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Urgent
Terms modified by Urgent Selected AbstractsField Guide to Urgent and Ambulatory Care ProceduresEMERGENCY MEDICINE AUSTRALASIA, Issue 2 2002Bryan Walpole No abstract is available for this article. [source] Categorizing Urgency of Infant Emergency Department Visits: Agreement between CriteriaACADEMIC EMERGENCY MEDICINE, Issue 12 2006Rakesh D. Mistry MD Abstract Background The lack of valid classification methods for emergency department (ED) visit urgency has resulted in large variation in reported rates of nonurgent ED utilization. Objectives To compare four methods of defining ED visit urgency with the criterion standard, implicit criteria, for infant ED visits. Methods This was a secondary data analysis of a prospective birth cohort of Medicaid-enrolled infants who made at least one ED visit in the first six months of life. Complete ED visit data were reviewed to assess urgency via implicit criteria. The explicit criteria (adherence to prespecified criteria via complete ED charts), ED triage, diagnosis, and resources methods were also used to categorize visit urgency. Concordance and agreement (,) between the implicit criteria and alternative methods were measured. Results A total of 1,213 ED visits were assessed. Mean age was 2.8 (SD ± 1.78) months, and the most common diagnosis was upper respiratory infection (21.0%). Using implicit criteria, 52.3% of ED visits were deemed urgent. Urgent visits using other methods were as follows: explicit criteria, 51.8%; ED triage, 60.6%; diagnosis, 70.3%; and resources, 52.7%. Explicit criteria had the highest concordance (78.3%) and agreement (,= 0.57) with implicit criteria. Of limited data methods, resources demonstrated the best concordance (78.1%) and agreement (,= 0.56), while ED triage (67.9%) and diagnosis (71.6%) exhibited lower concordance and agreement (,= 0.35 and ,= 0.42, respectively). Explicit criteria and resources equally misclassified urgency for 11.1% of visits; ED triage and diagnosis tended to overclassify visits as urgent. Conclusions The explicit criteria and resources methods best approximate implicit criteria in classifying ED visit urgency in infants younger than six months of age. If confirmed in further studies, resources utilized has the potential to be an inexpensive, easily applicable method for urgency classification of infant ED visits when limited data are available. [source] Why We Need Megareserves in AmazoniaCONSERVATION BIOLOGY, Issue 3 2005CARLOS A. PERES I consider several large-scale issues in biodiversity conservation planning (e.g., resource extraction, large areas needed for top predators, species migration, fire, and carbon sequestration) in light of our severely deficient understanding of basinwide patterns of species distribution and little-known Amazonian biota. The long-term persistence of this biota is best served by strictly protected and sustainable development forest reserves that are both embedded in a benign forest matrix and sufficiently large to support a full complement of species and landscape-scale ecological processes. Given rapidly accelerating trends in agricultural frontier expansion into previously unclaimed public lands, protection and controlled development of forests is urgent. Resumen:,La Amazonía brasileña enfrenta una de las mayores amenazas y oportunidades para la conservación de la biodiversidad tropical de nuestros tiempos. Considero varios aspectos de planificación de conservación de biodiversidad a gran escala (e. g. extracción de recursos, áreas extensas para depredadores mayores, migración de especies, fuego y secuestro de carbono) a la luz de nuestro entendimiento severamente deficiente de patrones de distribución de especies a nivel cuenca y de la poco conocida biota Amazónica. La persistencia a largo plazo de esta biota es favorecida por la protección estricta y por reservas forestales de desarrollo sustentable que estén embebidas en una matriz forestal benigna y que sean suficientemente extensas para sostener a un complemento completo de especies y procesos ecológicos a nivel paisaje. La protección y desarrollo controlado de bosques es urgente debido a la rápida aceleración de las tendencias en la expansión de la frontera agrícola hacia terrenos públicos no reclamados. [source] Risk factor control in patients with Type 2 diabetes and coronary heart disease: findings from the Swedish National Diabetes Register (NDR)DIABETIC MEDICINE, Issue 1 2009S. Gudbjörnsdottir Abstract Aims Patients with Type 2 diabetes and coronary heart disease (CHD) are infrequently treated to risk factor targets in current guidelines. We aimed to examine risk factor management and control levels in a large sample of patients with Type 2 diabetes with CHD. Methods This was an observational study of 1612 patients with first incidence of CHD before 2002, and of 4570 patients with first incidence of CHD before 2005, from the Swedish National Diabetes Register (NDR). Results In patients with CHD 1,2 years before follow-up, the achievement of cardiovascular risk factor targets (follow-up 2002/follow-up 2005) was: HbA1c < 7%, 47%/54% (P < 0.01); blood pressure , 130/80 mmHg, 31%/40% (P < 0.001); total cholesterol < 4.5 mmol/l, 47%/60% (P < 0.001); and low-density lipoprotein-cholesterol < 2.5 mmol/l, 49%/65% (P < 0.001). Use of medication: antihypertensives, 90%/94% (P < 0.01); lipid-lowering drugs, 75%/86% (P < 0.001); and aspirin, 85%/89% (P < 0.05). A high prevalence of adverse lifestyle characteristics prevailed (2002/2005): overweight [body mass index (BMI) , 25 kg/m2], 86%/85%; obesity (BMI , 30 kg/m2), 41%/42%; smokers in age group < 65 years, 16,23%/18,19%; as well as waist circumference , 102 cm (men) or , 88 cm (women), 68% in 2005. Conclusions Patients with a combination of Type 2 diabetes and CHD showed an increased use of lipid-lowering drugs over time, corresponding to improving blood lipid levels. A discrepancy existed between the prevalent use of antihypertensive drugs and the low proportion reaching blood pressure targets. Regretfully, a high prevalence of adverse lifestyle characteristics prevailed. Evidence-based therapy with professional lifestyle intervention and drugs seems urgent for improved quality of secondary prevention in these patients. [source] How can we preserve and restore species richness of pollinating insects on agricultural land?ECOGRAPHY, Issue 6 2008Markus Franzén During recent decades, concern about the loss of biodiversity on agricultural land has increased, and semi-natural grasslands have been highlighted as critical habitats. Temperate European agricultural landscapes require distinct and appropriate management to prevent further impoverishment of the flora and fauna. This is especially urgent for pollinating insects that provide important ecosystem services. Our aim was to examine how species richness of three important groups of pollinating insects; solitary bees, butterflies and burnet moths are related to different farm characteristics, and if there are any differences between these three groups. A further aim was to test if red-listed species are related to any farm characteristics. Species richness of solitary bees, butterflies and burnets was measured on all semi-natural grasslands at 16 farms in a forest-dominated area of 50 km2 in southern Sweden, using systematic transect walks in April to September 2003 (only butterflies and burnets) and 2005. Species richness of solitary bees and butterflies was intercorrelated, both before and after controlling for the area of semi-natural grassland. Species richness of solitary bees increased with the area of semi-natural grassland. After controlling for the effect of the area of semi-natural grassland species richness was strongly positively related with the density of the plant Knautia arvensis and negatively related with the proportion of grazed grassland. The results were similar for solitary bees and butterflies. The number of red-listed solitary bees was positively related to the proportion of meadows with late harvest (after mid-July) and decreased with increased farm isolation. The number of burnet species (all red-listed) was positively related to vegetation height, flower density and the proportion of meadows with late harvest on a farm. Areas with a high density of K. arvensis and with traditional hay-meadow with late harvest present, harbour most species. Promoting traditional hay-meadows, late extensive grazing and the herb K. arvensis, people managing agricultural biodiversity can encompass high species richness of pollinating insects and support red-listed species. Further, we suggest that the density of K. arvensis at a farm can be used as a biodiversity indicator, at least for pollinating insects. [source] Feeding signals to the hungry mindEXPERIMENTAL PHYSIOLOGY, Issue 8 2009Nina Balthasar Obesity, due to its associated co-morbidities, including type 2 diabetes and cardiovascular disease, is at the forefront of today's health care concerns. Our need for novel, multifaceted approaches to tackle the global increase of waistlines is urgent, and understanding the physiological processes underlying our vulnerability to weight gain is an important one of them. Evidence for considerable heritability of body weight indicates genetic influences in the susceptibility to our obesogenic environment. Here, we will focus on neurons in brain structures such as the hypothalamus, which sense the body's metabolic state and, through an intricate cascade of events, elicit an appropriate response. We will explore the use of genetically modified mouse models in the investigation of physiological functions of genes and pathways in neuronal regulation of metabolic balance. Use of these techniques allows us to make manipulations at the molecular level (e.g. in the neuronal metabolic sensing mechanism) and combine this with systems-level physiological analysis (e.g. body weight). Recent technological advances also enable the investigation of the contributions of genes to the co-morbidities of obesity, such as obesity-induced hypertension. Reviewing examples of improvements as well as large gaps in our knowledge, this lecture aims to incite interest in whole body physiological research. [source] Intelligent interaction design: the role of human-computer interaction research in the design of intelligent systemsEXPERT SYSTEMS, Issue 1 2001Ann BlandfordArticle first published online: 16 DEC 200 As more intelligent systems are introduced into the marketplace, it is becoming increasingly urgent to consider usability for such systems. Historically, the two fields of artificial intelligence (AI) and human- computer interaction (HCI) have had little in common. In this paper, we consider how established HCI techniques can usefully be applied to the design and evaluation of intelligent systems, and where there is an urgent need for new approaches. Some techniques - notably those for requirements acquisition and empirical evaluation - can usefully be adopted, and indeed are, within many projects. However, many of the tools and techniques developed within HCI to support design and theory-based evaluation cannot be applied in their present forms to intelligent systems because they are based on inappropriate assumptions; there is consequently a need for new approaches. Conversely, there are approaches that have been developed within AI - e.g. in research on dialogue and on ontologies - that could usefully be adapted and encapsulated to respond to this need. These should form the core of a future research agenda for intelligent interaction design. [source] Managing the Bank-System Crisis in Coordinated Market Economies: Institutions and Blame Avoidance Strategies in Sweden and JapanGOVERNANCE, Issue 1 2006TORSTEN SVENSSON Sweden and Japan represent two different positions regarding policymaking when faced with similar crises of the bank systems. Different institutional settings led the main actors to different paths of reactions in order to avoid blame. In the Japanese case, the very close relationship between private banks and the Ministry of Finance, in combination with the lesser degree of widespread perceptions of a system crisis, made it more urgent as well as possible to conceal the actual state of affairs for the politicians. Confronted with the threat of losing power over the financial administration to a new agency, the ministry postponed the reforms in order to conceal the deep financial problems. The institutional setting was different in Sweden. Deregulation had separated the government from the administration of banks. Among the public deteriorating economic conditions were easily connected to the banks. This brought about political unity. It was possible to put the blame on the banks and take the credit for the efforts to tidy up the mess without losing credibility. [source] Chylous effusions complicating lymphoma: a serious event with octreotide as a treatment optionHEMATOLOGICAL ONCOLOGY, Issue 2 2003J. Evans Abstract Chylous effusions have an identical appearance to milk and occur when the thoracic duct is blocked. Since chyle represents direct absorption of fat from the small intestine lacteals, it is rich in fat, calories, vitamins and immunoglobulins. Drainage of this milk-like fluid from any cavity (chest or abdomen) results in rapid weight loss and profound cachexia. The recognition of this milk-like fluid as chyle is urgent for the implementation of the correct treatment. In adults, lymphoma is one of the commonest malignancies to cause blockages in the thoracic duct. Once the diagnosis is made, conservative treatment with strict dietary adjustment often fails to prevent weight loss or resolve the underlying cause. Since the condition is uncommon, no guidelines exist. Many surgeons recommend early surgical intervention before the patient becomes too weak. Surgery may also fail. We report the case of a 62-year-old man with chylous effusions and a weight loss of 30,kg. The nature of the effusion was unrecognized for the first 16 weeks. Upon diagnosis, dietary adjustment was made and a lymphangiogram organized with a view to surgery. Literature searches revealed two cases in which somatostatin was used after surgical procedures failed. We therefore used octreotide (a synthetic analogue of somatostatin). We report complete resolution of the condition within 72,h leading to the resumption of a normal diet and discharge within 2 weeks. Copyright © 2003 John Wiley & Sons, Ltd. [source] Agency, Postmodernism, and the Causes of ChangeHISTORY AND THEORY, Issue 4 2001Michael L. Fitzhugh This theme issue's call for papers notes that "several prevalent and influential historical practices of the last thirty years have limited agency's significance, . . . seeing the human as the patient of History rather than its agent." The questions implicit in this statement are nowhere more urgent than in those practices collectively known as the "linguistic turn." Yet such questions have been explored sparsely enough in relation to this movement that some adherents can still insist that the ideas they favor do not devalue agency, while many simply ignore the issue and incorporate agency as an integral part of their work. By examining a largely unremarked episode in Michel Foucault's highly influential thought and considering its connections to foundational assumptions of the linguistic turn, we seek to demonstrate in detail why the premises that underlie both structuralism and poststructuralism (the theoretical movements most deeply implicated in the direction the linguistic turn has taken in history) logically require the denial of agency as a causal force and ultimately compel the conclusion that no change can occur in realities as interpreted by humans. We illustrate the intractability of these logical problems by analyzing unsatisfactory defenses from some of the few linguistic-turn historians who have discussed relevant issues, after which we conclude by suggesting that attention to current work in linguistics and cognitive science may help resolve such difficulties. [source] The Global Marketplace and the Privatisation of SecurityIDS BULLETIN, Issue 2 2009Jeffrey Isima The privatisation of security in the age of globalisation raises crucial concerns for global governance and development. Key among these are the impacts on the structures of poverty and inequality, and how these twin development issues shape global security privatisation. Equally important are the structural limits on public policy imposed by the promotion of the market as a powerful alternative mechanism for security provisioning. These concerns have become more urgent as the dominant neoliberal security governance paradigm has tended to avoid questions relating to poverty, social inequality and the dire condition of those who live on the margins of state protection. This calls for innovative policy changes for transforming security institutions and practices in a way that promotes security, not just for state officials and the wealthy, but most importantly, for the poor. This article attempts to explore these core development concerns in relation to the increasing outsourcing of security to non-state actors and how state actors, as leading agents of development, can protect and promote the wellbeing of vulnerable populations within the global market order. [source] The Perceptions of Infant Distress Signals Varying in Pitch by Cocaine-Using MothersINFANCY, Issue 1 2003Pamela Schuetze Perceptual responses to infant distress signals were studied in 16 cocaine-using and 15 comparison mothers. All mothers rated tape recordings of 48 replications of a newborn infant's hunger cry digitally altered to increase in fundamental frequency in 100-Hz increments. Cries were rated on 4 perceptual (arousing, aversive, urgent, and sick) and 6 caregiving rating scale items (clean, cuddle, feed, give pacifier, pick up, and wait and see) used in previous studies. Analyses of variance showed that, as cry pitch increased, cries were rated as more arousing, aversive, and urgent sounding. The highest pitched cries received the highest ratings for caregiving interventions. Main effects for cocaine use showed cocaine-using mothers (a) rated cries as less arousing, aversive, urgent, and sick; (b) indicated they were less likely to pick up or feed the infant; and (c) indicated they more likely to give the crying infant a pacifier or just "wait and see." A Group x Cry Pitch interaction effect showed that mothers in the cocaine group gave higher ratings to wait and see as the pitch of the cries increased, whereas mothers in the comparison group gave lower ratings to wait and see as the pitch of the cries increased. These ratings indicate that cocaine-using mothers found cries to be less perceptually salient and less likely to elicit nurturant caregiving responses. These results suggest that maternal cocaine use is associated with altered perceptions of infant distress signals that may provide the basis for differential social responsivity in the caregiving context. [source] Assessing the effects of hydromorphological degradation on macroinvertebrate indicators in rivers: examples, constraints, and outlookINTEGRATED ENVIRONMENTAL ASSESSMENT AND MANAGEMENT, Issue 1 2009Nikolai Friberg Abstract An extensive amount of literature on linkages between the in-stream physical environment and river benthic macroinvertebrates reports a number of relationships across multiple spatial scales. We analyzed data on different spatial scales to elucidate the linkages between different measurements of hydromorphological degradation and commonly used macroinvertebrate indices. A regression analysis of 1049 sites from 3 countries revealed that the strongest relationship between a biotic metric,average score per taxon,and physiochemical variables (R2 = 0.61) was obtained with a multiple regression model that included concentration of total phosphorus and percent arable land in the catchment, as well as hydromorphological quality variables. Analyses of 3 data sets from streams primarily affected by hydromorphological degradation showed an overall weak relationship (max R2 = 0.25) with the River Habitat Survey data of 28 Swedish streams, whereas moderate (R2 , 0.43) relationships with more detailed measurements of morphology were found in 2 Danish studies (39 and 6 streams, respectively). Although evidence exists in the literature on the importance of physical features for in-stream biota in general and macroinvertebrates specifically, we found only relatively weak relationships between various measures of hydromorphological stress and commonly used macroinvertebrate assessment tools. We attribute this to a combination of factors, including 1) the mixed nature of pressures acting on the majority of river reaches, 2) scaling issues (spatial and temporal) when relating habitat surveys to macroinvertebrate assessments, and 3) the scope of commonly used macroinvertebrate assessment systems (mainly focusing on water chemistry perturbation, such as eutrophication and acidification). The need is urgent to develop refined and updated biological assessment systems targeting hydromorphological stress for the use of the European Water Framework Directive (WFD) and national water-related policies. [source] Burden of stroke in Maori and Pacific peoples of New ZealandINTERNATIONAL JOURNAL OF STROKE, Issue 3 2007Valery L. Feigin Studying ethnic particularities of stroke epidemiology may not only provide a clue to the causes of the observed racial/ethnic differences in stroke mortality but is also important for appropriate, culturally specific health care planning, prevention in stroke and improved health outcomes. This overview of published population-based stroke incidence studies and other relevant research in the multi-ethnic New Zealand population demonstrates an obvious ethnic disparity in stroke in New Zealand, with the greatest and increasing burden of stroke being imposed on Maori, who are indigenous, and Pacific people, who have migrated and settled in this country. These data warrant urgent and effective measures to be undertaken by health policy makers and health care providers to reverse the unfavourable trends in stroke and improve Maori and Pacific people's health. [source] Developing an advanced nurse practitioner service in emergency care: attitudes of nurses and doctorsJOURNAL OF ADVANCED NURSING, Issue 3 2006Miriam Griffin MSc RGN PGCSNP Aim., This paper reports a study to determine the attitudes of nurses, doctors and general medical practitioners towards the development of an advanced nurse practitioner service within an emergency department. Background., The role of advanced nurse practitioner in emergency care has emerged in a number of countries, and has brought with it confusion about titles, role boundaries, clinical accountability and educational requirements. Initially, the role resulted from a need for healthcare professionals to provide a service to the increased numbers of patients presenting to hospital with less urgent problems. Since then, the service has evolved to one where nurse practitioners provide high-quality and cost-effective care to persons who seek help for non-urgent, urgent or emergent conditions in a variety of emergency care settings. However, little research could be identified on the attitudes of relevant nursing and medical staff towards the development of this role. Methods., A questionnaire survey was carried out, and a 29-item Likert rating scale was developed to measure attitudes. Along with some demographic variables, two open-ended questions were added to allow respondents to elaborate on what they perceived as benefits and difficulties associated with an advanced nurse practitioner service. All general practitioners, emergency nurses and emergency doctors in one health board in the Republic of Ireland were targeted, and 25 emergency nurses, 13 emergency doctors and 69 general practitioners were approached to take part. Data were collected in February 2004. Findings., An overall response rate of 74·8% was achieved. All respondents were positive towards the development of an advanced nurse practitioner service, with general practitioners being less positive. The principal differences appeared between general practitioners and hospital emergency care staff. Conclusion., There is a need for a multidisciplinary approach to the planning of advanced nurse practitioner services. To achieve multiprofessional acceptance, an accredited and standardized education programme is required, and this must address existing role boundaries. [source] Long-Term Results of Cardiac TransplantationJOURNAL OF CARDIAC SURGERY, Issue 3 2003Alberto Juffe M.D. From April 1991 to December 2000, 345 patients underwent heart transplantation at the Juan Canalejo Hospital. The mean age of recipients was54.5 ± 11.4 years; 286 (83%) were male patients. Idiopathic (52.2%) and ischemic (34.9%) end-stage cardiomyopathy were the main causes leading to transplantation. Ninety-four patients had undergone a previous heart operation. The mean left ventricular ejection fraction was22.8 ± 11.4. Forty patients (11.5%) were transplanted in urgent (status I) condition. The mean time spent on the waiting list was 35.9 days. In-hospital mortality was 10.6% and 24% for transplantations performed on an elective and urgent basis, respectively. Operative (30-day), one-year and six-year survival was 87.2%, 81.3% and 64%, respectively. In terms of actuarial survival, there were no significant differences with regard to the recipient's age, sex, previous cardiac surgery, and the etiology of the end-stage cardiomyopathy. The six-year actuarial survival for recipients receiving hearts from female donors was 59% compared with 72% for male donors(p = 0.05). There has been a low incidence of rejection, as well as cardiac graft vasculopathy. Actuarial survival at six years was 66% for patients transplantated on an elective basis compared with 57% for patients transplanted on an urgent basis(p = 0.04). The aim of the study was to evaluate long-term results for patients who underwent orthotopic heart transplantation. In our experience, status I is associated with a higher mortality.(J Card Surg 2003;18:183-189) [source] Waiting list management: priority criteria or first-in first-out?JOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 4 2009A case for total joint replacement Abstract Background, Total joint replacements are interventions with large waiting times from indication to the surgery management. These patients can be managed in two ways; first-in first-out or through a priority tool. The aim of this study was to compare real time on waiting list (TWL) with a priority criteria score, developed by our team, in patients awaiting joint replacement due to osteoarthritis. Methods, Consecutive patients placed on waiting list were eligible. Patients fulfilled a questionnaire which included items of our priority tool and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) specific questionnaire. Other priority items were extracted from the clinical history. The priority tool gives a score from 0 to 100 points, and three categories (urgent, preferent and ordinary). We studied the differences among categories and TWL by means of one-way analysis of variance. Correlational analysis was used to evaluate association among priority score and TWL and WOMAC baseline and gains at 6 months with priority score and TWL. Results, We have studied 684 patients. Women represented 62% of sample. The mean age was 70 years. There were not association between the categories of priority score and TWL (P = 0.12). The rho correlation coefficient between TWL and priority score was ,0.11. Among baseline WOMAC scores and priority score, the rho coefficients were 0.79, 0.7 and 0.52 with function, pain and stiffness dimensions, respectively. There were differences in the mean scores of WOMAC dimensions according to the three priority categories (P < 0.001) but no with TWL categories. Data of gains in both health-related quality of life dimensions at 6 months were similar, with differences according to priority categories but no regarding TWL. Conclusions, The results of the study support the necessity of implementing a prioritization system instead of the actual system if we want to manage the waiting list for joint replacement with clinical equity. [source] Current controversies surrounding liver transplantation for hepatocellular carcinomaJOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 7 2010Mauricio F Silva Abstract Liver transplantation (LT) for hepatocellular carcinoma (HCC) has progressed rapidly over the last decade from a futile therapy to the first choice therapy for suitable patients. Excellent outcomes of LT for HCC can be largely attributed to the use of the Milan Criteria, which have restricted LT to patients with early stage tumors. These criteria may be conservative, and it is likely that a subset of patients with tumors beyond these criteria can have acceptable outcomes. However, there is currently insufficient data to accept more liberal criteria as a standard of care, and a higher quality evidence base must be achieved to prevent poor utilization of valuable donor liver resources. In the future, it is probable that more sophisticated selection criteria will emerge incorporating aspects of tumor biology beyond tumor size and number. Dropout from the waiting list due to tumor progression remains a clinical challenge particularly in regions with prolonged waiting times. Priority allocation using HCC MELD points is a practical and transparent solution that has successfully reduced waitlist dropout for HCC patients. Further refinements of the HCC MELD point system are required to ensure equity of access to LT for non-HCC patients and prioritization of HCC patients with the highest risk of dropout. Improving the evidence base for pre-LT locoregional therapy to prevent waitlist dropout is an urgent and difficult challenge for the LT community. In the interim transplant clinicians must restrict the use of these therapies to those patients who are most likely to benefit from them. [source] Is there an easier way to autograft skin in chronic leg ulcers? ,Minced micrografts', a new techniqueJOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY & VENEREOLOGY, Issue 10 2008P Boggio Abstract Background Chronic venous leg ulcers represent an urgent and increasing problem for public health. The use of skin autografts results in a greater therapeutic success in healing chronic ulcers. Objective A simple method of skin autografting that could permit a wider use of skin grafts in outpatients is needed. A new technique allowing skin autografting in a simple one-step process, without complex surgical procedures or expensive technical supplies, is presented. Methods A small, full-thickness skin specimen taken from the patient is finely minced and spread on his leg ulcer bed allowing to cover a surface many times wider than the sample itself. Results This method induces faster re-epithelization of chronic leg ulcers that failed to heal despite good conservative local therapy and give the possibility to repair very large ulcers with small fragments of skin. A clinical case is shown as an example out of 20 ulcers we recently treated. Conclusion Our preliminary report shows that this technique results in a greater therapeutic success (18 of 20 cases) in healing chronic leg ulcers, a common pathology that often affects outpatients treated for very long periods at home or in the Dermatologist's office. In our experience, this new and successful reparative possibility makes ,mince grafting' a recommendable procedure. [source] Effect of age on the incidence of venous thromboembolism after major surgeryJOURNAL OF THROMBOSIS AND HAEMOSTASIS, Issue 8 2004R. H. White Summary.,Background:,Most guidelines for administration of thromboprophylaxis after major surgery use age as a major predictor of postoperative venous thromboembolism (VTE). We sought to quantify the effect of age on the risk of symptomatic VTE after a spectrum of surgical procedures. Methods:,Using the California Patient Discharge Data Set and specific ICD-9-CM surgical procedure codes, we retrospectively determined the incidence of VTE diagnosed within 91 days after 40 different urgent or elective surgeries performed in the hospital between 1992 and 1996. Logistic regression was used to quantify the effect of age on the incidence of postoperative VTE and to adjust for other risk factors. Results:,1 464 452 cases underwent one of 40 different procedures (mean cases per procedure = 35 718, range 4500,145 500). There was a significant interaction between age and the type of surgery performed (P<0.0001). Qualitative analysis of the effect of age on the incidence of VTE stratified by the presence or absence of malignancy revealed three general patterns: a steady increase in the incidence of VTE with age, exemplified by appendectomy or cholecystectomy; an increase in VTE up to approximately age 65 with no increase thereafter, exemplified by total hip arthroplasty; and no effect of age on the incidence of VTE, exemplified by vascular surgery. Conclusions:,The relationship between age and the risk of VTE after surgery is complex and depends on the nature of the surgery and the underlying pathologic process. Advancing age was a significant predictor for VTE following surgeries performed for conditions not inherently associated with significant comorbidity. Conversely, advancing age was not associated with a higher incidence of VTE after surgeries performed for conditions strongly associated with serious underlying comorbidity, such as a malignancy or severe peripheral vascular disease. [source] Review article: the treatment of hepatitis C virus recurrence after liver transplantationALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 2 2007R. R. ARJAL Summary Background Recurrent hepatitis C represents a major challenge for the liver transplant community. Given the potentially significant impact that hepatitis C recurrence has on graft and patient survival, several treatment strategies have been utilized to prevent/slow the progression to hepatitis C-related graft failure. Aim To review the efficacy and applicability of treatment strategies for managing recurrent hepatitis C. Methods Search of MEDLINE (1990 to December 2006) and national meeting abstracts. Search terms included hepatitis C, liver transplantation, treatment, sustained virological response (SVR), and end of treatment virological response. An emphasis was placed on randomized trials. Results The largest study of treatment prior to liver transplantation (n = 124) achieved SVR in 24%. Eight randomized trials (n = 383) examined the efficacy of preemptive therapy with SVR ranging from 0,33%. Eligibility for treatment was low and dose reduction common. Four randomized trials (n = 245; all abstracts) have reported SVR from 33,42% for treating those with histological evidence of recurrent disease. Conclusions Therapies for treating hepatitis C recurrence have limited applicability and tolerability, and they have a low SVR. Based on available results, preemptive therapy is not recommended. Pegylated interferon and ribavirin is currently the preferred choice for treating established recurrence. There is an urgent need for safer and more effective anti-viral therapy in this situation. [source] Decreasing incidence of hepatocellular carcinoma among children following universal hepatitis B immunizationLIVER INTERNATIONAL, Issue 5 2003Mei-Hwei Chang Abstract: Hepatocellular carcinoma (HCC) is one of the 10 most common malignant tumors worldwide. Chronic infection with hepatitis B or C virus is closely related to hepatocarcinogenesis. The outcome of current therapies for HCC is not satisfactory. Prevention is the best way to control HCC. Among the various strategies of HCC prevention, immunization against hepatitis B virus infection is the most effective. Universal hepatitis B immunization has proved to be effective in reducing the incidence of HCC to 1/4,1/3 of that in children born before the hepatitis B vaccination era in Taiwan. The problems we face in achieving global control of hepatitis-related HCC include: (1) no effective vaccine for the prevention of hepatitis C and its related HCC; (2) no immunization program for hepatitis B in areas with inadequate resources; (3) poor compliance to the immunization program as a result of ignorance, anxiety, or poverty; and (4) vaccine failure. Integration of the hepatitis B vaccination program into the expanded program of immunization for all infants throughout the world will be most urgent and important for HCC control. The reduction of the incidence of HCC will be seen in adults 30,40 years of age after the launch of the universal hepatitis B vaccination program. This concept of cancer vaccine can be applied to other infectious agents and their related cancers. [source] Allergen IgE-isotype-specific suppression by maternally derived monoclonal anti-IgG-idiotypeALLERGY, Issue 1 2010R. I. Tanasa Abstract Background:, The dramatic increase of IgE-mediated allergic diseases in western countries demonstrates the urgent need for new therapeutic or prophylactic approaches. In mice, a prophylactic long-lasting allergen-specific suppression of IgE responsiveness is induced by maternal IgG antibodies to allergens like ovalbumin, phospholipase A2 (bvPLA2) or ovomucoid. As neonatal application or maternally derived pathogen-reactive antibodies (idiotypes) as well as corresponding anti-idiotypes can induce anti-microbial protection, we probed the transgenerational IgE-suppressive mechanism with a syngeneic monoclonal anti-idiotypic antibody. Methods:, The monoclonal bee-venom-phospholipase A2 (bvPLA2)-reactive IgG antibody MS613 (idiotype) or the corresponding syngeneic anti-idiotype II/2-19 were injected during the first 2 days postpartum to the dams. Immunization of offspring with minute doses of IgE-inducing bvPLA2 was started at an adult age of 3½ months. Results:, The postnatal transfer of the anti-bvPLA2 idiotype MS613 or the corresponding anti-idiotype II/2-19 induced long-lasting allergen-specific IgE suppression in a dose-dependent manner, while the IgG response to the allergen developed normally. Quantitatively, the anti-idiotype was more effective than idiotype. Molecular modeling of the idiotype-anti-idiotype complex and its comparison with the bvPLA2 structure revealed that the anti-idiotype does not mimic bvPLA2 epitopes and thus can not be regarded as an internal image antibody and, consequently, does not function as a surrogate antigen. Conclusions:, Idiotypic network reactivity is at least one major factor for induction of transgenerational IgE suppression by maternal IgG antibodies. If applicable to humans, these data suggest the possibility of a prophylactic and possibly therapeutic treatment of IgE-mediated allergic diseases with anti-idiotypic antibodies. [source] Putting teamwork in contextMEDICAL EDUCATION, Issue 11 2000Noel Boaden Multidisciplinary teamwork is becoming more important in both the delivery of health care and in the organization and management of that delivery. The first of these has been accepted but traditional professional education has done little to address the challenge it presents to professionals. Recent reforms in the British NHS have made the challenge more urgent. Professionals must work together but in increasingly flexible and innovatory ways. They are also required to play more formal roles in NHS management and policy. Where teamwork has been addressed in professional education it has concentrated on the inter-personal dynamics of working teams. This remains important but to respond effectively to the new challenges curricula and educational practice will have to be clearer about the variety of teams involved and the importance of the context within which teams work. One view is offered as to how that context might be understood in order to map team diversity. Two models are offered to help develop multidisciplinary team learning. One of these deals with key aspects of the organizational setting and the other with factors that affect team processes. It is argued that both should help to facilitate multidisciplinary curriculum development but also suggest learning needs to be met within unidisciplinary professional education. Concentration on team dynamics alone will not deliver the teamwork required in the new NHS. [source] Loss of accreditation at historically Black colleges and universitiesNEW DIRECTIONS FOR HIGHER EDUCATION, Issue 151 2010Rhonda E. Baylor Regaining accreditation is an urgent and immediate task to maintain an institution's sources of support. [source] Criminal justice, cultural justice: The limits of liberalism and the pragmatics of difference in the new south africaAMERICAN ETHNOLOGIST, Issue 2 2004John L. Comaroff ABSTRACT What are the limits of liberalism in accommodating the growing demands of difference? Can a Euromodernist nation-state, founded on One Law, infuse itself with another, with an African jurisprudence? And how is it to deal with cultural practices deemed "dangerous" by the canons of enlightenment reason? These questions are especially urgent in postcolonies like South Africa, with highly diverse populations whose traditional ways and means are accorded constitutional protection. Here we examine how South Africans are dealing with such "dangerous" practices in an era in which their nation is becoming ever more policultural; how, in the process, an Afromodernity is taking organic shape in the interstices between new democratic institutions and the kingdom of custom; how the confrontation between Culture, in the upper case, and a state founded on liberal universalism is beginning to reconfigure the political landscape of this postcolony,as it is, we argue, in many places across the planet. [source] Invasibility of grassland and heath communities exposed to extreme weather events , additive effects of diversity resistance and fluctuating physical environmentOIKOS, Issue 10 2008Juergen Kreyling Understanding the resistance of plant communities to invasion is urgent in times of changes in the physical environment due to climate change and changes in the resident communities due to biodiversity loss. Here, we test the interaction between repeated drought or heavy rainfall events and functional diversity of grassland and heath communities on invasibility, measured as the number of plant individuals invading from the matrix vegetation. Invasibility of experimental plant communities was influenced by extreme weather events, although no change in above-ground productivity of the resident communities was observed. Drought decreased invasibility while heavy rainfall increased invasibility, a pattern that is consistent with the fluctuating resource hypothesis. Higher community diversity generally decreased invasibility, which can be explained by a combination of the fluctuating resource hypothesis and niche theory. The effects of the physical environment (extreme weather events) and diversity resistance (community composition) were additive, as they were independent from each other. Differences in the composition of invading species sets were found, and Indicator Species Analysis revealed several invading species with significant affinity to one particular extreme weather event or community composition. This finding supports niche theory and contradicts neutral species assembly. Our data supports theories which predict decreased resistance of plant communities due to both increased climate variability and biodiversity loss. The effects of these two factors, however, appear to be independent from each other. [source] The United Nations as a Vehicle for DialoguePEACE & CHANGE, Issue 4 2003Courtney B. Smith The United Nations (UN) proclaimed 2001 as the Year of Dialogue among Civilizations in an effort to examine how confrontation and hostility in world politics could be replaced by discourse and understanding. However, in the midst of this process the world was witness to the tragic events of September 11, 2001. Since terrorism represents the antithesis to dialogue, the UN's discussion of these issues became more urgent and focused. Two major documents were produced, but they do not explore adequately the United Nations' potential role in regard to building dialogue. This article begins this undertaking by considering the UN as a forum for debate where different peoples of the world meet and as a catalyst for an ongoing process of interaction and change. In other words, serious thinking about the UN's role as a vehicle for dialogue requires appreciating both its passive and dynamic characteristics and functions. [source] Epidemiology of influenza-associated encephalitis-encephalopathy in Hokkaido, the northernmost island of JapanPEDIATRICS INTERNATIONAL, Issue 2 2000Takehiro Togashi AbstractBackground: It is well known that acute onset brain dysfunction, which usually is diagnosed as encephalitis or encephalopathy, occurs in association with influenza. However, this may have been underestimated as a rather infrequent event. Sixty-four infants and children developed encephalitis-encephalopathy during the five recent influenza seasons in Hokkaido, the northernmost island of Japan. Methods: Inquiries were sent at the end of each season, from October 1994 to March 1999, to 94 hospitals and institutes in Hokkaido which accept pediatric age patients, asking if there were any admitted cases of encephalitis or encephalopathy. Results: The patients were 42 boys and 22 girls and 47 (73.4%) were 4 years of age or younger. None of them had received an influenza vaccine nor had an oral administration of aspirin. Most of the patients became comatose with or without convulsions within a few days of the onset of fever. Twenty-eight (43.8%) patients died and 13 (20.3%) had neurological sequelae. Patients with clotting disorders, elevations of serum creatine kinase and/or aspartate aminotransferase and alanine aminotransferase, and brain CT abnormalities had a poor prognosis compared with patients without. Among these affected patients, the influenza genome (H3) was detected by polymerase chain reaction in nine cerebrospinal fluid samples, influenza virus A (H3N2) was isolated in 18 nasopharyngeal swab samples and a four-fold or greater rise in serum hemagglutinin inhibition antibody titer against H3N2 was observed in seven patients. Conclusions: It appears urgent to promote vaccination against influenza in young children to prevent these devastating disease conditions. [source] Occupational exposure to blood and body fluids among health care workers in a general hospital, ChinaAMERICAN JOURNAL OF INDUSTRIAL MEDICINE, Issue 2 2009Min Zhang BM Abstract Objectives To understand current status of occupational exposure to blood and body fluids (BBF), and awareness of knowledge about occupational bloodborne pathogen exposures and universal precaution among hospital-based health care workers (HCWs). Methods A cross-sectional study was conducted during April to May 2004 to study incidence of occupational exposure to BBF among 1,144 hospital-based HCWs. Results The total incidence and the average number of episodes exposure to BBF was 66.3/100 HCWs per year and 7.5 per person per year in the past year, respectively. The incidence (per 100/HCWs per year) and the average number of episodes (per HCW per year) of percutaneous injury (PCI), mucous-membrane exposure (MME), and exposure to BBF by damaged skin was 50.3 and 1.8; 34.4 and 1.7; and 37.9 and 4.0, respectively. The leading incidence and the average number of episodes of PCI occurred in delivery room (82.6 and 1.8). The highest percentage of PCI's that occurred during the previous 2 weeks occurred during a surgical operation (22.8%). Of all sharp instruments, the suture needle contributed the highest percentage of PCI's (24.7%) among HCWs in the last 2 weeks. Over two-thirds (68.3%) of respondents were immunized with Hepatitis B vaccine; less than one-half (47%) of HCWs wore gloves while doing procedures on patients. The respondents demonstrated a lack of knowledge regarding transmission of bloodborne diseases and universal precautions. Conclusions Risk for potential exposure to BBF appears high in HCWs, and almost all of episodes are not reported. It is urgent to establish the Guideline for Prevention and Control of Occupational Exposure to Bloodborne Pathogens among HCWs. Am. J. Ind. Med. 52:89,98, 2009. © 2008 Wiley-Liss, Inc. [source] | ||||||||||||||||||||||||||||||||||||||||