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Unnecessary
Terms modified by Unnecessary Selected AbstractsACE Inhibitors Unnecessary for Some Heart PatientsNURSING FOR WOMENS HEALTH, Issue 1 2005Carolyn Davis Cockey MLS No abstract is available for this article. [source] Relieving Unnecessary, Treatable Pain for the Sake of Human DignityTHE JOURNAL OF LAW, MEDICINE & ETHICS, Issue 2001Sandra H. Johnson No abstract is available for this article. [source] Airway Management After Maxillectomy: Routine Tracheostomy Is Unnecessary,THE LARYNGOSCOPE, Issue 6 2003Ho-Sheng Lin MD Abstract Objectives/Hypothesis There is a paucity of data to guide the optimal management of the airway in patients after maxillectomy. The decision on whether a concomitant tracheostomy is needed is often dictated by the surgeon's training and experience. We reviewed our experience with maxillectomy to assess the need for tracheostomy in postoperative airway management. Study Design Retrospective analysis at a university hospital. Methods We identified 121 patients who underwent 130 maxillectomies between October 1990 and September 2001. Twenty-four of these were total (all six walls removed), 45 were subtotal (two or more walls removed), and 61 were limited (only one wall removed). Reconstruction ranged from none to microvascular free flap, with split-thickness skin graft being the most common reconstructive option. Results Only 10 tracheostomies (7.7%) were performed at the time of maxillectomy. These included four tracheostomies in patients who underwent bulky flap reconstruction, two tracheostomies in patients who underwent both flap reconstruction and mandibulectomy, one tracheostomy in a patient who underwent mandibulectomy, one tracheostomy in a patient with mucormycosis in anticipation of prolonged ventilatory support postoperatively, and two tracheostomies at the surgeons' discretion because of concern for upper airway edema. Among the 111 patients who underwent 120 maxillectomies without concomitant tracheostomy, 1 patient (0.9%), a 74 year-old man with oxygen-dependent chronic obstructive pulmonary disease, required repeat intubation on day 3 and again on day 10 after the surgery, because of respiratory failure; fiberoptic examination confirmed the absence of upper airway compromise. Conclusions The routine performance of tracheostomy in patients undergoing maxillectomy is unnecessary. Selective use of tracheostomy may be indicated in situations in which mandibulectomy or bulky flap reconstruction is performed or a concern for postoperative oropharyngeal airway obstruction because of edema or packing exists. [source] Routine Packing of Simple Cutaneous Abscesses Is Painful and Probably UnnecessaryACADEMIC EMERGENCY MEDICINE, Issue 5 2009Gerald F. O'Malley DO Abstract Objectives:, The objective was to determine whether the routine packing of simple cutaneous abscesses after incision and drainage (I&D) confers any benefit over I&D alone. Methods:, In a prospective, randomized, single-blinded trial, subjects with simple cutaneous abscesses (less than 5 cm largest diameter) underwent incision, drainage, irrigation, and standard abscess preparation in the usual manner. Subjects were then randomized to either packing or no-packing. Visual analog scales (VAS; 100 mm) of pain were recorded in the emergency department (ED). All patients received trimethoprim-sulfamethoxazole (TMP-SMX), ibuprofen, and narcotic prescriptions, recorded twice daily VAS pain scores, and returned in 48 hours at which time dressings and packing, if present, were removed and a physician blinded to the randomization and not part of the initial visit repeated measurements and determined the need for further intervention. Results:, Forty-eight subjects were included in the final analysis. There were no significant differences in age, sex, abscess location, or initial pain scores between the two groups. There was no significant difference in need for a second intervention at the 48-hour follow-up between the packed (4 of 23 subjects) and nonpacked (5 of 25 subjects) groups (p = 0.72; relative risk = 1.3, 95% confidence interval [CI] = 0.4 to 4.2). Patients in the group that received packing reported higher pain scores immediately postprocedure (mean difference = 23.8 mm; p = 0.014, 95% CI = 5 to 42 mm) and at 48 hours postprocedure (mean difference = 16.4 mm; p = 0.03, 95% CI = 1.6 to 31.2 mm), as well as greater use of ibuprofen (mean difference = 0.32; p = 0.12, 95% CI = ,1.4 to 2.0) and oxycodone/acetaminophen (mean difference = 2.19; p = 0.03, 95% CI = 0.2 to 4.1). Conclusion:, In this pilot study, not packing simple cutaneous abscesses did not result in any increased morbidity, and patients reported less pain and used fewer pain medications than packed patients. [source] Adjunctive Atropine Is Unnecessary during Ketamine Sedation in ChildrenACADEMIC EMERGENCY MEDICINE, Issue 4 2008Lance Brown MD Abstract Background:, The prophylactic coadministration of atropine or other anticholinergics during dissociative sedation has historically been considered mandatory to mitigate ketamine-associated hypersalivation. Emergency physicians (EPs) are known to omit this adjunct, so a prospective study to describe the safety profile of this practice was initiated. Objectives:, To quantify the magnitude of excessive salivation, describe interventions for hypersalivation, and describe any associated airway complications. Methods:, In this prospective observational study of emergency department (ED) pediatric patients receiving dissociative sedation, treating physicians rated excessive salivation on a 100-mm visual analog scale and recorded the frequency and nature of airway complications and interventions for hypersalivation. Results:, Of 1,090 ketamine sedations during the 3-year study period, 947 (86.9%) were performed without adjunctive atropine. Treating physicians assigned the majority (92%) of these subjects salivation visual analog scale ratings of 0 mm, i.e., "none," and only 1.3% of ratings were , 50 mm. Transient airway complications occurred in 3.2%, with just one (brief desaturation) felt related to hypersalivation (incidence 0.11%, 95% confidence interval = 0.003% to 0.59%). Interventions for hypersalivation (most commonly suctioning) occurred in 4.2%, with no occurrences of assisted ventilation or intubation. Conclusions:, When adjunctive atropine is omitted during ketamine sedation in children, excessive salivation is uncommon, and associated airway complications are rare. Anticholinergic prophylaxis is not routinely necessary in this setting. [source] A Fast Simulation Method Using Overlapping Grids for Interactions between Smoke and Rigid ObjectsCOMPUTER GRAPHICS FORUM, Issue 2 2008Yoshinori Dobashi Abstract Recently, many techniques using computational fluid dynamics have been proposed for the simulation of natural phenomena such as smoke and fire. Traditionally, a single grid is used for computing the motion of fluids. When an object interacts with a fluid, the resolution of the grid must be sufficiently high because the shape of the object is represented by a shape sampled at the grid points. This increases the number of grid points that are required, and hence the computational cost is increased. To address this problem, we propose a method using multiple grids that overlap with each other. In addition to a large single grid (a global grid) that covers the whole of the simulation space, separate grids (local grids) are generated that surround each object. The resolution of a local grid is higher than that of the global grid. The local grids move according to the motion of the objects. Therefore, the process of resampling the shape of the object is unnecessary when the object moves. To accelerate the computation, appropriate resolutions are adaptively-determined for the local grids according to their distance from the viewpoint. Furthermore, since we use regular (orthogonal) lattices for the grids, the method is suitable for GPU implementation. This realizes the real-time simulation of interactions between objects and smoke. [source] A flexible framework for consistency managementCONCURRENCY AND COMPUTATION: PRACTICE & EXPERIENCE, Issue 1 2002S. Weber Abstract Recent distributed shared memory (DSM) systems provide increasingly more support for the sharing of objects rather than portions of memory. However, like earlier DSM systems these distributed shared object systems (DSO) still force developers to use a single protocol, or a small set of given protocols, for the sharing of application objects. This limitation prevents the applications from optimizing their communication behaviour and results in unnecessary overhead. A current general trend in software systems development is towards customizable systems, for example frameworks, reflection, and aspect-oriented programming all aim to give the developer greater flexibility and control over the functionality and performance of their code. This paper describes a novel object-oriented framework that defines a DSM system in terms of a consistency model and an underlying coherency protocol. Different consistency models and coherency protocols can be used within a single application because they can be customized, by the application programmer, on a per-object basis. This allows application specific semantics to be exploited at a very fine level of granularity and with a resulting improvement in performance. The framework is implemented in JAVA and the speed-up obtained by a number of applications that use the framework is reported. Copyright © 2002 John Wiley & Sons, Ltd. [source] Fluoroscopy-Guided Endovenous Foam Sclerotherapy Using a Microcatheter in Varicose Tributaries Followed by Endovenous Laser Treatment of Incompetent Saphenous Veins: Technical Feasibility and Early ResultsDERMATOLOGIC SURGERY, Issue 5 2009SANG WOO PARK MD OBJECTIVES To evaluate the technical feasibility and preliminary results of endovenous foam sclerotherapy using a microcatheter in varicose tributaries followed by endovenous laser treatment (EVLT) of incompetent saphenous veins. MATERIALS AND METHODS From July 2005 to August 2006, 312 patients (M:F=139:173, mean age 45.8) who presented with varicose veins with reflux in the saphenofemoral, saphenopopliteal junction or tributaries were enrolled. Under ultrasound or fluoroscopy guidance, selective microcatheterization and endovenous foam slcerotherapy were first performed in varicose tributaries, followed by EVLT (980 nm) of incompetent saphenous veins. Follow-up at 1-week and 1-, 3-, and 6-month intervals was done. RESULTS Technical success was seen in 410 of 411 limbs (99%). Continued closure of the saphenous veins and the complete sclerosis of varicose tributaries were noted in 332 of 373 limbs (89%) at the 1-month follow-up, all 307 limbs (100%) at the 3-month follow-up, and all 274 limbs (100%) at the 6-month follow-up. No serious complication was noted. CONCLUSION Endovenous foam sclerotherapy using a microcatheter in varicose tributaries followed by EVLT in incompetent saphenous veins is a safe, effective, and technically feasible treatment for varicose veins. It not only reduces additional sclerotherapy and technical failure, but also makes multiple therapeutic sessions unnecessary. [source] Fine-needle aspiration cytology of metastatic nasopharyngeal carcinomaDIAGNOSTIC CYTOPATHOLOGY, Issue 4 2005José M. Viguer M.D. Abstract Cytological features of nasopharyngeal carcinoma (NPC) were reviewed in an attempt to select cytological criteria that permit a specific recognition of metastases. For this purpose, 54 fine-needle aspiration (FNA) procedures from 43 patients with NPC were analyzed. Thirty-two (59.3%) procedures were performed before the histological diagnosis. In 25 (46.3%) procedures, smears showed many neoplastic single cells, clusters, and abundant lymphoid cells (mixed pattern). A dissociated (single cell) pattern consisting of individual neoplastic and lymphoid cells was seen in 18 (33.3%) cases. Finally, 11 (20.4%) cases showed cohesive epithelial clusters (cohesive pattern) without relevant cellular dissociation or lymphoid cells. Squamous-cell differentiation was seen in three of these cases. Most single neoplastic cells presented as large, pleomorphic naked nuclei. Other interesting findings were granulomas (n = 3), prominent eosinophilic infiltrates (n = 4), and suppurative changes (n = 5). In most smears with mixed and dissociated patterns, a nasopharyngeal origin could be suggested. On the contrary, those smears with a cohesive pattern were indistinguishable from other head and neck carcinomas. The presence (on cervical lymph nodes) of a dissociated or mixed (single cells and groups) architectural pattern of large, anaplastic cells and naked nuclei accompanied by an abundant lymphoid component is highly suggestive of undifferentiated NPC. Cytology offers a rapid diagnosis, establishes the necessity of a complete cavum examination, and helps in avoiding unnecessary and harmful biopsies. Diagn. Cytopathol. 2005;32:233,237. © 2005 Wiley-Liss, Inc. [source] SURGICAL INDICATIONS AND PROCEDURES FOR BLEEDING PEPTIC ULCERDIGESTIVE ENDOSCOPY, Issue 2010Nobutsugu Abe Recent important insights into the surgical treatment of bleeding peptic ulcer are reviewed in this article. Although the widespread use of endoscopic treatment and interventional radiology has reduced the number of surgical cases, surgery still plays a pivotal role in managing bleeding peptic ulcer. Failure to stop the bleeding by endoscopy and/or interventional radiology is the most important indication for emergency surgery. An early elective/planned surgery after the initial endoscopic control to prevent life-threatening rebleeding seems justified in patients who have risk factors for rebleeding, although its true efficacy still remains controversial. The surgical procedures in emergency situations should be limited to safe hemostasis. The addition of acid-reduction surgery may be unnecessary as a result of the increasing utilization of proton pump inhibitors. Angiographic embolization may be a less invasive alternative to surgery, and may further enhance endoscopic hemostasis. [source] CLINICAL USEFULNESS OF COLONOSCOPIC INSERTION OF A DECOMPRESSION TUBE FOR OBSTRUCTIVE COLORECTAL CANCERDIGESTIVE ENDOSCOPY, Issue 2004Kiyonori Kobayashi ABSTRACT We evaluated the clinical usefulness of colonoscopic insertion of a decompression tube (decompression method) for the treatment of ileus associated with left-sided colorectal cancer. Decompression method was done in 48 patients with colorectal cancer (38 primary cancer, 10 metastatic cancer). A decompression tube was successfully inserted in all but 10 patients who had primary cancer with severe strictures. The overall insertion rate was 79%. Decompression method improved obstructive symptoms and decreased intestinal gas as evaluated on plain X-ray films of the abdomen. Emergency operation was unnecessary in 96% of the patients with primary cancers, in whom the decompression tube was successfully inserted. We conclude that decompression method can improve abdominal symptoms caused by obstructive colorectal cancer and reduce the need for emergency operation. [source] Antral Red Streaking is a Negative Endoscopic Sign for Helicobacter Pylori InfectionDIGESTIVE ENDOSCOPY, Issue 3 2002Takao Kawabe Background: ,One of the most important endoscopic findings for the diagnosis of chronic gastritis is erythema. Erythema is classified into two groups: spotted or scattered erythema and linear erythema. We feel that red streaking has a tendency to be found on the apparently normal gastric mucosa without inflammation. Methods: ,To evaluate this association prospectively, we conducted the present study in 1513 consecutive patients undergoing endoscopy. Helicobacter pylori infection was assessed by rapid urease test, culture, pathological test, serological test and urea breath test using 13C. Results: ,Of these patients, red streaking was recognized in 94 patients (6.2%). All of the tests showed very low prevalence (0,3.5%) of H. pylori infection in patients with red streaking whereas positive results were obtained recognized in 42,49% of 94 age-sex-matched patients without red streaking. Additionally, no peptic-ulcer diseases, such as gastric ulcer/ulcer scar and duodenal ulcer/ulcer scar, were found in the patients with red streaks. In conclusion, red streaking is a negative sign for H. pylori infection and peptic-ulcer diseases. Conclusions: ,The understanding of these results might also improve the effort and cost-effectiveness of endoscopic examinations by avoiding unnecessary further testing. [source] The Role of Research Institutions in Seed,related Disaster Relief: Seeds of Hope Experiences in RwandaDISASTERS, Issue 4 2002Robin A. Buruchara The article describes the efforts of a coalition of agricultural research centres, Seeds of Hope (SOH) in the rebuilding of Rwanda, after the genocide and war of 1994. Research involvement in emergency relief and rehabilitation was unusual at the time and SOH had to forge its unique complementary role. Focusing on crop and variety development and conservation it: provided technical advice to relief agencies on seed procurement; used its baseline ken to assess the effects of war on seed diversity and seed security; made preparations to restore specific germplasm (which, fortunately, proved unnecessary) and spent substantial effort on rebuilding human resource capacity in research as well as basic scientific facilities. The involvement of SOH highlighted the critical, yet very different, roles for research during emergency versus rehabilitation periods and demonstrated the cost effectiveness of building in a diagnostic component , before massive seed or germplasm distributions are programmed. [source] Is esophagoscopy necessary for corrosive ingestion in adults?DISEASES OF THE ESOPHAGUS, Issue 8 2009Burcin Celik SUMMARY The aim of the study was to determine whether early esophagoscopy is really necessary for the patients who have ingested a corrosive agent. Patients who were followed up with the diagnosis of corrosive ingestion in our clinic between the years 1998 and 2008 were studied retrospectively. The data were collected through the medical records of the patients and from interviews with them. The analyzed parameters included age, gender, the nature and the amount of the ingested agent, whether the event was accidental or suicidal, diagnostic tools, treatment and the results of the treatment, and long-term follow up. Over a 10-year period, a total of 124 cases of corrosive ingestion cases were determined. Of these, 64 (51.6%) were male and 60 (48.4%) were female. The mean age was 38 ± 17.5 years. The most commonly ingested corrosive agents were sodium hypochlorite in 50 (40.3%) patients and hydrochloric acid in 33 (26.6%) patients. The mean admission time for the emergency department after ingestion of the corrosive agent was 2.5 ± 3.7 hours. Ingestion was accidental in 82% of the patients and as a result of a suicide attempt in 18%. The amount of ingested corrosive agent in the suicidal group (190 ± 208.3 mL) was higher than that of accidental group (66 ± 58.3 mL) (P= 0.012). Nine patients underwent esophagoscopy, six of which were performed in other clinical centers. Only three (2.4%) patients experienced esophageal stricture, which were treated with repeated dilatations. In the long-term follow up, we could get in touch with only 63 patients and none of them had complications due to corrosive ingestion. The follow-up period ranged from 1 to 120 months (median 45 ± 29.2 months). Based on our study, early esophagoscopy appears to be unnecessary in adult patients who ingested the corrosive agent accidentally. A larger prospective study is needed to answer the question. [source] Financial Frictions and Risky Corporate DebtECONOMIC NOTES, Issue 1 2007Doriana Ruffino We offer clarifications on Cooley and Quadrini (2001) regarding financial frictions and risky corporate debt pricing. Even in a frictionless world, the promised rate on corporate debt is not identical across firms and across capital structures and it is not equal to the risk-free rate. Frictions are unnecessary for credit spreads to arise. Only if the macroeconomy is in actuality risk free or risk neutral do interest rates on corporate debt reflect default probabilities. To the extent that the firm's entire financial structure is traded, a bias in credit spreads introduces an exploitable arbitrage opportunity. Re-establishing no-arbitrage, firm dynamics move in the opposite direction to Cooley and Quadrini's. [source] Commentary: A Response to Reckase's Conceptual Framework and Examples for Evaluating Standard Setting MethodsEDUCATIONAL MEASUREMENT: ISSUES AND PRACTICE, Issue 3 2006E. Matthew Schulz A look at real data shows that Reckase's psychometric theory for standard setting is not applicable to bookmark and that his simulations cannot explain actual differences between methods. It is suggested that exclusively test-centered, criterion-referenced approaches are too idealized and that a psychophysics paradigm and a theory of group behavior could be more useful in thinking about the standard setting process. In this view, item mapping methods such as bookmark are reasonable adaptations to fundamental limitations in human judgments of item difficulty. They make item ratings unnecessary and have unique potential for integrating external validity data and student performance data more fully into the standard setting process. [source] Female Attraction to Conspecific Chemical Cues in the Palmate Newt Triturus helveticusETHOLOGY, Issue 8 2005Jean Secondi Although chemosignals are largely used in sexual communication in urodeles, olfactometer studies in newts provided contrasting results about the sex specificity of female behavioural responses. Because long-range sexual advertisement is believed to be costly, some species might restrain this activity to close interactions with conspecifics. We tested chemical-mediated sexual attraction in female palmate newt (Triturus helveticus) by measuring the attraction to male and female odours in a linear water olfactometer. Unexpectedly, females were attracted towards conspecifics regardless of sex. They did not show attraction towards Limnaea stagnalis, a common sympatric aquatic gastropod. These results do not support the use of long-range male sexual signalling in the palmate newt. Instead, conspecific attraction is likely to promote aggregation of males and females in breeding ponds. Observations in the field and in the laboratory tend to support the aggregative behaviour of this species. We discuss the possible function of conspecific attraction in this context. Heading towards any conspecific would increase the probability of finding potential mates. Chemical cues do not need to be sex-specific at that stage so that long-range sexual advertisement might be unnecessary. This work emphasizes the need for studies investigating the evolutionary relationships between sexual signalling systems and population-distribution patterns. [source] Rejection of Conspecific Eggs in Chaffinches: The Effect of Age and Clutch CharacteristicsETHOLOGY, Issue 6 2004Bård G. Stokke Previous experimental studies have found that the majority of chaffinches, Fringilla coelebs, are able to reject both non-mimetic and mimetic cuckoo eggs and also non-mimetic conspecific eggs. However, interestingly the frequency of rejecters of moderately mimetic conspecific eggs has been found to be only approx. 50%. We examined the possibility that acceptors of moderately mimetic conspecific eggs are first time breeders, because these individuals may lack the experience needed to reject eggs that deviate only slightly from their own eggs. Older individuals, with good knowledge of their own egg appearance, should therefore reject such eggs. We also examined the possibility that acceptors of moderately mimetic eggs have a higher intraclutch variation in egg appearance, which makes it more difficult to recognize such eggs when compared with rejecters. We obtained no support for any age-specific pattern in rejection behaviour. Furthermore, there was no relationship between age and intraclutch variation, or intraclutch variation and rejection behaviour. As there is no evidence of intraspecific brood parasitism in this species, the rejection of any foreign eggs is most probably an adaptation to past cuckoo, Cuculus canorus, parasitism. Acceptance of good and moderately mimetic conspecific eggs is probably due to cognitive limitations, because evolution of a more fine-tuned recognition ability is unnecessary in the absence of intraspecific brood parasitism. [source] Undoing Trauma: Reconstructing the Church of Our Lady in DresdenETHOS, Issue 2 2006Jason James This article is an examination of the recent reconstruction of the Church of Our Lady (Frauenkirche) in Dresden, Germany, in relation to a desire for normalcy, which in this case finds expression in a fantasy of resurrection. The reconstruction of a monumental edifice framed as a victim of World War II and socialism both depends on and enacts the fantasy that historical loss can be undone. In addition, the project identifies Germany with German cultural heritage, which appears wholly distinct from the nation's burdened pasts, and offers a monumental symbolic touchstone for narratives of modern German history in which the nation and its citizens figure primarily as suffering victims. In this way, the reconstruction of the church embodies something more complex than mere forgetting. It enacts a fantasy of undoing loss, rendering the work of mourning unnecessary, while at the same time embracing injury and victimhood. [Germany, Dresden, nationalism, architecture, memory] [source] Addressing complex ethical issues in the treatment of children and adolescents with eating disorders: application of a framework for ethical decision-makingEUROPEAN EATING DISORDERS REVIEW, Issue 3 2001Ronald S. Manley Abstract Ethically problematic situations frequently arise in the care of children and adolescents with eating disorders. The younger person with anorexia nervosa can often deteriorate quickly, therefore the child who is in denial with respect to the seriousness of her condition and/or markedly ambivalent regarding renourishment is at grave risk. Involuntary treatment is likely to be a consideration during such a medical crisis. In this paper we outline an ethical decision-making framework that can assist the clinician in engaging the young patient and her family well in advance of a crisis, so that decisions can be made at a time when recourse to establishing incompetency or enforcing involuntary treatment are unnecessary. We have adopted a narrative approach in our application of the decision-making framework, and safety is emphasized as the central concept underlying the application of this model. Finally, a number of recommendations are made regarding application of the ethical decision-making framework with younger persons. Copyright © 2001 John Wiley & Sons, Ltd and Eating Disorders Association. [source] Redefining Emergency Medicine Procedures: Canadian Competence and Frequency SurveyACADEMIC EMERGENCY MEDICINE, Issue 7 2001FRCPC, Ken Farion MD Objective: To redefine the Royal College of Physicians and Surgeons (RCPS) procedural skills list for Canadian emergency medicine (EM) residents through a national survey of EM specialists to determine procedural performance frequency and self-assessment of competence. Methods: The survey instrument was developed in three phases: 1) an EM program directors survey identified inappropriate or dated procedures, endorsing 127 skills; 2) a search of EM literature added 98 skills; and 3) an expert panel designed the survey instrument and finalized a list of 150 skills. The survey instrument measured the frequency of procedure performance or supervision, self-reported competence (yes/no), and endorsement of one of four training levels for each skill: undergraduate (UG), postgraduate (PG), knowledge only, or un-necessary (i.e., too infrequently performed to maintain competence). Results: All 289 Canadian EM specialists were surveyed by mail; 231 (80%) responded, 221 completed surveys, and 10 were inactive. More than 60% reported competence in 125 (83%) procedures, and 55 procedures were performed at least three times a year. The mean competence score was 121 (SD ± 17.7, median = 122) procedures. Competence score correlation with patient volume was r= 0.16 (p = 0.02) and with hours worked was r= 0.19 (p = 0.01). Competence score was not associated with year or route (residency vs grandfather) of certification. Each procedure was assigned to a training level using response consensus and decision rules (UG: 1%; PG: 82%; unnecessary: 17%). Conclusions: A survey of EM clinicians reporting competence and frequency of skill performance defined 127 procedural skills appropriate for Canadian RCPS postgraduate training and EM certification. [source] A Nolan Committee for the German ethics infrastructure?EUROPEAN JOURNAL OF POLITICAL RESEARCH, Issue 5 2002Nathalie Behnke An international trend towards establishing and conforming standards of ethical behaviour in the public sector has repeatedly been stated. Germany, however, remains surprisingly reluctant to adopt such recommendations. This article argues that the likelihood of German decision makers implementing new, and especially soft, ethics measures depends on the demand for such measures, on the one hand, and their supply, on the other. The analysis shows that contradictory forces have an impact on Germany. The demand for new ethics measures is relatively low as a high level of hard ethics measures incorporated in the longstanding formal legal system of rules and regulations make the implementation of new measures seem unnecessary. Also, the demand for soft ethics measures is less marked in Germany than in the United Kingdom. This comparatively weak pressure meets the natural inertia caused by cognitive and institutional path,dependency in institutional choices of political decision makers. On the other hand, external bodies (such as the Organisation for Economic Cooperation and Development , OECD) provide blueprints for soft ethics measures and encourage the implementation of uniform standards across countries. Which of these forces will prevail in the long run, however, cannot be deduced from the present situation. [source] Methods for determining labile cadmium and zinc in soilEUROPEAN JOURNAL OF SOIL SCIENCE, Issue 1 2000S. D. Young Summary Isotopically exchangeable cadmium and zinc (,E values') were measured on soils historically contaminated by sewage sludge and ones on zinc-rich mine spoil. The E -value assay involves determining the distribution of an added metal isotope, e.g. 109Cd, between the solid and solution phases of a soil suspension. The E values for both metals were found to be robust to changes in the position of the metal solid,solution equilibrium, even though the concentration of dissolved metal varied substantially with electrolyte composition and soil:solution ratio. Concentration of labile metal was also invariant over isotope equilibration times of 2,6 days. The use of a submicron filtration procedure, in addition to centrifuging at 2200 g, proved unnecessary if 0.1 m Ca electrolyte was used to suspend the soils. The proportion of ,fixed' metal, in non-labile forms, apparently increased with increasing pH, although there was considerable variation in both sets of contaminated soil. Zinc and cadmium in the sludged soils were similarly labile. Several possible methods for the measurement of chemically reactive metal were explored for comparison with E values, including single extraction with 1 m CaCl2 and a ,pool depletion' (PD) method. The latter involves comparing solid,solution metal equilibria in two electrolytes with differing degrees of (solution) complex formation, 0.1 m Ca(NO3)2 and CaCl2. Both the single extraction and the PD method gave good estimates of E value for Cd, although the single extraction was more consistent. Neither technique was a useful substitute for determining labile Zn, because of weak chloro-complexation of Zn2+. We therefore suggest that 1 m CaCl2 extraction of Cd alone be used as an alternative to E values to avoid the inconvenience of isotopic dilution procedures. [source] Still in Deficit: Rights, Regulation, and Democracy in the EU1EUROPEAN LAW JOURNAL, Issue 6 2006Richard Bellamy Recently two groups of theorists have argued neither deficit need prove problematic. The first group adopts a rights-based view of democracy and claims that a European consensus on rights, as represented by the Charter of Fundamental European Rights, can offer the basis of citizen allegiance to EU wide democracy, thereby overcoming the demos deficit. The second group adopts a public-interest view of democracy and argues that so long as delegated authorities enact policies that are ,for' the people, then the absence of institutional forms that facilitate democracy ,by' the people are likewise unnecessary,indeed, in certain areas they may be positively harmful. This article argues that both views are normatively and empirically flawed. This is because there is no consensus on rights or the public interest apart from the majority view of a demos secured through parliamentary institutions. To the extent that these remain absent at the EU level, a democratic deficit continues to exist. [source] Complete subunit sequences, structure and evolution of the 6 × 6-mer hemocyanin from the common house centipede, Scutigera coleoptrataFEBS JOURNAL, Issue 13 2003Kristina Kusche Hemocyanins are large oligomeric copper-containing proteins that serve for the transport of oxygen in many arthropod species. While studied in detail in the Chelicerata and Crustacea, hemocyanins had long been considered unnecessary in the Myriapoda. Here we report the complete molecular structure of the hemocyanin from the common house centipede Scutigera coleoptrata (Myriapoda: Chilopoda), as deduced from 2D-gel electrophoresis, MALDI-TOF mass spectrometry, protein and cDNA sequencing, and homology modeling. This is the first myriapod hemocyanin to be fully sequenced, and allows the investigation of hemocyanin structure,function relationship and evolution. S. coleoptrata hemocyanin is a 6 × 6-mer composed of four distinct subunit types that occur in an approximate 2 : 2 : 1 : 1 ratio and are 49.5,55.5% identical. The cDNA of a fifth, highly diverged, putative hemocyanin was identified that is not included in the native 6 × 6-mer hemocyanin. Phylogenetic analyses show that myriapod hemocyanins are monophyletic, but at least three distinct subunit types evolved before the separation of the Chilopoda and Diplopoda more than 420 million years ago. In contrast to the situation in the Crustacea and Chelicerata, the substitution rates among the myriapod hemocyanin subunits are highly variable. Phylogenetic analyses do not support a common clade of Myriapoda and Hexapoda, whereas there is evidence in favor of monophyletic Mandibulata. [source] Ground-roll attenuation using a 2D time-derivative filterGEOPHYSICAL PROSPECTING, Issue 3 2009Paulo E. M. Melo ABSTRACT We present a new filtering method for the attenuation of ground-roll. The method is based on the application of a bi-dimensional filter for obtaining the time-derivative of the seismograms. Before convolving the filter with the input data matrix, the normal moveout correction is applied to the seismograms with the purpose of flattening the reflections. The method can locally attenuate the amplitude of data of low frequency (in the ground-roll and stretch normal moveout region) and enhance flat events (reflections). The filtered seismograms can reveal horizontal or sub-horizontal reflections while vertical or sub-vertical events, associated with ground-roll, are attenuated. A regular set of samples around each neighbourhood data sample of the seismogram is used to estimate the time-derivative. A numerical approximation of the derivative is computed by taking the difference between the interpolated values calculated in both the positive and the negative neighbourhood of the desired position. The coefficients of the 2D time-derivative filter are obtained by taking the difference between two filters that interpolate at positive and negative times. Numerical results that use real seismic data show that the proposed method is effective and can reveal reflections masked by the ground-roll. Another benefit of the method is that the stretch mute, normally applied after the normal moveout correction, is unnecessary. The new filtering approach provides results of outstanding quality when compared to results obtained from the conventional FK filtering method. [source] Elective treatment of the neck in squamous cell carcinoma of the larynx: Clinical experienceHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 2 2003Giuseppe Spriano MD Abstract Background. In head and neck cancer, the best prophylactic treatment for the N0 neck is a subject of debate. Some authors propose lateral selective lymph node dissection (levels II,IV) on the basis of the probability of finding occult metastases in those lymph nodes. A more extensive procedure including Vth level is considered unnecessary because of the low incidence of metastases in the posterior triangle. Methods. We retrospectively evaluated 346 N0 patients affected by laryngeal carcinoma and consecutively treated at the Department of Otorhinolaryngology of the Ospedale di Circolo, Varese, Italy. The patients underwent elective selective neck dissection (levels II,V) for a total of 602 dissected heminecks. Result. Seventy heminecks (11.6%) were pN+, and in 10 of 70 cases (14.3%) level V was involved; in 5 of 10 metastases were isolated. Conclusion. Our retrospective study confirms the probabilistic criteria of the incidence of occult metastasis by level in laryngeal cancer. On the basis of our data Vth level nodes, although very rarely, 10 of 604 (1.6%), are involved with laryngeal cancer. Our approach to routinely dissect Vth level nodes is discussed. © 2003 Wiley Periodicals, Inc. Head Neck 25: 97,102, 2003 [source] Malignant tumors of the nasal cavity and paranasal sinuses,HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 9 2002Teri S. Katz MD Abstract Purpose To evaluate the role of radiation therapy in patients with nasal cavity and paranasal sinus tumors. Materials and Methods Between October 1964 and July 1998, 78 patients with malignant tumors of the nasal cavity (48 patients), ethmoid sinus (24 patients), sphenoid sinus (5 patients), or frontal sinus (1 patient) were treated with curative intent by radiation therapy alone or in the adjuvant setting. There were 25 squamous cell carcinomas, 14 undifferentiated carcinomas, 31 minor salivary gland tumors (adenocarcinoma, adenoid cystic carcinoma, and mucoepidermoid carcinoma), 8 esthesioneuroblastomas, and 1 transitional cell carcinoma. Forty-seven patients were treated with irradiation alone, 25 with surgery and postoperative irradiation, 2 with preoperative irradiation and surgery, and 4 with chemotherapy in combination with irradiation with or without surgery. Results The 5-year actuarial local control rate for stage I (limited to the site of origin; 22 patients) was 86%; for stage II (extension to adjacent sites (eg, adjacent sinuses, orbit, pterygomaxillary fossa, nasopharynx; 21 patients) was 65%; and for stage III (destruction of skull base or pterygoid plates, or intracranial extension; 35 patients) was 34%. The 5-year actuarial local control rate for patients receiving postoperative irradiation was 79% and for patients receiving irradiation alone was 49% (p = .05). The 5-, 10-, 15-, and 20-year ultimate local control rates for all 78 patients were 60%, 56%, 48%, and 48%, respectively. The 5-, 10-, 15-, and 20-year cause-specific survival rates for all 78 patients were 56%, 45%, 39%, and 39%, respectively. The 5-, 10-, 15-, and 20-year absolute survival rates for all 78 patients were 50%, 31%, 21%, and 16%, respectively. Of the 67 (86%) patients who were initially seen with node-negative disease, 39 (58%) received no elective neck treatment, and 28 (42%) received elective neck irradiation. Of the 39 patients who received no elective neck treatment, 33 (85%) did not experience recurrence in the neck compared with 25 (89%) of 28 patients who received elective neck irradiation. Most patients who received elective neck irradiation (57%) had stage III disease. Twenty-one (27%) of 78 patients had unilateral blindness develop secondary to radiation retinopathy or optic neuropathy; the complication was anticipated in most of these patients, because the ipsilateral eye was irradiated to a high dose. Four patients (5%) unexpectedly had bilateral blindness develop because of optic neuropathy. All four of these patients received irradiation alone. Conclusion Surgery and postoperative radiation therapy may result in improved local control, absolute survival, and complications when compared with radiation therapy alone. Elective neck irradiation is probably unnecessary for patients with early-stage disease. © 2002 Wiley Periodicals, Inc. Head Neck 24: 821,829, 2002 [source] Differential activity in left inferior frontal gyrus for pseudowords and real words: An event-related fMRI study on auditory lexical decisionHUMAN BRAIN MAPPING, Issue 2 2005Zhuangwei Xiao Abstract After Newman and Twieg ([2001]: Hum Brain Mapp 14:39,47) and others, we used a fast event-related functional magnetic resonance imaging (fMRI) design and contrasted the lexical processing of pseudowords and real words. Participants carried out an auditory lexical decision task on a list of randomly intermixed real and pseudo Chinese two-character (or two-syllable) words. The pseudowords were constructed by recombining constituent characters of the real words to control for sublexical code properties. Processing of pseudowords and real words activated a highly comparable network of brain regions, including bilateral inferior frontal gyrus, superior, middle temporal gyrus, calcarine and lingual gyrus, and left supramarginal gyrus. Mirroring a behavioral lexical effect, left inferior frontal gyrus (IFG) was significantly more activated for pseudowords than for real words. This result disconfirms a popular view that this area plays a role in grapheme-to-phoneme conversion, as such a conversion process was unnecessary in our task with auditory stimulus presentation. An alternative view was supported that attributes increased activity in left IFG for pseudowords to general processes in decision making, specifically in making positive versus negative responses. Activation in left supramarginal gyrus was of a much larger volume for real words than for pseudowords, suggesting a role of this region in the representation of phonological or semantic information for two-character Chinese words at the lexical level. Hum Brain Mapp 25:212,221, 2005. © 2005 Wiley-Liss, Inc. [source] Analytical solution to a bias in the TOPMODEL framework balanceHYDROLOGICAL PROCESSES, Issue 7 2004G.-M. Saulnier Abstract The increasing need for distributed hydrological modelling leads to an intense use of spatially distributed predictions of physically based models, such as TOPMODEL as addressed here. The ability of these models to reproduce the internal behaviour of catchments physically is increasingly tested through field experiments (geochemical investigation, distributed measurements network, etc.). This paper will show that, in the case of TOPMODEL, an implicit approximation remains in the classic derivation of the equations that consists in neglecting the surface of saturated areas with respect to the total surface of the catchment. This simplifying, though unnecessary, approximation leads to a systematic underestimation of the catchment water storage deficit and to divergence in the water budget accounting. This may also significantly change the predicted ratio between subsurface and surface water fluxes in the total discharge. An analytical solution is suggested that leads to water balance accounting which is better defined, and more consistent in comparison with field water storage recording. It is expected that this work will ensure more accurate TOPMODEL predictions, consistent with the assumptions of the model. This will then improve the interpretation of comparisons between results of simulation and field experiments. Copyright © 2004 John Wiley & Sons, Ltd. [source] | ||||||||||||||||||||||||||||||||||||||||||||||||||||