,500 ppm in drinking water for various times. Caecal colonization levels were determined at various time-points after start-of-treatment, and the susceptibility of recovered isolates to ciprofloxacin was monitored. Resistance was indicated by growth on agar containing 4 ,g ml,1 ciprofloxacin, MICs of 16 ,g ml,1 and the Thr86Ile mutation in gyrA. Enrofloxacin at doses of 12,250 ppm reduced Camp. jejuni colonization over the first 48,72 h after start-of-treatment. The degree of reduction in colonization was dose, but not treatment time, dependent. In all cases, maximal colonization was re-established within 4,6 days. Fluoroquinolone-resistant organisms were recoverable within 48 h of start-of-treatment; after a further 24 h all recovered isolates were resistant. In contrast, a dose of 500 ppm enrofloxacin reduced colonization to undetectable levels within 48 h, and the treated birds remained Campylobacter negative throughout the remaining experimental period. By high pressure liquid chromatography, for all doses, the maximum concentrations of enrofloxacin and ciprofloxacin in the caecal contents were detected at the point of treatment completion. Thereafter, levels declined to undetectable by 7 days post-treatment withdrawal. Conclusions:, In a model using chickens maximally colonized with Camp. jejuni 81116P, treatment with enrofloxacin, at doses of 12,250 ppm in drinking water, enables the selection, and clonal expansion, of fluoroquinolone-resistant organisms. However, this is preventable by treatment with 500 ppm of enrofloxacin. Significance and impact of the study:, Treatment of chickens with enrofloxacin selects for resistance in Camp. jejuni in highly pre-colonized birds. However, a dose of 500 ppm enrofloxacin prevented the selection of resistant campylobacters. [source] Influence of relative gas humidity on the inactivation efficiency of a low temperature gas plasmaJOURNAL OF APPLIED MICROBIOLOGY, Issue 6 2008P. Muranyi Abstract Aims:, To investigate the effect of relative gas humidity on the inactivation efficiency of a cascaded dielectric barrier discharge (CDBD) in air against Aspergillus niger and Bacillus subtilis spores on PET foils. Methods and Results:, The inactivation kinetics as a function of treatment time were determined using synthetic air with different relative humidity as the process gas. Spores of A. niger and B. subtilis respectively were evenly sprayed on PET foils for use as bioindicators. In the case of A. niger, increased spore mortality was found at a high relative gas humidity of 70% (approx. 2 log10). This effect was more evident at prolonged treatment times. In contrast, B. subtilis showed slightly poorer inactivation at high gas humidity. Conclusions:, Water molecules in the process gas significantly affect the inactivation efficiency of CDBD in air. Significance and Impact of the Study:, Modifying simple process parameters such as the relative gas humidity can be used to optimize plasma treatment to improve inactivation of resistant micro-organisms such as conidiospores of A. niger. [source] Occurrence of sublethal injury after pulsed electric fields depending on the micro-organism, the treatment medium ph and the intensity of the treatment investigatedJOURNAL OF APPLIED MICROBIOLOGY, Issue 1 2005D. García Abstract Aims:, The objective was to investigate the occurrence of sublethal injury after pulsed electric field (PEF) depending on the treatment time, the electric field strength and the pH of the treatment media in two Gram-positive (Bacillus subtilis ssp. niger, Listeria monocytogenes) and six Gram-negative (Escherichia coli, Escherichia coli O157:H7, Pseudomonas aeruginosa, Salmonella serotype Senftenberg 775W, Salmonella serotype Typhimurium, Yersinia enterocolitica) bacterial strains. Methods and Results:, A characteristic behaviour was observed for the Gram-positive and Gram-negative bacteria studied. Whereas Gram-positive bacteria showed a higher PEF resistance at pH 7·0, the Gram-negative were more resistant at pH 4·0. In these conditions, in which bacteria showed their maximum resistance, a large proportion of sublethally injured cells were detected. In most cases, the longer the treatment time and the higher the electric field applied, the greater the proportion of sublethally injured cells that were detected. No sublethal injury was detected when Gram-positive bacteria were treated at pH 4·0 and Gram-negative at pH 7·0. Conclusions:, Sublethal injury was detected after PEF so, bacterial inactivation by PEF is not an ,all or nothing' event. Significance and Impact of the Study:, This work could be useful for improving food preservation by PEF. [source] Preparation and pH-sensitivity of polyacrylonitrile (PAN) based porous hollow gel fibersJOURNAL OF APPLIED POLYMER SCIENCE, Issue 1 2008Xinyuan Shen Abstract Polyacrylonitrile based porous hollow gel fibers were prepared from PAN hollow fibers by oxidation and subsequent alkaline treatment. Fourier-transform infrared (FTIR), X-ray diffraction, and scanning electron microscope (SEM) analyses showed that the PAN porous hollow gel fiber was a kind of amphoteric fiber due to the combination of cationic groups of pyridyl and anionic groups of carboxyl; after gelation the hollow channel and finger-like pores on the fiber walls were conserved. The effects of cyclization reaction degree, alkaline solution concentration, and alkaline treatment time on the mechanical properties or pH-sensitive behavior of the porous hollow gel fibers were investigated. The elongation/contraction behavior was studied in detail. It was found that the gel fiber exhibited a large swelling in an alkaline solution and contracting in an acid solution; the swelling change in length was above 90%; the responsive time of elongation/contraction was less than 20 s; the maximum contraction force was 20 N/cm2; and pH-sensitivity was reversible. © 2008 Wiley Periodicals, Inc. J Appl Polym Sci, 2008 [source] Synthesis and properties of starch-graft-acrylic acid/Na-montmorillonite superabsorbent nanocomposite hydrogelsJOURNAL OF APPLIED POLYMER SCIENCE, Issue 1 2008Ebru Al Abstract The graft copolymerization of acrylic acid (AA) onto starch was carried out with monomer/starch weight ratio = 1.5. Cerium ammonium nitrate (CAN) and N,N,-methylenebis acrylamide (NMBA) were used as initiator and crosslink agent, respectively. Na-montmorillonite was used as nanoparticles. Starch- graft -acrylic acid/Na-MMT (S -g-AA/MMT) nanocomposite hydrogels were characterized by X-ray diffraction (XRD) and FTIR analysis. The effect of Na-MMT content in nanocomposite hydrogels on the swelling behavior was investigated. Increasing the Na-MMT/monomers ratio up to 1% causes an increment in water absorbency, which indicates that Na-MMT can improve the ability of water absorbency but further increase of Na-MMT causes a decrease in water absorbency. In addition, we describe the removal of safranine T from aqueous solutions using S -g-AA/MMT nanocomposite hydrogels. Effects of various parameters such as treatment time, initial dye concentration, and amount of the Na-MMT were investigated. The Freundlich equations were used to fit the equilibrium isotherms. © 2008 Wiley Periodicals, Inc. J Appl Polym Sci, 2008 [source] Laser scanning confocal microscope characterization of dye diffusion in nylon 6 fibers treated with atmospheric pressure plasmasJOURNAL OF APPLIED POLYMER SCIENCE, Issue 3 2008Chunxia Wang Abstract The effect of atmospheric pressure plasma treatment on wettability and dyeability of nylon 6 fibers is investigated. The plasma treatments resulted in an average of 10°,20° decrease in the advancing contact angle and 20°,30° decrease in the receding contact angle. An increased dye diffusion rate of nylon 6 fibers was observed using laser scanning confocal microscope (LSCM). Scanning electron microscope confirmed that the fiber surfaces were roughened, and X-ray photoelectron spectroscopy showed that the polar groups on the fiber surfaces increased after the plasma treatments. As the plasma treatment time increased, a greater degree of etching was achieved and more polar groups such as hydroxyl and carboxyl groups produced on the surfaces of the nylon 6 fibers, leading to a better wettability and thus a better dyeability of the fiber. This study proved that LSCM may be effectively used in detecting the change of dye diffusion rate in nylon fibers treated with plasmas and the mounting medium should have a close refractive index as the fiber to avoid distortion of the fiber cross section image. © 2007 Wiley Periodicals, Inc. J Appl Polym Sci, 2008 [source] Does low-intensity pulsed ultrasound stimulate maturation of tissue-engineered cartilage?JOURNAL OF BIOMEDICAL MATERIALS RESEARCH, Issue 1 2004Georg N. Duda Abstract Traumatic events are a primary cause of local lesions of articular cartilage. Tissue engineered, cartilage-like structures represent an alternative to current treatment methods. The time necessary for tissue maturation and the mechanical quality of the regenerate at implantation are both critical factors for clinical success. Low-intensity pulsed ultrasound has proven to accelerate chondrogenesis in vitro. The goal of this study was to evaluate whether low-intensity pulsed ultrasound is capable of accelerating the process of cartilage maturation and increasing regenerate stability. Hyaline-like cartilage specimens were generated in vitro and subcutaneously implanted in the backs of nude mice. Twenty-eight animals received 20 min of low-intensity pulsed ultrasound treatment daily, and 28 animals received a sham treatment. Specimens were explanted after 1, 3, 6, and 12 weeks, mechanically tested with the use of an indentation test, histologically examined, and processed for RT-PCR. The Young's moduli significantly increased from 3 to 12 weeks, and at 6 weeks were comparable to those of native articular cartilage. In histological examination, specimens showed neocartilage formation. There was no significant difference between ultrasound-treated and sham-treated groups. The mechanical stability of the neocartilage specimens increased with treatment time and reached values of native cartilage after 6 weeks in vivo. Low-intensity pulsed-ultrasound stimulation showed no stimulatory effect on tissue maturation. In contrast, ultrasound-treated specimens showed a reduced Col 2 expression at 1 week and were significantly less stiff compared to native cartilage at 6 and 12 weeks. An acceleration of the maturation of tissue-engineered neocartilage in a clinical setting by means of low-intensity pulsed ultrasound therefore appears rather unrealistic. © 2003 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 68B: 21,28, 2004 [source] Recombinant Human Parathyroid Hormone (1,34) [Teriparatide] Improves Both Cortical and Cancellous Bone StructureJOURNAL OF BONE AND MINERAL RESEARCH, Issue 11 2003Yebin Jiang MD Abstract Histomorphometry and ,CT of 51 paired iliac crest biopsy specimens from women treated with teriparatide revealed significant increases in cancellous bone volume, cancellous bone connectivity density, cancellous bone plate-like structure, and cortical thickness, and a reduction in marrow star volume. Introduction: We studied the ability of teriparatide (rDNA origin) injection [rhPTH(1,34), TPTD] to improve both cancellous and cortical bone in a subset of women enrolled in the Fracture Prevention Trial of postmenopausal women with osteoporosis after a mean treatment time of 19 months. This is the first report of a biopsy study after treatment with teriparatide having a sufficient number of paired biopsy samples to provide quantitative structural data. Methods: Fifty-one paired iliac crest bone biopsy specimens (placebo [n = 19], 20 ,g teriparatide [n = 18], and 40 ,g teriparatide [n = 14]) were analyzed using both two-dimensional (2D) histomorphometry and three-dimensional (3D) microcomputed tomography (,CT). Data for both teriparatide treatment groups were pooled for analysis. Results and Conclusions: By 2D histomorphometric analyses, teriparatide significantly increased cancellous bone volume (median percent change: teriparatide, 14%; placebo, ,24%; p = 0.001) and reduced marrow star volume (teriparatide, ,16%; placebo, 112%; p = 0.004). Teriparatide administration was not associated with osteomalacia or woven bone, and there were no significant changes in mineral appositional rate or wall thickness. By 3D cancellous and cortical bone structural analyses, teriparatide significantly decreased the cancellous structure model index (teriparatide, ,12%; placebo, 7%; p = 0.025), increased cancellous connectivity density (teriparatide, 19%; placebo, ,14%; p = 0.034), and increased cortical thickness (teriparatide, 22%; placebo, 3%; p = 0.012). These data show that teriparatide treatment of postmenopausal women with osteoporosis significantly increased cancellous bone volume and connectivity, improved trabecular morphology with a shift toward a more plate-like structure, and increased cortical bone thickness. These changes in cancellous and cortical bone morphology should improve biomechanical competence and are consistent with the substantially reduced incidences of vertebral and nonvertebral fractures during administration of teriparatide. [source] High glucose levels upregulate upstream stimulatory factor 2 gene transcription in mesangial cellsJOURNAL OF CELLULAR BIOCHEMISTRY, Issue 6 2008Lihua Shi Abstract Previously, we demonstrated that upstream stimulatory factor 2 (USF2) mediates high glucose-induced thrombospondin1 (TSP1) gene expression and TGF-, activity in glomerular mesangial cells and plays a role in diabetic renal complications. In the present studies, we further determined the molecular mechanisms by which high glucose levels regulate USF2 gene expression. In primary rat mesangial cells, we found that glucose treatment time and dose-dependently up-regulated USF2 expression (mRNA and protein). By using cycloheximide to block the de novo protein synthesis, similar rate of USF2 degradation was found under either normal glucose or high glucose conditions. USF2 mRNA stability was not altered by high glucose treatment. Furthermore, high glucose treatment stimulated USF2 gene promoter activity. By using the luciferase-promoter deletion assay, site-directed mutagenesis, and transactivation assay, we identified a glucose-responsive element in the USF2 gene promoter (,1,740 to ,1,620, relative to the transcription start site) and demonstrated that glucose-induced USF2 expression is mediated through a cAMP-response element-binding protein (CREB)-dependent transactivation of the USF2 promoter. Furthermore, siRNA-mediated CREB knock down abolished glucose-induced USF2 expression. Taken together, these data indicate that high glucose levels up-regulate USF2 gene transcription in mesangial cells through CREB-dependent transactivation of the USF2 promoter. J. Cell. Biochem. 103: 1952,1961, 2007. © 2007 Wiley-Liss, Inc. [source] Efficacy and safety of DALI LDL-apheresis at high blood flow rates: A prospective multicenter studyJOURNAL OF CLINICAL APHERESIS, Issue 4 2003T. Wendler Abstract Direct adsorption of lipids (DALI) is the first LDL-apheresis method compatible with whole blood. Usually, the blood flow rate is adjusted at 60,80 ml/min, which results in session times of about 2 hr. The present study was performed to test the safety and efficacy of low-density lipoprotein cholesterol (LDL-C) and lipoprotein (a) [Lp(a)] removal by DALI at high blood flow rates in order to reduce treatment time. Thirteen chronic DALI patients in seven centers suffering from hypercholesterolemia (LDL-C 162 ± 42 mg/dl at baseline) and coronary artery disease were treated on a weekly or biweekly basis by DALI apheresis. The blood flow rate QB was held constant for at least two sessions, respectively, and was increased from 60 to 80, 120, 160, 200, and 240 ml/min. All patients had pre-existing av-fistulas. The anticoagulation was performed by a heparin bolus plus ACD-A at a ratio of citrate: blood ranging from 1:20 to 1:90. Clinically, the sessions were well tolerated and only 26/201 sessions (12%) of the treatments were fraught with minor adverse events. Acute LDL-C reductions (derived from LDL-C levels determined by lipoprotein electrophoresis) averaged 72/66/60/53/50/48% for QB = 60/80/120/160/200/240 ml/min. Lp(a) reductions were 68/67/62/60/58/56%, whereas HDL-C losses were ,10%. Routine blood chemistries and blood cell counts remained in the normal range. Treatment times averaged 142/83/45 min at Qb = 60/120/240 ml/min. On average, DALI LDL-apheresis could be performed safely and effectively at high blood flow rates up to at least 120 ml/min in patients with good blood access, which significantly reduced treatment time from 142 to 83 min (,42%). J. Clin. Apheresis 18:157,166, 2003. © 2003 Wiley-Liss, Inc. [source] The use of light-emitting diode therapy in the treatment of photoaged skinJOURNAL OF COSMETIC DERMATOLOGY, Issue 3 2007FACCS, FRACGP, Fabien Baez MBBS, MAACS, MCPSA Summary Background, Light-emitting diode (LED) therapy is an increasingly popular methodology for the treatment of sun damage. Combination use of light wavelengths reported to stimulate collagen synthesis and accelerate fibroblast,myofibroblast transformation may display a composite rejuvenative effect. Objective, To clinically assess reduction in sun damage signs following a 5-week course of LED therapy and to assess subject's perception of the treatment. Methods, Thirteen subjects with wrinkles or fine lines in the periorbital and nasolabial region and those presenting Glogau scale photodamage grade II,III received nine 20-min duration light treatments using the OmniluxÔ LED system. The treatments combined wavelengths of 633 and 830 nm at fluences of 126 and 66 J/cm2, respectively. Sun-damage reduction was assessed at 6, 9, and 12 weeks by clinical photography and patient satisfaction scores. Results, The majority of subjects displayed "moderate" (50%) or "slight" (25%) response to treatment at investigator assessment. Treatment of the periorbital region was reported more effective than the nasolabial region. At 12-week follow-up, 91% of subjects reported improved skin tone, and 82% reported enhanced smoothness of skin in the treatment area. Conclusion, Good response to LED therapy has been shown in this modest sample. Larger trials are needed to assess optimum frequency of light treatments and overall treatment time. [source] IMMEDIATE LOADING OF IMPLANTS IN THE ESTHETIC ZONEJOURNAL OF ESTHETIC AND RESTORATIVE DENTISTRY, Issue 5 2005Saj Jivraj DDS The predictability of dental implants using the traditional Branemark protocol has been well documented. Since its inception, this protocol has been progressively challenged to decrease treatment time, minimize the number of surgical procedures, and maximize esthetic outcomes. Today, in specific clinical situations, implants may be placed and immediately loaded with provisional restorations. Immediate loading in the edentulous mandible has been well documented. There are also good data to show that immediate loading of the edentulous maxilla is also feasible if bone quality is suitable. The focus now has shifted toward immediate loading of implants placed in the esthetic zone. Clinicians have recognized that the challenge of providing anterior tooth replacements is in preserving the hard and soft tissue components that exist around natural teeth. The advantages of immediate restoration are obvious; however, the application of immediate or early load may pose an increased risk of implant failure in single-tooth situations. The prerequisites for achieving and maintaining acceptable results are not fully known. This review examines some of the literature concerning the reliability of early or immediate loading of implants placed in the esthetic zone. [source] | |||||||||||||||||||||||||||||||||||||