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Sample records for compromised patients part

  1. The medically compromised patient.

    PubMed

    Parnell, A G

    1986-06-01

    Diabetes mellitus is found in up to 5 per cent of the population. There is an excess of blood sugar due to a deficiency or diminished effectiveness of insulin. It is a complex disease which, if not controlled, has many major complications including an increased incidence of heart attacks, strokes and vascular changes in many other organs. The management of young onset diabetic patients is directed towards: controlling the carbohydrate intake, testing the blood sugar by the patient and regular insulin injections. Great care must be taken in treating diabetics in the dental surgery. Except for children, any diabetic can be treated for simple dental procedures by ensuring freedom from pain, by eliminating stress and by ensuring that the patient does not miss a meal. Children, unstable diabetic patients and those with infections or requiring multiple extractions should be treated in hospital under the care of an endocrinologist. In hypertension it is only after a number of years that complications begin to appear. The main ones are those of stroke, retinal haemorrhages, renal failure and heart disease. Dentists should be encouraged to take the blood pressure of all adults who present for treatment. Patients with increased blood pressure yet controlled by drugs may be treated as normal patients. Those that are not well controlled should be referred to their physician. Dental appointments must be free of pain and stress should be avoided. A screening method is presented which assists in the evaluation of medically compromised patients. PMID:2941377

  2. Patient-clinician conflict: causes and compromises.

    PubMed

    Lask, Bryan

    2003-03-01

    Conflict is an everyday phenomenon, a part of everyday life. It is hardly surprising that it also occurs in a clinical setting, not only between clinicians and within teams, but also between patients, their families and clinicians. This is all the more the likely in a setting that deals with a chronic disease such as CF. The physical, emotional, social and practical burdens of the illness are such that coping mechanisms are stretched to their limits. Disagreements, misunderstandings, impaired trust and different expectations may all challenge the patient-clinician relationship. In a context in which children and adolescents form at least half the clientele, the potential for conflict is intensified because of the involvement of parents. This paper emphasises the normality of such conflicts, and using case illustrations, explains the reasons for conflicts and explores how best to resolve them. The basic principles of conflict-resolution are outlined, and useful techniques, readily applicable in everyday practice, are described. PMID:15463846

  3. Compromised quality of life in adult patients who have received a radiation dose towards the basal part of the brain. A case-control study in long-term survivors from cancer in the head and neck region

    PubMed Central

    2012-01-01

    Background Adult patients with hypothalamic-pituitary disorders have compromised quality of life (QoL). Whether this is due to their endocrine consequences (hypopituitarism), their underlying hypothalamic-pituitary disorder or both is still under debate. The aim of this trial was to measure quality of life (QoL) in long-term cancer survivors who have received a radiation dose to the basal part of the brain and the pituitary. Methods Consecutive patients (n=101) treated for oropharyngeal or epipharyngeal cancer with radiotherapy followed free of cancer for a period of 4 to10 years were identified. Fifteen patients (median age 56 years) with no concomitant illness and no hypopituitarism after careful endocrine evaluation were included in a case-control study with matched healthy controls. Doses to the hypothalamic-pituitary region were calculated. QoL was assessed using the Symptom check list (SCL)-90, Nottingham Health Profile (NHP), and Psychological Well Being (PGWB) questionnaires. Level of physical activity was assessed using the Baecke questionnaire. Results The median accumulated dose was 1.9 Gy (1.5–2.2 Gy) to the hypothalamus and 2.4 Gy (1.8–3.3 Gy) to the pituitary gland in patients with oropharyngeal cancer and 6.0–9.3 Gy and 33.5–46.1 Gy, respectively in patients with epipharyngeal cancer (n=2). The patients showed significantly more anxiety and depressiveness, and lower vitality, than their matched controls. Conclusion In a group of long time survivors of head and neck cancer who hade received a low radiation dose to the hypothalamic-pituitary region and who had no endocrine consequences of disease or its treatment QoL was compromised as compared with well matched healthy controls. PMID:23101561

  4. Implant surgery in healthy compromised patients-review of literature.

    PubMed

    Gheorghiu, I M; Stoian, I M

    2014-01-01

    Systemic diseases are of major importance in terms of prosthetic restorations supported by dental implants in healthy compromised patients. Each treatment stage from conception of the treatment plan to the long-term monitoring is under the necessity of the interdisciplinary approach to the underlying disease. PMID:25870664

  5. Video-assisted thoracoscopy in compromised pediatric patients.

    PubMed

    Gamba, Piergiorgio; Midrio, Paola; Betalli, Pietro; Snijders, Deborah; Leon, Francesco Fascetti

    2010-02-01

    The use of video-assisted techniques (VATs) in the paediatric field has become increasingly more frequent, based on reports of prompter recovery following VATs in respect to standard techniques. Specific advantages have been documented, in particular for pediatric patients undergoing chemioradiotherapic treatment. We retrospectively reviewed data of severely compromised patients who underwent VAT for lung wedge resections and biopsies carried out in our center over a 7-year period. As far as the area of therapeutic tumor resection is concerned, the present data are consistent with the view that thoracoscopy is both an effective and safe tool in diagnostic procedures. PMID:19811063

  6. Progress in Pain Assessment: The Cognitively Compromised Patient

    PubMed Central

    Chapman, C. Richard

    2009-01-01

    Purpose of review Pain assessment is essential for patient care in many settings, but it proves difficult when the patient is cognitively compromised or otherwise unable to produce a conventional pain report. This review describes progress in pain assessment technology that involves the coding of human facial expression. Recent findings It is possible to quantify facial expression by coding patterns of facial muscle contraction and relaxation. These patterns are action units, and they can gauge the intensity of pain as well as signal its occurrence. The experience of pain seems to generate a unique facial expression comprising several action units. Concerns have existed about whether demented patients produce diagnostically meaningful facial expressions of pain because they tend to generate more non-specific facial expressions and perhaps code pain intensity less well than normals. Recent work shows that facial expression reflects pain as well or better in demented patients compared to normals. Summary Although still nascent, coded facial expression appears to work reliably as a pain assessment tool with cognitively compromised patients. Clinical application awaits the development of technology that can automate facial coding and scoring. PMID:18784487

  7. Secretion of salivary statherin is compromised in uncontrolled diabetic patients

    PubMed Central

    Izumi, Masahiro; Zhang, Bin-Xian; Dean, David D.; Lin, Alan L.; Saunders, Michèle J.; Hazuda, Helen P.; Yeh, Chih-Ko

    2015-01-01

    Background Statherin is an important salivary protein for maintaining oral health. The purpose of the current study was to determine if differences in statherin levels exist between diabetic and healthy subjects. Methods A total of 48 diabetic and healthy controls were randomly selected from a community-based database. Diabetic subjects (n = 24) had fasting glucose levels > 180 mg/dL, while controls (n = 24) had levels < 110 mg/dL. Parotid saliva (PS) and sublingual/submandibular saliva (SS) were collected and salivary flow rates determined. Salivary statherin levels were determined by densitometry of Western blots. Blood hemoglobin A1c (HbA1c) and total protein in saliva were also obtained. Results SS, but not PS, salivary flow rate and total protein in diabetics were significantly less than those in healthy controls (p = 0.021 & p < 0.001 respectively). Correlation analysis revealed the existence of a negative correlation between PS statherin levels and HbA1c (p = 0.012) and fasting glucose (p = 0.021) levels, while no such correlation was found for SS statherin levels. When statherin levels were normalized to total salivary protein, the proportion of PS statherin, but not SS statherin, in diabetics was significantly less than that in controls (p = 0.032). In contrast, the amount of statherin secretion in SS, but not PS, was significantly decreased in diabetics compared to controls (p = 0.016). Conclusions and general significance The results show that synthesis and secretion of statherin is reduced in diabetics and this reduction is salivary gland specific. As compromised salivary statherin secretion leads to increased oral health risk, this study indicates that routine oral health assessment of these patients is warranted. PMID:25793156

  8. An interactive case study assessment. Nursing care of the cancer patient with compromised immunity: practicum cases.

    PubMed

    O'Neill, P N; Adsit, K I; Volker, D

    1991-01-01

    This demonstration will present an interactive videodisc (IVD) case study assessment of nursing care of the immunocompromised cancer patient. This module is the third part of a series of instructional IVD programs entitled Nursing Care of the Cancer Patient with Compromised Immunity. The series has been developed to provide education for fourth year nursing students, experienced nurses new to the field of oncology nursing, and for continuing education. The series has been developed to run on an InfoWindow platform and can also run on an M-Motion system. The demonstration will cover the rationale, treatment, content, and instructional strategies used in the module. The technology including the development platform and authoring environment will also be presented. PMID:1807768

  9. Implant failure associated with actinomycosis in a medically compromised patient.

    PubMed

    Sun, Chun-Xiao; Henkin, Jeffrey M; Ririe, Craig; Javadi, Elham

    2013-04-01

    Oral actinomycosis is not a common disease, but it can cause massive destruction. This article reports a case of implant failure associated with actinomycosis. A 55-year-old Caucasian male patient had tooth #20 extracted years ago and an implant placed 3 years ago. The #20 implant area developed an abscess about 1½ years after implant placement. Radiographic findings revealed a large radiolucency on the mesial aspect of the #20 implant. The implant was surgically removed and the lesion thoroughly debrided. The patient experienced severe pain when the apical soft tissue was curreted following implant removal. A periapical radiograph revealed that the lesion approached the mental foramen. A short course of antibiotics was prescribed. Histological observation found sulfur granules, which were found to be actinomycotic colonies. Peri-implant actinomycosis was diagnosed. No recurrence had occurred at the 1-year follow-up. PMID:21767210

  10. Full mouth rehabilitation in a medically compromised patient with fluorosis.

    PubMed

    Bansal, Ramta; Jain, Aditya; Mittal, Sunandan; Kumar, Tarun

    2014-07-01

    Severely worn out dentition needs to be given definite attention as it not only affects aesthetics but can also cause psychological distress to the affected individual. It can cause chewing difficulty, temporomandibular joint problems, headaches, pain and facial collapse. Before any attempt to restore severely worn dentition, aetiology of excessive tooth wear should be established. Severe wear can result from chemical cause, mechanical cause or a combination of various causes. Dental fluorosis can also result in severe wear of teeth. Teeth sometimes become extremely porous and friable with a mottled appearance ranging from yellow to brown-black. There occurs loss of tooth substance and anatomic dental deformities resulting in un-aesthetic dentition requiring full mouth rehabilitation. Here a similar case of full mouth rehabilitation of severely worn dentition due to dental fluorosis in a 27-year-old patient is presented. This case report conjointly presents the uncommon association of diabetes insipidus with dental fluorosis. Diabetes insipidus through its characteristic symptom of polydipsia can result in intake of more than permitted dose of fluoride thus causing dental fluorosis. In literature only few cases have been reported of dental fluorosis in association of diabetes insipidus. Full mouth rehabilitation of the patient was successfully accomplished through well-planned systematic approach to simultaneously fulfill aesthetic, occlusal and functional parameters. PMID:25177654

  11. Orthodontic treatment in the severely compromised periodontal patient.

    PubMed

    Feu, Daniela; Menezes, Fernanda Catharino; Augusto Mendes Miguel, José; Cardoso Abdo Quintão, Catia

    2012-12-01

    We describe the diagnosis and treatment of a class II division 1 malocclusion complicated by severe periodontal disease, tooth loss, dentoalveolar protrusion associated with tipping and extrusion of the maxillary incisors, and a traumatic occlusion. Treatment involved the use of a modified palatal arch to intrude and retract the maxillary incisors and high-pull headgear to enhance anchorage and correct the Class II relationship. After active treatment for 19 months, a good anterior occlusion was achieved, with 17° of lingual retroclination and 3 mm of intrusion at the apex of the maxillary incisors. An acceptable occlusion and periodontal status was maintained over a retention period of 2 years. With the patient's cooperation, a successful outcome was achieved with this approach. PMID:23269694

  12. Is patient confidentiality compromised with the electronic health record?: a position paper.

    PubMed

    Wallace, Ilse M

    2015-02-01

    In order for electronic health records to fulfill their expected benefits, protection of privacy of patient information is key. Lack of trust in confidentiality can lead to reluctance in disclosing all relevant information, which could have grave consequences. This position paper contemplates whether patient confidentiality is compromised by electronic health records. The position that confidentiality is compromised was supported by the four bioethical principles and argued that despite laws and various safeguards to protect patients' confidentiality, numerous data breaches have occurred. The position that confidentiality is not compromised was supported by virtue ethics and a utilitarian viewpoint and argued that safeguards keep information confidential and the public feels relatively safe with the electronic health record. The article concludes with an ethically superior position that confidentiality is compromised with the electronic health record. Although organizational and governmental ways of enhancing the confidentiality of patient information within the electronic health record facilitate confidentiality, the ultimate responsibility of maintaining confidentiality rests with the individual end-users and their ethical code of conduct. The American Nurses Association Code of Ethics for nurses calls for nurses to be watchful with data security in electronic communications. PMID:25532832

  13. Clinical Outcomes of Osseointegrated Prosthetic Auricular Reconstruction in Patients With a Compromised Ipsilateral Temporoparietal Fascial Flap.

    PubMed

    Zuo, Kevin J; Wilkes, Gordon H

    2016-01-01

    Patients with major ear deformities and associated compromise of the superficial temporal artery are poor candidates for autogenous ear reconstruction because of a tenuous ipsilateral temporoparietal fascial flap (TPFF). Osseointegrated prosthetic auricular reconstruction (OPAR) is an alternative to contralateral free TPFF microsurgical and autogenous reconstruction, but data on clinical outcomes are limited. The records of patients with ear loss or major deformity and a compromised ipsilateral TPFF who underwent OPAR from 1989 to 2013 were reviewed. Satisfaction was assessed using a questionnaire based on a 5 point Likert scale. Thirty-two patients (8 women, 24 men) with mean age 43.0 years (range, 10-70 years) underwent OPAR. The ipsilateral TPFF was compromised due to major trauma (13 patients), cancer extirpation (9), burn injury (4), previous harvest (4), arteriovenous malformation (1), or infection (1). All but 2 patients had an associated craniofacial defect, such as soft tissue deformity (87.5%), hearing loss (46.9%), or bony deformity (31.3%). The overall implant success rate was 88.6% at mean follow-up time of 7.6 years post-OPAR. Prosthesis wear averaged 12.2 hours/day and 6.6 days/week (80.5 hours/week). All 5 patients who experienced implant failures had received prior head and neck irradiation. With their prosthesis, 76.2% (16 patients) stated that their self-consciousness and self-esteem were "better" or "much better," whereas 85.7% (18 patients) stated that their self-image was "better" or "much better." All patients declared that they would undergo the treatment again. Osseointegrated prosthetic auricular reconstruction is a reliable option in this challenging population with high patient satisfaction. Patients with prior radiotherapy may have a higher chance of implant failure and would benefit from extended annual follow-up. PMID:26703031

  14. Indications and contraindications of dental implants in medically compromised patients: Update

    PubMed Central

    Gómez-de Diego, Rafael; Mang-de la Rosa, María del Rocío; Romero-Pérez, María J.; Cutando-Soriano, Antonio

    2014-01-01

    The aim of this study was to review the current scientific literature in order to analyse the indications and contraindications of dental implants in medically compromised patients. A reference research was carried out on PubMed using the key words “implant” AND (oral OR dental) AND (systemic disease OR medically compromised), in articles published between 1993 and 2013. The inclusion criteria were the following: clinical studies in which, at least, 10 patients were treated, consensus articles, reviewed articles and meta-analysis performed in humans treated with dental implants, and which included the disease diagnosis. A total of 64 articles were found, from which 16 met the inclusion criteria. Cardiac systemic diseases, diabetic endocrine pathologies or controlled metabolic disorders do not seem to be a total or partial contraindication to the placement of dental implants. Tobacco addiction, and head and neck radiotherapy are correlated to a higher loss of dental implants. Patients suffering from osteoporosis undergoing biphosphonates therapy show an increased risk of developing bone necrosis after an oral surgery, especially if the drugs are administered intravenously or they are associated to certain concomitant medication. Key words:Dental implants, medically compromised patient, systemic diseases. PMID:24608222

  15. Axillary lymph node tuberculosis masquerading as inflammatory breast carcinoma in an immune-compromised patient.

    PubMed

    Chikkannaiah, Panduranga; Vani, B R; Benachinmardi, Kirtilaxmi; Murthy, V Srinivasa

    2016-02-01

    While tuberculosis is still the leading opportunistic infection among human immunodeficiency virus-seropositive patients, extra-pulmonary tuberculosis is more common than pulmonary tuberculosis, with lymph nodes being a common site. Axillary lymph node pathology such as tuberculosis and lymphoma rarely mimics inflammatory breast carcinoma by producing lymphatic obstruction. We report a case of axillary lymph node tuberculosis in a 40-year-old immune-compromised woman, clinically presenting as inflammatory breast carcinoma. PMID:25681261

  16. Mycobacterium mucogenicum bacteremia in immune-compromised patients, 2008-2013.

    PubMed

    Abidi, M Z; Ledeboer, N; Banerjee, A; Hari, P

    2016-06-01

    Mycobacterium mucogenicum (MM) is a rapidly growing nontuberculous mycobacterium that may rarely cause bacteremia in immune-compromised hosts. All MM cases from 2008 to 2013 were analyzed across 4 risk groups: stem cell transplantation (SCT), hematologic malignancy, solid tumors, and others. Descriptive analysis was performed, as well as comparative analysis of neutropenic patients (absolute neutrophil count ≤1000/μL) with nonneutropenic patients. Of 39 MM cases, 27 patients had undergone SCT. Neutropenia was present in 12 patients. There was a significant difference in the presence of fever at the time of MM bacteremia between neutropenic and nonneutropenic groups (92% versus 42%; P=0.005). Central venous catheter (CVC) was present in 33 cases. All patients were treated with >1 antibiotic. Most frequently used combination antibiotic regimen involved clarithromycin and amikacin. Median duration of antibiotic treatment was 42days. Bacteremia resolved in all cases with CVC removal and combination antibiotic treatment. PMID:27117516

  17. Medial and Lateral Plantar Artery Angiosome Rotational Flaps for Transmetatarsal and Lisfranc Amputation in Patients With Compromised Plantar Tissue.

    PubMed

    Boffeli, Troy J; Waverly, Brett J

    2016-01-01

    Traditional incision techniques for midfoot amputation might not provide immediate soft tissue coverage of the underlying metatarsal and tarsal bones in the presence of a large plantar soft tissue defect. Patients undergoing transmetatarsal and Lisfranc amputation frequently have compromised plantar tissue in association with neuropathic ulcers, forefoot gangrene, and infection, necessitating wide resection as a part of the amputation procedure. Open amputation will routinely be performed under these circumstances, although secondary healing could be compromised owing to residual bone exposure. Alternatively, the surgeon might elect to perform a more proximal lower extremity amputation, which will allow better soft tissue coverage but compromises function of the lower extremity. A third option for this challenging situation is to modify the plantar flap incision design to incorporate a medial or lateral plantar artery angiosome-based rotational flap, which will provide immediate coverage of the forefoot and midfoot soft tissue defects without excessive shortening of the bone structure. A plantar medial soft tissue defect is treated with the lateral plantar artery angiosome flap, and a plantar lateral defect is treated with the medial plantar artery angiosome flap. Medial and lateral flaps can be combined to cover a central plantar wound defect. Incorporating large rotational flaps requires knowledge of the applicable angiosome anatomy and specific modifications to incision planning and dissection techniques to ensure adequate soft tissue coverage and preservation of the blood supply to the flap. A series of 4 cases with an average follow-up duration of 5.75 years is presented to demonstrate our patient selection criteria, flap design principles, dissection pearls, and surgical staging protocol. PMID:25681945

  18. Evaluation of instant cup noodle, irradiated for immuno-compromised patients

    NASA Astrophysics Data System (ADS)

    Lee, Ji-Hye; Kim, Jae-Kyung; Park, Jae-Nam; Yoon, Young-Min; Sung, Nak-Yun; Kim, Jae-Hun; Song, Beom-Seok; Yook, Hong-Sun; Kim, Byeong-Keun; Lee, Ju-Woon

    2012-08-01

    In the present study, initial microbial load of instant cup noodle (ICN) was investigated and gamma irradiation applied to develop immuno-compromised patients food for their safe consumption. The initial microbial population of dried vegetable and meat, and noodle was below the detection limit (1 log CFU/g); however, that of seasoning powder was just above 4 log CFU/g. Moreover, rehydrated-ICN with water at 100 °C still show above 3 log CFU/g of microbial load, which indicates the need for an additional process to control microbial safety of the seasoning powder. The total aerobic bacteria in seasoning powder and rehydrated-ICN could be controlled with 17 kGy gamma irradiation. This result referred 17 kGy gamma irradiation could reach 'practical sterility' of ICN. The overall difference in sensory properties between the non-irradiated and irradiated ICN was insignificant. Thus, gamma irradiation could improve the microbial quality of ICN, and reduce the risk of infection posed by the seasoning powder, without any adverse effects on their sensory quality. These results suggest that gamma-irradiated ICN can be used as a snack food for immuno-compromised patients.

  19. Immediate implants and immediate loading in periodontally compromised patients-a 3-year prospective clinical study.

    PubMed

    Alves, Celia Coutinho; Correia, Andre Ricardo; Neves, Manuel

    2010-10-01

    To avoid the necessity of a removable provisional prosthesis, and therefore preserve the patient's functional outcome, esthetics, and quality of life, a clinical protocol was developed to approach periodontally compromised patients presenting a full-arch irreversibly lost dentition: full-arch extraction and immediate replacement with a provisional acrylic resin implant-supported fixed partial denture (FPD). A total of 23 periodontally compromised patients (11 women, 12 men; 4 smokers, 4 controlled diabetics) were included in this study. Pretreatment casts were taken and vertical dimension of occlusion was determined. In most patients, 6 Straumann implants were distributed along the arch according to the surgical guide or bone availability, with the most distal ones in the maxilla slightly tilted so they could emerge more distally. A total of 168 implants (146 Straumann, 10 Nobel Biocare, 8 Biomet 3i, and 4 Lifecore) were placed (83 in the maxilla, 85 in the mandible). Of those in the maxilla, 74 were loaded immediately (implant stability quotient mentor [ISQm] > 70) and 9 placed with delayed loading (ISQm =/< 70). Of the 85 implants placed in the mandible, all were loaded immediately (ISQm > 70). If an FPD had not been fabricated already, impressions were taken during surgery to do so. The prosthesis was then adapted (cemented or screwed) to the 6 implants within the first 48 hours postsurgery. After 2 months, definitive impressions were taken, and a definitive porcelain-fused-to-metal implant-supported 12-element FPD was fabricated and cemented or screwed to all 6 implants. Of the 168 implants, 108 were immediate implants and 159 immediately loaded. Only 2 implants (1 in the mandible, 1 in the maxilla) did not osseointegrate. This yields a 3-year cumulative survival rate of 98.74% (98.65% in the maxilla, 98.82% in the mandible). From a total of 26 immediately loaded prostheses (12 in the maxilla, 14 in the mandible), 6 were cemented and 20 screw-retained. The 3

  20. Respect in forensic psychiatric nurse-patient relationships: a practical compromise.

    PubMed

    Rose, Donald N; Peter, Elizabeth; Gallop, Ruth; Angus, Jan E; Liaschenko, Joan

    2011-03-01

    The context of forensic psychiatric nursing is distinct from other psychiatric settings as, it involves placement of patients in secure environments with restrictions determined by the courts. Previous literature has identified that nurses morally struggle with respecting patients who have committed heinous offences, which can lead to the patient being depersonalized and dehumanized. Although respect is fundamental to ethical nursing practice, it has not been adequately explored conceptually or empirically. As a result, little knowledge exists that identifies how nurses develop, maintain, and express respect for patients. The purpose of this study is to analyze the concept of respect systematically, from a forensic psychiatric nurse's perspective using the qualitative methodology of focused ethnography. Forensic psychiatric nurses were recruited from two medium secure forensic rehabilitation units. In the first interview, 13 registered nurses (RNs) and two registered practical nurses (RPNs) participated, and although all informants were invited to the second interview, six RNs were lost to follow-up. Despite this loss, saturation was achieved and the data were interpreted through a feminist philosophical lens. Respect was influenced by factors categorized into four themes: (1) emotive-cognitive reactions, (2) nonjudgmental approach, (3) social identity and power, and (4) context. The data from the themes indicate that forensic psychiatric nurses strike a practical compromise, in their understanding and enactment of respect in therapeutic relationships with forensic psychiatric patients. PMID:21348929

  1. Cost of Herpes Zoster in Patients With Selected Immune-Compromised Conditions in the United States.

    PubMed

    Li, Qian; Chen, Shih-Yin; Burstin, Stuart J; Levin, Myron J; Suaya, Jose A

    2016-04-01

    Background.  This retrospective study investigates the healthcare costs of herpes zoster (HZ) in patients with selected immune-compromised (IC) conditions in the United States (US). Methods.  Patients with incident HZ diagnosis (index date) were selected from nationwide administrative claims databases from 2005 to 2009. Baseline IC groups, analyzed separately, included adults aged 18-64 years with the following: human immunodeficiency virus infection (HIV), solid organ transplant (SOT), bone marrow or stem cell transplant (BMSCT), or cancer; and older adults (aged ≥65 years) with cancer. Herpes zoster patients (n = 2020, n = 1053, n = 286, n = 13 178, and n = 9089, respectively) were 1-to-1 matched to controls without HZ (with randomly selected index date) in the same baseline group. The healthcare resource utilization and costs (2014 US dollars) during the first 2 postindex quarters were compared between matched cohorts with continuous enrollment during the quarter. Results.  Herpes zoster patients generally had greater use of inpatient, emergency room and outpatient services, and pain medications than matched controls (P < .05). The incremental costs of HZ during the first postindex quarter were $3056, $2649, $13 332, $2549, and $3108 for HIV, SOT, BMSCT, cancer in adults aged 18-64 years, and cancer in older adults, respectively (each P < .05). The incremental costs of HZ during the second quarter were only significant for adults aged 18-64 years with cancer ($1748, P < .05). The national incremental costs of HZ were projected to be $298 million annually across the 5 IC groups. Conclusions.  The healthcare cost associated with HZ among patients with studied IC conditions was sizable and occurred mainly during the first 90 days after diagnosis. PMID:27419151

  2. Cost of Herpes Zoster in Patients With Selected Immune-Compromised Conditions in the United States

    PubMed Central

    Li, Qian; Chen, Shih-Yin; Burstin, Stuart J.; Levin, Myron J.; Suaya, Jose A.

    2016-01-01

    Background. This retrospective study investigates the healthcare costs of herpes zoster (HZ) in patients with selected immune-compromised (IC) conditions in the United States (US). Methods. Patients with incident HZ diagnosis (index date) were selected from nationwide administrative claims databases from 2005 to 2009. Baseline IC groups, analyzed separately, included adults aged 18–64 years with the following: human immunodeficiency virus infection (HIV), solid organ transplant (SOT), bone marrow or stem cell transplant (BMSCT), or cancer; and older adults (aged ≥65 years) with cancer. Herpes zoster patients (n = 2020, n = 1053, n = 286, n = 13 178, and n = 9089, respectively) were 1-to-1 matched to controls without HZ (with randomly selected index date) in the same baseline group. The healthcare resource utilization and costs (2014 US dollars) during the first 2 postindex quarters were compared between matched cohorts with continuous enrollment during the quarter. Results. Herpes zoster patients generally had greater use of inpatient, emergency room and outpatient services, and pain medications than matched controls (P < .05). The incremental costs of HZ during the first postindex quarter were $3056, $2649, $13 332, $2549, and $3108 for HIV, SOT, BMSCT, cancer in adults aged 18–64 years, and cancer in older adults, respectively (each P < .05). The incremental costs of HZ during the second quarter were only significant for adults aged 18–64 years with cancer ($1748, P < .05). The national incremental costs of HZ were projected to be $298 million annually across the 5 IC groups. Conclusions. The healthcare cost associated with HZ among patients with studied IC conditions was sizable and occurred mainly during the first 90 days after diagnosis. PMID:27419151

  3. Radiation-treated ready-to-eat (RTE) chicken breast Adobo for immuno-compromised patients.

    PubMed

    Feliciano, Chitho P; De Guzman, Zenaida M; Tolentino, Levelyn Mitos M; Cobar, Maria Lucia C; Abrera, Gina B

    2014-11-15

    Usually in hospitals low-bacterial diets are served to immuno-compromised patients (ICPs). However, low-bacterial diets still pose a high risk of microbial infections and limit the food selection of the patients. Thus, pathogen-free dishes must be made available. This study presents the development of pathogen-free ready-to-eat (RTE) Filipino ethnic food chicken breast Adobo, sterilized by exposure to high-dose gamma rays (25 kGy) in combination with conventional treatments. Frozen vacuum-packed samples artificially inoculated with Escherichia coli, Listeria monocytogenes, Bacillus cereus, Staphylococcus aureus and Salmonella enterica subsp. enterica serovar Typhimurium, were exposed to 25 kGy gamma radiation for complete sterilization. Microbial quality and sterility of the samples were analysed following 15, 30, and 60 days of storage at -4°C. The effects of high-dose gamma irradiation on the nutritional quality and sensory characteristics of RTE chicken breast Adobo were also evaluated. PMID:24912709

  4. Gamma processing of Arabic bread for immune system-compromised cancer patients

    SciTech Connect

    Grecz, N.; Brannon, R.; Jaw, R.; Al-Harithy, R.; Hahn, E.W.

    1985-12-01

    Arabic bread prepared from local Saudi flour contained a total of up to 105/sup 4/ organisms per g. Most of these were bacterial spores that survived the baking process (1.3 x 10/sup 2/ to 3.5 x 10/sup 3/) and a small number of yeasts and molds (10 to 40 cells per g). The organisms in Arabic bread appear to be harmless to healthy individuals. However, for immune system-compromised cancer patients and bone marrow transplant recipients, it is prudent to irradiate the bread to reduce microbial contamination. The decimal reduction doses (10% survival) for the most radiation-resistant organisms (spore formers) in bread were 0.11 to 0.15 Mrad. Accordingly, 0.6 Mrad was sufficient to reduce the number of spores in Arabic bread by a factor of 10,000, i.e., to <1/g. This treatment constitutes radiation pasteurization (radicidation), and to this extent, provides a margin of microbiological safety. Sensory evaluation by the nine-point hedonic scale showed no detectable loss of organoleptic quality of bread up to 0.6 Mrad, while irradiation to 2.5 Mrad induced unacceptable organoleptic changes.

  5. From Space to the Septic Patient: Assessment of Cellular Immunity in Severely Immune Compromised Conditions

    NASA Technical Reports Server (NTRS)

    Sudhoff, Lars; Kaufmann, Ines; Feuerecker, Matthias; Crucian, Brian; Sams, Clarence; Mehta, Satish; Pierson, Duane; Schelling, Gustav; Chouker, Alexander

    2016-01-01

    PWM, LPS and CD3/28. Moreover, inter-patient comparisons revealed that patients receiving stress doses of hydrocortisone and patients in hypoxemia (pO2 less than 80mmHg) showed a significantly impaired TNF-alpha release in PWM-stimulated whole blood compared to the respective control group. Conclusion: Shortly after the onset of severe sepsis and septic shock, patients attain a general immunosuppressive state affecting both the innate as well as the acquired part of the immune system. This is partly mediated by T-cell apoptosis and a shift of the equilibrium to anti-inflammatory mediators. Its degree of severity correlates with conditions that are commonly present in aeronautics and spaceflight, such as increased hydrocortisone levels and hypoxemia (a condition resulting also from future space habitats). It entails an increase in secondary infection and subsequent late-phase morbidity and mortality. New therapeutic approaches such as reverse isolation and immune-stimulatory interventions should be discussed to improve patient outcome. Those can be of another translational benefit for immune-dysfunctional states in Space.

  6. Robust detection of gearbox deterioration using compromised autoregressive modeling and Kolmogorov Smirnov test statistic. Part II: Experiment and application

    NASA Astrophysics Data System (ADS)

    Zhan, Yimin; Mechefske, Chris K.

    2007-07-01

    Optimal maintenance decision analysis is heavily dependent on the accuracy of condition indicators. A condition indicator that is subject to such varying operating conditions as load is unable to provide precise condition information of the monitored object for making optimal operational maintenance decisions even if the maintenance program is established within a rigorous theoretical framework. For this reason, the performance of condition monitoring techniques applied to rotating machinery under varying load conditions has been a long-term concern and has attracted intensive research interest. Part I of this study proposed a novel technique based on adaptive autoregressive modeling and hypothesis tests. The method is able to automatically search for the optimal time-series model order and establish a compromised autoregressive model fitting based on the healthy gear motion residual signals under varying load conditions. The condition of the monitored gearbox is numerically represented by a modified Kolmogorov-Smirnov test statistic. Part II of this study is devoted to applications of the proposed technique to entire lifetime condition detection of three gearboxes with distinct physical specifications, distinct load conditions, and distinct failure modes. A comprehensive and thorough comparative study is conducted between the proposed technique and several counterparts. The detection technique is further enhanced by a proposed method to automatically identify and generate fault alerts with the aid of the Wilcoxon rank-sum test and thus requires no supervision from maintenance personnel. Experimental analysis demonstrated that the proposed technique applied to automatic identification and generation of fault alerts also features two highly desirable properties, i.e. few false alerts and early alert for incipient faults. Furthermore, it is found that the proposed technique is able to identify two types of abnormalities, i.e. strong ghost components abruptly

  7. Respiratory failure associated with the lipodystrophy syndrome in an HIV-positive patient with compromised lung function.

    PubMed

    Press, N; Montessori, V; Bai, T R; Montaner, J

    2001-01-01

    Protease inhibitors, used as treatment in human immunodeficiency virus (HIV) infection, are associated with a syndrome of peripheral lipodystrophy, central adiposity, hyperlipidemia and insulin resistance. An HIV-positive patient with chronic obstructive pulmonary disease is presented who developed the lipodystrophy syndrome that is associated with the use of protease inhibitors. It is postulated that the lipodystrophy syndrome further compromised his lung function, leading to respiratory failure. Patients who have pulmonary disease and are taking protease inhibitors require monitoring of clinical status and pulmonary function tests. PMID:11521144

  8. Complete Healing of a Giant Wart in a Severely Immune-Compromised Patient with HIV Infection Treated with Acupuncture

    PubMed Central

    Ursini, T.; Polilli, E.; Congedo, G.; Tontodonati, M.; Di Masi, F.; Mazzotta, E.; Parruti, G.; Pippa, L.

    2011-01-01

    Giant warts are infrequent dermatological viral infections caused by Papillomavirus (HPV) in immune-compromised patients. Treatment may often be difficult and unsatisfactory, either by surgery or cytotoxic agents, because of poor immune control of viral activity in such hosts. Here we report on the case of a patient with advanced and persistent immune suppression caused by HIV disease, who developed a monstrous wart covering the entirety of the radial district of his right hand. He was completely healed after a long treatment with traditional Chinese acupuncture, in spite of minimal immune recovery induced by efficacious antiretroviral therapy. To the best of our knowledge, therefore, the present report may be the first direct clinical evidence that acupuncture may be effective in the treatment of cutaneous warts also in HIV-infected patients. PMID:22059074

  9. Oral surgery in Norwegian general dental practice--a survey. Extent, scope, referrals, emergencies, and medically compromised patients.

    PubMed

    Berge, T I

    1992-02-01

    A questionnaire containing 37 questions concerning oral surgery and oral medicine was mailed to a systematic random sample of 500 Norwegian general dental practitioners in October 1989. A 60% return rate was obtained. From the 20 questions included in this paper the following conclusions were drawn: Norwegian general practitioners perform a substantial number and diversity of procedures in the field of oral surgery and oral medicine. The predictor variables sex, age, geographic location, and type of practice (private/public) showed by multiple classification analysis only limited correlation with the amount and diversity of procedures. On average, 12.3 patients were referred per practitioner per year to specialists in oral surgery. The indicated need for orthognathic consultations was 0.75 patient per year per practitioner. Serious emergencies demanding referral seldom occurred. Each month 6.6 medically compromised patients were seen in general practice, among which cardiovascular disorders dominated. PMID:1533083

  10. Complex all-ceramic rehabilitation of a young patient with a severely compromised dentition: a case report.

    PubMed

    Groten, Martin

    2009-01-01

    A young patient with dentinogenesisimperfecta and a dentition severely compromised by discolorations,abrasion, and breakage of enamel on several teeth was prosthodontically treated with CAD/CAM-manufactured all-ceramic restorations. To reduce treatment risk, preparations were limited paragingivally. Maxillary anterior teeth and premolars were restored with adhesively luted ceramic crowns. All other teeth were treated with zirconia-based restorations luted with a self-etching resin-based material. Considering the deficient pretreatment situation, the use of tooth-colored restoration and luting materials yielded a satisfying functional and good esthetic result. The patient is highly satisfied, even though 3 minor chippings occurred shortly after the completion of treatment PMID:19159020

  11. A Ferromagnetic Foreign Body at the Lateral Aspect of the Mandibular Ramus in a Medically Compromised Patient.

    PubMed

    Yamamoto, K; Nakayama, Y; Yamamoto, I; Matsusue, Y; Shimotsuji, H; Kirita, T

    2016-01-01

    A case of a ferromagnetic foreign body in a medically compromised patient was reported. The patient was a 45-year-old male who consulted our department complaining of a foreign body accidentally impacted in the right cheek. X-ray examination revealed a foreign body at the lateral aspect of the right mandibular ramus. The removal of the foreign body was scheduled, but the patient did not return for the procedure. After 8 years he revisited our department for the removal of the foreign body, because it had been found to be ferromagnetic and a barrier to MRI examination. X-ray examination confirmed the foreign body was located at the same site as 8 years prior. Although the patient was suffering from liver cirrhosis with thrombocytopenia and leukopenia, the foreign body was successfully removed under general anesthesia. The foreign body was 12 × 5 × 1 mm, weighed 0.48 g, and was ferromagnetic. The patient's postoperative course was uneventful. X-ray examination confirmed the removal of the foreign body. Since the surgery, the patient has been in generally stable condition with no complications. This case was a rare example of a foreign body that needed to be removed for medical examination. PMID:27583049

  12. A comparison of cardiac rate-pressure product and pressure-rate quotient in healthy and medically compromised patients.

    PubMed

    Campbell, R L; Langston, W G

    1995-08-01

    Healthy and medically compromised patients were studied to compare blood pressure and heart rate changes in response to stress of routine dental extractions performed while they were under local anesthesia. Thirty-nine patients divided into American Society of Anesthesiologists (ASA) I and II groups were noninvasively monitored every 5 minutes. Systolic, diastolic, and mean arterial pressures and heart rate were recorded. Rate pressure products (RPP) and pressure rate (PRQ) quotients were calculated and compared in each group. Significant results were measures of RPP greater than 12,000 and PRQ less than one. Of the 24 patients in the ASA I category, 50% demonstrated elevated RPP values, but only two of 24 had coincidental PRQ abnormalities. Of the 15 patients in the ASA II category, 80% demonstrated elevated RPP values, but two of 15 had coincidental PRQ abnormalities. Patients in the ASA II category had a higher incidence of RPP and PRQ abnormalities, as was expected. However, it is not known which of these two measures is a more sensitive indicator of increased risk associated with stimulation of the sympathetic-adrenergic axis during oral surgery performed with patients under local anesthesia. Correlation studies with continuous Holter monitoring for ST-T wave changes on electrocardiography are forthcoming. PMID:7552876

  13. Nutrition and Aging: Assessment and Treatment of Compromised Nutritional Status in Frail Elderly Patients

    PubMed Central

    Wells, Jennie L; Dumbrell, Andrea C

    2006-01-01

    Nutrition is an important determinant of health in persons over the age of 65. Malnutrition in the elderly is often underdiagnosed. Careful nutritional assessment is necessary for both the successful diagnosis and development of comprehensive treatment plans for malnutrition in this population. The purpose of this article is to provide clinicians with an educational overview of this essential but often underecognized aspect of geriatric assessment. This article will review some common issues in nutrition for the elderly in both hospital and community settings. The complexity and impact of multiple comorbidities on the successful nutritional assessment of elderly patients is highlighted by using case scenarios to discuss nutritional issues common to elderly patients and nutritional assessment tools. Three case studies provide some context for an overview of these issues, which include the physiology of aging, weight loss, protein undernutrition, impaired cognition, malnutrition during hospitalization, screening procedures, and general dietary recommendations for patients 65 years of age and older. PMID:18047259

  14. Double segmentectomy for T4 lung cancer in a pulmonary-compromised patient

    PubMed Central

    Tezel, Cagatay; Bayram, Serkan; Yalçınkaya, Irfan; Tezel, Yelda

    2015-01-01

    Complete resection is the optimal treatment for primary lung cancer. The choice of surgical methods varies depending on tumor size, tumor location, and each patient’s respiratory reserve. Currently, lobectomy with lymph node dissection is the gold standard for the surgical management of lung cancer. However, many thoracic surgical candidates also have chronic obstructive pulmonary disease or emphysema and thus present with minimal lung reserve. In the past few years, more reports have been published on the outcomes of patients who underwent anatomic segmentectomy for lung cancer. Herein we report the surgical outcomes of a patient with limited respiratory reserve, who underwent double segmentectomy. PMID:26807416

  15. A Ferromagnetic Foreign Body at the Lateral Aspect of the Mandibular Ramus in a Medically Compromised Patient

    PubMed Central

    Yamamoto, K; Nakayama, Y; Yamamoto, I; Matsusue, Y; Shimotsuji, H; Kirita, T

    2016-01-01

    A case of a ferromagnetic foreign body in a medically compromised patient was reported. The patient was a 45-year-old male who consulted our department complaining of a foreign body accidentally impacted in the right cheek. X-ray examination revealed a foreign body at the lateral aspect of the right mandibular ramus. The removal of the foreign body was scheduled, but the patient did not return for the procedure. After 8 years he revisited our department for the removal of the foreign body, because it had been found to be ferromagnetic and a barrier to MRI examination. X-ray examination confirmed the foreign body was located at the same site as 8 years prior. Although the patient was suffering from liver cirrhosis with thrombocytopenia and leukopenia, the foreign body was successfully removed under general anesthesia. The foreign body was 12 × 5 × 1 mm, weighed 0.48 g, and was ferromagnetic. The patient’s postoperative course was uneventful. X-ray examination confirmed the removal of the foreign body. Since the surgery, the patient has been in generally stable condition with no complications. This case was a rare example of a foreign body that needed to be removed for medical examination. PMID:27583049

  16. Vascular Compromise from Soft Tissue Augmentation

    PubMed Central

    Humphrey, Shannon; Carruthers, Jean D.A.; Carruthers, Alastair

    2014-01-01

    The popularity of soft tissue fillers is, in part, due to their favorable side-effect profile. However, serious complications can occur. The authors describe their extensive clinical experience with soft-tissue augmentation and the rare complication of vascular compromise, which can lead to necrosis and scarring. Over a 10-year period between January 2003 and January 2013, the authors observed a total of 12 cases of vascular compromise. Eight patients in their clinical practice showed evidence of vascular compromise out of a total of 14,355 filler injections (0.05%). In addition, four patients treated with an experimental particulate filler had vascular complications. All cases were examined for filler type, location of complication, risk factors, treatment, and outcomes. Although treatment plans differed for each patient in their series, all cases of vascular compromise resolved fully. The authors believe that an office-based protocol for both immediate and ongoing care—including a thorough individualized assessment and treatment plan for each patient—is critical to timely and effective resolution of side effects. They propose key recommendations for the prevention and management of vascular compromise to improve patient outcomes and reduce the risk of permanent complications. PMID:25276276

  17. Cardiac oxygen supply is compromised during the night in hypertensive patients.

    PubMed

    Westerhof, Berend E; van Lieshout, Johannes J; Parati, Gianfranco; van Montfrans, Gert A; Guelen, Ilja; Spaan, Jos A E; Westerhof, Nico; Karemaker, John M; Bos, Willem Jan W

    2011-09-01

    The enhanced heart rate and blood pressure soon after awaking increases cardiac oxygen demand, and has been associated with the high incidence of acute myocardial infarction in the morning. The behavior of cardiac oxygen supply is unknown. We hypothesized that oxygen supply decreases in the morning and to that purpose investigated cardiac oxygen demand and oxygen supply at night and after awaking. We compared hypertensive to normotensive subjects and furthermore assessed whether pressures measured non-invasively and intra-arterially give similar results. Aortic pressure was reconstructed from 24-h intra-brachial and simultaneously obtained non-invasive finger pressure in 14 hypertensives and 8 normotensives. Supply was assessed by Diastolic Time Fraction (DTF, ratio of diastolic and heart period), demand by Rate-Pressure Product (RPP, systolic pressure times heart rate, HR) and supply/demand ratio by A(dia)/A(sys), with A(dia) and A(sys) diastolic and systolic areas under the aortic pressure curve. Hypertensives had lower supply by DTF and higher demand by RPP than normotensives during the night. DTF decreased and RPP increased in both groups after awaking. The DTF of hypertensives decreased less becoming similar to the DTF of normotensives in the morning; the RPP remained higher. A(dia)/A(sys) followed the pattern of DTF. Findings from invasively and non-invasively determined pressure were similar. The cardiac oxygen supply/demand ratio in hypertensive patients is lower than in normotensives at night. With a smaller night-day differences, the hypertensives' risk for cardiovascular events may be more evenly spread over the 24 h. This information can be obtained noninvasively. PMID:21786015

  18. The use of the pectoralis major flap for advanced and recurrent head and neck malignancy in the medically compromised patient.

    PubMed

    Avery, C M E; Crank, S T; Neal, C P; Hayter, J P; Elton, C

    2010-11-01

    A retrospective review of seventy-one PPM flaps used between 1996 and 2010 primarily for oral and oropharyngeal squamous cell carcinoma presenting as either advanced stage IV primary disease (41/43), extensive recurrent (10) or metastatic (9) neck disease. The PPM flap was most commonly used following resection of the mandible (23) or the tongue/oropharynx (19). When the PPM flap was the preferred reconstruction option (54) the main indication, in addition to advanced disease, was significant medical co-morbidity (23). The majority of PPM flaps (75%) were used in the latter half of the series for an increasing number of patients in poor health with advanced disease. There was no evidence of an increase in age, ASA grade or extent of disease during this period. Approximately one quarter (17) of the flaps were used after failure of a free flap, most commonly a DCIA (7) or radial (6) flap. The 30day mortality in this group of compromised patients undergoing major surgery for advanced disease was 7% (5/71). The overwhelming majority had significant co-morbidity (94% grade 2 or higher with 63% ASA grade 3) and 90% had already undergone previous major surgery and/or radiotherapy. The 1-year, 3-year and 5-year overall survival rates were 65.5%, 39.1% and 11.0% respectively with cancer-specific survival rates of 82.0%, 65.5% and 65.5%. The majority died of disease related to the underlying co-morbidity. We recommend an aggressive approach to the surgical resection of advanced and recurrent disease but a pragmatic approach to reconstruction. The PPM major flap is reliable for reconstruction of defects of the mandible, tongue and oropharynx with a complete flap failure rate of 2.8%. Lateral defects of the mandible were managed without a plate and with an acceptable outcome in the context of limited life expectancy. This is the largest study of the use of the PPM flap for this type of patient group. The flap retains a major role in the management of advanced primary or

  19. Oral inflammatory process and general health. Part 2: How does the periapical inflammatory process compromise general health?

    PubMed

    Somma, F; Castagnola, R; Bollino, D; Marigo, L

    2011-01-01

    At present, the focal infection theory still has very controversial aspects. In spite of the great number of studies, there is no evidence that focal infections or even antigenic mimicry are responsible for anything other than sporadic abscesses/infections and possibly rare autoimmune disorders. linflammation of endodontic origin (i.e., apical periodontitis--AP) has not received the same attention as inflammation originating from the periodontium. Endodontics is a microbiological problem, since the bacterial infection is the "prime mover" of pulp (before) and periapical (later) disease. The aims of endodontic treatment have to be considered from a microbiological viewpoint. Considering these problems in this second part of their study, the Authors, after close examination of the virulence of microorganisms and of the host defense, analyze the endodontic infection and microbiological species. They emphasize the possibility of a relationship between periapical inflammatory lesions and bacterial endocarditis in preventing metafocal disease. Bacterial endocarditis deserves special mention because despite involving specialists of two scientific fields, its prophylaxis is almost always assigned to medical practice, and especially, to dentistry. Given the dangers of the disease, antibiotic prophylaxis is both absolutely necessary and can be very effective, and it should be used especially in clinical situations with high risk individuals. However, the ability of antibiotic therapy to prevent or reduce the frequency, magnitude or duration of bacteremia associated with a dental procedure is controversial. Studies should also be undertaken to determine to compare the efficacy of endodontic treatment with alternative therapy such as implants, prosthetic replacements or no treatment other than extraction. To date, these studies have not been carried out, and there is no evidence to support the theory that modern endodontic therapy is not safe and effective. PMID:21381498

  20. Effect of a dedicated oral care program on periodontal status of medically compromised patients at the Toronto Rehabilitation Institute Dental Clinic.

    PubMed

    Schlosser, Robert; Hebbes, Trudy

    2016-01-01

    Medically compromised patients attending the dental clinic at the Toronto Rehabilitation Institute have considerable gingival inflammation and breath odor. The objective of this study was to evaluate the effect of toothbrushing on the periodontal status of these patients and to determine if there were any additional benefit in combining brushing with an application of an antibiotic rinse. During the first 7 days of the study, the teeth of 11 participants were brushed twice a day by a dental hygienist using a soft-bristle suction toothbrush without toothpaste. Soft interproximal brushes were used to clean interproximal surfaces from the facial aspect. During the second week, facial and interproximal cleaning were repeated in the same patients, but the toothbrush and interproximal brush were dipped in 10-mL of a solution consisting of water and 40 mg/mL of metronidazole with nystatin. Each patient underwent an oral examination and biofilm sampling at baseline, after brushing without toothpaste (week 1), and after brushing with antibiotic solution (week 2). After week 1, tissues improved substantially, and there was a notable change in the biofilm on the teeth. The addition of an antibiotic solution increased healing and resulted in a further decrease in oral biofilm. Medically compromised patients would benefit considerably from a treatment regimen of antibiotic solution to decrease oral infection followed by a daily oral care program of brushing and interdental cleaning to maintain healthy oral tissues. PMID:27367641

  1. Extended virulence genotypes of Escherichia coli strains from patients with urosepsis in relation to phylogeny and host compromise.

    PubMed

    Johnson, J R; Stell, A L

    2000-01-01

    Among 75 urosepsis isolates of Escherichia coli, 29 virulence factor (VF) genes were detected by use of a novel polymerase chain reaction (PCR) assay. Compared with probe hybridization, the PCR assay's specificity was 100% and sensitivity 97.1%. fyuA (yersiniabactin: overall prevalence, 93%), traT (serum resistance, 68%), and a pathogenicity-associated island marker (71%) occurred in most strains from both compromised and noncompromised hosts. Present in <20% of strains each were sfaS, focG (F1C fimbriae), afa/dra, bmaE (M fimbriae), gafD (G fimbriae), cnf1, cdtB (cytolethal distending toxin), cvaC (colicin V), and ibeA (invasion of brain endothelium). Different VFs were variously confined to virulence-associated phylogenetic group B2 (as defined by multilocus enzyme electrophoresis); concentrated in group B2, but with spread beyond; or concentrated outside of group B2. These findings provide novel insights into the VFs of extraintestinal pathogenic E. coli and demonstrate the new PCR assay's utility for molecular epidemiological studies. PMID:10608775

  2. [Tuberculosis in compromised hosts].

    PubMed

    2003-11-01

    Recent development of tuberculosis in Japan tends to converge on a specific high risk group. The proportion of tuberculosis developing particularly from the compromised hosts in the high risk group is especially high. At this symposium, therefore, we took up diabetes mellitus, gastrectomy, dialysis, AIDS and the elderly for discussion. Many new findings and useful reports for practical medical treatment are submitted; why these compromised hosts are predisposed to tuberculosis, tuberculosis diagnostic and remedial notes of those compromised hosts etc. It is an important question for the future to study how to prevent tuberculosis from these compromised hosts. 1. Tuberculosis in diabetes mellitus: aggravation and its immunological mechanism: Kazuyoshi KAWAKAMI (Department of Internal Medicine, Division of Infectious Diseases, Graduate School and Faculty of Medicine, University of the Ryukyus). It has been well documented that diabetes mellitus (DM) is a major aggravating factor in tuberculosis. The onset of this disease is more frequent in DM patients than in individuals with any underlying diseases. However, the precise mechanism of this finding remains to be fully understood. Earlier studies reported that the migration, phagocytosis and bactericidal activity of neutrophils are all impaired in DM patients, which is related to their reduced host defense to infection with extracellular bacteria, such as S. aureus and E. colli. Host defense to mycobacterial infection is largely mediated by cellular immunity, and Th1-related cytokines, such as IFN-gamma and IL-12, play a central role in this response. It is reported that serum level of these cytokines and their production by peripheral blood mononuclear cells (PBMC) are reduced in tuberculosis patients with DM, and this is supposed to be involved in the high incidence of tuberculosis in DM. Our study observed similar findings and furthermore indicated that IFN-gamma and IL-12 production by BCG-stimulated PBMC was lower

  3. 49 CFR 1018.51 - Reasons for compromising a claim.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... compromise in accordance with the guidelines in 4 CFR 103.4. (b) The Board shall determine the debtor's... compromise in accordance with the Federal Claims Collection Standards, 4 CFR part 103. (c) Compromises... 49 Transportation 8 2010-10-01 2010-10-01 false Reasons for compromising a claim. 1018.51...

  4. Integrity and compromise in nursing ethics.

    PubMed

    Winslow, B J; Winslow, G R

    1991-06-01

    Nurses are often caught in the middle of what appear to be intractable moral conflicts. For such times, the function and limits of moral compromise need to be explored. Compromise is compatible with moral integrity if a number of conditions are met. Among these are the sharing of a moral language, mutual respect on the part of those who differ, acknowledgement of factual and moral complexities, and recognition of limits to compromise. Nurses are in a position uniquely suited to leadership in fostering an environment that makes compromise with integrity possible. PMID:1880466

  5. Pilot Study on the Influence of Nutritional Counselling and Implant Therapy on the Nutritional Status in Dentally Compromised Patients

    PubMed Central

    Wöstmann, Bernd; Simon, Teresa; Neuhäuser-Berthold, Monika; Rehmann, Peter

    2016-01-01

    Objectives To investigate the impact of implant-prosthetic rehabilitation combined with nutritional counseling on the nutritional status of patients with severely reduced dentitions. Design An explorative intervention study including an intra-individual comparison of 20 patients with severely reduced dentitions in terms of nutrition- and quality of life-related parameters recorded at baseline and at six and twelve months after implant-prosthetic rehabilitation. Participants Twenty patients from the Department of Prosthetic Dentistry of Justus-Liebig University of Giessen, with an mean age of 63 years, who had fewer than ten pairs of antagonists. Measurements The baseline data collection included dental status, a chewing ability test, laboratory parameters, anthropometric data (body mass index), energy supply, a 3-day dietary record, an analysis of the oral health-related quality of life (OHRQoL) with the OHIP-G14, the Mini-Mental Status (MMS) and Mini Nutritional Assessment (MNA). Six months after implantation and prosthetic rehabilitation, individual nutritional counseling was performed by a dietician. Data were again collected and analyzed. A final follow-up was conducted 12 months after prosthetic rehabilitation. Results Despite the highly significant improvement in masticatory ability and OHRQoL after implant-prosthetic rehabilitation, no significant changes were observed regarding MNA, anthropometric data or energy supply. Except for cholinesterase (p = 0.012), ferritin (p = 0.003), folic acid (p = 0.019) and vitamin A (p = 0.004), no laboratory parameter changed significantly during the investigation period. In addition, no general significant differences were observed for nutrient intake or food choice. Conclusion The present study does not confirm the assumption that the implant-prosthetic rehabilitation of patients with severely reduced residual dentitions with or without an individual nutritional counseling influences nutritional status. PMID:26821352

  6. 48 CFR 32.610 - Compromising debts.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... REQUIREMENTS CONTRACT FINANCING Contract Debts 32.610 Compromising debts. For debts under $100,000, excluding interest, the designated agency official may compromise the debt pursuant to the Federal Claims Collection Standards (31 CFR part 902) and agency regulations. Unless specifically authorized by agency...

  7. Mentalizing in male schizophrenia patients is compromised by virtue of dysfunctional connectivity between task-positive and task-negative networks.

    PubMed

    Das, Pritha; Calhoun, Vince; Malhi, Gin S

    2012-09-01

    Schizophrenia can be conceptualized as a disorder of functional connectivity within the fronto-temporal (FT) and/or default-mode (DM) networks. Recent evidence suggests that dysfunctional integration between these large neural networks may also contribute to the illness, and that the ability to mentalize or have a Theory of Mind (ToM) is discernibly impaired in patients with schizophrenia. Hence in this study, we examined whether impaired functional network connectivity (FNC) contributes to a compromise in the ability to mentalize in patients with schizophrenia. Functional magnetic resonance imaging data were acquired from 20 male schizophrenia patients and 19 matched healthy controls while performing a well-known ToM task. The study revealed that relative to non-ToM the engagement of ToM produced reduced neural activity in the lateral FT and insula networks in patients, as compared to healthy subjects. The findings also indicated that in comparison to healthy subjects the DM and medial FT networks are less suppressed in patients irrespective of the task (ToM/non-ToM). Further, FNC analyses showed that the degree of functional connectivity between task-positive (lateral FT and insula) and task-negative (medial FT, posterior DM) networks was significantly reduced in patients as compared to controls. Of note, a significant correlation between the functional connectivity strength of the lateral FT network with the medial FT and the degree to which this is modulated by the ToM task, suggests that mentalizing deficits in male schizophrenia patients may stem from impaired communication between neural networks that comprehend the mental states of self (medial FT) and others (lateral FT). PMID:22795367

  8. The Production of Interleukin-11 and Decidualization Are Compromised in Endometrial Stromal Cells Derived from Patients with Infertility

    PubMed Central

    Karpovich, Natalia; Klemmt, Petra; McVeigh, J. Enda; Barlow, David H.; Mardon, Helen J.; Hwang, Jung Hye; Heath, John K.

    2006-01-01

    IL-11 signaling is critical for decidualization of the endometrial stroma in early pregnancy in the mouse. In this study, we investigate the function of IL-11 signaling in cAMP-induced decidualization of human endometrial stromal cells. We show that treatment of endometrial stromal cells with 8-bromo-cAMP (8-Br-cAMP) results in an increase in the levels of secreted IL-11, whereas levels of cell surface IL-11 receptor α are similar with or without 8-Br-cAMP treatment. The production of IL-11 correlates with the production of molecular markers of decidualization, prolactin and IGF-binding protein-1. The expression of these markers is inhibited when IL-11 signaling is specifically blocked in decidualizing endometrial stromal cells by the IL-11 antagonist W147A. We demonstrate that 8-Br-cAMP-induced endometrial stromal cells derived from patients with primary infertility produce lower levels of prolactin, IGF-binding protein-1, and IL-11 than cells derived from fertile women. Our results suggest that IL-11 expression is critically important during decidualization in the human endometrium, and that aberrant regulation of endometrial IL-11 production may be associated with some types of infertility. PMID:15613426

  9. Neuron-Specific Enolase Is Correlated to Compromised Cerebral Metabolism in Patients Suffering from Acute Bacterial Meningitis; An Observational Cohort Study

    PubMed Central

    Bartek, Jiri; Thelin, Eric Peter; Ghatan, Per Hamid; Glimaker, Martin; Bellander, Bo-Michael

    2016-01-01

    . Conclusion In this observational cohort study, we were able to show that cerebral metabolism is frequently affected in patients with ABM. Furthermore, patients with high LPR (LPR>40) had significantly higher levels of NSE, suggesting ongoing deterioration in compromised cerebral tissue. However, the potential clinical impact of MD and biomarker monitoring in ABM patients will need to be further elaborated in larger clinical trials. PMID:27019200

  10. The effects of microvesicles on endothelial progenitor cells are compromised in type 2 diabetic patients via downregulation of the miR-126/VEGFR2 pathway.

    PubMed

    Wu, Keng; Yang, Yi; Zhong, Yun; Ammar, Hala Mustafa; Zhang, Peihua; Guo, Runmin; Liu, Hua; Cheng, Chuanfang; Koroscil, Thomas M; Chen, Yanfang; Liu, Shiming; Bihl, Ji C

    2016-05-15

    Our previous study showed that circulating microvesicles (cMVs) of diabetic mice have negative effects on the function of endothelial progenitor cells (EPCs). Whether this is true in diabetic patients deserves further study. In this study, the effects of cMVs and EPC-derived MVs (EPC-MVs) on EPC migration, apoptosis, and reactive oxygen species (ROS) production in healthy controls, well-controlled, and uncontrolled diabetic patients were investigated. The levels of miR-126 and vascular endothelial growth factor receptor 2 (VEGFR2) in cMVs, EPC-MVs, and/or EPCs were analyzed. Moreover, miR-126 inhibitor or mimic was applied to EPCs to modulate the miR-126 level in EPC-MVs. We found the following: 1) the circulating EPC level was reduced but the circulating EPC-MV level increased in uncontrolled diabetic patients; 2) the cMVs and EPC-MVs of healthy controls had beneficial effects on EPCs (migration, apoptosis, ROS), whereas the effects were reversely changed in the cMVs and EPC-MVs of uncontrolled diabetic patients; and 3) the cMVs and EPC-MVs of uncontrolled diabetic patients carried less miR-126 and had downregulated VEGFR2 expression in EPCs. Manipulating the miR-126 level in EPC-MVs with inhibitor or mimic changed their function. The effects of cMVs and EPC-MVs are compromised in diabetes due to the reduction of their carried miR-126, which might provide a therapy target for diabetic vascular complications. PMID:26956185

  11. A compromise on abortion?

    PubMed

    Rhoden, N K

    1989-01-01

    Rhoden's article is one of three on "Abortion: searching for common ground" in this issue of the Hastings Center Report. Her article, together with those by M. Mahowald and M. Glendon, was prompted by the expectation that the impending U.S. Supreme Court decision in Webster v. Reproductive Health Services (3 July 1989) would overturn or restrict Roe v. Wade (1973). Rhoden, an advocate for the pro-choice position, asks whether a compromise leading to an acceptable regulatory policy is possible or desirable among those on opposite sides of the abortion issue. She identifies several reasons why the Roe decision is vulnerable to review, but argues that effective education about sexuality and comprehensive social support of women are better approaches to abortion than restrictive legislation. PMID:2663778

  12. A study protocol of a randomised controlled trial incorporating a health economic analysis to investigate if additional allied health services for rehabilitation reduce length of stay without compromising patient outcomes

    PubMed Central

    2010-01-01

    Background Reducing patient length of stay is a high priority for health service providers. Preliminary information suggests additional Saturday rehabilitation services could reduce the time a patient stays in hospital by three days. This large trial will examine if providing additional physiotherapy and occupational therapy services on a Saturday reduces health care costs, and improves the health of hospital inpatients receiving rehabilitation compared to the usual Monday to Friday service. We will also investigate the cost effectiveness and patient outcomes of such a service. Methods/Design A randomised controlled trial will evaluate the effect of providing additional physiotherapy and occupational therapy for rehabilitation. Seven hundred and twelve patients receiving inpatient rehabilitation at two metropolitan sites will be randomly allocated to the intervention group or control group. The control group will receive usual care physiotherapy and occupational therapy from Monday to Friday while the intervention group will receive the same amount of rehabilitation as the control group Monday to Friday plus a full physiotherapy and occupational therapy service on Saturday. The primary outcomes will be patient length of stay, quality of life (EuroQol questionnaire), the Functional Independence Measure (FIM), and health utilization and cost data. Secondary outcomes will assess clinical outcomes relevant to the goals of therapy: the 10 metre walk test, the timed up and go test, the Personal Care Participation Assessment and Resource Tool (PC PART), and the modified motor assessment scale. Blinded assessors will assess outcomes at admission and discharge, and follow up data on quality of life, function and health care costs will be collected at 6 and 12 months after discharge. Between group differences will be analysed with analysis of covariance using baseline measures as the covariate. A health economic analysis will be carried out alongside the randomised

  13. Initial Management and Evaluation of the Multisystem Injured Patient, Part 1

    PubMed Central

    Jacobs, Lenworth M.

    1987-01-01

    Trauma is the fourth leading cause of death for all Americans, with a mortality rate of 61 deaths per 100,000 people. Although the definitive place for the management of major abdominal or thoracic hemorrhage, as well as neurological or orthopedic problems, is the operating room in a tertiary care hospital, trauma is a time-related disease, and the more quickly hemorrhage is controlled and appropriate management initiated, the better the outcome. The author outlines a systematic approach to prehospital management of the trauma patient that includes a primary survey and a secondary survey. The primary survey (Part 1) focuses on life-threatening conditions that affect the airway and methods to clear the airway immediately. Once the airway is cleared, any anatomical or physiologic compromise that limits ventilation is identified and corrected, hemorrhage is controlled, and the cervical spine, if injury is suspected, is protected. The secondary survey (Part 2) is a comprehensive examination. PMID:3586032

  14. [Pulmonary compromise in leptospirosis].

    PubMed

    de Carvalho, J E; Marchiori, E dos S; Guedes e Silva, J B; Netto, B A; Tavares, W; de Paula, A V

    1992-01-01

    To study the pulmonary complications in leptospirosis case records of 23 such patients admitted at the Hospital Universitário Antônio Pedro, Universidade Federal Fluminense, Niterói, Brasil, were reviewed. Hemoptysis were seen in 21.7% and sputal blood in 30.4% of patients. Arterial gasometry detected hypoxemia and hypocapnia in most cases. Thoracic radiology showed an alveolar pattern in 60% of the patients, alveolo-interstitial in 20%, interstitial in 6%, and in 14% the lungs were considered to be normal. Necropsy of 13 cases showed edema, congestion and hemorrhage in the lungs in all cases. Hyaline membrane was found in 30% and fibrin thrombi in 46% of these cases, resulting in a diagnosis of adult respiratory distress syndrome and acute disseminated intravascular coagulation (consumption coagulopathy) in leptospirosis. PMID:1308063

  15. [Alveolar soft part sarcoma in pediatric patients].

    PubMed

    Paillard, Catherine; Coulomb, Aurore; Helfre, Sylvie; Orbach, Daniel

    2015-09-01

    Alveolar soft part sarcoma, ASPS, is a rare malignant tumor, with preferential primary localization in limbs, usually occurring in adolescents and young adults. This sarcoma, well defined histologically and at molecular level, has an indolent course, but a high potential metastatic pulmonary and cerebral evolution, sometimes late. ASPS is characterized by an almost specific translocation t(X, 17)(p11;25) which creates a fusion protein, APSL-TFE3, acting as an aberrant transcription factor. An in-bloc resection of the primary tumor is the treatment of choice in cases of localized disease. Conventional chemotherapy is generally ineffective. The role of radiotherapy is discussed in case of micro- or macroscopical incomplete residue. It seems to reduce local recurrence, but did not influence overall survival. The 5 years survival rate in children, adolescents and young adults is close to 80% in case of localized disease but poorer in presence of metastases. Recently, systemic anti-tumoral treatments have been focused on the use of targeted therapies. Anti-angiogenic drugs and tyrosine kinase inhibitors are the most promising approaches, but require further study. Prognostic risk factors in the literature are age (>10Y), tumor size (>5cm) and presence of metastases. This article reviews the clinical manifestations, diagnosis modalities, radiographic characteristics and therapeutic strategy of this disease in the pediatric population. PMID:26235420

  16. Reduced Expression of Enac in Placenta Tissues of Patients with Severe Preeclampsia Is Related to Compromised Trophoblastic Cell Migration and Invasion during Pregnancy

    PubMed Central

    Yang, Yue; Liu, Ying; Diao, Ruiying; Sheng, Kai; Liu, Xinghui; Xu, Wenming

    2013-01-01

    The purpose of the study is to investigate the expression of epithelial sodium channel (ENaC) in normal pregnancy and severe preeclampsia placenta and to explore the underlying mechanism of the relationship between the altered ENaC expression and onset of preeclampsia. Reverse transcription polymerase chain reaction (RT-PCR) and Western blot were used to check epithelial sodium channel subunits expression in mRNA and protein level in first term and full term placental tissue. ENaCα specific RNAi were used to knockdown ENaC expression and cell invasion and migration assay were used to check whether reduced expression of ENaC can compromise trophoblast cell function. The result showed that ENaCα was highly expressed in first term placental trophoblast cells; while EnaCβ was highly expressed in full term placenta. Knockdown ENaCα expression by using small interfering RNA reduced the invasive and migration abilities of HTR-8/SVneo cell. Real time-PCR and Western blot analysis showed that the expression levels of ENaCβ were also significantly lower in severe preeclampsia compared with normal pregnancy. It is concluded that the ENaC played an important role in trophoblast cell invasion and migration. Reduced expression and activity of epithelial sodium channel in trophoblast cells may be involved in the pathogenesis of preeclampsia. PMID:23977235

  17. Care of the patient with chronic pain: part II.

    PubMed

    Wells-Federman, C L

    2000-01-01

    Chronic nonmalignant pain frequently results in significant physical, behavioral, psychological, social, and spiritual issues for patients and their families. It is often misunderstood and unsuccessfully managed. Advanced practice nurses who are knowledgeable about chronic pain and the complex biopsychosocial-spiritual needs of this patient population serve an important role in recognizing these patients and intervening appropriately in their care. The purpose of this two-part article is to provide that information. Part I [Clinical Excellence for Nurse Practitioners, 3 (4), 192-204] outlined the pathophysiology, assessment, biopsychosocial-spiritual aspects, and pharmacologic treatment of chronic pain. In Part II, a variety of nonpharmacologic and self-management interventions one can use in the primary care setting to treat these difficult health problems are introduced. PMID:11858295

  18. Care of the patient with chronic pain: Part I.

    PubMed

    Wells-Federman, C L

    1999-07-01

    Chronic nonmalignant pain is estimated to affect over 50 million Americans. It frequently results in significant physical, behavioral, psychological, social, and spiritual problems for patients and their families. In spite of its prevalence and consequences, chronic pain is often misunderstood and inadequately managed by healthcare professionals. Advanced practice nurses who are knowledgeable about chronic pain and the complex biopsychosocial-spiritual needs of this patient population serve an important role in recognizing these patients and intervening appropriately in their care. The purpose of this two-part article is to provide that information. Part I outlines the pathophysiology, assessment, biopsychosocial-spiritual aspects, and pharmacological treatment of chronic pain. Part II addresses a variety of nonpharmacologic and self-management interventions one can use in the primary care setting to treat these difficult health problems. PMID:10711057

  19. Effect of Part-time Practice on Patient Outcomes

    PubMed Central

    Parkerton, Patricia H; Wagner, Edward H; Smith, Dean G; Straley, Hugh L

    2003-01-01

    BACKGROUND Primary care physicians are spending fewer hours in direct patient care, yet it is not known whether reduced hours are associated with differences in patient outcomes. OBJECTIVE To determine whether patient outcomes vary with physicians' clinic hours. DESIGN Cross-sectional retrospective design assessing primary care practices in 1998. SETTING All 25 outpatient-clinics of a single medical group in western Washington. PARTICIPANTS One hundred ninety-four family practitioners and general internists, 80% of whom were part-time, who provided ambulatory primary care services to specified HMO patient panels. Physician appointment hours ranged from 10 to 35 per week (30% to 100% of full time). MEASUREMENTS Twenty-three measures of individual primary care physician performance collected in an administrative database were aggregated into 4 outcome measures: cancer screening, diabetic management, patient satisfaction, and ambulatory costs. Multivariate regression on each of the 4 outcomes controlled for characteristics of physicians (administrative role, gender, seniority) and patient panels (size, case mix, age, gender). MAIN RESULTS While the effects were small, part-time physicians had significantly higher rates for cancer screening (4% higher, P = .001), diabetic management (3% higher, P = .033), and for patient satisfaction (3% higher, P = .035). After controlling for potential confounders, there was no significant association with patient satisfaction (P = .212) or ambulatory costs (P = .323). CONCLUSIONS Primary care physicians working fewer clinical hours were associated with higher quality performance than were physicians working longer hours, but with patient satisfaction and ambulatory costs similar to those of physicians working longer hours. The trend toward part-time clinical practice by primary care physicians may occur without harm to patient outcomes. PMID:12950480

  20. Long QT Syndrome Leading to Multiple Cardiac Arrests After Posaconazole Administration in an Immune-Compromised Patient with Sepsis: An Unusual Case Report

    PubMed Central

    Panos, George; Velissaris, Dimitrios; Karamouzos, Vasilios; Matzaroglou, Charalampos; Tyllianakis, Minos

    2016-01-01

    Patient: Female, 26 Final Diagnosis: Sepsis • drug induced long QT syndrome Symptoms: Cardiac arrest • cardiac arrhythmia • fever • Qt prolongation Medication: Posaconazole Clinical Procedure: Pacemaker insertion Specialty: Infectious Diseases Objective: Rare disease Background: We present the case of a septic patient with severe immunodeficiency, who developed QT interval prolongation followed by episodes of lethal cardiac arrhythmia. Cardiac events occurred after posaconazole administration, incriminating posaconazole use, alone or in combination with voriconazole, as the culpable agent. Case Report: A 26-year-old female patient underwent orthopedic surgery to remove ectopic calcifications in her left hip joint. On the first post-operative day she became septic due to a surgical wound infection. Despite being treated according to the therapeutic protocols for sepsis, no clinical improvement was noticed and further assessment revealed an underlying immunodeficiency. Considering the underlying immunodeficiency and to that point poor clinical response, an antifungal agent was added to the antibiotic regiment. Following discontinuation of multiple antifungal agents due to adverse effects, posaconazole was administered. Posaconazole oral intake was followed by episodes of bradycardia and QT interval prolongation. The patient suffered continuous incidents of cardiac arrest due to polymorphic ventricular tachycardia (torsades des pointes) that degenerated to lethal ventricular fibrillation. Posaconazole was immediately discontinued and a temporary pacemaker was installed. The patient finally recovered without any neurological deficit, and was discharged in a good clinical status. Conclusions: Close cardiac monitoring is recommended in cases where posaconazole administration is combined with coexisting risk factors, as they may lead to severe ECG abnormalities and cardiac arrhythmias such as long QT interval syndrome and torsades de pointes. Posaconazole

  1. Long QT Syndrome Leading to Multiple Cardiac Arrests After Posaconazole Administration in an Immune-Compromised Patient with Sepsis: An Unusual Case Report.

    PubMed

    Panos, George; Velissaris, Dimitrios; Karamouzos, Vasilios; Matzaroglou, Charalampos; Tylianakis, Minos

    2016-01-01

    BACKGROUND We present the case of a septic patient with severe immunodeficiency, who developed QT interval prolongation followed by episodes of lethal cardiac arrhythmia. Cardiac events occurred after posaconazole administration, incriminating posaconazole use, alone or in combination with voriconazole, as the culpable agent. CASE REPORT A 26-year-old female patient underwent orthopedic surgery to remove ectopic calcifications in her left hip joint. On the first post-operative day she became septic due to a surgical wound infection. Despite being treated according to the therapeutic protocols for sepsis, no clinical improvement was noticed and further assessment revealed an underlying immunodeficiency. Considering the underlying immunodeficiency and to that point poor clinical response, an antifungal agent was added to the antibiotic regiment. Following discontinuation of multiple antifungal agents due to adverse effects, posaconazole was administered. Posaconazole oral intake was followed by episodes of bradycardia and QT interval prolongation. The patient suffered continuous incidents of cardiac arrest due to polymorphic ventricular tachycardia (torsades des pointes) that degenerated to lethal ventricular fibrillation. Posaconazole was immediately discontinued and a temporary pacemaker was installed. The patient finally recovered without any neurological deficit, and was discharged in a good clinical status. CONCLUSIONS Close cardiac monitoring is recommended in cases where posaconazole administration is combined with coexisting risk factors, as they may lead to severe ECG abnormalities and cardiac arrhythmias such as long QT interval syndrome and torsades de pointes. Posaconazole interactions with medications metabolized via the CYP3A4 pathway should be considered an additional risk factor for lethal cardiac incidents. PMID:27125217

  2. Surviving cancer without compromising aspirations.

    PubMed

    McGregor, Sandra

    2011-07-01

    This short paper is a reflection of how one person coped, survived and grew following numerous metastatic incidences over a 20 year period. Surviving cancer is a complex process but coping with the threat of regular recurrence has required a coping strategy that embraced the disease, set it aside and refused to compromise hopes, dreams and future life. Central to this personal journey has been the need to redefine normality, live with and set aside the fear of future metastases and death and find an answer and meaning in a changing biology, increased morbidity and possible mortality. This paper contends that not compromising the direction of travel and being able to focus on a career has ensured that survival was valuable and valued. A working environment in which students' problems have been immediate has produced different stressors. These have ultimately forced personal worries to be set aside, while living with cancer has become normal and accepted. PMID:21514884

  3. Trichobezoar Causing Airway Compromise during Esophagogastroduodenoscopy.

    PubMed

    Kao, Erica Y; Scalzitti, Nicholas J; Dion, Gregory R; Bowe, Sarah N

    2015-01-01

    Objectives. (1) Report the case of a 5-year-old female with trichotillomania and trichophagia that suffered airway compromise during esophagogastroduodenoscopy for removal of a trichobezoar. (2) Provide management recommendations for an unusual foreign body causing extubation and partial airway obstruction. Methods. Case report of a rare situation of airway compromise caused by a trichobezoar. Results. A 5-year-old patient underwent endoscopic retrieval of a gastric trichobezoar (hairball) by the gastroenterology service under general endotracheal anesthesia in a sedation unit. During removal, the hairball, due to its large size, dislodged the endotracheal tube, effectively extubating the patient. The bezoar became lodged at the cricopharyngeus muscle. Attempts to remove the bezoar or reintubation were unsuccessful. The child was able to be mask ventilated while the otolaryngology service was called. Direct laryngoscopy revealed a hairball partially obstructing the view of the glottis from its position in the postcricoid area. The hairball, still entrapped in the snare from the esophagoscope, was grasped with Magill forceps and slowly extracted. The patient was then reintubated and the airway and esophagus were reevaluated. Conclusions. Trichobezoar is an uncommon cause of airway foreign body. Careful attention to airway management during these and similar foreign body extractions can prevent inadvertent extubations. PMID:26457086

  4. Trichobezoar Causing Airway Compromise during Esophagogastroduodenoscopy

    PubMed Central

    Kao, Erica Y.; Scalzitti, Nicholas J.; Dion, Gregory R.; Bowe, Sarah N.

    2015-01-01

    Objectives. (1) Report the case of a 5-year-old female with trichotillomania and trichophagia that suffered airway compromise during esophagogastroduodenoscopy for removal of a trichobezoar. (2) Provide management recommendations for an unusual foreign body causing extubation and partial airway obstruction. Methods. Case report of a rare situation of airway compromise caused by a trichobezoar. Results. A 5-year-old patient underwent endoscopic retrieval of a gastric trichobezoar (hairball) by the gastroenterology service under general endotracheal anesthesia in a sedation unit. During removal, the hairball, due to its large size, dislodged the endotracheal tube, effectively extubating the patient. The bezoar became lodged at the cricopharyngeus muscle. Attempts to remove the bezoar or reintubation were unsuccessful. The child was able to be mask ventilated while the otolaryngology service was called. Direct laryngoscopy revealed a hairball partially obstructing the view of the glottis from its position in the postcricoid area. The hairball, still entrapped in the snare from the esophagoscope, was grasped with Magill forceps and slowly extracted. The patient was then reintubated and the airway and esophagus were reevaluated. Conclusions. Trichobezoar is an uncommon cause of airway foreign body. Careful attention to airway management during these and similar foreign body extractions can prevent inadvertent extubations. PMID:26457086

  5. Intestinal Cell Barrier Function In Vitro Is Severely Compromised by Keratin 8 and 18 Mutations Identified in Patients with Inflammatory Bowel Disease

    PubMed Central

    Zupancic, Tina; Stojan, Jure; Lane, Ellen Birgitte; Komel, Radovan; Bedina-Zavec, Apolonija; Liovic, Mirjana

    2014-01-01

    Keratin 8 and 18 (K8/K18) mutations have been implicated in the aetiology of certain pathogenic processes of the liver and pancreas. While some K8 mutations (K8 G62C, K8 K464N) are also presumed susceptibility factors for inflammatory bowel disease (IBD), the only K18 mutation (K18 S230T) discovered so far in an IBD patient is thought to be a polymorphism. The aim of our study was to demonstrate that these mutations might also directly affect intestinal cell barrier function. Cell monolayers of genetically engineered human colonocytes expressing these mutations were tested for permeability, growth rate and resistance to heat-stress. We also calculated the change in dissociation constant (Kd, measure of affinity) each of these mutations introduces into the keratin protein, and present the first model of a keratin dimer L12 region with in silico clues to how the K18 S230T mutation may affect keratin function. Physiologically, these mutations cause up to 30% increase in paracellular permeability in vitro. Heat-stress induces little keratin clumping but instead cell monolayers peel off the surface suggesting a problem with cell junctions. K18 S230T has pronounced pathological effects in vitro marked by high Kd, low growth rate and increased permeability. The latter may be due to the altered distribution of tight junction components claudin-4 and ZO-1. This is the first time intestinal cells have been suggested also functionally impaired by K8/K18 mutations. Although an in vitro colonocyte model system does not completely mimic the epithelial lining of the intestine, nevertheless the data suggest that K8/K18 mutations may be also able to produce a phenotype in vivo. PMID:24915158

  6. Morgellons: contested illness, diagnostic compromise and medicalisation.

    PubMed

    Fair, Brian

    2010-05-01

    The case of Morgellons illustrates how the emergence of a new medically contested illness intersected with and impacted on the diagnostic processes of an existing uncontested psychiatric condition, Delusional Parasitosis (DP). More specifically, the sociopolitical processes at play in the contested illness, Morgellons, dubiously reflect patient empowerment, as well the resilience and power of medical jurisdiction. This research offers insights into the contested illness and medicalisation literatures, and aims to bridge these two approaches towards the relationship between patient empowerment and medical authority, which I do through the notion of doctor-patient compromise. The data for this research come from a comprehensive qualitative analysis of Morgellons discourse through four key sources: the pro-Morgellons website Morgellons.org; the anti-Morgellons website Morgellonswatch.com; the popular media's portrayal of Morgellons; and the DP and Morgellons articles published in peer-reviewed medical journals, as made available on PubMed. PMID:20149149

  7. Caregiver Fatigue: Implications for Patient and Staff Safety, Part 2.

    PubMed

    Smith-Miller, Cheryl A; Harden, Jacqueline; Seaman, Christa W; Li, Yin; Blouin, Ann Scott

    2016-01-01

    Fatigue negatively affects healthcare workers' health and well-being, decreases patient safety, and negatively impacts the work environment. Although individual lifestyle choices influence fatigue levels, much responsibility lies with nursing administrators to prevent situations that may result in sleep deprivation or overwork. This article, the 2nd in a 2-part series, describes the results that were achieved from a fatigue reduction intervention. PMID:27442904

  8. Noninvasive Facial Rejuvenation. Part 1: Patient-Directed.

    PubMed

    Commander, Sarah Jane; Chang, Daniel; Fakhro, Abdulla; Nigro, Marjory G; Lee, Edward I

    2016-08-01

    A proper knowledge of noninvasive facial rejuvenation is integral to the practice of a cosmetic surgeon. Noninvasive facial rejuvenation can be divided into patient- versus physician-directed modalities. Patient-directed facial rejuvenation combines the use of facial products such as sunscreen, moisturizers, retinoids, α-hydroxy acids, and various antioxidants to both maintain youthful skin and rejuvenate damaged skin. Physicians may recommend and often prescribe certain products, but the patients are in control of this type of facial rejuvenation. On the other hand, physician-directed facial rejuvenation entails modalities that require direct physician involvement, such as neuromodulators, filler injections, laser resurfacing, microdermabrasion, and chemical peels. With the successful integration of each of these modalities, a complete facial regimen can be established and patient satisfaction can be maximized. This article is the first in a three-part series describing noninvasive facial rejuvenation. The authors focus on patient-directed facial rejuvenation. It is important, however, to emphasize that even in a patient-directed modality, a physician's involvement through education and guidance is integral to its success. PMID:27478421

  9. Patient experience should be part of meaningful-use criteria.

    PubMed

    Ralston, James D; Coleman, Katie; Reid, Robert J; Handley, Matthew R; Larson, Eric B

    2010-04-01

    The proposed federal "meaningful use" criteria for electronic health records include the direct engagement of patients in their care. In this study, we sought to describe the adoption and use of online services linked to the electronic health record at Group Health Cooperative. By August 2009, six years after the introduction of these services, 30 percent of outpatient "encounters" were actually conducted through secure electronic messaging. Meanwhile, 10 percent of enrollees reviewed medical test results online, while 10 percent went online to request medication refills. These results highlight the need to measure the patient experience as part of meaningful use and to enact policies supporting online and phone communication by patients and providers. PMID:20368589

  10. A variant in 3′-untranslated region of KRAS compromises its interaction with hsa-let-7g and contributes to the development of lung cancer in patients with COPD

    PubMed Central

    Hu, Hua; Zhang, Linlin; Teng, Geling; Wu, Yanhua; Chen, Ying

    2015-01-01

    Objective The objective of the present study was to explore the molecular mechanism by which a single nucleotide polymorphism (rs712) interferes with interaction between 3′-untranslated region (3′-UTR) of KRAS and let-7g, and its association with development of lung cancer in the patients with COPD. Materials and methods In this study, we confirmed that KRAS is a target of let-7g in lung cancer cells, and that introduction of rs712 minor allele into 3′-UTR significantly compromised the miRNA/mRNA interaction by using a luciferase reporter system. Additionally, a total of 35 lung tissue samples were obtained (TT:17, TG:12, GG:6), and let-7g and KRAS expression levels were determined. Results We showed that let-7g level was similar between groups, and the concentration of KRAS in GG genotype group was significantly higher than in TT or GT genotype group. Meanwhile, we found COPD patients with GG genotype had significantly higher risk for lung cancer (odds ratio OR =6.83, P=0.0081), compared with TT and GT genotypes. Conclusion Our study demonstrated that KRAS 3′-UTR rs712 polymorphism interfered with miRNA/mRNA interaction, and showed that the minor allele was associated with an elevated risk for development of lung cancer in COPD. PMID:26316738

  11. Novel psoriasis therapies and patient outcomes, part 1: topical medications.

    PubMed

    Feely, Meghan A; Smith, Barry L; Weinberg, Jeffrey M

    2015-03-01

    In recent years, advances in our understanding of inflammatory mediators and the underlying pathogenesis of psoriasis and psoriatic arthritis have shed light on potential therapeutic targets, which has led to the development of several new promising treatments. In this article, key clinical trials, mechanisms of action, patient outcomes, and relevant safety information for these novel topical medications will be evaluated. This article is the first in a 3-part series on treatments presently in the pipeline for the management of psoriasis and psoriatic arthritis including topical agents, biologic treatments, and systemic therapies in phase 2 and phase 3 clinical trials. With novel approaches to the disease process, these therapies may afford more targeted individualized treatment regimens and offer hope to patients with psoriasis and psoriatic arthritis who have reported a suboptimal therapeutic response to conventional therapies. PMID:25844785

  12. 48 CFR 432.616 - Compromise actions.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 48 Federal Acquisition Regulations System 4 2010-10-01 2010-10-01 false Compromise actions. 432.616 Section 432.616 Federal Acquisition Regulations System DEPARTMENT OF AGRICULTURE GENERAL CONTRACTING REQUIREMENTS CONTRACT FINANCING Contract Debts 432.616 Compromise actions. Compromise of a...

  13. Forensic Analysis of Compromised Computers

    NASA Technical Reports Server (NTRS)

    Wolfe, Thomas

    2004-01-01

    Directory Tree Analysis File Generator is a Practical Extraction and Reporting Language (PERL) script that simplifies and automates the collection of information for forensic analysis of compromised computer systems. During such an analysis, it is sometimes necessary to collect and analyze information about files on a specific directory tree. Directory Tree Analysis File Generator collects information of this type (except information about directories) and writes it to a text file. In particular, the script asks the user for the root of the directory tree to be processed, the name of the output file, and the number of subtree levels to process. The script then processes the directory tree and puts out the aforementioned text file. The format of the text file is designed to enable the submission of the file as input to a spreadsheet program, wherein the forensic analysis is performed. The analysis usually consists of sorting files and examination of such characteristics of files as ownership, time of creation, and time of most recent access, all of which characteristics are among the data included in the text file.

  14. 47 CFR 1.1915 - Exploration of compromise.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... Federal Claims Collection Standards (31 CFR part 902). The Commission will also consider a request... justification of the offer and addressing the bases for compromise at 31 CFR 902.2. Debtors will provide full... evaluate an offer, using the factors set forth in 31 CFR 902.2 and, as appropriate, refer the offer...

  15. Making Treatment of Special Needs Patients an Important Part of Your Growing Dental Practice.

    PubMed

    Spangler, Craig C

    2016-07-01

    Today many young dentists want to find a way to make their practices satisfying in ways other than the financial rewards of dentistry. Some of these practitioners have gained additional training in diagnosis and treatment of medically and physically compromised patients in hospital-based, general practice residency programs. A hospital affiliation can create a unique niche that will allow dentists to differentiate themselves from other dentists. By welcoming those ongoing relationships for patients with special needs, and having the resources and desire to treat them, dentists will achieve greater visibility and a reputation as caring, capable practitioners in their community. PMID:27264856

  16. 49 CFR 1503.425 - Compromise orders.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 49 Transportation 9 2014-10-01 2014-10-01 false Compromise orders. 1503.425 Section 1503.425... Assessment of Civil Penalties by TSA § 1503.425 Compromise orders. (a) Issuance. At any time before the issuance of an Order Assessing Civil Penalty under this subpart, an agency attorney and a person subject...

  17. 49 CFR 1503.425 - Compromise orders.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 49 Transportation 9 2011-10-01 2011-10-01 false Compromise orders. 1503.425 Section 1503.425... Assessment of Civil Penalties by TSA § 1503.425 Compromise orders. (a) Issuance. At any time before the issuance of an Order Assessing Civil Penalty under this subpart, an agency attorney and a person subject...

  18. 48 CFR 1432.610 - Compromising debts.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false Compromising debts. 1432.610 Section 1432.610 Federal Acquisition Regulations System DEPARTMENT OF THE INTERIOR GENERAL CONTRACTING REQUIREMENTS CONTRACT FINANCING Contract Debts 1432.610 Compromising debts. The CO may...

  19. 26 CFR 301.7122-1 - Compromises.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... Secretary may, at the Secretary's discretion, compromise any civil or criminal liability arising under the internal revenue laws prior to reference of a case involving such a liability to the Department of Justice for prosecution or defense. (2) An agreement to compromise may relate to a civil or criminal...

  20. 27 CFR 70.482 - Offers in compromise of liabilities (other than forfeiture) under 26 U.S.C.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 26 U.S.C. (a) In general. The appropriate TTB officer may compromise any civil or criminal liability... involving such liability to the Department of Justice for prosecution or defense. (For compromise of forfeiture liability, see § 70.484 of this part.) Any such liability may be compromised only upon one or...

  1. Practice improvement, part II: update on patient communication technologies.

    PubMed

    Roett, Michelle A; Coleman, Mary Thoesen

    2013-11-01

    Patient portals (ie, secure web-based services for patient health record access) and secure messaging to health care professionals are gaining popularity slowly. Advantages of web portals include timely communication and instruction, access to appointments and other services, and high patient satisfaction. Limitations include inappropriate use, security considerations, organizational costs, and exclusion of patients who are uncomfortable with or unable to use computers. Attention to the organization's strategic plan and office policies, patient and staff expectations, workflow and communication integration, training, marketing, and enrollment can facilitate optimal use of this technology. Other communication technologies that can enhance patient care include automated voice or text reminders and brief electronic communications. Social media provide another method of patient outreach, but privacy and access are concerns. Incorporating telehealthcare (health care provided via telephone or Internet), providing health coaching, and using interactive health communication applications can improve patient knowledge and clinical outcomes and provide social support. PMID:24261435

  2. Corticosteroids compromise survival in glioblastoma.

    PubMed

    Pitter, Kenneth L; Tamagno, Ilaria; Alikhanyan, Kristina; Hosni-Ahmed, Amira; Pattwell, Siobhan S; Donnola, Shannon; Dai, Charles; Ozawa, Tatsuya; Chang, Maria; Chan, Timothy A; Beal, Kathryn; Bishop, Andrew J; Barker, Christopher A; Jones, Terreia S; Hentschel, Bettina; Gorlia, Thierry; Schlegel, Uwe; Stupp, Roger; Weller, Michael; Holland, Eric C; Hambardzumyan, Dolores

    2016-05-01

    Glioblastoma is the most common and most aggressive primary brain tumour. Standard of care consists of surgical resection followed by radiotherapy and concomitant and maintenance temozolomide (temozolomide/radiotherapy→temozolomide). Corticosteroids are commonly used perioperatively to control cerebral oedema and are frequently continued throughout subsequent treatment, notably radiotherapy, for amelioration of side effects. The effects of corticosteroids such as dexamethasone on cell growth in glioma models and on patient survival have remained controversial. We performed a retrospective analysis of glioblastoma patient cohorts to determine the prognostic role of steroid administration. A disease-relevant mouse model of glioblastoma was used to characterize the effects of dexamethasone on tumour cell proliferation and death, and to identify gene signatures associated with these effects. A murine anti-VEGFA antibody was used in parallel as an alternative for oedema control. We applied the dexamethasone-induced gene signature to The Cancer Genome Atlas glioblastoma dataset to explore the association of dexamethasone exposure with outcome. Mouse experiments were used to validate the effects of dexamethasone on survival in vivo Retrospective clinical analyses identified corticosteroid use during radiotherapy as an independent indicator of shorter survival in three independent patient cohorts. A dexamethasone-associated gene expression signature correlated with shorter survival in The Cancer Genome Atlas patient dataset. In glioma-bearing mice, dexamethasone pretreatment decreased tumour cell proliferation without affecting tumour cell viability, but reduced survival when combined with radiotherapy. Conversely, anti-VEGFA antibody decreased proliferation and increased tumour cell death, but did not affect survival when combined with radiotherapy. Clinical and mouse experimental data suggest that corticosteroids may decrease the effectiveness of treatment and shorten

  3. Female genital alteration: a compromise solution.

    PubMed

    Arora, Kavita Shah; Jacobs, Allan J

    2016-03-01

    Despite 30 years of advocacy, the prevalence of non-therapeutic female genital alteration (FGA) in minors is stable in many countries. Educational efforts have minimally changed the prevalence of this procedure in regions where it has been widely practiced. In order to better protect female children from the serious and long-term harms of some types of non-therapeutic FGA, we must adopt a more nuanced position that acknowledges a wide spectrum of procedures that alter female genitalia. We offer a revised categorisation for non-therapeutic FGA that groups procedures by effect and not by process. Acceptance of de minimis procedures that generally do not carry long-term medical risks is culturally sensitive, does not discriminate on the basis of gender, and does not violate human rights. More morbid procedures should not be performed. However, accepting de minimis non-therapeutic f FGA procedures enhances the effort of compassionate practitioners searching for a compromise position that respects cultural differences but protects the health of their patients. PMID:26902479

  4. Mutant Cullin causes cardiovascular compromise

    PubMed Central

    Luft, Friedrich C

    2015-01-01

    Mendelian hypertension is rare; however, Mendelian syndromes have taught us an amazing amount about mechanisms of distal sodium and chloride reabsorption, as well as how systemic hypertension might come about. In this issue of EMBO Molecular Medicine, Schumacher et al (2015) present a mouse model of the Cullin-3 (CUL3Δ403–459) mutation, which causes a form of pseudohypoaldosteronism type-2 (PHA-2). CUL3 is involved in ubiquitination. Surprising is the severity of the hypertension, which may be explained in part on the basis of CUL3 actions in vascular cells. The findings underscore the role of “cleanup” in the maintenance of normal physiology. PMID:26294796

  5. Patient-Centred Interviewing Part II: Finding Common Ground

    PubMed Central

    Brown, Judith Belle; Weston, W. Wayne; Stewart, Moira A.

    1989-01-01

    Developing an effective management plan requires physicians and patients to reach agreement in three key areas: the nature of the problems, the goals and priorities of treatment, and the roles of the doctor and patient. Often doctors and patients have widely divergent views in each of these areas. The process of finding a satisfactory resolution is not so much one of bargaining or negotiating but rather of moving towards a meeting of minds or finding common ground. This framework reminds physicians to incorporate patients' ideas, feelings, and expectations into treatment planning. PMID:21253279

  6. 28 CFR Appendix to Subpart Y of... - Redelegations of Authority To Compromise and Close Civil Claims

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 28 Judicial Administration 1 2010-07-01 2010-07-01 false Redelegations of Authority To Compromise and Close Civil Claims Appendix to Subpart Y of Part 0 Judicial Administration DEPARTMENT OF JUSTICE ORGANIZATION OF THE DEPARTMENT OF JUSTICE Authority To Compromise and Close Civil Claims and Responsibility for Judgments, Fines, Penalties,...

  7. 31 CFR 29.514 - Requests for waiver and/or compromise.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... standards set forth in the FCCS in 31 CFR part 902. (2) A waiver or compromise decision by the Department... Justice for consideration pursuant to 31 CFR 902.1(b). ... waiver and/or compromise. Individuals who receive a demand letter regarding an overpayment may ask...

  8. 28 CFR Appendix to Subpart Y of... - Redelegations of Authority To Compromise and Close Civil Claims

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 28 Judicial Administration 1 2013-07-01 2013-07-01 false Redelegations of Authority To Compromise and Close Civil Claims Appendix to Subpart Y of Part 0 Judicial Administration DEPARTMENT OF JUSTICE ORGANIZATION OF THE DEPARTMENT OF JUSTICE Authority To Compromise and Close Civil Claims and Responsibility for Judgments, Fines, Penalties,...

  9. 7 CFR 3.19 - Standards for the compromise of claims.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 1 2010-01-01 2010-01-01 false Standards for the compromise of claims. 3.19 Section 3.19 Agriculture Office of the Secretary of Agriculture DEBT MANAGEMENT Standards for the... follow the standards set forth in 31 CFR part 902 for the compromise of debts pursuant to 31 U.S.C....

  10. 7 CFR 3.19 - Standards for the compromise of claims.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... follow the standards set forth in 31 CFR part 902 for the compromise of debts pursuant to 31 U.S.C. 3711... 7 Agriculture 1 2012-01-01 2012-01-01 false Standards for the compromise of claims. 3.19 Section 3.19 Agriculture Office of the Secretary of Agriculture DEBT MANAGEMENT Standards for...

  11. 39 CFR 931.1 - Compromise of obligations.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 39 Postal Service 1 2010-07-01 2010-07-01 false Compromise of obligations. 931.1 Section 931.1 Postal Service UNITED STATES POSTAL SERVICE PROCEDURES RULES OF PROCEDURE GOVERNING THE COMPROMISE OF OBLIGATIONS § 931.1 Compromise of obligations. Any proposition of compromise shall be submitted in writing, and the amount offered in compromise...

  12. Part I: The Difficult Patient: Medical and Legal Approaches

    PubMed Central

    Ovens, Howard

    1989-01-01

    Difficult patients are defined as those who elicit strong negative emotions from their physicians. If not acknowledged and managed correctly, these feelings can lead to diagnostic errors, unpleasant confrontations, and troublesome complaints or legal claims. The author reviews common personalities and situations that are associated with difficult encounters in emergency departments and describes an approach stressing flexibility in communication and the early establishment of rapport. He discusses diagnostic possibilities in the agitated or confused, unco-operative patient, reviews relevant laws governing restraint and competence to consent, and outlines techniques to reduce medicolegal risks. PMID:21249058

  13. Radionuclide scrotal imaging: further experience with 210 patients. Part I. Anatomy, pathophysiology, and methods

    SciTech Connect

    Chen, D.C.P.; Holder, L.E.; Melloul, M.

    1983-08-01

    Ten years' experience with radionuclide scrotal imaging (RSI) to evaluate perfusion of the scrotal contents has confirmed the value of this examination. In 1973, Nadel et al. first proposed using sodium pertechnetate (Tc-99m) to diagnose testicular torsion. By the end of 1982, more than thirty articles have been published on this topic, with most emphasizing the usefulness of RSI in managing patients with acute scrotal pain. The present communication describes our findings in 210 patients, not previously reported. There were four groups with relatively distinct clinical presentations: (a) acute scrotal pain, (b) chronic scrotal pain, (c) scrotal injury, and (d) scrotal mass. The anatomic and pathophysiologic bases for the scan findings will be emphasized. We discuss the staging of testicular torsion; viability of the compromised testicle; variability in the presentation of acute infection; anatomy of trauma, varicocele, and inguinal hernia; and the correlation with scrotal sonography.

  14. Perpetually perplexing pediatric patients: it's complicated: part 2.

    PubMed

    Block, Stan L

    2015-01-01

    Many pediatric patients that you encounter will challenge your diagnostic and therapeutic skills. As the following cases will illustrate, some will perplex you with their esoteric or convoluted illnesses despite your best attempts. Although their initial presentation may often be mundane, thorough history taking and physical examination, and a keen "clinical intuition" will be invaluable. PMID:25594207

  15. Rheumatological management of patients with hemophilia. Part 1: joint manifestations.

    PubMed

    Alcalay, Michel; Deplas, Adeline

    2002-10-01

    The advent of factor VIII and IX replacement therapy has radically changed the physiognomy of hemophilia. In patients with no inhibitors, early replacement therapy shortens the immobilization and decreases the structural and functional alterations related to recurrent hemarthrosis. Routine prophylactic replacement therapy before or after the first episode of hemarthrosis is still rarely used in France. Recurrent hemarthrosis in the same joint can cause synovitis and chronic arthropathy. Injection synovectomy is now the preferred treatment, as opposed to secondary prophylactic replacement therapy and to arthroscopic or open synovectomy. The palliative treatment of chronic arthropathy is difficult and rests on analgesics and rehabilitation therapy, with orthotic devices and/or surgery where appropriate. The treatment of hemophilia is far more difficult in patients with inhibitors and, consequently, considerable hope is being placed in gene therapy, whose first results are encouraging. PMID:12477227

  16. Failing to forget: inhibitory-control deficits compromise memory suppression in posttraumatic stress disorder.

    PubMed

    Catarino, Ana; Küpper, Charlotte S; Werner-Seidler, Aliza; Dalgleish, Tim; Anderson, Michael C

    2015-05-01

    Most people have experienced distressing events that they would rather forget. Although memories of such events become less intrusive with time for the majority of people, those with posttraumatic stress disorder (PTSD) are afflicted by vivid, recurrent memories of their trauma. Often triggered by reminders in the daily environment, these memories can cause severe distress and impairment. We propose that difficulties with intrusive memories in PTSD arise in part from a deficit in engaging inhibitory control to suppress episodic retrieval. We tested this hypothesis by adapting the think/no-think paradigm to investigate voluntary memory suppression of aversive scenes cued by naturalistic reminders. Retrieval suppression was compromised significantly in PTSD patients, compared with trauma-exposed control participants. Furthermore, patients with the largest deficits in suppression-induced forgetting were also those with the most severe PTSD symptoms. These results raise the possibility that prefrontal mechanisms supporting inhibitory control over memory are impaired in PTSD. PMID:25847536

  17. Modeling the Dynamics of Compromised Networks

    SciTech Connect

    Soper, B; Merl, D M

    2011-09-12

    Accurate predictive models of compromised networks would contribute greatly to improving the effectiveness and efficiency of the detection and control of network attacks. Compartmental epidemiological models have been applied to modeling attack vectors such as viruses and worms. We extend the application of these models to capture a wider class of dynamics applicable to cyber security. By making basic assumptions regarding network topology we use multi-group epidemiological models and reaction rate kinetics to model the stochastic evolution of a compromised network. The Gillespie Algorithm is used to run simulations under a worst case scenario in which the intruder follows the basic connection rates of network traffic as a method of obfuscation.

  18. From function to esthetics: anterior or occlusal compromises to esthetics.

    PubMed

    Guichet, D L; Guichet, N F

    1993-01-01

    Increased patient expectations together with improved diagnostic, material, and surgical advances have expanded the boundaries of esthetic dentistry. To optimize functional and esthetic success, existing techniques are being enhanced through careful patient selection and management of the occlusion. During the period from 1991 to 1992, several areas relating anterior or occlusal compromises to esthetics have been identified. These include: dental and skeletal malocclusion, periodontal esthetic defects, restorative materials and laboratory techniques, tooth arrangement and maxillomandibular relations, and implant dentistry. This paper reviews some of the literature on these areas during this period. PMID:8401825

  19. Patient Cost Sharing and Receipt of Erythropoiesis-Stimulating Agents Through Medicare Part D

    PubMed Central

    Davidoff, Amy J.; Hendrick, Franklin B.; Zeidan, Amer M.; Baer, Maria R.; Stuart, Bruce C.; Shenolikar, Rahul A.; Gore, Steven D.

    2015-01-01

    Purpose: Medicare Part D prescription benefits cover injected medications, normally covered under Part B, when administered outside of physician offices. Erythropoiesis-stimulating agents (ESAs) used for chronic anemia management in patients with myelodysplastic syndromes (MDS) are commonly injected in a physician office but can be administered safely at home. In this study, we explored out-of-pocket (OOP) costs and receipt of Part D–covered ESAs in Medicare beneficiaries with MDS. Materials and Methods: Patients with MDS enrolled in Medicare Parts A, B, and D were identified using diagnosis codes from 100% claims from 2006 to 2008. OOP costs for the mean erythropoietin alfa claim were compared for Parts B and D. Multivariable models examined the effect of low-income subsidy (LIS) and other Part D cost sharing on receipt of any ESA and any Part D–covered ESA. Results: A total of 13,117 (62.9%) of 20,848 patients received ESAs, but only 1,436 (6.9%) had any Part D claim. OOP payment was $348 under Part D versus $161 under Part B. Among patients with ESA use, those with LIS were 4× more likely to receive Part D ESAs (P < .01). Conclusion: Few patients with MDS received ESAs through Part D. OOP payments required under Part D were substantially higher than under Part B. Cost sharing, as reflected by LIS receipt, likely affected decisions to prescribe ESAs outside of the physician office. Improved coordination between Part B and D benefits regarding issues of home injection of medications may create incentives that improve patient access and convenience and reduce costs associated with administration. PMID:25563701

  20. Patients with oral tumors. Part 1: Prosthetic rehabilitation following tumor resection.

    PubMed

    Fierz, Janine; Hallermann, Wok; Mericske-Stern, Regina

    2013-01-01

    The present study reports on the surgical and prosthodontic rehabilitation of 46 patients, 31 male and 15 female, after resection of oral tumors. The treatment was carried out from 2004 to 2007 at the Department of Prosthodontics, University of Bern, with a follow-up time of 3 to 6 years. The average age at diagnosis was 54 years. 76% of all tumors were squamous cell carcinoma, followed by adenocarcinoma. Resection of the tumors including soft and/or hard tissues was performed in all patients. 80% of them additionally underwent radiotherapy and 40% chemotherapy. A full block resection of the mandible was perfomed in 23 patients, and in 10 patients, the tumor resection resulted in an oronasal communication. 29 patients underwent grafting procedures, mostly consisting of a free fibula flap transplant. To enhance the prosthetic treatment outcome and improve the prosthesis stability, a total of 114 implants were placed. However, 14 implants were not loaded because they failed during the healing period or the patient could not complete the final treatment with the prostheses. The survival rate of the implants reached 84.2% after 4 to 5 years. Many patients were only partially dentate before the tumors were detected, and further teeth had to be extracted in the course of the tumor therapy. Altogether, 31 jaws became or remained edentulous. Implants provide stability and may facilitate the adaptation to the denture, but their survival rate was compromised. Mostly, patients were fitted with removable prostheses with obturators in the maxilla and implant-supported complete dentures with bars in the mandible. Although sequelae of tumor resection are similar in many patients, the individual intermaxillary relations, facial morphology and functional capacity vary significantly. Thus, individual management is required for prosthetic rehabilitation. PMID:23512240

  1. Preparing patients to travel abroad safely. Part 2: Updating vaccinations.

    PubMed Central

    Thomas, R. E.

    2000-01-01

    OBJECTIVE: To provide, for family physicians without access to a travel clinic, evidence-based recommendations on vaccinating infants and children, adults, pregnant women, and immunocompromised patients traveling to non-Western countries. QUALITY OF EVIDENCE: Searches were undertaken of MEDLINE from 1990 to November 1998 (372 articles); the Cochrane Collaboration Library; publications of the National Action Committee on Immunization and the Committee to Advise on Tropical Medicine and Travel in Canada Communicable Disease Reports; the Canadian Immunization Guide; and Laboratory Centre for Disease Control, United States Centres for Disease Control, and World Health Organization websites. Evidence-based statements, randomized controlled trials, systematic reviews, and meta-analyses were selected. Vaccination recommendations are based on this evidence. MAIN MESSAGE: Physicians should complete vaccination schedules for children whose primary series is incomplete and vaccinate unvaccinated adults. Hepatitis A is widespread, and travelers to areas where it is endemic should be vaccinated. The elderly should be vaccinated against influenza and pneumococcal disease. Pregnant women should receive vaccines appropriate to their trimester. Immunocompromised patients should be vaccinated, but BCG and live vaccines are contraindicated. Travelers to areas where meningitis, typhoid, cholera, Japanese encephalitis, and rabies are endemic should be vaccinated if they are likely to be exposed. Those traveling to areas where tuberculosis is endemic should take precautions and should have skin tests before traveling and 2 to 4 months after return. CONCLUSIONS: Family physicians can administer all necessary vaccinations. They can advise pregnant women and immunocompromised people about the balance of risk of disease and benefits of vaccination. PMID:10752003

  2. An Unstructured Workshop as a Training Compromise.

    ERIC Educational Resources Information Center

    Moore, R. J.

    1978-01-01

    Because of its poor labor relations and consequent public image, New Zealand's meat industry asked the University of Otago to provide management training. Describes difficulties in developing effective training acceptable to the industry, the compromise workshop approach involving questionnaires and diaries, and the workshop's qualified success.…

  3. 49 CFR 1503.425 - Compromise orders.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 49 Transportation 9 2012-10-01 2012-10-01 false Compromise orders. 1503.425 Section 1503.425 Transportation Other Regulations Relating to Transportation (Continued) TRANSPORTATION SECURITY ADMINISTRATION, DEPARTMENT OF HOMELAND SECURITY ADMINISTRATIVE AND PROCEDURAL RULES INVESTIGATIVE AND ENFORCEMENT PROCEDURES Assessment of Civil Penalties...

  4. 49 CFR 1503.425 - Compromise orders.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 9 2010-10-01 2010-10-01 false Compromise orders. 1503.425 Section 1503.425 Transportation Other Regulations Relating to Transportation (Continued) TRANSPORTATION SECURITY ADMINISTRATION, DEPARTMENT OF HOMELAND SECURITY ADMINISTRATIVE AND PROCEDURAL RULES INVESTIGATIVE AND ENFORCEMENT PROCEDURES Assessment of Civil Penalties...

  5. 48 CFR 232.616 - Compromise actions.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 48 Federal Acquisition Regulations System 3 2010-10-01 2010-10-01 false Compromise actions. 232.616 Section 232.616 Federal Acquisition Regulations System DEFENSE ACQUISITION REGULATIONS SYSTEM... actions. Only the department/agency contract financing offices (see 232.070(c)) are authorized...

  6. Political Compromise Makes the World Go 'Round

    ERIC Educational Resources Information Center

    Everett, Diana

    2007-01-01

    Compromise in any context is often hard to accept. It feels like a person is giving up on his or her ideals. This is especially true in dealing with politics. Legislative and congressional bills can be written with the highest of ideals in mind. By the time the bill progresses through committees and the floor debate process, it can look like a…

  7. 40 CFR 13.25 - Standards for compromise.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 40 Protection of Environment 1 2010-07-01 2010-07-01 false Standards for compromise. 13.25 Section 13.25 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY GENERAL CLAIMS COLLECTION STANDARDS Compromise of Debts § 13.25 Standards for compromise. (a) EPA may compromise a claim pursuant to this...

  8. 38 CFR 1.931 - Bases for compromise.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Bases for compromise. 1.931 Section 1.931 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS GENERAL PROVISIONS Standards for Compromise of Claims § 1.931 Bases for compromise. (a) VA may compromise a debt if it cannot collect the full amount because:...

  9. Gender Differences in the Readiness To Accept Career Compromise.

    ERIC Educational Resources Information Center

    Gati, Itamar

    Most career decisions involve compromises. The need to compromise can be attributed to the fact that the characteristics of the options in the occupational world do not necessarily match the ideal career image of the career decision maker. This study examined the readiness to compromise and the content of compromise in 1,252 deliberating women and…

  10. 31 CFR 902.5 - Further review of compromise offers.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Further review of compromise offers... COMPROMISE OF CLAIMS § 902.5 Further review of compromise offers. If an agency is uncertain whether to accept a firm, written, substantive compromise offer on a debt that is within the agency's...

  11. Patient participation as an integral part of patient-reported outcomes development ensures the representation of the patient voice: a case study from the field of rheumatology

    PubMed Central

    de Wit, M P T; Kvien, T K; Gossec, L

    2015-01-01

    Introduction Patient-reported outcomes (PROs) are important instruments to evaluate healthcare interventions, both in clinical practice and clinical research. Objective To describe how representation of the perspective of people with psoriatic arthritis was obtained through active participation on different levels in the development of PROs. Methods This case study focuses on the methods of involving patients in the elaboration and validation of the Psoriatic Arthritis Impact of Disease (PsAID) score. We used the concept of the participation ladder and the European League Against Rheumatism (EULAR) recommendations for the involvement of patient representatives in scientific projects to analyse the variety of ways patients participated in this process. Results Two patient experts were part of the steering group. 12 patient research partners, coming from 12 different European countries, participated in identifying domains, formulating items for the questionnaire and determining the number of items, the recall period and the questionnaire format. They also helped with the translation of the items into different European languages. Then, 139 patients took part in ranking and prioritising the domains for importance; 65 patients were involved in cognitive debriefing interviews; 499 new patients were recruited for the validation study. Challenges of patient participation in PRO development, such as the representation of patients, are discussed. Conclusions Making patient participation an integral part of the PRO development and validation process is an important requisite for outcome research. The variety of patient contributions at different phases in this case study resulted in an instrument with high face validity. PMID:26509075

  12. 46 CFR Appendix A to Subpart W of... - Example of Compromise Agreement To Be Used Under 46 CFR 502.604

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 46 Shipping 9 2011-10-01 2011-10-01 false Example of Compromise Agreement To Be Used Under 46 CFR 502.604 A Appendix A to Subpart W of Part 502 Shipping FEDERAL MARITIME COMMISSION GENERAL AND... Compromise Agreement To Be Used Under 46 CFR 502.604 Compromise Agreement FMC File No. ____ This Agreement...

  13. 46 CFR Appendix A to Subpart W of... - Example of Compromise Agreement To Be Used Under 46 CFR 502.604

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 46 Shipping 9 2014-10-01 2014-10-01 false Example of Compromise Agreement To Be Used Under 46 CFR 502.604 A Appendix A to Subpart W of Part 502 Shipping FEDERAL MARITIME COMMISSION GENERAL AND... Compromise Agreement To Be Used Under 46 CFR 502.604 Compromise Agreement FMC File No. ____ This Agreement...

  14. 46 CFR Appendix A to Subpart W of... - Example of Compromise Agreement To Be Used Under 46 CFR 502.604

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 46 Shipping 9 2010-10-01 2010-10-01 false Example of Compromise Agreement To Be Used Under 46 CFR 502.604 A Appendix A to Subpart W of Part 502 Shipping FEDERAL MARITIME COMMISSION GENERAL AND... Compromise Agreement To Be Used Under 46 CFR 502.604 Compromise Agreement FMC File No. ____ This Agreement...

  15. 46 CFR Appendix A to Subpart W of... - Example of Compromise Agreement To Be Used Under 46 CFR 502.604

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 46 Shipping 9 2013-10-01 2013-10-01 false Example of Compromise Agreement To Be Used Under 46 CFR 502.604 A Appendix A to Subpart W of Part 502 Shipping FEDERAL MARITIME COMMISSION GENERAL AND... Compromise Agreement To Be Used Under 46 CFR 502.604 Compromise Agreement FMC File No. ____ This Agreement...

  16. 46 CFR Appendix A to Subpart W of... - Example of Compromise Agreement To Be Used Under 46 CFR 502.604

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 46 Shipping 9 2012-10-01 2012-10-01 false Example of Compromise Agreement To Be Used Under 46 CFR 502.604 A Appendix A to Subpart W of Part 502 Shipping FEDERAL MARITIME COMMISSION GENERAL AND... Compromise Agreement To Be Used Under 46 CFR 502.604 Compromise Agreement FMC File No. ____ This Agreement...

  17. Patient-specific radiation dose and cancer risk estimation in CT: Part II. Application to patients

    SciTech Connect

    Li Xiang; Samei, Ehsan; Segars, W. Paul; Sturgeon, Gregory M.; Colsher, James G.; Toncheva, Greta; Yoshizumi, Terry T.; Frush, Donald P.

    2011-01-15

    Purpose: Current methods for estimating and reporting radiation dose from CT examinations are largely patient-generic; the body size and hence dose variation from patient to patient is not reflected. Furthermore, the current protocol designs rely on dose as a surrogate for the risk of cancer incidence, neglecting the strong dependence of risk on age and gender. The purpose of this study was to develop a method for estimating patient-specific radiation dose and cancer risk from CT examinations. Methods: The study included two patients (a 5-week-old female patient and a 12-year-old male patient), who underwent 64-slice CT examinations (LightSpeed VCT, GE Healthcare) of the chest, abdomen, and pelvis at our institution in 2006. For each patient, a nonuniform rational B-spine (NURBS) based full-body computer model was created based on the patient's clinical CT data. Large organs and structures inside the image volume were individually segmented and modeled. Other organs were created by transforming an existing adult male or female full-body computer model (developed from visible human data) to match the framework defined by the segmented organs, referencing the organ volume and anthropometry data in ICRP Publication 89. A Monte Carlo program previously developed and validated for dose simulation on the LightSpeed VCT scanner was used to estimate patient-specific organ dose, from which effective dose and risks of cancer incidence were derived. Patient-specific organ dose and effective dose were compared with patient-generic CT dose quantities in current clinical use: the volume-weighted CT dose index (CTDI{sub vol}) and the effective dose derived from the dose-length product (DLP). Results: The effective dose for the CT examination of the newborn patient (5.7 mSv) was higher but comparable to that for the CT examination of the teenager patient (4.9 mSv) due to the size-based clinical CT protocols at our institution, which employ lower scan techniques for smaller

  18. Interactive dose shaping part 2: proof of concept study for six prostate patients

    NASA Astrophysics Data System (ADS)

    Kamerling, Cornelis Ph; Ziegenhein, Peter; Sterzing, Florian; Oelfke, Uwe

    2016-03-01

    Recently we introduced interactive dose shaping (IDS) as a new IMRT planning strategy. This planning concept is based on a hierarchical sequence of local dose modification and recovery operations. The purpose of this work is to provide a feasibility study for the IDS planning strategy based on a small set of six prostate patients. The IDS planning paradigm aims to perform interactive local dose adaptations of an IMRT plan without compromising already established valuable dose features in real-time. Various IDS tools were developed in our in-house treatment planning software Dynaplan and were utilized to create IMRT treatment plans for six patients with an adeno-carcinoma of the prostate. The sequenced IDS treatment plans were compared to conventionally optimized clinically approved plans (9 beams, co-planar). For each patient, several IDS plans were created, with different trade-offs between organ sparing and target coverage. The reference dose distributions were imported into Dynaplan. For each patient, the IDS treatment plan with a similar or better trade-off between target coverage and OAR sparing was selected for plan evaluation, guided by a physician. For this initial study we were able to generate treatment plans for prostate geometries in 15-45 min. Individual local dose adaptations could be performed in less than one second. The average differences compared to the reference plans were for the mean dose: 0.0 Gy (boost) and 1.2 Gy (PTV), for {{D}98%}:-1.1 Gy and for {{D}2%}:1.1 Gy (both target volumes). The dose-volume quality indicators were well below the Quantec constraints. However, we also observed limitations of our currently implemented approach. Most prominent was an increase of the non-tumor integral dose by 16.4% on average, demonstrating that further developments of our planning strategy are required.

  19. Interactive dose shaping part 2: proof of concept study for six prostate patients.

    PubMed

    Ph Kamerling, Cornelis; Ziegenhein, Peter; Sterzing, Florian; Oelfke, Uwe

    2016-03-21

    Recently we introduced interactive dose shaping (IDS) as a new IMRT planning strategy. This planning concept is based on a hierarchical sequence of local dose modification and recovery operations. The purpose of this work is to provide a feasibility study for the IDS planning strategy based on a small set of six prostate patients. The IDS planning paradigm aims to perform interactive local dose adaptations of an IMRT plan without compromising already established valuable dose features in real-time. Various IDS tools were developed in our in-house treatment planning software Dynaplan and were utilized to create IMRT treatment plans for six patients with an adeno-carcinoma of the prostate. The sequenced IDS treatment plans were compared to conventionally optimized clinically approved plans (9 beams, co-planar). For each patient, several IDS plans were created, with different trade-offs between organ sparing and target coverage. The reference dose distributions were imported into Dynaplan. For each patient, the IDS treatment plan with a similar or better trade-off between target coverage and OAR sparing was selected for plan evaluation, guided by a physician. For this initial study we were able to generate treatment plans for prostate geometries in 15-45 min. Individual local dose adaptations could be performed in less than one second. The average differences compared to the reference plans were for the mean dose: 0.0 Gy (boost) and 1.2 Gy (PTV), for D98% : -1.1 Gy and for D2% : 1.1 Gy (both target volumes). The dose-volume quality indicators were well below the Quantec constraints. However, we also observed limitations of our currently implemented approach. Most prominent was an increase of the non-tumor integral dose by 16.4% on average, demonstrating that further developments of our planning strategy are required. PMID:26948274

  20. Identifying genetic relatives without compromising privacy

    PubMed Central

    He, Dan; Furlotte, Nicholas A.; Hormozdiari, Farhad; Joo, Jong Wha J.; Wadia, Akshay; Ostrovsky, Rafail; Sahai, Amit; Eskin, Eleazar

    2014-01-01

    The development of high-throughput genomic technologies has impacted many areas of genetic research. While many applications of these technologies focus on the discovery of genes involved in disease from population samples, applications of genomic technologies to an individual’s genome or personal genomics have recently gained much interest. One such application is the identification of relatives from genetic data. In this application, genetic information from a set of individuals is collected in a database, and each pair of individuals is compared in order to identify genetic relatives. An inherent issue that arises in the identification of relatives is privacy. In this article, we propose a method for identifying genetic relatives without compromising privacy by taking advantage of novel cryptographic techniques customized for secure and private comparison of genetic information. We demonstrate the utility of these techniques by allowing a pair of individuals to discover whether or not they are related without compromising their genetic information or revealing it to a third party. The idea is that individuals only share enough special-purpose cryptographically protected information with each other to identify whether or not they are relatives, but not enough to expose any information about their genomes. We show in HapMap and 1000 Genomes data that our method can recover first- and second-order genetic relationships and, through simulations, show that our method can identify relationships as distant as third cousins while preserving privacy. PMID:24614977

  1. National Lipid Association Recommendations for Patient-Centered Management of Dyslipidemia: Part 2.

    PubMed

    Jacobson, Terry A; Maki, Kevin C; Orringer, Carl E; Jones, Peter H; Kris-Etherton, Penny; Sikand, Geeta; La Forge, Ralph; Daniels, Stephen R; Wilson, Don P; Morris, Pamela B; Wild, Robert A; Grundy, Scott M; Daviglus, Martha; Ferdinand, Keith C; Vijayaraghavan, Krishnaswami; Deedwania, Prakash C; Aberg, Judith A; Liao, Katherine P; McKenney, James M; Ross, Joyce L; Braun, Lynne T; Ito, Matthew K; Bays, Harold E; Brown, W Virgil

    2015-01-01

    An Expert Panel convened by the National Lipid Association previously developed a consensus set of recommendations for the patient-centered management of dyslipidemia in clinical medicine (part 1). These were guided by the principle that reducing elevated levels of atherogenic cholesterol (non-high-density lipoprotein cholesterol and low-density lipoprotein cholesterol) reduces the risk for atherosclerotic cardiovascular disease. This document represents a continuation of the National Lipid Association recommendations developed by a diverse panel of experts who examined the evidence base and provided recommendations regarding the following topics: (1) lifestyle therapies; (2) groups with special considerations, including children and adolescents, women, older patients, certain ethnic and racial groups, patients infected with human immunodeficiency virus, patients with rheumatoid arthritis, and patients with residual risk despite statin and lifestyle therapies; and (3) strategies to improve patient outcomes by increasing adherence and using team-based collaborative care. PMID:26699442

  2. Graphical electrocardiogram waveforms as part of an integrated hospital system's patient record.

    PubMed Central

    Enison, E. J.; Dayhoff, R.; Fletcher, R. D.

    1993-01-01

    The U.S. Department of Veterans Affairs (VA) has an ongoing project to integrate diagnostic images into its existing text-based hospital information system. High-quality images from cardiology, pulmonary medicine, gastroenterology, endoscopy, pathology, radiology, hematology and nuclear medicine can be displayed for clinicians quickly and conveniently on workstations throughout the hospital. As a part of this endeavor, diagnostic-quality computer generated 12-lead electrocardiograms, including both median and rhythm data, can be viewed as a part of the on-line patient record of an integrated hospital information system. Now computer generated graphics can be included in the longitudinal patient record. Incorporating generated graphics and images into a text based patient record is another step towards the next generation of integrated hospital information system with multimedia patient records. PMID:8130498

  3. “The Heart Game”: Using Gamification as Part of a Telerehabilitation Program for Heart Patients

    PubMed Central

    Dithmer, Marcus; Grönvall, Erik; Spindler, Helle; Hansen, John; Nielsen, Gitte; Sørensen, Stine Bæk; Dinesen, Birthe

    2016-01-01

    Abstract Objective: The aim of this article is to describe the development and testing of a prototype application (“The Heart Game”) using gamification principles to assist heart patients in their telerehabilitation process in the Teledialog project. Materials and Methods: A prototype game was developed via user-driven innovation and tested on 10 patients 48–89 years of age and their relatives for a period of 2 weeks. The application consisted of a series of daily challenges given to the patients and relatives and was based on several gamification principles. A triangulation of data collection techniques (interviews, participant observations, focus group interviews, and workshop) was used. Interviews with three healthcare professionals and 10 patients were carried out over a period of 2 weeks in order to evaluate the use of the prototype. Results: The heart patients reported the application to be a useful tool as a part of their telerehabilitation process in everyday life. Gamification and gameful design principles such as leaderboards, relationships, and achievements engaged the patients and relatives. The inclusion of a close relative in the game motivated the patients to perform rehabilitation activities. Conclusions: “The Heart Game” concept presents a new way to motivate heart patients by using technology as a social and active approach to telerehabilitation. The findings show the potential of using gamification for heart patients as part of a telerehabilitation program. The evaluation indicated that the inclusion of the patient's spouse in the rehabilitation activities could be an effective strategy. A major challenge in using gamification for heart patients is avoiding a sense of defeat while still adjusting the level of difficulty to the individual patient. PMID:26579590

  4. Evaluation and diagnosis of the hair loss patient: part I. History and clinical examination.

    PubMed

    Mubki, Thamer; Rudnicka, Lidia; Olszewska, Malgorzata; Shapiro, Jerry

    2014-09-01

    Hair loss (alopecia) is a common problem and is often a major source of distress for patients. The differential diagnosis of alopecia includes both scarring and nonscarring alopecias. In addition, many hair shaft disorders can produce hair shaft fragility, resulting in different patterns of alopecia. Therefore, an organized and systematic approach is needed to accurately address patients' complaints to achieve the correct diagnosis. Part 1 of this 2-part continuing medical education article on alopecia describes history taking and the clinical examination of different hair loss disorders. It also provides an algorithmic diagnostic approach based on the most recent knowledge about different types of alopecia. PMID:25128118

  5. 49 CFR 89.13 - Documentary evidence of compromise.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 1 2010-10-01 2010-10-01 false Documentary evidence of compromise. 89.13 Section 89.13 Transportation Office of the Secretary of Transportation IMPLEMENTATION OF THE FEDERAL CLAIMS COLLECTION ACT General § 89.13 Documentary evidence of compromise. A compromise of any claim is not final...

  6. 49 CFR 89.13 - Documentary evidence of compromise.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 49 Transportation 1 2011-10-01 2011-10-01 false Documentary evidence of compromise. 89.13 Section 89.13 Transportation Office of the Secretary of Transportation IMPLEMENTATION OF THE FEDERAL CLAIMS COLLECTION ACT General § 89.13 Documentary evidence of compromise. A compromise of any claim is not final...

  7. 26 CFR 300.3 - Offer to compromise fee.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 26 Internal Revenue 18 2010-04-01 2010-04-01 false Offer to compromise fee. 300.3 Section 300.3... ADMINISTRATION USER FEES § 300.3 Offer to compromise fee. (a) Applicability. This section applies to the... provided in this section, this fee applies to all offers to compromise accepted for processing. (b) Fee....

  8. 20 CFR 340.13 - Compromise of amounts recoverable.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... INSURANCE ACT RECOVERY OF BENEFITS § 340.13 Compromise of amounts recoverable. The Board or its designee may compromise an amount recoverable, provided such amount does not exceed $100,000, excluding interest, or such... 20 Employees' Benefits 1 2010-04-01 2010-04-01 false Compromise of amounts recoverable....

  9. 31 CFR 902.2 - Bases for compromise.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 31 Money and Finance:Treasury 3 2011-07-01 2011-07-01 false Bases for compromise. 902.2 Section 902.2 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) FEDERAL CLAIMS COLLECTION STANDARDS (DEPARTMENT OF THE TREASURY-DEPARTMENT OF JUSTICE) STANDARDS FOR THE COMPROMISE OF CLAIMS § 902.2 Bases for compromise....

  10. 49 CFR 89.13 - Documentary evidence of compromise.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 49 Transportation 1 2013-10-01 2013-10-01 false Documentary evidence of compromise. 89.13 Section 89.13 Transportation Office of the Secretary of Transportation IMPLEMENTATION OF THE FEDERAL CLAIMS COLLECTION ACT General § 89.13 Documentary evidence of compromise. A compromise of any claim is not final...

  11. 49 CFR 89.13 - Documentary evidence of compromise.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 49 Transportation 1 2012-10-01 2012-10-01 false Documentary evidence of compromise. 89.13 Section 89.13 Transportation Office of the Secretary of Transportation IMPLEMENTATION OF THE FEDERAL CLAIMS COLLECTION ACT General § 89.13 Documentary evidence of compromise. A compromise of any claim is not final...

  12. 49 CFR 89.13 - Documentary evidence of compromise.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 49 Transportation 1 2014-10-01 2014-10-01 false Documentary evidence of compromise. 89.13 Section 89.13 Transportation Office of the Secretary of Transportation IMPLEMENTATION OF THE FEDERAL CLAIMS COLLECTION ACT General § 89.13 Documentary evidence of compromise. A compromise of any claim is not final...

  13. 5 CFR 185.146 - Compromise or settlement.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Compromise or settlement. 185.146 Section 185.146 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PROGRAM FRAUD CIVIL REMEDIES § 185.146 Compromise or settlement. (a) Parties may make offers of compromise...

  14. 49 CFR 1018.71 - Referral of a compromise offer.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 8 2010-10-01 2010-10-01 false Referral of a compromise offer. 1018.71 Section... § 1018.71 Referral of a compromise offer. The Board may refer a debtor's firm written offer of compromise which is substantial in amount to GAO or to DOJ if the Board is uncertain whether the offer should...

  15. 27 CFR 70.436 - Offers in compromise.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 2 2010-04-01 2010-04-01 false Offers in compromise. 70.436 Section 70.436 Alcohol, Tobacco Products and Firearms ALCOHOL AND TOBACCO TAX AND TRADE BUREAU... Cigarette Papers and Tubes § 70.436 Offers in compromise. Procedure in the case of offers in compromise...

  16. 27 CFR 70.415 - Offers in compromise.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 2 2010-04-01 2010-04-01 false Offers in compromise. 70.415 Section 70.415 Alcohol, Tobacco Products and Firearms ALCOHOL AND TOBACCO TAX AND TRADE BUREAU... Beer § 70.415 Offers in compromise. Procedure in the case of offers in compromise of liabilities...

  17. Integrative Analyses of Uterine Transcriptome and MicroRNAome Reveal Compromised LIF-STAT3 Signaling and Progesterone Response in the Endometrium of Patients with Recurrent/Repeated Implantation Failure (RIF)

    PubMed Central

    Lim, Eun Jin; Park, Miseon; Yoon, Jung Ah; Kim, Yeon Sun; Kim, Eun-Kyung; Shin, Ji-Eun; Kim, Ji Hyang; Kwon, Hwang; Song, Haengseok; Choi, Dong-Hee

    2016-01-01

    Intimate two-way interactions between the implantation-competent blastocyst and receptive uterus are prerequisite for successful embryo implantation. In humans, recurrent/repeated implantation failure (RIF) may occur due to altered uterine receptivity with aberrant gene expression in the endometrium as well as genetic defects in embryos. Several studies have been performed to understand dynamic changes of uterine transcriptome during menstrual cycles in humans. However, uterine transcriptome of the patients with RIF has not been clearly investigated yet. Here we show that several signaling pathways as well as many genes and microRNAs are dysregulated in the endometrium of patients with RIF (RIFE). Whereas unsupervised hierarchical clustering showed that overall mRNA and microRNA profiles of RIFE were similar to those of endometria of healthy women, many genes were significantly dysregulated in RIFE (cut off at 1.5 fold change). The majority (~75%) of differentially expressed genes in RIFE including S100 calcium binding protein P (S100P), Chemokine (C-X-C motif) ligand 13 (CXCL13) and SIX homeobox 1 (SIX1) were down-regulated, suggesting that reduced uterine expression of these genes is associated with RIF. Gene Set Enrichment analyses (GSEA) for mRNA microarrays revealed that various signaling pathways including Leukemia inhibitory factor (LIF) signaling and a P4 response were dysregulated in RIFE although expression levels of Estrogen receptor α (ERα) and Progesterone receptor (PR) were not significantly altered in RIFE. Furthermore, expression and phosphorylation of Signal transducer and activator of transcription 3 (STAT3) are reduced and a gene set associated with Janus kinase (JAK)-STAT signaling pathway is systemically down-regulated in these patients. Pairwise analyses of microRNA arrays with prediction of dysregulated microRNAs based on mRNA expression datasets demonstrated that 6 microRNAs are aberrantly regulated in RIFE. Collectively, we here suggest

  18. Institutional Commitments, Individual Compromises: Identity-Related Responses to Compromise in an Australian University

    ERIC Educational Resources Information Center

    Churchman, Deborah

    2006-01-01

    This study explores compromises by individual academic staff, which reflect their multiple understandings of academic work. I offer a brief overview of the changing Australian tertiary sector environment and the ways in which this has had an impact on the academic role. The discussion centres around the need for investigations of academia to be…

  19. The spatial encoding of body parts in patients with neglect and neurologically unimpaired participants.

    PubMed

    Sposito, Ambra V; Bolognini, Nadia; Vallar, Giuseppe; Posteraro, Lucio; Maravita, Angelo

    2010-01-01

    Body parts are represented in the brain in a very specific fashion, as compared to other three-dimensional objects, with reference to their prototypic shape and multisensory coding. However, evidence is lacking about the spatial representation of body parts. To address this issue, in Experiment 1 we first compared the metric representation of body parts and of non-bodily objects in 14 right-brain-damaged patients with left unilateral spatial neglect (USN), and in 14 neurologically unimpaired control participants. Participants bisected, by manual pointing, a three-dimensional object, or their own left forearm. Patients showed the well-known ipsilesional rightward displacement of the subjective midpoint, in both forearm and solid bisection. Both USN patients and control participants were overall more accurate in the bisection of their own forearm, relative to the extracorporeal object. In four patients this advantage of the forearm was significant in a single-case analysis, while two patients showed the opposite dissociation, being more accurate with the solid object. In Experiment 2 neurologically unimpaired participants were more accurate in the bisection of a fake forearm, as well as of their own forearm, as compared to the extrapersonal object. Overall, the results indicate that the representation of the metric of the body is more reliable than that of extrapersonal objects, and also more resistant to the disruption of spatial representations brought about by USN, possibly due to the prototypical shape of body parts. Furthermore, the double dissociation found in USN patients suggests that the metrics of body parts and of extrapersonal objects are supported by independent spatial processes. PMID:19800899

  20. Putting patients first: patient-centered care: more than the sum of its parts.

    PubMed

    Frampton, Susan B; Guastello, Sara

    2010-09-01

    This is the seventh and last in a series of articles from Planetree, an international non profit organization founded in 1978 that's "committed to improving medical care from the patient's perspective." For more information, go to www.planetree.org. To register for a free Webinar based on this series that starts on September 21, go to http://bit.ly/aezmEu. PMID:20736711

  1. How End-Stage Renal Disease Patients Manage the Medicare Part D Coverage Gap

    ERIC Educational Resources Information Center

    Kovacs, Pamela J.; Perkins, Nathan; Nuschke, Elizabeth; Carroll, Norman

    2012-01-01

    Medicare Part D was enacted to help elderly and disabled individuals pay for prescription drugs, but it was structured with a gap providing no coverage in 2010 between $2,830 and $6,440. Patients with end-stage renal disease (ESRD) are especially likely to be affected due to high costs of dialysis-related drugs and the importance of adherence for…

  2. Internal Fixation Versus Nonoperative Treatment for Displaced 3-Part or 4-Part Proximal Humeral Fractures in Elderly Patients: A Meta-Analysis of Randomized Controlled Trials

    PubMed Central

    Li, Jing; Chen, Aimin

    2013-01-01

    Background A few studies focused on open reduction and internal fixation (ORIF) or nonoperative treatment of displaced 3-part or 4-part proximal humeral fractures in elderly patients have been published, all of whom had a low number of patients. In this meta-analysis of randomized controlled trials (RCTs), we aimed to assess the effect of ORIF or nonoperative treatment of displaced 3-part or 4-part proximal humeral fractures in elderly patients on the clinical outcomes and re-evaluate of the potential benefits of conservative treatment. Methods We searched PubMed and the Cochrane Central Register of Controlled Trials databases for randomized controlled trials comparing ORIF and nonoperative treatment of displaced 3-part or 4-part proximal humeral fractures in elderly patients. Our outcome measures were the Constant scores. Results: Three randomized controlled trials with a total of 130 patients were identified and analyzed. The overall results based on fixed-effect model did not support the treatment of open reduction and internal fixation to improve the functional outcome when compared with nonoperative treatment for treating elderly patients with displaced 3-part or 4-part proximal humeral fractures (WMD −0.51, 95% CI: −7.25 to 6.22, P = 0.88, I2 = 0%). Conclusions Although our meta-analysis did not support the treatment of open reduction and internal fixation to improve the functional outcome when compared with nonoperative treatment for treating elderly patients with displaced 3-part or 4-part proximal humeral fractures, this result must be considered in the context of variable patient demographics. Only a limited recommendation can be made based on current data. Considering the limitations of included studies, a large, well designed trial that incorporates the evaluation of clinically relevant outcomes in participants with different underlying risks of shoulder function is required to more adequately assess the role for ORIF or nonoperative

  3. Conflict and Compromise: Catholic and Public Hospital Partnerships

    PubMed Central

    Wall, Barbra Mann

    2010-01-01

    This article analyzes the tensions and uneasy negotiations, based on a case study, that occurred among Catholic sisters, administrators, bishops, physicians, and the Vatican for more than seven years at a hospital in Austin, Texas. Here, the largest health care system in the city, which was Catholic, joined with the local public, tax-supported hospital that provided the majority of reproductive health care services in the region. A clash resulted over whether the hospital could continue providing sterilization and contraceptive services to its primarily poor patients. This article examines the fierce debates that occurred, especially over emergency contraception and attempts to develop creative solutions after a hierarchical crackdown from the Vatican. The end result was a compromise that included the creation of a “hospital within a hospital.” PMID:20067093

  4. A new paradigm in patient education: a four-part model using videotape production.

    PubMed

    Meymandi, A; Deaver, E L

    1999-06-01

    In this article, the effectiveness of an instructional videotape for newly admitted hospitalized psychiatric patients is discussed and evaluated. It is suggested that by using 'actors' with whom the patient is familiar (hospital staff), the educational and therapeutic benefit of the video is enhanced. This paper provides a method for pre-production planning of an effective videotape based on a four-part model. In this model, the educational subject matter is divided into four categories; facts, procedures, support, and mastery. An attempt is made to match various styles of presentation by each member of the treatment team to the nature of the part being presented. The short attention span common to newly admitted depressed patients, for example, is remedied by the use of concise messages delivered by each treatment team member. Although videotapes are not a substitute for one-to-one professional interaction, they can provide some basic understanding of the therapeutic environment and allay some of the fears that often plague the newly admitted patient. This paper also demonstrates how the use of videotaped instruction allows the treatment team to administer organized information using unlicensed personnel or the patient himself, thus conserving the professional staff's time. PMID:10633670

  5. Patients' Perceptions of Endodontic Treatment as Part of Public Health Services: A Qualitative Study.

    PubMed

    Melgaço-Costa, José Leonardo Barbosa; Martins, Renata Castro; Ferreira, Efigênia Ferreira; Sobrinho, Antônio Paulino Ribeiro

    2016-01-01

    Evaluations by patients constitute an important part of the process of improving health services. This study examined patients' perceptions of secondary dental care in three cities in Minas Gerais, Brazil based on the endodontic treatment received. Data were collected using semi-structured interviews (addressing access, treatment and results) and a field diary (direct observations and report of professionals). The interviews were audiotaped, fully transcribed, and analyzed using content analysis. Two principal themes were identified: access to service and quality of service. The difficulties in accessing service were associated with the insufficient number of professionals to meet the high demand for endodontic treatment, problems in referring from primary to secondary care and geographic barriers. Service quality was related to the presence/absence of pain and anxiety that patients experienced, the time and number of sessions required to complete treatment, how patients were treated by dentists, and whether those patients would recommend the service to other patients. Access to endodontic treatment was a problem emphasized by users, and satisfaction with the quality of the service was more related to how patients were treated than to the technical competence of the dentist. PMID:27128932

  6. Athletics' Little Sisters. Women's Colleges Face Pressure To Score Higher, but Fear Compromising Their Ideals.

    ERIC Educational Resources Information Center

    Jacobson, Jennifer

    2003-01-01

    Women's colleges, which have generally considered sports an integral part of academic life, now face pressures to compete with coed institutions at which sports have taken on a more competitive attitude. Many fear compromising their ideals if they endeavor to match the athletic programs of other institutions. (SLD)

  7. 20 CFR 725.544 - Collection and compromise of claims for overpayment.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 20 Employees' Benefits 3 2011-04-01 2011-04-01 false Collection and compromise of claims for... OF LABOR FEDERAL COAL MINE HEALTH AND SAFETY ACT OF 1969, AS AMENDED CLAIMS FOR BENEFITS UNDER PART C OF TITLE IV OF THE FEDERAL MINE SAFETY AND HEALTH ACT, AS AMENDED Payment of Benefits...

  8. 20 CFR 725.544 - Collection and compromise of claims for overpayment.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false Collection and compromise of claims for... LABOR FEDERAL COAL MINE HEALTH AND SAFETY ACT OF 1969, AS AMENDED CLAIMS FOR BENEFITS UNDER PART C OF TITLE IV OF THE FEDERAL MINE SAFETY AND HEALTH ACT, AS AMENDED Payment of Benefits...

  9. Fabricating an immediate denture for a medically compromised elderly patient.

    PubMed

    Lee, Ju-Hyoung

    2015-04-01

    Fabricating an immediate denture (ID) in the conventional manner may be complicated and difficult. An alternative technique is described for the fabrication of an ID that eliminates the need for an interim prosthesis and reduces treatment time. PMID:25681356

  10. Patients with atrial fibrillation undergoing percutaneous coronary intervention: current concepts and concerns: part II.

    PubMed

    Dzeshka, Mikhail S; Brown, Richard A; Lip, Gregory Y H

    2015-01-01

    Atrial fibrillation (AF) and coronary artery disease (CAD) often present concomitantly. Given the increased risk of thrombotic complications with either of them but different pathogenesis of clot formation, combined antithrombotic therapy is necessary in patients developing acute coronary syndrome and/or undergoing percutaneous coronary intervention (PCI). Different antithrombotic regimens in this group of patients have been summarized and discussed earlier. Triple therapy remains the treatment of choice in these patients despite the increased risk of hemorrhagic complications. Given the absence of evidence from randomized controlled trials, balancing the risk of stroke and stent thrombosis against the risk of major bleeding is a challenge. Precise stroke and bleeding risk assessment is an essential part of the decision making process regarding antithrombotic management. Continuing the discussion of current concepts and concerns of antithrombotic management in AF patients undergoing PCI, we emphasize the importance of various strategies to reduce bleeding in the modern era, namely, radial access combined with careful selection of a P2Y₁₂ receptor inhibitor, use of newer drug-eluting stents, and uninterrupted anticoagulation for patients undergoing procedures. We also focus on the role of the non-vitamin K oral anticoagulants (novel oral anticoagulants, eg, dabigatran, rivaroxaban, apixaban, and edoxaban) which are increasingly used for stroke prevention in AF. Finally, recent recommendations on the management of antithrombotic therapy in AF patients presenting with acute coronary syndrome and/or undergoing PCI as well as ongoing clinical trials and future directions are highlighted. PMID:25534093

  11. Neuroimaging for patient selection for medial temporal lobe epilepsy surgery: Part 1 Structural neuroimaging.

    PubMed

    Stylianou, Petros; Hoffmann, Chen; Blat, Ilan; Harnof, Sagi

    2016-01-01

    The objective of part one of this review is to present the structural neuroimaging techniques that are currently used to evaluate patients with temporal lobe epilepsy (TLE), and to discuss their potential to define patient eligibility for medial temporal lobe surgery. A PubMed query, using Medline and Embase, and subsequent review, was performed for all English language studies published after 1990, reporting neuroimaging methods for the evaluation of patients with TLE. The extracted data included demographic variables, population and study design, imaging methods, gold standard methods, imaging findings, surgical outcomes and conclusions. Overall, 56 papers were reviewed, including a total of 1517 patients. This review highlights the following structural neuroimaging techniques: MRI, diffusion-weighted imaging, tractography, electroencephalography and magnetoencephalography. The developments in neuroimaging during the last decades have led to remarkable improvements in surgical precision, postsurgical outcome, prognosis, and the rate of seizure control in patients with TLE. The use of multiple imaging methods provides improved outcomes, and further improvements will be possible with future studies of larger patient cohorts. PMID:26362835

  12. 10 CFR 429.132 - Compromise and settlement.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 10 Energy 3 2012-01-01 2012-01-01 false Compromise and settlement. 429.132 Section 429.132 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION CERTIFICATION, COMPLIANCE, AND ENFORCEMENT FOR CONSUMER PRODUCTS AND COMMERCIAL AND INDUSTRIAL EQUIPMENT Enforcement § 429.132 Compromise and settlement. (a) DOE may...

  13. 10 CFR 429.132 - Compromise and settlement.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 10 Energy 3 2014-01-01 2014-01-01 false Compromise and settlement. 429.132 Section 429.132 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION CERTIFICATION, COMPLIANCE, AND ENFORCEMENT FOR CONSUMER PRODUCTS AND COMMERCIAL AND INDUSTRIAL EQUIPMENT Enforcement § 429.132 Compromise and settlement. (a) DOE may...

  14. 10 CFR 429.132 - Compromise and settlement.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 10 Energy 3 2013-01-01 2013-01-01 false Compromise and settlement. 429.132 Section 429.132 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION CERTIFICATION, COMPLIANCE, AND ENFORCEMENT FOR CONSUMER PRODUCTS AND COMMERCIAL AND INDUSTRIAL EQUIPMENT Enforcement § 429.132 Compromise and settlement. (a) DOE may...

  15. 38 CFR 1.970 - Standards for compromise.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Standards for compromise. 1.970 Section 1.970 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS GENERAL PROVISIONS Referrals to Gao, Department of Justice, Or Irs § 1.970 Standards for compromise. Decisions of...

  16. 38 CFR 1.970 - Standards for compromise.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2011-07-01 2011-07-01 false Standards for compromise. 1.970 Section 1.970 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS GENERAL PROVISIONS Referrals to Gao, Department of Justice, Or Irs § 1.970 Standards for compromise. Decisions of...

  17. 48 CFR 252.239-7000 - Protection against compromising emanations.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 48 Federal Acquisition Regulations System 3 2010-10-01 2010-10-01 false Protection against... CLAUSES Text of Provisions And Clauses 252.239-7000 Protection against compromising emanations. As prescribed in 239.7103(a), use the following clause: Protection Against Compromising Emanations (JUN 2004)...

  18. 20 CFR 355.46 - Compromise or settlement.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 20 Employees' Benefits 1 2010-04-01 2010-04-01 false Compromise or settlement. 355.46 Section 355.46 Employees' Benefits RAILROAD RETIREMENT BOARD ADMINISTRATIVE REMEDIES FOR FRAUDULENT CLAIMS OR STATEMENTS REGULATIONS UNDER THE PROGRAM FRAUD CIVIL REMEDIES ACT OF 1986 § 355.46 Compromise or settlement. (a) Parties may make offers of...

  19. 5 CFR 1312.30 - Loss or possible compromise.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ..., DOWNGRADING, DECLASSIFICATION AND SAFEGUARDING OF NATIONAL SECURITY INFORMATION Control and Accountability of Classified Information § 1312.30 Loss or possible compromise. Any person who has knowledge of the loss or possible compromise of classified information shall immediately secure the material and then report...

  20. 49 CFR 209.109 - Payment of penalty; compromise.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 4 2010-10-01 2010-10-01 false Payment of penalty; compromise. 209.109 Section... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION RAILROAD SAFETY ENFORCEMENT PROCEDURES Hazardous Materials Penalties Civil Penalties § 209.109 Payment of penalty; compromise. (a) Payment of a civil penalty may be made...

  1. 49 CFR 209.109 - Payment of penalty; compromise.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 49 Transportation 4 2011-10-01 2011-10-01 false Payment of penalty; compromise. 209.109 Section... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION RAILROAD SAFETY ENFORCEMENT PROCEDURES Hazardous Materials Penalties Civil Penalties § 209.109 Payment of penalty; compromise. (a) Payment of a civil penalty may be made...

  2. 49 CFR 107.327 - Compromise and settlement.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 49 Transportation 2 2011-10-01 2011-10-01 false Compromise and settlement. 107.327 Section 107.327 Transportation Other Regulations Relating to Transportation PIPELINE AND HAZARDOUS MATERIALS SAFETY... PROGRAM PROCEDURES Enforcement Compliance Orders and Civil Penalties § 107.327 Compromise and...

  3. 49 CFR 107.327 - Compromise and settlement.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 2 2010-10-01 2010-10-01 false Compromise and settlement. 107.327 Section 107.327 Transportation Other Regulations Relating to Transportation PIPELINE AND HAZARDOUS MATERIALS SAFETY... PROGRAM PROCEDURES Enforcement Compliance Orders and Civil Penalties § 107.327 Compromise and...

  4. 5 CFR 1215.32 - Compromise, suspension and termination.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 5 Administrative Personnel 3 2010-01-01 2010-01-01 false Compromise, suspension and termination. 1215.32 Section 1215.32 Administrative Personnel MERIT SYSTEMS PROTECTION BOARD ORGANIZATION AND PROCEDURES DEBT MANAGEMENT Claims Collection § 1215.32 Compromise, suspension and termination. (a)...

  5. 19 CFR 161.5 - Compromise of Government claims.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 19 Customs Duties 2 2014-04-01 2014-04-01 false Compromise of Government claims. 161.5 Section 161... Government claims. (a) Offer. An offer made pursuant to section 617, Tariff Act of 1930, as amended (19 U.S.C. 1617), in compromise of a Government claim arising under the Customs laws and the terms upon which...

  6. 27 CFR 70.449 - Offers in compromise.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 2 2010-04-01 2010-04-01 false Offers in compromise. 70.449 Section 70.449 Alcohol, Tobacco Products and Firearms ALCOHOL AND TOBACCO TAX AND TRADE BUREAU... Cartridges, and Explosives § 70.449 Offers in compromise. The procedures in the case of offers in...

  7. Choosing to Compromise: Women Studying Childcare

    ERIC Educational Resources Information Center

    Wright, Hazel R.

    2013-01-01

    Reporting on a study of mature women training to work in childcare, this article demonstrates how some women choose to be part-time mothers, workers and students, wanting "the best of both worlds". It presents a theory of integrated lives that contrasts with customary deficit models and shows how a series of reciprocal links bind the…

  8. Skeletal Health Part 2: Development of a Nurse Practitioner Bone Support Clinic for Urologic Patients.

    PubMed

    Turner, Bruce; Ali, Sacha; Drudge-Coates, Lawrence; Pati, Jhumur; Nargund, Vinod; Wells, Paula

    2016-01-01

    Part 1 of this article highlighted the potential negative effects of cancer on the skeleton and provided an overview of available treatment options. Part 2 presents a nurse practitioner-led Bone Support Clinic, which was developed for patients with cancer-induced bone disease and cancer therapy-induced bone loss. This clinic, started in 2011 in a university medical center urology/oncology outpatient center in London, England, United Kingdom, has been a collaborative effort among a multidisciplinary team of doctors, nurse practitioners and nurses. Patients have responded positively to the improved continuity of care, and we have been able to assess and treat impending skeletal-related events in a more timely manner The needs of our patient population and problems with the existing service are reviewed, and the importance of a multidisciplinary approach to these problems is discussed. Initiation of a nurse practitioner-led Bone Support Clinic and the impact of timely response to the effects of cancer and cancer therapies on the skeletal system are outlined and offered as a model. PMID:27093760

  9. Engaging and empowering patients to manage their type 2 diabetes, Part II: Initiatives for success.

    PubMed

    Jacob, Stephan; Serrano-Gil, Manuel

    2010-10-01

    Type 2 diabetes (T2D) has reached pandemic proportions. The impact of it and its long-term sequelae represent a significant burden for many healthcare systems around the world, and a significant number of patients struggle to achieve the internationally recommended targets for the modifiable risk factors that optimize healthy outcomes. In the first part of this two-part review, the scene was set showing that there seems to be a knowledge, attitude, and practice (KAP) gap hindering successful management of T2D. Although theoretical knowledge about how T2D should be managed exists, the attitude of patients and healthcare professionals seems to influence the practicalities of implementing life-enhancing changes for patients living with diabetes. Following the chronic care model, macro-level initiatives such as Finland's national diabetes program, "The Development Programme for the Prevention and Care of Diabetes" (DEHKO), encourage a coordinated, supportive policy and financial environment for healthcare system change, and are advocated by the International Diabetes Federation. Over a 10-year period, the DEHKO program aims to demonstrate that a top-down population approach to prevention, focusing on reducing obesity, increasing physical activity, and encouraging healthier eating habits, may improve the overall health of the nation. However, the patient is the focus of day-to-day management of T2D, and innovative strategies that use a community (meso-level) approach to encourage self-management, or that embrace new technologies to access diabetes self-management education or support networks, are likely to be the way forward. Such measures may close the apparent KAP gap and bring about real and measurable benefits in quality of life and life expectancy. The second part of this review describes some of the many and varied initiatives designed to engage and empower patients to self-manage their T2D, with the aim of increasing the proportion of patients reaching health

  10. Direct Pay/Concierge/Blended Care: Where Is The Sweet Spot? Part II--Seen from Your Patients' Perspective.

    PubMed

    Childs, Susan

    2015-01-01

    Physicians are actively considering the direct pay and concierge models as plausible options in providing more patient-oriented care. What are the major considerations and how do we obtain accurate data that may help in sophisticated decision-making? Part I of this article introduced the models, typical patient contract configurations, physician/provider considerations, and commercial payers. In Part II, we discuss the access, cost, and value from a patient's point of view. We also consider patient loyalty and self-care, approaches for introducing and inviting patients, and how to work with other providers and in community relations. Lastly, we share some creative concierge models that are evolving. PMID:26399038

  11. Sterile diets for the immuno-compromised: Is there a need?

    NASA Astrophysics Data System (ADS)

    Butterweck, Joseph S.

    1995-02-01

    There is a general misunderstanding in the radiation processing industry about the use of sterile diets in the medical profession. Sterile diets are used on a limited basis in hospitals that specialize in cancer treatment and organ transplants. These patients are severely immuno-compromised. There are many other patients that are immuno-compromised that do not require sterile diets. These patients may require a diet that is pathogen-free and are aslo "low-microbial diets". Nosocomial infections have become a major issue in US hospitals. The "infection control committee" is the focus group responsible to assure nosocomial infections incidence are below the hospital goals. Application of ionizing radiation to sterilize diets has not been chosen because the product is not available at a reasonable total cost. This paper will discuss the hospitals views.

  12. Contribution of consultants to care of compromised pregnancies.

    PubMed Central

    Bird, J. S.; Taslimi, M. M.; Gonzales, A. R.; Duggan, M.

    1996-01-01

    Obstetricians often seek consultative services of other specialists in the management of compromised pregnancies. However, the extent of such consultations and the contribution of these consultants have not been addressed in the literature. This study is addresses the contribution of consultants to the care of complicated pregnancies at a tertiary care center. During the 2 1/2 years of this retrospective study, 2263 antepartum admissions were made for pregnancy complications. One hundred sixty-six of those patients were hospitalized 176 times and were treated by one or more consulting physicians for a consultation rate of 7.8%. Eighteen specialties were consulted, including 54 (32%) consultations from maternal fetal medicine, 44 (24%) from internal medicine, 28 (16%) from general surgery, and 22 (12%) from endocrinology. Of the initial admission diagnoses, 87.9% were confirmed and 46 new diagnoses were made by the consultants. A significant positive correlation was noted between the number of consultants, maternal length of hospital stay, and maternal hospitalization cost. PMID:8776065

  13. Compromised central tolerance of ICA69 induces multiple organ autoimmunity

    PubMed Central

    Fan, Yong; Gualtierotti, Giulio; Tajima, Asako; Grupillo, Maria; Coppola, Antonina; He, Jing; Bertera, Suzanne; Owens, Gregory; Pietropaolo, Massimo; Rudert, William A.; Trucco, Massimo

    2015-01-01

    For reasons not fully understood, patients with an organ-specific autoimmune disease have increased risks of developing autoimmune responses against other organs/tissues. We identified ICA69, a known β-cell autoantigen in Type 1 diabetes, as a potential common target in multi-organ autoimmunity. NOD mice immunized with ICA69 polypeptides exhibited exacerbated inflammation not only in the islets, but also in the salivary glands. To further investigate ICA69 autoimmunity, two genetically modified mouse lines were generated to modulate thymic ICA69 expression: the heterozygous ICA69del/wt line and the thymic medullary epithelial cell-specific deletion Aire-ΔICA69 line. Suboptimal central negative selection of ICA69-reactive T-cells was observed in both lines. Aire-ΔICA69 mice spontaneously developed coincident autoimmune responses to the pancreas, the salivary glands, the thyroid, and the stomach. Our findings establish a direct link between compromised thymic ICA69 expression and autoimmunity against multiple ICA69-expressing organs, and identify a potential novel mechanism for the development of multi-organ autoimmune diseases. PMID:25088457

  14. Osteonecrosis of the Jaw in Patients Receiving Bone-Targeted Therapies: An Overview--Part I.

    PubMed

    Turner, Bruce; Drudge-Coates, Lawrence; Ali, Sacha; Pati, Jhumur; Nargund, Vinod; Ali, Enamul; Cheng, Leo; Wells, Paula

    2016-01-01

    Urologic patients receiving bone-targeted therapies are at risk of developing osteonecrosis of the jaw (ONJ). ONJ has historically been associated with bisphosphonate therapy. More recently, RANK-Ligand inhibitors (denosumab) have also been used to reduce the risk of skeletal-related events in patients who have advanced cancers with bone metastases. More than 65% of men with metastatic prostate cancer and nearly 75% of women with metastatic breast cancer are affected by bone metastases. The literature has described ONJ associated with bisphosphonate therapy as bisphosphonate-related osteonecrosis of the jaw (BRONJ). However, with evidence also linking the use of RANK-Ligand inhibitors with osteonecrosis of the jaw, we advocate use of the term "anti-bone resorption therapy-related osteonecrosis of the jaw" (ABRT-ONJ). The term "medication-related osteonecrosis of the jaw" (MRONJ) is now becoming more widespread. There is not a universally accepted definition of ABRT-ONJ, which may have hindered recognition and reporting of the condition. In Part I of this article, a review of current knowledge around the etiology of ABRT-ONJ and incidence data are provided. In Part II, we provide an audit of ONJ in a nurse consultant-led bone support clinic. In the article, we refer to zoledronic acid because this is the bisphosphonate of choice for use in men with prostate cancer in the United Kingdom. PMID:27501591

  15. Periodic Fever: A Review on Clinical, Management and Guideline for Iranian Patients - Part II

    PubMed Central

    Ahmadinejad, Zahra; Mansouri, Sedigeh; Ziaee, Vahid; Aghighi, Yahya; Moradinejad, Mohammad-Hassan; Fereshteh-Mehregan, Fatemeh

    2014-01-01

    Periodic fever syndromes are a group of diseases characterized by episodes of fever with healthy intervals between febrile episodes. In the first part of this paper, we presented a guideline for approaching patients with periodic fever and reviewed two common disorders with periodic fever in Iranian patients including familial Mediterranean fever (FMF) and periodic fever syndromes except for periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis (PFAPA). In this part, we review other autoinflammatory disorders including hyper IgD, tumor necrosis factor receptor–associated periodic syndrome (TRAPS), cryopyrin associated periodic syndromes, autoinflammatory bone disorders and some other rare autoinflammatory disorders such as Sweet’s and Blau syndromes. In cryopyrin associated periodic syndromes group, we discussed chronic infantile neurologic cutaneous and articular (CINCA) syndrome, Muckle-Wells syndrome and familial cold autoinflammatory syndrome. Autoinflammatory bone disorders are categorized to monogenic disorders such as pyogenic arthritis, pyoderma ;gangraenosum and acne (PAPA) syndrome, the deficiency of interleukine-1 receptor antagonist (DIRA) and Majeed syndrome and polygenic background or sporadic group such as chronic recurrent multifocal osteomyelitis (CRMO) or synovitis, acne, pustulosis, hyperostosis and osteitis (SAPHO) syndrome are classified in sporadic group. Other autoinflammatory syndromes are rare causes of periodic fever in Iranian system registry. PMID:25562014

  16. Medicare Part D Benzodiazepine Exclusion and Use of Psychotropic Medication by Patients With New Anxiety Disorders

    PubMed Central

    Ong, Michael K.; Zhang, Lily; Xu, Haiyong; Azocar, Francisca; Ettner, Susan L.

    2015-01-01

    Objective The Medicare Modernization Act (MMA) specifically excluded benzodiazepines from Medicare Part D coverage starting in 2006; however, benzodiazepines are an effective, low-cost treatment for anxiety. This study evaluated the effect of the Medicare Part D benzodiazepine coverage exclusion among patients with new anxiety disorders. Methods The authors used a quasi-experimental cohort design to study patients with new anxiety diagnoses from a large national health plan during the first six months of 2005, 2006, and 2007. Logistic and zero-truncated negative-binomial regression models using covered claims for behavioral, medical, and pharmaceutical care linked with eligibility files were used to estimate utilization and costs of psychotropic medication and health care utilization among elderly Medicare Advantage enrollees (N=8,397) subject to the MMA benzodiazepine exclusion and a comparison group of near-elderly (ages 60–64) enrollees (N=1,657) of a managed care plan. Results Medicare Advantage enrollees diagnosed in 2005 had significantly (p<.05) higher rates of covered claims for benzodiazepines and all psychotropic drugs, lower rates of covered claims for nonbenzodiazepines, and lower expenditures for psychotropic drugs than enrollees diagnosed in 2006 and 2007. There were no significant differences over time in utilization or expenditures related to psychotropic medication among the comparison group. There also were no significant changes over time in outpatient visits for behavioral care by either cohort. Conclusions Among elderly patients with new anxiety diagnoses, the MMA benzodiazepine exclusion increased use of nonbenzodiazepine psychotropic drugs without substitution of increased behavioral care. Overall, the exclusion was associated with a modest increase in covered claims for psychotropic medication. PMID:22549332

  17. Robot assisted radical prostatectomy: how I do it. Part I: Patient preparation and positioning.

    PubMed

    Valdivieso, Roger F; Hueber, Pierre-Alain; Zorn, Kevin C

    2013-10-01

    Radical prostatectomy remains the standard treatment for long term cure of clinically localized prostate cancer, offering excellent oncologic outcomes, with cancer-specific survival approaching 95% at 15 years after surgery. The introduction of the "da Vinci Robotic Surgical System" (Intuitive Surgical, Sunnyvale, CA, USA) has been another important step toward a minimally invasive approach to radical prostatectomy. Technologic peculiarities, such as three-dimensional vision, wristed instrumentation with seven degrees of freedom of motion, lack of tremor, a 10x-magnification and a comfortable seated position for the surgeon has added value to the surgeon and patient. In this first part of a two article series, we describe preoperative patient preparation and positioning protocols for robot assisted radical prostatectomy (RARP) that are currently used in our institution (University of Montreal Hospital Center (CHUM)-Hopital St-Luc). We use the four-arm da Vinci Si Surgical System. Our experience with RARP is now over 250 cases with the senior surgeon having performed over 1200 RARPs and we have continually refined our technique to improve patient outcomes. PMID:24128839

  18. Listening to the Narratives of Our Patients as Part of Holistic Nursing Care.

    PubMed

    Alicea-Planas, Jessica

    2016-06-01

    Nurses in all settings interact with individuals often identified as vulnerable or marginalized, and at times are frustrated by their own inability to "make a difference." By allowing oneself to listen, a fuller appreciation of the individual circumstance, or that which is unwritten, can be appreciated. Storytelling is a way to set the stage for experiences to be shared and can provide insight into lives. The narratives told by patients are often complex, affected by various influences of the environment, and personal, which in combination with nursing informs their individual healing journeys. Using a philosophy of nursing that encompasses all of the distinct influences on these narratives can allow nurses to more holistically care and advocate for their patients. As this case study shows, nursing plays a significant role in the narratives of others. Although many vulnerable populations live in a perpetual cycle of poverty and poor health, some nurses are able to assess the intricacies of a situation and facilitate understanding, as part of their support, caring, and advocacy for their patients. PMID:26088595

  19. 15 CFR 904.106 - Compromise of civil penalty.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... be sent to Agency counsel at the address specified in the NOVA. (c) Neither the existence of the... which a NOVA becomes final. (d) NOAA will not compromise, modify, or remit a civil penalty assessed,...

  20. 15 CFR 904.106 - Compromise of civil penalty.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... be sent to Agency counsel at the address specified in the NOVA. (c) Neither the existence of the... which a NOVA becomes final. (d) NOAA will not compromise, modify, or remit a civil penalty assessed,...

  1. 15 CFR 904.106 - Compromise of civil penalty.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... be sent to Agency counsel at the address specified in the NOVA. (c) Neither the existence of the... which a NOVA becomes final. (d) NOAA will not compromise, modify, or remit a civil penalty assessed,...

  2. 15 CFR 904.106 - Compromise of civil penalty.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... be sent to Agency counsel at the address specified in the NOVA. (c) Neither the existence of the... which a NOVA becomes final. (d) NOAA will not compromise, modify, or remit a civil penalty assessed,...

  3. 15 CFR 904.106 - Compromise of civil penalty.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... be sent to Agency counsel at the address specified in the NOVA. (c) Neither the existence of the... which a NOVA becomes final. (d) NOAA will not compromise, modify, or remit a civil penalty assessed,...

  4. 34 CFR 30.70 - How does the Secretary exercise discretion to compromise a debt or to suspend or terminate...

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... standards in the FCCS, 4 CFR part 103, to determine whether compromise of a debt is appropriate if— (1) The... standards in the FCCS, 4 CFR part 104, to determine whether suspension or termination of collection action... 34 Education 1 2012-07-01 2012-07-01 false How does the Secretary exercise discretion...

  5. 34 CFR 30.70 - How does the Secretary exercise discretion to compromise a debt or to suspend or terminate...

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... standards in the FCCS, 4 CFR part 103, to determine whether compromise of a debt is appropriate if— (1) The... standards in the FCCS, 4 CFR part 104, to determine whether suspension or termination of collection action... 34 Education 1 2011-07-01 2011-07-01 false How does the Secretary exercise discretion...

  6. 34 CFR 30.70 - How does the Secretary exercise discretion to compromise a debt or to suspend or terminate...

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... standards in the FCCS, 4 CFR part 103, to determine whether compromise of a debt is appropriate if— (1) The... standards in the FCCS, 4 CFR part 104, to determine whether suspension or termination of collection action... 34 Education 1 2010-07-01 2010-07-01 false How does the Secretary exercise discretion...

  7. 34 CFR 30.70 - How does the Secretary exercise discretion to compromise a debt or to suspend or terminate...

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... standards in the FCCS, 4 CFR part 103, to determine whether compromise of a debt is appropriate if— (1) The... standards in the FCCS, 4 CFR part 104, to determine whether suspension or termination of collection action... 34 Education 1 2013-07-01 2013-07-01 false How does the Secretary exercise discretion...

  8. Periodic Fever: a review on clinical, management and guideline for Iranian patients - part I.

    PubMed

    Ahmadinejad, Zahra; Mansori, Sedigeh; Ziaee, Vahid; Alijani, Neda; Aghighi, Yahya; Parvaneh, Nima; Mordinejad, Mohammad-Hassan

    2014-02-01

    Periodic fever syndromes are a group of diseases characterized by episodes of fever with healthy intervals between febrile episodes. The first manifestation of these disorders are present in childhood and adolescence, but infrequently it may be presented in young and middle ages. Genetic base has been known for all types of periodic fever syndromes except periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis (PFAPA). Common periodic fever disorders are Familial Mediterranean fever (FMF) and PFAPA. In each patient with periodic fever, acquired infection with chronic and periodic nature should be ruled out. It depends on epidemiology of infectious diseases. Some of them such as Familial Mediterranean fever and PFAPA are common in Iran. In Iran and other Middle East countries, brucellosis, malaria and infectious mononucleosis should be considered in differential diagnosis of periodic fever disorders especially with fever and arthritis manifestation. In children, urinary tract infection may be presented as periodic disorder, urine analysis and culture is necessary in each child with periodic symptoms. Some malignancies such as leukemia and tumoral lesions should be excluded in patients with periodic syndrome and weight loss in any age. After excluding infection, malignancy and cyclic neutropenia, FMF and PFAPA are the most common periodic fever disorders. Similar to other countries, Hyper IgD, Chronic Infantile Neurologic Cutaneous and Articular, TRAPS and other auto-inflammatory syndromes are rare causes of periodic fever in Iranian system registry. In part 1 of this paper we reviewed the prevalence of FMF and PFAPA in Iran. In part 2, some uncommon auto-inflammatory disorders such as TRAPS, Hyper IgD sydrome and cryopyrin associated periodic syndromes will be reviewed. PMID:25793039

  9. Periodic Fever: A Review on Clinical, Management and Guideline for Iranian Patients - Part I

    PubMed Central

    Ahmadinejad, Zahra; Mansori, Sedigeh; Ziaee, Vahid; Alijani, Neda; Aghighi, Yahya; Parvaneh, Nima; Mordinejad, Mohammad-Hassan

    2014-01-01

    Periodic fever syndromes are a group of diseases characterized by episodes of fever with healthy intervals between febrile episodes. The first manifestation of these disorders are present in childhood and adolescence, but infrequently it may be presented in young and middle ages. Genetic base has been known for all types of periodic fever syndromes except periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis (PFAPA). Common periodic fever disorders are Familial Mediterranean fever (FMF) and PFAPA. In each patient with periodic fever, acquired infection with chronic and periodic nature should be ruled out. It depends on epidemiology of infectious diseases. Some of them such as Familial Mediterranean fever and PFAPA are common in Iran. In Iran and other Middle East countries, brucellosis, malaria and infectious mononucleosis should be considered in differential diagnosis of periodic fever disorders especially with fever and arthritis manifestation. In children, urinary tract infection may be presented as periodic disorder, urine analysis and culture is necessary in each child with periodic symptoms. Some malignancies such as leukemia and tumoral lesions should be excluded in patients with periodic syndrome and weight loss in any age. After excluding infection, malignancy and cyclic neutropenia, FMF and PFAPA are the most common periodic fever disorders. Similar to other countries, Hyper IgD, Chronic Infantile Neurologic Cutaneous and Articular, TRAPS and other auto-inflammatory syndromes are rare causes of periodic fever in Iranian system registry. In part 1 of this paper we reviewed the prevalence of FMF and PFAPA in Iran. In part 2, some uncommon auto-inflammatory disorders such as TRAPS, Hyper IgD sydrome and cryopyrin associated periodic syndromes will be reviewed. PMID:25793039

  10. Dental implants in bilateral bifid canal and compromised interocclusal space using cone beam computerized tomography

    PubMed Central

    Ahmed, Nizar; Arunachalam, Lalitha Tanjore; Jacob, Caroline Annette; Kumar, Suresh Anand

    2016-01-01

    Knowledge of various anatomic landmarks is pivotal for important success. Bifid canals pose a challenge and can lead to difficulties while performing implant surgery in the mandible. Bifid canals can be diagnosed with panoramic radiography and more accurately with cone beam computerized tomography (CBCT). This case report details the placement of the implant in a patient with bilateral bifid canal and compromised interocclusal space, which was successfully treated using CBCT. PMID:27433073

  11. Immediate Esthetic Rehabilitation of Periodontally Compromised Anterior Tooth Using Natural Tooth as Pontic

    PubMed Central

    Kumar, K. Pavan; Nujella, Surya Kumari; Gopal, S. Sujatha

    2016-01-01

    For patients who require removal of anterior teeth and their replacement various treatment modalities are available. With advancement in technology and availability of glass/polyethylene fibres, use of natural tooth as pontic with fibre reinforced composite restorations offers the promising results. The present case report describes management of periodontally compromised mandibular anterior tooth using natural tooth pontic with fibre reinforcement. A 1-year follow-up showed that the bridge was intact with good esthetics and no problem was reported. PMID:27195156

  12. Dental implants in bilateral bifid canal and compromised interocclusal space using cone beam computerized tomography.

    PubMed

    Ahmed, Nizar; Arunachalam, Lalitha Tanjore; Jacob, Caroline Annette; Kumar, Suresh Anand

    2016-01-01

    Knowledge of various anatomic landmarks is pivotal for important success. Bifid canals pose a challenge and can lead to difficulties while performing implant surgery in the mandible. Bifid canals can be diagnosed with panoramic radiography and more accurately with cone beam computerized tomography (CBCT). This case report details the placement of the implant in a patient with bilateral bifid canal and compromised interocclusal space, which was successfully treated using CBCT. PMID:27433073

  13. Immediate Esthetic Rehabilitation of Periodontally Compromised Anterior Tooth Using Natural Tooth as Pontic.

    PubMed

    Kumar, K Pavan; Nujella, Surya Kumari; Gopal, S Sujatha; Roy, K Karthik

    2016-01-01

    For patients who require removal of anterior teeth and their replacement various treatment modalities are available. With advancement in technology and availability of glass/polyethylene fibres, use of natural tooth as pontic with fibre reinforced composite restorations offers the promising results. The present case report describes management of periodontally compromised mandibular anterior tooth using natural tooth pontic with fibre reinforcement. A 1-year follow-up showed that the bridge was intact with good esthetics and no problem was reported. PMID:27195156

  14. Why patients take part in the Royal College of Physicians Practical Assessment of Clinical Examination Skills (MRCP PACES).

    PubMed

    McFarland, Lorraine; Barlow, Julie; Nwokolo, Chuka

    2012-02-01

    The aim of this study was to examine patients' motivation to participate in the Royal College of Physicians Practical Assessment of Clinical Examination Skills (PACES). An exploratory cross-sectional study was performed with data collected via telephone interviews. All patients aged 18+ who participated in PACES at University Hospitals Coventry and Warwickshire in the last two years were invited to take part; 28 patients were interviewed. Data were analysed using thematic content analysis. Motivational factors identified included the opportunity to give something back for the care received, contributing to doctors' learning processes, altruism and being able to learn more about one's own condition. Patients believed that they offered real-life experiences that cannot be provided by actors. The social environment during PACES played a large part in volunteer retention. Recruitment of patient volunteers needs to emphasise the altruistic nature of the role in assisting the learning process for doctors and the subsequent benefit for future patients. PMID:22372221

  15. National lipid association recommendations for patient-centered management of dyslipidemia: part 1--full report.

    PubMed

    Jacobson, Terry A; Ito, Matthew K; Maki, Kevin C; Orringer, Carl E; Bays, Harold E; Jones, Peter H; McKenney, James M; Grundy, Scott M; Gill, Edward A; Wild, Robert A; Wilson, Don P; Brown, W Virgil

    2015-01-01

    The leadership of the National Lipid Association convened an Expert Panel to develop a consensus set of recommendations for patient-centered management of dyslipidemia in clinical medicine. An Executive Summary of those recommendations was previously published. This document provides support for the recommendations outlined in the Executive Summary. The major conclusions include (1) an elevated level of cholesterol carried by circulating apolipoprotein B-containing lipoproteins (non-high-density lipoprotein cholesterol and low-density lipoprotein cholesterol [LDL-C], termed atherogenic cholesterol) is a root cause of atherosclerosis, the key underlying process contributing to most clinical atherosclerotic cardiovascular disease (ASCVD) events; (2) reducing elevated levels of atherogenic cholesterol will lower ASCVD risk in proportion to the extent that atherogenic cholesterol is reduced. This benefit is presumed to result from atherogenic cholesterol lowering through multiple modalities, including lifestyle and drug therapies; (3) the intensity of risk-reduction therapy should generally be adjusted to the patient's absolute risk for an ASCVD event; (4) atherosclerosis is a process that often begins early in life and progresses for decades before resulting a clinical ASCVD event. Therefore, both intermediate-term and long-term or lifetime risk should be considered when assessing the potential benefits and hazards of risk-reduction therapies; (5) for patients in whom lipid-lowering drug therapy is indicated, statin treatment is the primary modality for reducing ASCVD risk; (6) nonlipid ASCVD risk factors should also be managed appropriately, particularly high blood pressure, cigarette smoking, and diabetes mellitus; and (7) the measurement and monitoring of atherogenic cholesterol levels remain an important part of a comprehensive ASCVD prevention strategy. PMID:25911072

  16. Compromised GABAergic inhibition contributes to tumor-associated epilepsy.

    PubMed

    MacKenzie, Georgina; O'Toole, Kate K; Moss, Stephen J; Maguire, Jamie

    2016-10-01

    Glioblastoma Multiforme (GBM) is the most common form of primary brain tumor with 30-50% of patients presenting with epilepsy. These tumor-associated seizures are often resistant to traditional antiepileptic drug treatment and persist after tumor resection. This suggests that changes in the peritumoral tissue underpin epileptogenesis. It is known that glioma cells extrude pathological concentrations of glutamate which is thought to play a role in tumor progression and the development of epilepsy. Given that pathological concentrations of glutamate have been shown to dephosphorylate and downregulate the potassium chloride cotransporter KCC2, we hypothesized that glioma-induced alterations in KCC2 in the peritumoral region may play a role in tumor-associated epilepsy. Consistent with this hypothesis, we observe a decrease in total KCC2 expression and a dephosphorylation of KCC2 at residue Ser940 in a glioma model which exhibits hyperexcitability and the development of spontaneous seizures. To determine whether the reduction of KCC2 could potentially contribute to tumor-associated epilepsy, we generated mice with a focal knockdown of KCC2 by injecting AAV2-Cre-GFP into the cortex of floxed KCC2 mice. The AAV2-Cre-mediated knockdown of KCC2 was sufficient to induce the development of spontaneous seizures. Further, blocking NKCC1 with bumetanide to offset the loss of KCC2 reduced the seizure susceptibility in glioma-implanted mice. These findings support a mechanism of tumor-associated epilepsy involving downregulation of KCC2 in the peritumoral region leading to compromised GABAergic inhibition and suggest that modulating chloride homeostasis may be useful for seizure control. PMID:27513374

  17. [The Patient Rights Act (PatRG)--part 2: informed consent, duty to inform, documentation of treatment, access to the patient file].

    PubMed

    Parzeller, Markus; Zedler, Barbara

    2013-01-01

    The article deals with the new regulations in the German Civil Code (BGB) which came into effect in Germany on 26 Feb 2013 as the Patient Rights Act (PatRG). In the second part, the consent of the patient (Section 630d Civil Code), the physician's duties to inform the patient (Section 630e Civil Code), the documentation of treatment (Section 630f Civil Code), and the right of access to the patient file (Section 630g Civil Code) are discussed and critically analysed. PMID:24547617

  18. Alchemy or Science? Compromising Archaeology in the Deep Sea

    NASA Astrophysics Data System (ADS)

    Adams, Jonathan

    2007-06-01

    In the torrid debate between archaeology and treasure hunting, compromise is often suggested as the pragmatic solution, especially for archaeology carried out either in deep water or beyond the constraints that commonly regulate such activities in territorial seas. Both the wisdom and the need for such compromise have even been advocated by some archaeologists, particularly in forums such as the internet and conferences. This paper argues that such a compromise is impossible, not in order to fuel confrontation but simply because of the nature of any academic discipline. We can define what archaeology is in terms of its aims, theories, methods and ethics, so combining it with an activity founded on opposing principles must transform it into something else. The way forward for archaeology in the deep sea does not lie in a contradictory realignment of archaeology’s goals but in collaborative research designed to mesh with emerging national and regional research and management plans.

  19. Pilot Analysis of Asbestos-induced Diffuse Pleural Thickening with Respiratory Compromise.

    PubMed

    Nojima, Daisuke; Fujimoto, Nobukazu; Kato, Katsuya; Fuchimoto, Yasuko; Kiura, Katsuyuki; Kishimoto, Takumi; Tanimoto, Mitsune

    2015-01-01

    We investigated the clinical features of asbestos-induced diffuse pleural thickening (DPT) with severe respiratory compromise. We conducted a retrospective study of consecutive subjects with asbestos-induced DPT. Medical data such as initial symptoms, radiological findings, respiratory function test results, and clinical course were collected and analyzed. There were 24 patients between 2003 and 2012. All were men, and the median age at the development of DPT was 74 years. The top occupational category associated with asbestos exposure was dockyard workers. The median duration of asbestos exposure was 35.0 years, and the median latency from first exposure to the onset of DPT was 49.0 years. There were no significant differences in respiratory function test results between the higher and lower Brinkman index groups or between unilateral and bilateral DPT. Thirteen patients had a history of benign asbestos pleural effusion (BAPE), and the median duration from pleural fluid accumulation to DPT with severe respiratory compromise was 28.4 months. DPT with severe respiratory compromise can develop after a long latency following occupational asbestos exposure and a history of BAPE. PMID:26490022

  20. Patients with oral tumors. Part 2: Quality of life after treatment with resection prostheses. Resection prosthetics: evaluation of quality of life.

    PubMed

    Fierz, Janine; Bürgin, Walter; Mericske-Stern, Regina

    2013-01-01

    In the present study, the oral health-related quality of life of 18 patients (13 men and 5 women) was evaluated using validated questionnaires as proposed by the European Organization of Research and Treatment of Cancer (EORTC). The patients belonged to a cohort of 48 patients, whose prosthetic treatment was performed during the years 2004-2007. In the course of tumor resection, 12 patients underwent graft surgery and 14 patients radiotherapy. One patient required a nasal epithesis since resection of the nose became necessary. Five patients underwent a full block resection of the mandible, and tumor resection in 3 patients resulted in a large oronasal communication. Prosthetic rehabilitation was performed in all patients, and the follow-up period with regular care covered a minimum of 3 years. Eleven patients received dental implants for better support and retention of the prostheses. In spite of compromised oral conditions, functional restrictions, and some difficulties with the prostheses, the answers to the questionnaire were quite positive. The majority judged their general health as good or even excellent. The subjective perception of the patients may contradict the objective view by the dentist. In fact, the individual patient's history and experience provide a better understanding of the impact of oral tumors on daily life. The overall assessment identified 4 items that were perceived as major problems by all patients: swallowing solid food, dry mouth, limited mouth opening, and appearance. Prosthetic rehabilitation has only a limited influence on such problems. PMID:23526454

  1. Indirect porcelain veneers in periodontally compromised teeth. The hybrid technique: a case report.

    PubMed

    Garcia-Baeza, David; Saavedra, Carlos; Garcia-Adámez, Ramón

    2015-01-01

    The loss of periodontal structure causes an esthetic problem for many patients, especially when the esthetic zone is compromised. Among the various types of solutions is the use of composite resins. While this procedure is not aggressive towards tooth structure, it does require the clinician to have a precise technique, and demands strict longterm maintenance. 1 Another way of treating the compromised teeth is with porcelain veneers. This procedure is especially difficult, however, if carried out on periodontal teeth, as it requires preparation along the roots. 2 The intention of the hybrid technique described in this article is to combine both of these procedures in order to obtain a less aggressive treatment with precise management of the soft tissue and an adequate esthetic outcome. The hybrid technique consists of enlarging the root portion of the teeth with composite resin to obtain a less aggressive tooth preparation, and thereafter placing porcelain veneers. PMID:26171444

  2. Advanced medical life support procedures in vitally compromised children by a helicopter emergency medical service

    PubMed Central

    2010-01-01

    Background To determine the advanced life support procedures provided by an Emergency Medical Service (EMS) and a Helicopter Emergency Medical Service (HEMS) for vitally compromised children. Incidence and success rate of several procedures were studied, with a distinction made between procedures restricted to the HEMS-physician and procedures for which the HEMS is more experienced than the EMS. Methods Prospective study of a consecutive group of children examined and treated by the HEMS of the eastern region of the Netherlands. Data regarding type of emergency, physiological parameters, NACA scores, treatment, and 24-hour survival were collected and subsequently analysed. Results Of the 558 children examined and treated by the HEMS on scene, 79% had a NACA score of IV-VII. 65% of the children had one or more advanced life support procedures restricted to the HEMS and 78% of the children had one or more procedures for which the HEMS is more experienced than the EMS. The HEMS intubated 38% of all children, and 23% of the children intubated and ventilated by the EMS needed emergency correction because of potentially lethal complications. The HEMS provided the greater part of intraosseous access, as the EMS paramedics almost exclusively reserved this procedure for children in cardiopulmonary resuscitation. The EMS provided pain management only to children older than four years of age, but a larger group was in need of analgesia upon arrival of the HEMS, and was subsequently treated by the HEMS. Conclusions The Helicopter Emergency Medical Service of the eastern region of the Netherlands brings essential medical expertise in the field not provided by the emergency medical service. The Emergency Medical Service does not provide a significant quantity of procedures obviously needed by the paediatric patient. PMID:20211021

  3. 40 CFR 27.46 - Compromise or settlement.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 40 Protection of Environment 1 2010-07-01 2010-07-01 false Compromise or settlement. 27.46 Section 27.46 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY GENERAL PROGRAM FRAUD CIVIL REMEDIES... at any time after the date on which the reviewing official is permitted to issue a complaint...

  4. 14 CFR 1261.414 - Compromise of claims.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... the Claims Collection Litigation Report. See § 1261.417(e) or 4 CFR 105.2(b). Claims for which the... Department of Justice for litigation. The Comptroller General may exercise such compromise authority with... other debtors that resistance to payment is not likely to succeed. (f) Enforcement policy....

  5. 14 CFR 1261.414 - Compromise of claims.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... the Claims Collection Litigation Report. See § 1261.417(e) or 4 CFR 105.2(b). Claims for which the... Department of Justice for litigation. The Comptroller General may exercise such compromise authority with... other debtors that resistance to payment is not likely to succeed. (f) Enforcement policy....

  6. 14 CFR 1261.414 - Compromise of claims.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... the Claims Collection Litigation Report. See § 1261.417(e) or 4 CFR 105.2(b). Claims for which the... Department of Justice for litigation. The Comptroller General may exercise such compromise authority with... other debtors that resistance to payment is not likely to succeed. (f) Enforcement policy....

  7. 14 CFR § 1261.414 - Compromise of claims.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... the Claims Collection Litigation Report. See § 1261.417(e) or 4 CFR 105.2(b). Claims for which the... Department of Justice for litigation. The Comptroller General may exercise such compromise authority with... other debtors that resistance to payment is not likely to succeed. (f) Enforcement policy....

  8. 14 CFR 1261.414 - Compromise of claims.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... the Claims Collection Litigation Report. See § 1261.417(e) or 4 CFR 105.2(b). Claims for which the... Department of Justice for litigation. The Comptroller General may exercise such compromise authority with... other debtors that resistance to payment is not likely to succeed. (f) Enforcement policy....

  9. Whatever It Takes: Health Compromising Behaviors in Female Athletes

    ERIC Educational Resources Information Center

    Waldron, Jennifer J.; Krane, Vikki

    2005-01-01

    The power and performance model of sport stresses a sport ethic of doing "whatever it takes" to win (Coakley, 2004). Uncritical acceptance of this model may lead to various health-compromising behaviors. Employing achievement goal theory, we examine why female athletes may adopt the power and performance approach. An ego motivational climate and a…

  10. 49 CFR 209.109 - Payment of penalty; compromise.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 49 Transportation 4 2013-10-01 2013-10-01 false Payment of penalty; compromise. 209.109 Section 209.109 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL RAILROAD ADMINISTRATION, DEPARTMENT OF TRANSPORTATION RAILROAD SAFETY ENFORCEMENT PROCEDURES Hazardous Materials Penalties Civil Penalties § 209.109 Payment...

  11. Evil Searching: Compromise and Recompromise of Internet Hosts for Phishing

    NASA Astrophysics Data System (ADS)

    Moore, Tyler; Clayton, Richard

    Attackers compromise web servers in order to host fraudulent content, such as malware and phishing websites. While the techniques used to compromise websites are widely discussed and categorized, analysis of the methods used by attackers to identify targets has remained anecdotal. In this paper, we study the use of search engines to locate potentially vulnerable hosts. We present empirical evidence from the logs of websites used for phishing to demonstrate attackers’ widespread use of search terms which seek out susceptible web servers. We establish that at least 18% of website compromises are triggered by these searches. Many websites are repeatedly compromised whenever the root cause of the vulnerability is not addressed. We find that 19% of phishing websites are recompromised within six months, and the rate of recompromise is much higher if they have been identified through web search. By contrast, other public sources of information about phishing websites are not currently raising recompromise rates; we find that phishing websites placed onto a public blacklist are recompromised no more frequently than websites only known within closed communities.

  12. Time-to-Compromise Model for Cyber Risk Reduction Estimation

    SciTech Connect

    Miles A. McQueen; Wayne F. Boyer; Mark A. Flynn; George A. Beitel

    2005-09-01

    We propose a new model for estimating the time to compromise a system component that is visible to an attacker. The model provides an estimate of the expected value of the time-to-compromise as a function of known and visible vulnerabilities, and attacker skill level. The time-to-compromise random process model is a composite of three subprocesses associated with attacker actions aimed at the exploitation of vulnerabilities. In a case study, the model was used to aid in a risk reduction estimate between a baseline Supervisory Control and Data Acquisition (SCADA) system and the baseline system enhanced through a specific set of control system security remedial actions. For our case study, the total number of system vulnerabilities was reduced by 86% but the dominant attack path was through a component where the number of vulnerabilities was reduced by only 42% and the time-to-compromise of that component was increased by only 13% to 30% depending on attacker skill level.

  13. CONCENTRATED AMBIENT PARTICULATE STUDIES IN HEALTHY AND COMPROMISED RODENTS

    EPA Science Inventory


    CONCENTRATED AMBIENT PARTICULATE STUDIES IN HEALTHY AND COMPROMISED RODENTS. WP Watkinson1, LB Wichers2, JP Nolan1, DW Winsett1, UP Kodavanti1, MCJ Schladweiler1, LC Walsh1, ER Lappi1, D Terrell1, R Slade1, AD Ledbetter1, and DL Costa1. 1USEPA, ORD/NHEERL/ETD/PTB, RTP, NC, US...

  14. Vehicle influence on permeation through intact and compromised skin.

    PubMed

    Gujjar, Meera; Banga, Ajay K

    2014-09-10

    The purpose of this study was to compare the transdermal permeation of a model compound, diclofenac diethylamine, from a hydrophilic and lipophilic vehicle across in vitro models simulating compromised skin. Mineral oil served as a lipophilic vehicle while 10mM phosphate buffered saline served as a hydrophilic vehicle. Compromised skin was simulated by tape stripping, delipidization, or microneedle application and compared with intact skin as a control. Transepidermal water loss was measured to assess barrier function. Skin compromised with tape stripping and delipidization significantly (p<0.05) increased permeation of diclofenac diethylamine compared to intact and microneedle treated skin with phosphate buffered saline vehicle. A similar trend in permeation was observed with mineral oil as the vehicle. For both vehicles, permeation across skin increased in the same order and correlated with degree of barrier impairment as indicated by transepidermal water loss values: intactcompromised skin. PMID:24979534

  15. 32 CFR 2400.33 - Loss or possible compromise.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 2400.33 National Defense Other Regulations Relating to National Defense OFFICE OF SCIENCE AND TECHNOLOGY POLICY REGULATIONS TO IMPLEMENT E.O. 12356; OFFICE OF SCIENCE AND TECHNOLOGY POLICY INFORMATION... measures taken to negate or minimize any adverse effect of the compromise. (b) The Security Officer...

  16. 32 CFR 2400.33 - Loss or possible compromise.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 2400.33 National Defense Other Regulations Relating to National Defense OFFICE OF SCIENCE AND TECHNOLOGY POLICY REGULATIONS TO IMPLEMENT E.O. 12356; OFFICE OF SCIENCE AND TECHNOLOGY POLICY INFORMATION... measures taken to negate or minimize any adverse effect of the compromise. (b) The Security Officer...

  17. 45 CFR 1177.12 - Compromise, suspension and termination.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... THE ARTS AND THE HUMANITIES NATIONAL ENDOWMENT FOR THE HUMANITIES CLAIMS COLLECTION § 1177.12 Compromise, suspension and termination. (a) The Chairperson of the National Endowment for the Humanities or... available to the public. (b) The Chairperson of the National Endowment for the Humanities may...

  18. 45 CFR 1177.12 - Compromise, suspension and termination.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... THE ARTS AND THE HUMANITIES NATIONAL ENDOWMENT FOR THE HUMANITIES CLAIMS COLLECTION § 1177.12 Compromise, suspension and termination. (a) The Chairperson of the National Endowment for the Humanities or... available to the public. (b) The Chairperson of the National Endowment for the Humanities may...

  19. 45 CFR 1177.12 - Compromise, suspension and termination.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... THE ARTS AND THE HUMANITIES NATIONAL ENDOWMENT FOR THE HUMANITIES CLAIMS COLLECTION § 1177.12 Compromise, suspension and termination. (a) The Chairperson of the National Endowment for the Humanities or... available to the public. (b) The Chairperson of the National Endowment for the Humanities may...

  20. 45 CFR 1177.12 - Compromise, suspension and termination.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... THE ARTS AND THE HUMANITIES NATIONAL ENDOWMENT FOR THE HUMANITIES CLAIMS COLLECTION § 1177.12 Compromise, suspension and termination. (a) The Chairperson of the National Endowment for the Humanities or... available to the public. (b) The Chairperson of the National Endowment for the Humanities may...

  1. 45 CFR 1177.12 - Compromise, suspension and termination.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... THE ARTS AND THE HUMANITIES NATIONAL ENDOWMENT FOR THE HUMANITIES CLAIMS COLLECTION § 1177.12 Compromise, suspension and termination. (a) The Chairperson of the National Endowment for the Humanities or... available to the public. (b) The Chairperson of the National Endowment for the Humanities may...

  2. 32 CFR 2400.33 - Loss or possible compromise.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 32 National Defense 6 2013-07-01 2013-07-01 false Loss or possible compromise. 2400.33 Section 2400.33 National Defense Other Regulations Relating to National Defense OFFICE OF SCIENCE AND TECHNOLOGY POLICY REGULATIONS TO IMPLEMENT E.O. 12356; OFFICE OF SCIENCE AND TECHNOLOGY POLICY...

  3. 26 CFR 601.203 - Offers in compromise.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... STATEMENT OF PROCEDURAL RULES Rulings and Other Specific Matters § 601.203 Offers in compromise. (a) General... Department of Justice for prosecution or defense. Certain functions of the Commissioner with respect to... prosecution are pending in the Office of the Chief Counsel, the Department of Justice, or in an office of...

  4. 7 CFR 1956.124 - Compromise and adjustment.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 7 Agriculture 14 2012-01-01 2012-01-01 false Compromise and adjustment. 1956.124 Section 1956.124 Agriculture Regulations of the Department of Agriculture (Continued) RURAL HOUSING SERVICE, RURAL BUSINESS-COOPERATIVE SERVICE, RURAL UTILITIES SERVICE, AND FARM SERVICE AGENCY, DEPARTMENT OF AGRICULTURE (CONTINUED) PROGRAM REGULATIONS...

  5. An Item Response Model for Characterizing Test Compromise.

    ERIC Educational Resources Information Center

    Segall, Daniel O.

    2002-01-01

    Developed an item response model for characterizing test-compromise that enables the estimation of item preview and score-gain distributions. In the approach, models parameters and posterior distributions are estimated by Markov Chain Monte Carlo procedures. Simulation study results suggest that when at least some test items are known to be…

  6. Providing medications for low-income and indigent patients: success for Medicare Part D walks in the back door.

    PubMed

    Flaer, Paul J; Younis, Mustafa Z; Malow, Robert M

    2008-01-01

    Hailed by politicians as long-awaited assistance for seniors and the disabled with the rising costs of prescription drugs, Medicare Part D primarily helps indigent and low-income patients. Moreover, poverty-level patients will find stable prices and versatility in obtaining prescription medications under Medicare D. For low-income patients using pharmacies of their choice--including hospital pharmacies, if they so choose, there are reduced transportation hassles and reduced associated expenses. Poverty-level patients with the additional Social Security subsidy have no deductible and no gaps in their coverage. However, two unintended, unforeseen circumstances occurred with the implementation of Medicare Part D: 1. The exodus of patients from hospital pharmacies and from central pharmacies (e.g., pharmacies serving a particular HMO plan) to neighborhood pharmacies lowered the volume of medications provided and stabilized a teetering and overwhelmed system of prescription drug provision; and 2. Many hospital pharmacies charge on a sliding scale, and the users of specialty medications (e.g., Zyprexa) with large copays under Medicare Part D found minimal costs and big savings at the low end of the sliding scale (for example, $5). The biggest successes for Medicare Part D truly came through an unintended back door and serve as an economic advantage for the poor. PMID:18468374

  7. 22 CFR 511.6 - Board authority to adjust, determine, compromise, and settle claims and limitations upon that...

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... settle claims asserted under the provisions of section 2672 of the Act and under this part. (b) Limitation on Board authority: An award, compromise, or settlement of a claim by the Board under the provisions of section 2672 of the Act, in excess of $25,000, shall be effected only with the prior...

  8. A review of dental treatment of head and neck cancer patients, before, during and after radiotherapy: part 2.

    PubMed

    Jawad, H; Hodson, N A; Nixon, P J

    2015-01-01

    The incidence of head and neck cancer is on the rise. Radiation therapy is one of the major treatment modalities for the management of oral malignancies. As with any treatment modality, radiation therapy is associated with various complications. The second part of this series is a review of the oral changes that occur during and after radiotherapy and the oral management of head and neck oncology patients before, during and after radiotherapy. Dental practitioners will encounter patients who have been affected by cancer or who are current cancer patents. General dental practitioners (GDPs) have a vital and proactive role in supporting such patients. The aim of this article is to review the oral management of these patients during and after radiotherapy, and gives practical advice for GDPs and their teams in the long-term care of these patients. PMID:25613261

  9. A brief historical and theoretical perspective on patient autonomy and medical decision making: Part II: The autonomy model.

    PubMed

    Will, Jonathan F

    2011-06-01

    As part of a larger series addressing the intersection of law and medicine, this essay is the second of two introductory pieces. Beginning with the Hippocratic tradition and lasting for the next 2,400 years, the physician-patient relationship remained relatively unchanged under the beneficence model, a paternalistic framework characterized by the authoritative physician being afforded maximum discretion by the trusting, obedient patient. Over the last 100 years or so, in response to certain changes taking place in both research and clinical practice, the bioethics movement ushered in the autonomy model, and with it, a profoundly different way of approaching decision making in medicine. The shift from the beneficence model to the autonomy model is governed legally by the informed consent doctrine, which emphasizes disclosure to patients of information sufficient to permit them to make intelligent choices regarding treatment alternatives. As this legal doctrine became established, philosophers identified an inherent value in respecting patients as autonomous agents, even where patient choice seems to conflict with the physician's duty to act in the patient's best interests. Whereas the beneficence model presumed that the physician knew what was in the patient's best interests, the autonomy model starts from the premise that the patient knows what treatment decision is in line with his or her true sense of well-being, even where that decision is the refusal of treatment and the result is the patient's death. PMID:21652559

  10. Biochemical characterization of the component parts of intestinal mucin from patients with cystic fibrosis.

    PubMed Central

    Mantle, M; Forstner, G G; Forstner, J F

    1984-01-01

    Previous studies have shown that human small-intestinal mucin consists of high-Mr glycoproteins and a smaller S-S-bonded protein of 118 kDa. The major antigenic determinants of the mucin were associated with the large glycoproteins, but depended for stability on intact disulphide bonds, and were destroyed by digestion with Pronase. In the present study we isolated and analysed the component parts of mucin from patients with cystic fibrosis with special attention being paid to the peptide constituents. After reduction with 0.2 M-beta-mercaptoethanol [5 min, 100 degrees C in 1% SDS (sodium dodecyl sulphate)], the large glycoproteins and smaller peptide with an apparent molecular size of 118 kDa were separated by equilibrium density-gradient centrifugation in CsCl, Sepharose 4B chromatography or preparative SDS/polyacrylamide-gel electrophoresis. The large glycoproteins contained about 70% of the protein of the native mucin. Digestion with Pronase resulted in a further loss of 'naked' protein (10% of the native mucin protein) from the C-terminal end of the glycoprotein peptide core, and left behind highly glycosylated proteins comprised mainly (70 mol%) of threonine, serine and proline. The 118 kDa component, which contained about 30% of the native mucin protein, consisted mainly of aspartic acid, serine, glutamic acid and glycine (40 mol%), plus threonine, proline, alanine, valine and leucine (35 mol%). Together with the 'naked' protein segment, the 118 kDa component contained most of the cysteine residues of the native mucin. Surprisingly, the peptide also contained carbohydrate (less than or equal to 5% of the native mucin carbohydrate but 50% by weight of the 118 kDa component), which included 9 mol% mannose, suggesting the presence of N-linked oligosaccharides. The peptide exhibited strong non-covalent interactions with the high-Mr glycoproteins and a tendency to self-aggregate in the absence of dissociating agents. Our findings therefore suggest that native

  11. Securing Single Points of Compromise (SPoC)

    SciTech Connect

    Belangia, David Warren

    2015-06-25

    Securing the Single Points of Compromise that provide central services to the institution’s environment is paramount to success when trying to protect the business. (Fisk, 2014) Time Based Security mandates protection (erecting and ensuring effective controls) that last longer than the time to detect and react to a compromise. When enterprise protections fail, providing additional layered controls for these central services provides more time to detect and react. While guidance is readily available for securing the individual critical asset, protecting these assets as a group is not often discussed. Using best business practices to protect these resources as individual assets while leveraging holistic defenses for the group increases the opportunity to maximize protection time, allowing detection and reaction time for the SPoCs that is commensurate with the inherent risk of these centralized services.

  12. A technique to salvage endodontically compromised maxillary anterior tooth.

    PubMed

    Comut, Alper; Foran, Denise; Cunningham, Ralph P

    2014-01-01

    A complication of endodontic treatment is over-preparation of the tooth structure in an attempt to access calcified pulp chambers and root canals. This could result in thin root walls that might compromise the long-term prognosis of the tooth. There are various treatment options when such a complication occurs, among them, extraction of the compromised tooth and its replacement with a dental implant. This clinical report describes a nonsurgical, multidisciplinary treatment alternative where a maxillary anterior tooth with a thinned root wall was successfully saved by repairing the damaged root to its original thickness using a composite resin material and subsequently restoring with a cast post and core and a crown. PMID:24654367

  13. Creating clones, kids & chimera: liberal democratic compromise at the crossroads.

    PubMed

    Adams, Nathan A

    2004-01-01

    The objective of this article is to find middle ground between the supporters and opponents of biotechnology by perpetuating the existing legal compromise pertaining to the complete range of health and welfare doctrines relevant to the biotechnological industry. The author aspires neither to add to nor detract from this liberal democratic consensus, but to preserve its constitutive balance between positivism and natural law and over-regulation and under-regulation in the hopes of stabilizing new political fault lines developing around the few biotechnological innovations already grabbing headlines. The most feasible solution is to extend the existing liberal democratic compromise with respect to equal protection, reproductive rights, the First Amendment, human subject experimentation, patent law, and parental rights. This includes banning or monopolizing certain biotechnologies and extending substantive special respect to the ex vivo living human embryo. Biotechnology must not be left to regulate itself. PMID:15382747

  14. Formative evaluation of a telemedicine model for delivering clinical neurophysiology services part II: The referring clinician and patient perspective

    PubMed Central

    2010-01-01

    Background Feedback from service users will provide insight into opportunities for improvement so that performance can be optimised. In the context of a formative evaluation referring clinician and patient satisfaction with a teleneurophysiology service was examined during a 20 week pilot period. Methods Questionnaire surveys of referring clinicians and patients were conducted. Results Fifteen (58%) clinicians responded to the first part of a postal survey which examined their satisfaction with traditional clinical neurophysiology services. Nine (35%) responded to a second part which assessed their experience with the teleneurophysiology service. Teleneurophysiology improved satisfaction with waiting times, availability of results and impact on patient management. There was unanimous support from the clinicians for the permanent development of a teleneurophysiology service, although 2 cautioned this could delay establishing a neurology service in their region. Eighty-two percent (116/142) of patients responded to a survey of their satisfaction with teleneurophysiology. This was compared to a previous report of 322 patients' experience with traditional CN services in Ireland. Waiting times for appointment were shorter for the former group who supported the telemedicine model recognising that it reduced the travel burden and need for overnight journeys. The two groups were equally anxious about the investigation although the teleneurophysiology patients received more prior information. Conclusion This study illustrates that teleneurophysiology is an acceptable model of service delivery for its primary customers. Their feedback is important in informing appropriate design and governance of such innovative models of health service provision. PMID:20843310

  15. Telephone calls to patients after discharge from the hospital: an important part of transitions of care

    PubMed Central

    Record, Janet D.; Niranjan-Azadi, Ashwini; Christmas, Colleen; Hanyok, Laura A.; Rand, Cynthia S.; Hellmann, David B.; Ziegelstein, Roy C.

    2015-01-01

    Background Teaching interns patient-centered communication skills, including making structured telephone calls to patients following discharge, may improve transitions of care. Objective To explore associations between a patient-centered care (PCC) curriculum and patients’ perspectives of the quality of transitional care. Methods We implemented a novel PCC curriculum on one of four inpatient general medicine resident teaching teams in which interns make post-discharge telephone calls to patients, contact outpatient providers, perform medication adherence reviews, and engage in patient-centered discharge planning. Between July and November of 2011, we conducted telephone surveys of patients from all four teaching teams within 30 days of discharge. In addition to asking if patients received a call from their hospital physician (intern), we administered the 3-Item Care Transitions Measure (CTM-3), which assesses patients’ perceptions of preparedness for the transition from hospital to home (possible score range 0–100). Results The CTM-3 scores (mean±SD) of PCC team patients and standard team patients were not significantly different (82.4±17.3 vs. 79.6±17.6, p=0.53). However, regardless of team assignment, patients who reported receiving a post-discharge telephone call had significantly higher CTM-3 scores than those who did not (84.7±16.0 vs. 78.2±17.4, p=0.03). Interns exposed to the PCC curriculum called their patients after discharge more often than interns never exposed (OR=2.78, 95% CI [1.25, 6.18], p=0.013). Conclusions The post-discharge telephone call, one element of PCC, was associated with higher CTM-3 scores – which, in turn, have been shown to lessen patients’ risk of emergency department visits within 30 days of discharge. PMID:25933623

  16. Potential Soviet compromise on ballistic missile defense. Final report

    SciTech Connect

    Nguyen, H.P.

    1989-11-01

    The body of this research memorandum was written before the Baker-Shevardnadze meeting in Wyoming. It presented evidence suggesting that the Soviet Union might agree to a compromise at the Wyoming meeting that defers the issue of ballistic missile defense (BMD) negotiations to a later stage in arms reductions, thus facilitating a first-stage cut in offensive arms without an explicit Soviet endorsement of the Strategic Defense Initiative (SDI). Through this compromise, offensive arms reductions should first be delinked from an agreement on BMD, and then be relinked during the second stage of deeper cuts. Therefore, negotiations on limiting BMD systems, though deterred, are deemed inevitable if the U.S. persists in deploying a strategic defense system (SDS). Moreover, some Soviet arms controllers already look beyond the first stage to the prospect of negotiated transition into a strategic defense environment (i.e., a reliance on defensive deterrence). In this approach, Wyoming, then, was expected to be only a first move in the Soviet negotiating strategy for a grand compromise on strategic defense. As explained in the afterword added to the paper, the actual events at Wyoming seem consistent with that interpretation.

  17. Rules for improving pharmacotherapy in older adult patients: part 1 (rules 1-5).

    PubMed

    Wooten, James M

    2015-02-01

    The population of older adult patients in the United States is growing each year. Appropriate pharmacotherapy has allowed many older patients to live longer and maintain healthy lives. Unfortunately, the inappropriate utilization of medications can be harmful to older adult patients. Inappropriate pharmacotherapy may lead to overusing medications and polypharmacy. Polypharmacy can contribute to a higher incidence of adverse effects, increase the risk of dangerous drug interactions, cause noncompliance with appropriate medication use, and significantly increase the cost of health care. The polypharmacy issue with geriatric patients has been described as an epidemic and this issue must be addressed. This review provides objective rules that may help prevent polypharmacy. Consideration of these rules when prescribing, dispensing, and caring for older adult patients will improve the overall pharmacotherapy regimens instituted by healthcare providers. PMID:25688894

  18. Management of malignant airway compromise with laser and low dose rate brachytherapy. The Mayo Clinic experience

    SciTech Connect

    Schray, M.F.; McDougall, J.C.; Martinez, A.; Cortese, D.A.; Brutinel, W.M.

    1988-02-01

    Between January 1983 and October 1985, 65 patients with malignant airway compromise have had 93 flexible bronchoscopic placements of a nylon afterloading catheter for low dose rate iridium-192 temporary intraluminal brachytherapy. All patients received prior (59 patients) and/or concurrent (13 patients) external beam irradiation to tolerance and were not candidates for surgery. Forty of these patients also received neodymium-YAG laser treatment prior to brachytherapy in a planned combined approach to provide immediate symptomatic relief and facilitate catheter placement. A dose of 3000 cGy is prescribed to 5 mm and 10 mm radii over 20-40 hours in the bronchus and trachea, respectively. Of 59 patients treated with palliative intent, 40 patients (68%) have had follow-up bronchoscopy, 18 patients have had clinical follow-up only, and one patient was lost to follow-up. Of 40 patients examined by bronchoscope in follow-up, 24 (60%) responded, eight were stable, and eight progressed. Lack of progression after prior external beam radiation for periods of greater than 12 months, six-12 months and less than six months yielded response rates to brachytherapy in 83, 50 and 31%, respectively. Most patients with clinical follow-up only expired at early intervals with airway palliation from extra-airway disease progression. Four of five patients treated with curative intent are disease-free at a median of 16 months. Eleven patients have experienced fistula and/or hemorrhage, of which seven instances (11% of all patients) appear to be treatment-induced. This brachytherapy technique is simple, well tolerated, and convenient for the patient providing airway palliation in the significant majority of patients with acceptable risk.

  19. Patient-reported outcomes in post-traumatic stress disorder Part I: Focus on psychological treatment

    PubMed Central

    d'Ardenne, Patricia; Heke, Sarah

    2014-01-01

    Since 2000, patient reports have contributed significantly to the widening diagnostic criteria for post-traumatic stress disorder, notably with the inclusion of complex, repeated, and indirect threat to people who develop symptoms. This paper describes and explains why patient reports matter, through worldwide mental health users' movements and the human rights movement. It looks at 46 recent patient-reported outcomes of preferred psychological treatments in clinical research and practice, and compares them with clinician-reported outcomes, using rating scales that diagnose and measure therapeutic gains. Attention is given to one qualitative study of survivors of the London bombings as an example of patients' personal traumatic experiences. Understanding patients' views and their limitations can help increase success in trauma-focused therapy outcomes, particularly where patients fail to engage with or complete treatment, where they doubt the validity of the treatment, or do not see it as culturally appropriate, or fear of revisiting the past. Specific recommendations are made for a more collaborative approach with patients in psychiatric and community care and clinical research. PMID:25152659

  20. Patient-reported outcomes in post-traumatic stress disorder. Part I: focus on psychological treatment.

    PubMed

    d'Ardenne, Patricia; Heke, Sarah

    2014-06-01

    Since 2000, patient reports have contributed significantly to the widening diagnostic criteria for post-traumatic stress disorder, notably with the inclusion of complex, repeated, and indirect threat to people who develop symptoms. This paper describes and explains why patient reports matter, through worldwide mental health users' movements and the human rights movement. It looks at 46 recent patient-reported outcomes of preferred psychological treatments in clinical research and practice, and compares them with clinician-reported outcomes, using rating scales that diagnose and measure therapeutic gains. Attention is given to one qualitative study of survivors of the London bombings as an example of patients' personal traumatic experiences. Understanding patients' views and their limitations can help increase success in trauma-focused therapy outcomes, particularly where patients fail to engage with or complete treatment, where they doubt the validity of the treatment, or do not see it as culturally appropriate, or fear of revisiting the past. Specific recommendations are made for a more collaborative approach with patients in psychiatric and community care and clinical research. PMID:25152659

  1. Lymphocyte transformation by grass pollen allergens: a study of atopic patients receiving immunotherapy. Part II. Patients during maintenance treatment.

    PubMed

    Broman, P; Möller, E

    1988-07-01

    We have previously reported on peripheral blood lymphocyte (PBL) transformation by allergen, PPD as a control antigen and PHA as a mitogen during and after a preseasonal immunotherapy period. The present report describes similar parameters during and after the ensuing maintenance treatment period. Ten patients with grass pollen rhinitis were treated with Allpyral extract and 10 with Conjuvac two-grass mixture. Lymphocyte transformation responses to grass antigen continued to be low for PBL from patients during the maintenance treatment. Postseasonal values were higher during treatment. In late autumn 1980, when treatment had been stopped, there was a spontaneous fall in lymphocyte stimulation values. Occasional high values were noticed in some patients, two of whom had treatment side effects (urticaria). Clinical data during the whole treatment period (skin prick test, provocation tests, serological parameters, total IgE, grass-specific IgE, grass-specific IgG, pollen counts, symptom scores, clinical effect and adverse reactions) have been published separately. PMID:3414911

  2. Evaluation and diagnosis of the hair loss patient: part II. Trichoscopic and laboratory evaluations.

    PubMed

    Mubki, Thamer; Rudnicka, Lidia; Olszewska, Malgorzata; Shapiro, Jerry

    2014-09-01

    The use of trichoscopy for evaluating a number of hair and scalp disorders is gaining popularity. It is a simple and noninvasive in vivo tool for visualizing hair shafts and the scalp. Recently, alopecias have been classified according to their trichoscopic findings. The second part of this 2-part continuing medical education article reviews recent advances in this field and describes a systematic approach for using the differential diagnostic findings of trichoscopy in alopecia. PMID:25128119

  3. Thienopyridine Use After Coronary Stenting in Low Income Patients Enrolled in Medicare Part D Receiving Maintenance Dialysis

    PubMed Central

    Chang, Tara I.; Montez‐Rath, Maria E.; Shen, Jenny I.; Solomon, Matthew D.; Chertow, Glenn M.; Winkelmayer, Wolfgang C.

    2014-01-01

    Background Coronary stenting in patients on dialysis has increased by nearly 50% over the past decade, despite heightened risks of associated stent thrombosis and bleeding relative to the general population. We examined clopidogrel, prasugrel or ticlopidine use after percutaneous coronary intervention (PCI) with stenting in patients on dialysis. We conducted 3‐, 6‐, and 12‐month landmark analyses to test the hypothesis that thienopyridine discontinuation prior to those time points would be associated with higher risks of death, myocardial infarction, or repeat revascularization, and a lower risk of major bleeding episodes compared with continued thienopyridine use. Methods and Results Using the US Renal Data System, we identified 8458 patients on dialysis with Medicare Parts A+B+D undergoing PCI with stenting between July 2007 and December 2010. Ninety‐nine percent of all thienopyridine prescriptions were for clopidogrel. At 3 months, 82% of patients who received drug‐eluting stents (DES) had evidence of thienopyridine use. These proportions fell to 62% and 40% at 6 and 12 months, respectively. In patients who received a bare‐metal stent (BMS), 70%, 34%, and 26% of patients had evidence of thienopyridine use at 3, 6, and 12 months, respectively. In patients who received a DES, there was a suggestion of higher risks of death or myocardial infarction associated with thienopyridine discontinuation in the 3‐, 6‐, and 12‐months landmark analyses, but no higher risk of major bleeding episodes. In patients who received a BMS, there were no differences in death or cardiovascular events, and possibly lower risk of major bleeding with thienopyridine discontinuation in the 3‐ and 6‐month landmark analyses. Conclusions The majority of patients on dialysis who undergo PCI discontinue thienopyridines before 1 year regardless of stent type. While not definitive, these data suggest that longer‐term thienopyridine use may be of benefit to patients on

  4. Hypnosis in nursing practice--emphasis on the "problem patient' who has pain--Part II.

    PubMed

    Zahourek, R P

    1982-04-01

    The program of treating burned patients with hypnosis was expanded to treating multi-problem and chronic pain patients on the same surgical unit at Denver General Hospital. The majority of patients received some benefit. Many gained control over intense pain and many increased their sense of self-esteem and mastery. The behavioral problems diminished and the staff became reinterested and reinvolved with these very needy people. Whether or not nurses elect to practice hypnosis, the principles are familiar and can be added to the repertory of nursing practice. Physical and psychological relaxation relieves distress and potentiates patients' comfort with or without pain medication. Communicate to the patient that what you are doing builds confidence and increases the probability that treatment wil be effective. Furthermore, recognizing imaginary capacities as powerful in promoting comfort adds an option for intervention not always considered or used by nurses. Whether or not nurses describe what they do as "hypnosis," the use of these techniques can be useful to their practice and to the patients in whom they attempt to alleviate suffering and promote comfort and growth. PMID:7047732

  5. Needs for CME in geriatrics. Part 1: Perceptions of patients and community informants.

    PubMed Central

    Pereles, L.; Russell, M. L.

    1996-01-01

    OBJECTIVE: To describe the needs of physicians for continuing education in geriatrics as perceived by patients and community informants. DESIGN: Cross-sectional survey by mail and in-person interviews. SETTING: Organizations working with the elderly in the community and patients in a primary care population in Calgary. PARTICIPANTS: Key informants working with the elderly in the community, including managers and providers of physical, psychosocial, educational, or mental health services to the elderly, and the first two geriatric patients visiting physicians after telephone contact from study investigators were surveyed. Twenty-five of 27 key community informants and 32 of 61 geriatric patients responded. MAIN OUTCOME MEASURE: Potential topics for continuing medical education. RESULTS: The 10 most frequently identified topics were communication, time management, attitudes to the elderly, medication, continuity of care, mental health, medical management of complicated cases, knowledge of community resources, health promotion, and compassion. Patients were more concerned than key informants about the process of care. Key informants were concerned about the technical aspects of care. CONCLUSIONS: The process of care as well as technical aspects of care must be addressed in continuing education in geriatrics for physicians. PMID:8616284

  6. Preparing patients to travel abroad safely. Part 1: Taking a travel history and identifying special risks.

    PubMed Central

    Thomas, R. E.

    2000-01-01

    OBJECTIVE: To present for family physicians without access to a travel clinic and the Internet the questions to ask about the medical history and itinerary of their patients traveling abroad. To suggest ways to identify and advise high-risk patients. QUALITY OF EVIDENCE: MEDLINE searches from 1990 to November 1998 located 51 articles on travel and diabetes, 37 on travel and chronic obstructive pulmonary disease (COPD), 63 on travel and heart disease, 192 on travel and pregnancy, and 298 on travel with infants or children. Additional searches were undertaken in September 1999. The quality of evidence in most articles is level III (expert opinion). There are no randomized controlled trials of the best advice for family physicians to give travelers. MAIN MESSAGE: A history should include countries to be visited, planned activities, previous tropical travel, medical history, vaccination status, whether children are traveling, pregnancy status, and patients' opinions of the risks and precautions needed. Detailed advice should be given to reduce risks. The main causes of mortality abroad are existing cardiovascular conditions and accidents. High-risk conditions to be identified in travelers are cardiovascular illness, COPD, diabetes, immunodeficiency, pregnancy, and traveling with children. CONCLUSIONS: Patients with cardiovascular illness or COPD should be advised to avoid too much exertion while traveling. Detailed instruction should be given to diabetic patients on how to maintain stable glucose levels, to pregnant women on avoiding malarial infection, and to parents on protecting their children from infections and accidents. PMID:10660795

  7. [The Patient Rights Act (PatRG)--Part 3: Burden of proof in liability questions and critical resumé].

    PubMed

    Parzeller, Markus; Zedler, Barbara

    2014-01-01

    The article deals with the new regulations in the German Civil Code (Bürgerliches Gesetzbuch - BGB), which came into effect in Germany as the Patient Rights Act (PatRG) on the 2/26/2013. In the third part, the burden of proof in liability questions (and 630h BGB) are discussed and critically analysed. In the discussion and a final resume points of criticism of the new law are pointed out. PMID:24683869

  8. Realizing your marketing influence, Part 1. Meeting patient needs through collaboration.

    PubMed

    Woods, Dana K

    2002-04-01

    To what degree do or should marketing and nursing overlap? If marketing is about meeting patient needs, who better than the nursing staff to inform marketing decisions? Meeting patient needs profitably ensures that patient care can continue to move toward excellence. As competition continues to intensify and reimbursement remains insufficient, using all of the healthcare system's available intellectual capital is imperative to achieving maximum competitive advantage. The author applies current marketing theory to the healthcare environment and provides practical suggestions on how nursing administrators and staff can work collaboratively with marketing colleagues to develop and implement strategic marketing programs. This is the first in a series of 3 articles, which will move readers from broad marketing strategy to specific applications. The second (June, 2002) and third articles (July/August, 2002) will focus on internal marketing and using professional certification as a marketing tool. PMID:11984254

  9. Pre-Prosthetic surgical alterations in maxillectomy to enhance the prosthetic prognoses as part of rehabilitation of oral cancer patient

    PubMed Central

    El Fattah, Hisham; Zaghloul, Ashraf; Escuin, Tomas

    2012-01-01

    Objectives: After maxillectomy, prosthetic restoration of the resulting defect is an essential step because it signals the beginning of patient’s rehabilitation. The obturator used to restore the defect should be comfortable, restore adequate speech, deglutition, mastication, and be cosmetically acceptable, success will depend on the size and location of the defect and the quantity and integrity of the remaining structures, in addition to pre-prosthetic surgical preparation of defect site. Preoperative cooperation between the oncologist surgeon and the maxillofacial surgeon may allow obturation of a resultant defect by preservation of the premaxilla or the tuberosity on the defect side and maintaining the alveolar bone or teeth adjacent to the defect. This study evaluates the importance of pre-prosthetic surgical alterations at the time maxillectomy on the enhancement of the prosthetic prognoses as part of the rehabilitation of oral cancer patient. Study Design: The study was carried out between 2003- 2008, on 66 cancer patients(41 male-25 female) age ranged from 33 to 72 years, at National Cancer Institute, Cairo University, whom underwent maxillectomy surgery to remove malignant tumor as a part of cancer treatment. Patients were divided in two groups. Group A: Resection of maxilla followed by preprosthetic surgical preparation. Twenty-four cancer patients (13 male – 11 female). Group B: Resection of maxilla without any preprosthetic surgical preparation. Forty-two cancer patients (28 male-14 female). Results: Outcome variables measured included facial contour and aesthetic results, speech understandability, ability to eat solid foods, oronasal separation, socializing outside the home, and return-to-work status. Flap success and donor site morbidity were also studied. Conclusions: To improve the prosthetic restoration of maxillary defect resulting maxillary resection as part treatment of maxillofacial tumor depends on the close cooperation between

  10. Selected problems associated with the treatment and care for patients with colostomy – part 2

    PubMed Central

    Kachaniuk, Hanna; Szadowska-Szlachetka, Zdzisława; Charzyńska-Gula, Marianna; Kocka, Katarzyna; Bartoszek, Agnieszka; Celej-Szuster, Jolanta

    2013-01-01

    Generally, ostomy is a purposeful connection of the lumen of the intestine with abdominal integuments by surgery. The study presents practical solutions related to care for the colostomy patient, i.e. an ostomy on the large intestine. The following issues will be discussed: regulating the defecation cycle, risk connected with improper selection of ostomy equipment, instruction on colostomy irrigation with practical advice and irrigation equipment supply. The knowledge of these rules and mastering them in practice is to provide ostomy patients not only with highest-standard care and help but also to prepare them for dealing with problems independently, i.e. for self-care. PMID:24596509

  11. [Medroxyprogesterone Acetate as Part of Palliative Care for Terminal-Stage Breast Cancer Patients--A Report of Two Cases].

    PubMed

    Okamoto, Akiko; Ueno, Hiroshi; Yamashiro, Akiko; Okada, Megumi; Nakasone, Arisa; Hatano, Takahiko; Harada, Akiho; Taniguchi, Ayano; Onishi, Keiko; Kwon, Chul; Fukazawa, Keita; Taguchi, Tetsuya; Amaya, Fumimasa; Hosokawa, Toyoshi

    2016-03-01

    Various effective strategies have recently been described in the treatment of breast cancer, including endocrine therapy, chemotherapy, and molecular-targeted therapy, providing long-term survival benefits even after cancer recurrence. However, terminal-stage patients experience side effects and worse quality of life (QOL), in addition to deterioration of their general condition caused by the progression of the disease itself. When providing the best supportive care, use of anti-cancer drugs is not taboo and can represent a good option as long as physical, social, psychological, and spiritual supports are provided to both the patients and their families. Medroxyprogesterone acetate (MPA) is an endocrine therapeutic drug. In Japan, MPA is used only as a late-line endocrine therapy for breast cancer recurrence because many other endocrine therapy drugs are much more effective and MPA increases the risk of thrombosis and obesity. Here, we report 2 patients with breast cancer who reached terminal stage more than 10 years after the first diagnosis. MPA was administered as the final-line treatment. During that time, their appetite and QOL improved and the patients became more active than when they had been undergoing aggressive anticancer treatment. Both patients spent quality time with their families until their death. MPA may be a good option as part of palliative care of breast cancer patients in terminal stage. PMID:27067852

  12. Expert review--identification of intra-partum fetal compromise.

    PubMed

    Prior, Tomas; Kumar, Sailesh

    2015-07-01

    Whilst most cases of cerebral palsy occur as a consequence of an ante-natal insult, a significant proportion, particularly in the term fetus, are attributable to intra-partum hypoxia. Intra-partum monitoring using continuous fetal heart rate assessment has led to an increased incidence of operative delivery without a concurrent reduction in the incidence of cerebral palsy. Despite this, birth asphyxia remains the strongest and most consistent risk factor for cerebral palsy in term infants. This review evaluates current intra-partum monitoring techniques as well as alternative approaches aimed at better identification of the fetus at risk of compromise in labour. PMID:25917435

  13. [Frostbite injuries causing compromised airway after inhalation of propane].

    PubMed

    Straarup, Therese Simonsen; Fink, Anders Olsen; Larsen, Jens Kjærgaard Rolighed

    2015-01-01

    We describe a case report of a 23-year-old man with acute pharyngeal injuries due to frostbite subsequent to inhalation of propane. He was fiber-optically intubated on admission to hospital since his airways were considered acutely compromised. He was subsequently kept intubated for 11 days due to persistent pharyngeal oedema and frostbite injuries. The latter is caused by low temperature of propane upon release from a pressurized container. Injuries caused by frostbite often gradually progress and thus caution should be exerted in regards to airway management. PMID:25557449

  14. Compromising abnormalities of the brachial plexus as displayed by magnetic resonance imaging.

    PubMed

    Collins, J D; Shaver, M L; Disher, A C; Miller, T Q

    1995-01-01

    Magnetic resonance images (MRI) of brachial plexus anatomy bilaterally, not possible by plain radiographs or CT, were presented to the Vascular Surgery, Neurology, and the Neurosurgery departments. Patients were requested for MRI of their brachial plexus. They were referred for imaging and the imaging results were presented to the faculty and housestaff. Our technique was accepted and adopted to begin referrals for MRI evaluation of brachial plexopathy. Over 175 patients have been studied. Eighty-five patients were imaged with the 1.5 Tesla magnet (Signa; General Electric Medical Systems, Milwaukee, WI) 3-D reconstruction MRI. Coronal, transverse (axial), oblique transverse, and sagittal plane T1-weighted and selected T2-weighted pulse sequences were obtained at 4-5 mm slice thickness, 40-45 full field of view, and a 512 x 256 size matrix. Saline water bags were used to enhance the signal between the neck and the thorax. Sites of brachial plexus compromise were demonstrated. Our technique with 3-D reconstruction increased the definition of brachial plexus pathology. The increased anatomical definition enabled the vascular surgeons and neurosurgeons to improve patient care. Brachial plexus in vivo anatomy as displayed by MRI, magnetic resonance angiography (MRA), and 3-D reconstruction offered an opportunity to augment the teaching of clinical anatomy to medical students and health professionals. Selected case presentations (bodybuilder, anomalous muscle, fractured clavicle, thyroid goiter, silicone breast implant rupture, and cervical rib) demonstrated compromise of the brachial plexus displayed by MRI. The MRI and 3-D reconstruction techniques, demonstrating the bilateral landmark anatomy, increased the definition of the clinical anatomy and resulted in greater knowledge of patient care management. PMID:7697507

  15. Medicare Part D: Patients Bear The Cost Of 'Me Too' Brand-Name Drugs.

    PubMed

    Gastala, Nicole M; Wingrove, Peter; Gaglioti, Anne; Petterson, Stephen; Bazemore, Andrew

    2016-07-01

    Prescription drugs are a major source of US health care expenditure. "Me too" brand-name medications contribute to the cost of drugs, which is substantial for consumers. In 2013 patient copayments averaged 10.5 times more for two commonly prescribed brand-name medications versus generic therapeutic alternatives. PMID:27385239

  16. Oral antioxidant treatment partly improves integrity of human sperm DNA in infertile grade I varicocele patients.

    PubMed

    Gual-Frau, Josep; Abad, Carlos; Amengual, María J; Hannaoui, Naim; Checa, Miguel A; Ribas-Maynou, Jordi; Lozano, Iris; Nikolaou, Alexandros; Benet, Jordi; García-Peiró, Agustín; Prats, Juan

    2015-09-01

    Infertile males with varicocele have the highest percentage of sperm cells with damaged DNA, compared to other infertile groups. Antioxidant treatment is known to enhance the integrity of sperm DNA; however, there are no data on the effects in varicocele patients. We thus investigated the potential benefits of antioxidant treatment specifically in grade I varicocele males. Twenty infertile patients with grade I varicocele were given multivitamins (1500 mg L-Carnitine, 60 mg vitamin C, 20 mg coenzyme Q10, 10 mg vitamin E, 200 μg vitamin B9, 1 μg vitamin B12, 10 mg zinc, 50 μg selenium) daily for three months. Semen parameters including total sperm count, concentration, progressive motility, vitality, and morphology were determined before and after treatment. In addition, sperm DNA fragmentation and the amount of highly degraded sperm cells were analyzed by Sperm Chromatin Dispersion. After treatment, patients showed an average relative reduction of 22.1% in sperm DNA fragmentation (p = 0.02) and had 31.3% fewer highly degraded sperm cells (p = 0.07). Total numbers of sperm cells were increased (p = 0.04), but other semen parameters were unaffected. These data suggest that sperm DNA integrity in grade I varicocele patients may be improved by oral antioxidant treatment. PMID:26090928

  17. Care at home of the patient with advanced multiple sclerosis--part 2.

    PubMed

    Reitman, Nancy Clayton

    2010-05-01

    Clinicians caring for patients with advanced MS have choices of different options and approaches. Whatever path is chosen, interventions must incorporate the wishes and capabilities of the patient and be supported by the care team, usually led by the nurse. As the work of the great psychologist Abraham Maslow has shown, in his famous "hierarchy of needs," the basic levels of needs must be met before the highest self-actualization can be accomplished (Maslow, 1943). This is equally true in the nursing care of very ill patients, as authors Zalenski and Raspa write: "The five levels of the hierarchy of needs as adapted to palliative care are: (1) distressing symptoms, such as pain or dyspnea; (2) fears for physical safety, of dying or abandonment; (3) affection, love and acceptance in the face of devastating illness; (4) esteem, respect, and appreciation for the person; (5) self-actualization and transcendence. Maslow's modified hierarchy of palliative care needs could be utilized to provide a comprehensive approach for the assessment of patients' needs and the design of interventions to achieve goals that start with comfort and potentially extend to the experience of transcendence."(Zalenski & Raspa, 2006, p.1120). PMID:20463509

  18. Effects of Aronia melanocarpa juice as part of the dietary regimen in patients with diabetes mellitus.

    PubMed

    Simeonov, Simeon B; Botushanov, Nikolai P; Karahanian, Eksapet B; Pavlova, Maria B; Husianitis, Haralambos K; Troev, Dimitar M

    2002-01-01

    The low calorie juice Aronia melanocarpa (sugar free, with artificial sweeteners) could be a valuable adjunct to the complex therapy of patients with diabetes mellitus. In this study no increased blood glucose levels were established 60 min. following ingestion of 200 ml Aronia juice. On the contrary, lower fasting blood glucose concentrations were measured in 16 patients with insulin dependent diabetes and in 25 patients with non-insulin dependent diabetes (25 women and 16 men, 3 to 62 years of age, median age 38.8 +/- 4.7) with duration of the disease from 1 month to 13 years. Serial blood glucose measurements showed: 14.23 +/- 1.32 mmol/l at baseline and 11.4 +/- 0.89 mmol/l blood glucose level after 60 min., the difference being statistically significant (p<0.05). The ingestion of 200 ml Aronia juice combined with a standard breakfast produced similar results (the basal concentration of glucose was 13.43 +/- 1.12 mmol/l; it decreased to 11.94 +/- 1.02 mmol/l at 60 min., the difference did not reach statistical significance. The daily intake of 200 ml Aronia juice over a period of 3 months was effective in lowering fasting blood glucose levels from 13.28 +/- 4.55 mmol/l to 9.10 +/- 3.05 mmol/l (p<0.001) in 21 patients with non-insulin dependent diabetes--13 women and 8 men aged from 42 to 62 (median age 53.6 +/- 3.65) with disease duration from 6 to 17 years. Aronia had a beneficial effect on HbA1c, total cholesterol and lipid levels. They dropped from 9.39 +/- 2.16% to 7.49 +/- 1.33% (p<0.001), from 6.45 +/- 1.59 mmol/l to 5.05 +/- 0.96 mmol/l (p<0.001) and from 2.92 +/- 2.15 mmol/l to 1.7 +/- 1.07 mmol/l (p<0.001), respectively. Results were compared with those obtained in 23 patients with non-insulin dependent diabetes (15 women and 8 men aged from 48 to 67 years, median age 54.9 +/- 3.34) with disease duration from 6 to 17 years. The above mentioned parameters remained unchanged in these patients. Accumulated data illustrated the hypoglycemic potential of

  19. [Genomic, proteomic and metabolomic predictors of nonalcoholic fatty liver disease development in obese patients. Part I].

    PubMed

    Chernyak, O O; Sentsova, T B; Vorozhko, I V; Tutelyan, V A; Gapparova, K M; Isakov, V A

    2015-01-01

    The prevention, diagnosis and treatment of diseases associated to obesity require a qualitative increase of efficiency. There are still disputable questions about diagnostic significance of some molecules, including genomic, proteomic and metabolomic biomarkers. We observed 72 obese patients (20 men and 52 women, mean age--41.3 +/- 2.5) and performed ultrasound elastography and ultrasound of liver. We have identified two groups of patients: Group 1 consisted of 50 obese patients without complications (BMI 43.2 +/- 0.6), group 2 consisted of 22 patients with obesity complicated with nonalcoholic fatty liver disease (BMI 45.8 +/- 2.3). Determination of the adipokines (adiponectin, ghrelin, resistin, visfatin, and apelin), cytokine (interleukin--6, TNFalpha) oxidized lipoproteins (oxLDL), adhesion molecule sICAM (soluble intercellular cell adhesion molecule), fatty acid transporter L-FABP in serum was performed by ELISA. The study of the lipid metabolism involved determination of the concentration of total cholesterols, triglycerides, low and high density lipoproteins (LDL and HDL) by turbidimetry and spectrophotometry by analyzer. In addition, we conducted analysis of polymorphic alleles epsilon2, epsilon3, episolon4 of ApoE gene using polymerase chain reaction. Our data indicate that reducing the concentration of adiponectin (0.46-1.71 mcg/ml), increasing the level of glucose (5.57-6.25 mmol/l), triglycerides (2.06-3.94 mmol/l), TNFalpha (5.07-16.68 pg/ml) and L-FABP (11.62-23.76 pg/ml) are predictors of nonalcoholic fatty liver disease in obese patients, and the presence of genotype epsilon3/epsilon4 of ApoE gene is a poor prognostic marker of severity of nonalcoholic fatty liver disease. PMID:26852528

  20. Anthropogenic noise compromises antipredator behaviour in European eels.

    PubMed

    Simpson, Stephen D; Purser, Julia; Radford, Andrew N

    2015-02-01

    Increases in noise-generating human activities since the Industrial Revolution have changed the acoustic landscape of many terrestrial and aquatic ecosystems. Anthropogenic noise is now recognized as a major pollutant of international concern, and recent studies have demonstrated impacts on, for instance, hearing thresholds, communication, movement and foraging in a range of species. However, consequences for survival and reproductive success are difficult to ascertain. Using a series of laboratory-based experiments and an open-water test with the same methodology, we show that acoustic disturbance can compromise antipredator behaviour--which directly affects survival likelihood--and explore potential underlying mechanisms. Juvenile European eels (Anguilla anguilla) exposed to additional noise (playback of recordings of ships passing through harbours), rather than control conditions (playback of recordings from the same harbours without ships), performed less well in two simulated predation paradigms. Eels were 50% less likely and 25% slower to startle to an 'ambush predator' and were caught more than twice as quickly by a 'pursuit predator'. Furthermore, eels experiencing additional noise had diminished spatial performance and elevated ventilation and metabolic rates (indicators of stress) compared with control individuals. Our results suggest that acoustic disturbance could have important physiological and behavioural impacts on animals, compromising life-or-death responses. PMID:25098970

  1. [Electronic patient records and teleophthalmology : part 1: introduction to the various systems and standards].

    PubMed

    Schargus, M; Michelson, G; Grehn, F

    2011-05-01

    Electronic storage of patient-related data will replace paper-based patient records in the near future. Some steps in medical practice can even now not be achieved without electronic data processing. Both systems, conventional paper-based and electronic-based records, have advantages and disadvantages which have to be taken into consideration. The advantages of electronic-based records are e.g. good availability of data, structured storage of data, scientific analysis of long-term data and possible data exchange with colleagues in the context of teleconsultation systems. Problems have to be solved in the field of data security, initial high investment costs and time consumption in learning to use the system as well as in incompatibility of existing IT systems. PMID:21590353

  2. Giant Prolactinoma Presenting with Neck Pain and Structural Compromise of the Occipital Condyles.

    PubMed

    Yecies, Derek; Ajlan, Abdulrazag; Ratliff, John; Ziskin, Jennifer; Hwang, Peter; Vogel, Hannes; Katznelson, Laurence; Harsh, Griffith

    2015-11-01

    Prolactinomas are the most common form of endocrinologically active pituitary adenoma; they account for ∼ 45% of pituitary adenomas encountered in clinical practice. Giant adenomas are those > 4 cm in diameter. Less than 0.5% of pituitary adenomas encountered in neurosurgical practice are giant prolactinomas. Patients with giant prolactinomas typically present with highly elevated prolactin levels, endocrinologic disturbances, and neurologic symptoms from mass-induced pressure. Described here is an unusual case of a giant prolactinoma presenting with neck pain and structural compromise of the occipital condyles. Transnasal biopsy of the nasopharyngeal portion of the mass obtained tissue consistent with an atypical prolactinoma with p53 reactivity and a high Ki-67 index of 5%. Despite the size and invasiveness of the tumor, the patient had resolution of his clinical symptoms, dramatic reduction of his hyperprolactinemia, and near-complete disappearance of his tumor following medical treatment. PMID:26623246

  3. Giant Prolactinoma Presenting with Neck Pain and Structural Compromise of the Occipital Condyles

    PubMed Central

    Yecies, Derek; Ajlan, Abdulrazag; Ratliff, John; Ziskin, Jennifer; Hwang, Peter; Vogel, Hannes; Katznelson, Laurence; Harsh, Griffith

    2015-01-01

    Prolactinomas are the most common form of endocrinologically active pituitary adenoma; they account for ∼ 45% of pituitary adenomas encountered in clinical practice. Giant adenomas are those > 4 cm in diameter. Less than 0.5% of pituitary adenomas encountered in neurosurgical practice are giant prolactinomas. Patients with giant prolactinomas typically present with highly elevated prolactin levels, endocrinologic disturbances, and neurologic symptoms from mass-induced pressure. Described here is an unusual case of a giant prolactinoma presenting with neck pain and structural compromise of the occipital condyles. Transnasal biopsy of the nasopharyngeal portion of the mass obtained tissue consistent with an atypical prolactinoma with p53 reactivity and a high Ki-67 index of 5%. Despite the size and invasiveness of the tumor, the patient had resolution of his clinical symptoms, dramatic reduction of his hyperprolactinemia, and near-complete disappearance of his tumor following medical treatment. PMID:26623246

  4. Reexamining the Phosphorus-Protein Dilemma: Does Phosphorus Restriction Compromise Protein Status?

    PubMed

    St-Jules, David E; Woolf, Kathleen; Pompeii, Mary Lou; Kalantar-Zadeh, Kamyar; Sevick, Mary Ann

    2016-05-01

    Dietary phosphorus restriction is recommended to help control hyperphosphatemia in hemodialysis patients, but many high-phosphorus foods are important sources of protein. In this review, we examine whether restricting dietary phosphorus compromises protein status in hemodialysis patients. Although dietary phosphorus and protein are highly correlated, phosphorus intakes can range up to 600 mg/day for a given energy and protein intake level. Furthermore, the collinearity of phosphorus and protein may be biased because the phosphorus burden of food depends on: (1) the presence of phosphate additives, (2) food preparation method, and (3) bioavailability of phosphorus, which are often unaccounted for in nutrition assessments. Ultimately, we argue that clinically relevant reductions in phosphorus intake can be made without limiting protein intake by avoiding phosphate additives in processed foods, using wet cooking methods such as boiling, and if needed, substituting high-phosphorus foods for nutritionally equivalent foods that are lower in bioavailable phosphorus. PMID:26873260

  5. Non-Surgical Management of Critically Compromised Airway Due to Dilatation of Interposed Colon

    PubMed Central

    Min, Jinsoo

    2016-01-01

    We present a rare case of critically compromised airway secondary to a massively dilated sequestered colon conduit after several revision surgeries. A 71-year-old male patient had several operations after the diagnosis of gastric cancer. After initial treatment of pneumonia in the pulmonology department, he was transferred to the surgery department for feeding jejunostomy because of recurrent aspiration. However, he had respiratory failure requiring mechanical ventilation. The chest computed tomography (CT) scan showed pneumonic consolidation at both lower lungs and massive dilatation of the substernal interposed colon compressing the trachea. The dilated interposed colon was originated from the right colon, which was sequestered after the recent esophageal reconstruction with left colon interposition resulting blind pouch at both ends. It was treated with CT-guided pigtail catheter drainage via right supraclavicular route, which was left in place for 2 weeks, and then removed. The patient remained well clinically, and was discharged home. PMID:27066087

  6. Justification for conducting neurological clinical trials as part of patient care within private practice.

    PubMed

    Beran, R G; Stepanova, D; Beran, M E

    2016-05-01

    The aim of this review was to assess the benefits and drawbacks of conducting neurological clinical trials and research in private practice for the patients, clinician, Practice Manager, sponsors/Clinical Research Organisations (CROs) and Clinical Trial Coordinator (CTC) to determine if this is justified for all involved. A combination of literature reviews, original research articles and books were selected from 2005 to 2015. Provided that the practice has sufficient number of active trials to prevent financial loss, support staff, adequate facilities and equipment and time, the benefits outweigh the drawbacks. Clinical trials provide patients with more thorough monitoring, re-imbursement of trial-related expenses and the opportunity to try an innovative treatment at no charge when other options have failed. For the clinician, clinical trials provide more information to ensure better care for their patients and improved treatment methods, technical experience and global recognition. Trials collect detailed and up-to-date information on the benefits and risks of drugs, improving society's confidence in clinical research and pharmaceuticals, allow trial sponsors to explore new scientific questions and accelerate innovation. For the CTC, industry-sponsored clinical trials allow potential entry for a career in clinical research giving CTCs the opportunity to become Clinical Research Associates (CRAs), Study Start-Up Managers or Drug Safety Associates. PMID:27040457

  7. Developing a 'critical' approach to patient and public involvement in patient safety in the NHS: learning lessons from other parts of the public sector?

    PubMed

    Ocloo, Josephine E; Fulop, Naomi J

    2012-12-01

    There has been considerable momentum within the NHS over the last 10 years to develop greater patient and public involvement (PPI). This commitment has been reflected in numerous policy initiatives. In patient safety, the drive to increase involvement has increasingly been seen as an important way of building a safety culture. Evidence suggests, however, that progress has been slow and even more variable than in health care generally. Given this context, the paper analyses some of the key underlying drivers for involvement in the wider context of health and social care and makes some suggestions on what lessons can be learned for developing the PPI agenda in patient safety. To develop PPI further, it is argued that a greater understanding is needed of the contested nature of involvement in patient safety and how this has similarities to the emergence of user involvement in other parts of the public services. This understanding has led to the development of a range of critical theories to guide involvement that also make more explicit the underlying factors that support and hinder involvement processes, often related to power inequities and control. Achieving greater PPI in patient safety is therefore seen to require a more critical framework for understanding processes of involvement that can also help guide and evaluate involvement practices. PMID:21711471

  8. Effects of a virtual reality-based exercise program on functional recovery in stroke patients: part 1

    PubMed Central

    Lee, Kyoung-Hee

    2015-01-01

    This study aimed to determine the effects of a virtual reality exercise program using the Interactive Rehabilitation and Exercise System (IREX) on the recovery of motor and cognitive function and the performance of activities of daily living in stroke patients. [Subjects] The study enrolled 10 patients diagnosed with stroke who received occupational therapy at the Department of Rehabilitation Medicine of Hospital A between January and March 2014. [Methods] The patients took part in the virtual reality exercise program for 30 minutes each day, three times per week, for 4 weeks. Then, the patients were re-evaluated to determine changes in upper extremity function, cognitive function, and performance of activities of daily living 4 weeks after the baseline assessment. [Results] In the experimental group, there were significant differences in the Korea-Mini Mental Status Evaluation, Korean version of the modified Barthel index, and Fugl-Meyer assessment scores between the baseline and endpoint. [Conclusion] The virtual reality exercise program was effective for restoring function in stroke patients. Further studies should develop systematic protocols for rehabilitation training with a virtual reality exercise program. PMID:26180287

  9. Evaluation of Hand Written and Computerized Out-Patient Prescriptions in Urban Part of Central Gujarat

    PubMed Central

    Buch, Jatin; Kothari, Nitin; Shah, Nishal

    2016-01-01

    Introduction Prescription order is an important therapeutic transaction between physician and patient. A good quality prescription is an extremely important factor for minimizing errors in dispensing medication and it should be adherent to guidelines for prescription writing for benefit of the patient. Aim To evaluate frequency and type of prescription errors in outpatient prescriptions and find whether prescription writing abides with WHO standards of prescription writing. Materials and Methods A cross-sectional observational study was conducted at Anand city. Allopathic private practitioners practising at Anand city of different specialities were included in study. Collection of prescriptions was started a month after the consent to minimize bias in prescription writing. The prescriptions were collected from local pharmacy stores of Anand city over a period of six months. Prescriptions were analysed for errors in standard information, according to WHO guide to good prescribing. Statistical Analysis Descriptive analysis was performed to estimate frequency of errors, data were expressed as numbers and percentage. Results Total 749 (549 handwritten and 200 computerised) prescriptions were collected. Abundant omission errors were identified in handwritten prescriptions e.g., OPD number was mentioned in 6.19%, patient’s age was mentioned in 25.50%, gender in 17.30%, address in 9.29% and weight of patient mentioned in 11.29%, while in drug items only 2.97% drugs were prescribed by generic name. Route and Dosage form was mentioned in 77.35%-78.15%, dose mentioned in 47.25%, unit in 13.91%, regimens were mentioned in 72.93% while signa (direction for drug use) in 62.35%. Total 4384 errors out of 549 handwritten prescriptions and 501 errors out of 200 computerized prescriptions were found in clinicians and patient details. While in drug item details, total number of errors identified were 5015 and 621 in handwritten and computerized prescriptions respectively

  10. Investigations on the palatal rugae pattern in cleft patients. Part I: A morphological analysis.

    PubMed

    Kratzsch, H; Opitz, C

    2000-01-01

    The characteristics of the palatal rugae zone (number of rugae, relief type, posterior limitation) were investigated on the maxillary casts of 44 patients with unilateral cleft lip and palate and 28 patients with bilateral clefts by means of reflex microscopy, a three-dimensional, computer-assisted, touch-free measuring system for the metrical registration and analysis of the parameters directly on the maxillary casts for the segments of the 2 cleft groups. The features "number of palatal rugae" and "relief type" (primary rugae) were determined both before and after surgical repair of the cleft palate. Both segments in unilateral cleft lip and palate and both lateral segments in bilateral clefts most commonly had 4 to 5 palatal rugae. The number of rugae in cleft patients is thus in a range that other authors have reported for non-cleft individuals. Following palatal cleft repair, the rugae counts per segment decreased significantly in patients with unilateral and bilateral cleft lip and palate but the 3rd rugae was never lost after surgery. The relief type identified in unilateral and bilateral cleft lip and palate was the same as in isolated cleft palates and did not differ from that in non-cleft subjects. The posterior limitation of the palatal rugae zone was determined both in a tooth-defined manner and as an absolute linear distance (at all time points). The most frequent tooth-defined posterior limitation of the rugae zone in unilateral and bilateral clefts was the second deciduous molar, which is also the position identified for non-cleft individuals. The linear distance from the tuberosity line to the rugae zone increased in all segments of unilateral and bilateral clefts during the interval up to palatal cleft repair, indicating sagittal maxillary development in the posterior area of the palate. Surgical repair of the cleft palate resulted in a significant shortening of the distance in both segments of the unilateral cleft, most likely due to the

  11. Is Mold Toxicity Really a Problem for Our Patients? Part 2-Nonrespiratory Conditions.

    PubMed

    Pizzorno, Joseph; Shippy, Ann

    2016-06-01

    In my last editorial, I addressed the respiratory effects of mold exposure. The surprising research shows that as many as 50% of residential and work environments have water damage1 and that mold toxicity should be considered in all patients with any chronic respiratory condition. This is especially true in adult-onset asthma, two-thirds of which appears to be caused by toxins released from water-damaged buildings. The carcinogenic effects of food-borne mold contamination are also well documented. Less clear is the role of indoor mold exposure in water-damaged buildings and its relationship to nonrespiratory conditions. As we look at the research on mold toxicity and toxins in general, we propose that the medical community (by all its names) has focused too much on the "yellow canaries" and missed the big picture that toxins have now become a primary driver of disease in the general population, not only among those most susceptible. The mold toxicity conundrum illustrates this issue quite well. As summarized in this editorial, there clearly is a portion of the population, the size of which is currently unknown, who experience neurological and/or immunological damage from mold toxicity. In addition, a substantial portion of the population experiences chronic respiratory problems from mold exposure. This does not mean we should stop paying attention to our more affected patients. Rather, we need to realize that almost everyone is being affected by toxins to some degree: molds, metals, solvents, persistent organic pollutants, etc. PMID:27547160

  12. 7 CFR 3550.253 - Settlement of a debt by compromise or adjustment.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 7 Agriculture 15 2014-01-01 2014-01-01 false Settlement of a debt by compromise or adjustment. 3550.253 Section 3550.253 Agriculture Regulations of the Department of Agriculture (Continued) RURAL... Actions § 3550.253 Settlement of a debt by compromise or adjustment. Compromise or adjustment offers...

  13. 7 CFR 3550.253 - Settlement of a debt by compromise or adjustment.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 7 Agriculture 15 2011-01-01 2011-01-01 false Settlement of a debt by compromise or adjustment. 3550.253 Section 3550.253 Agriculture Regulations of the Department of Agriculture (Continued) RURAL... Actions § 3550.253 Settlement of a debt by compromise or adjustment. Compromise or adjustment offers...

  14. 40 CFR 1620.6 - Authority to adjust, determine, compromise, and settle.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ..., compromise, and settle. 1620.6 Section 1620.6 Protection of Environment CHEMICAL SAFETY AND HAZARD..., determine, compromise, and settle. The General Counsel of CSB, or his or her designee, is delegated authority to consider, ascertain, adjust, determine, compromise and settle claims under the provision of...

  15. 40 CFR 1620.6 - Authority to adjust, determine, compromise, and settle.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ..., compromise, and settle. 1620.6 Section 1620.6 Protection of Environment CHEMICAL SAFETY AND HAZARD..., determine, compromise, and settle. The General Counsel of CSB, or his or her designee, is delegated authority to consider, ascertain, adjust, determine, compromise and settle claims under the provision of...

  16. Compromises along the Way: Balancing Speed To Market with Sustainability while Delivering Knowledge Management Services.

    ERIC Educational Resources Information Center

    Heyman, Martha K.

    This paper will discuss some of the compromises, and the path to those compromises, that must be made while implementing a successful knowledge management program within a for-profit enterprise. Specifically the following compromises are addressed: (1) manage knowledge where it is created, but do that within a global system; (2) no single scope…

  17. Perceived Career Compromise, Affect and Work-Related Satisfaction in College Students

    ERIC Educational Resources Information Center

    Tsaousides, Theodore; Jome, LaRae

    2008-01-01

    The objective of this study was to investigate the effects of career compromise on positive affect (PA), negative affect (NA), and work-related satisfaction (WRS). Career compromise refers to the modification of occupational preferences under pressing external circumstances [Gottfredson, L. S. (1981). Circumscription and compromise: A…

  18. Designing and Operating Through Compromise: Architectural Analysis of CKMS for the Advanced Metering Infrastructure

    SciTech Connect

    Duren, Mike; Aldridge, Hal; Abercrombie, Robert K; Sheldon, Frederick T

    2013-01-01

    Compromises attributable to the Advanced Persistent Threat (APT) highlight the necessity for constant vigilance. The APT provides a new perspective on security metrics (e.g., statistics based cyber security) and quantitative risk assessments. We consider design principals and models/tools that provide high assurance for energy delivery systems (EDS) operations regardless of the state of compromise. Cryptographic keys must be securely exchanged, then held and protected on either end of a communications link. This is challenging for a utility with numerous substations that must secure the intelligent electronic devices (IEDs) that may comprise complex control system of systems. For example, distribution and management of keys among the millions of intelligent meters within the Advanced Metering Infrastructure (AMI) is being implemented as part of the National Smart Grid initiative. Without a means for a secure cryptographic key management system (CKMS) no cryptographic solution can be widely deployed to protect the EDS infrastructure from cyber-attack. We consider 1) how security modeling is applied to key management and cyber security concerns on a continuous basis from design through operation, 2) how trusted models and key management architectures greatly impact failure scenarios, and 3) how hardware-enabled trust is a critical element to detecting, surviving, and recovering from attack.

  19. Protecting Privacy of Shared Epidemiologic Data without Compromising Analysis Potential

    DOE PAGESBeta

    Cologne, John; Grant, Eric J.; Nakashima, Eiji; Chen, Yun; Funamoto, Sachiyo; Katayama, Hiroaki

    2012-01-01

    Objective . Ensuring privacy of research subjects when epidemiologic data are shared with outside collaborators involves masking (modifying) the data, but overmasking can compromise utility (analysis potential). Methods of statistical disclosure control for protecting privacy may be impractical for individual researchers involved in small-scale collaborations. Methods . We investigated a simple approach based on measures of disclosure risk and analytical utility that are straightforward for epidemiologic researchers to derive. The method is illustrated using data from the Japanese Atomic-bomb Survivor population. Results . Masking by modest rounding did not adequately enhance security but rounding to remove several digits ofmore » relative accuracy effectively reduced the risk of identification without substantially reducing utility. Grouping or adding random noise led to noticeable bias. Conclusions . When sharing epidemiologic data, it is recommended that masking be performed using rounding. Specific treatment should be determined separately in individual situations after consideration of the disclosure risks and analysis needs.« less

  20. Enhanced susceptibility to predation in corals of compromised condition

    PubMed Central

    Cameron, Caitlin M.; Miller, Margaret W.

    2015-01-01

    The marine gastropod, Coralliophila abbreviata, is an obligate corallivore that causes substantial mortality in Caribbean Acropora spp. Considering the imperiled status of Acropora cervicornis and A. palmata, a better understanding of ecological interactions resulting in tissue loss may enable more effective conservation strategies. We examined differences in susceptibility of A. cervicornis to C. abbreviata predation based on coral tissue condition. Coral tissue condition was a strong determinant of snail prey choice, with snails preferring A. cervicornis fragments that were diseased or mechanically damaged over healthy fragments. In addition, snails always chose fragments undergoing active predation by another snail, while showing no preference for a non-feeding snail when compared with an undisturbed prey fragment. These results indicate that the condition of A. cervicornis prey influenced foraging behavior of C. abbreviata, creating a potential feedback that may exacerbate damage from predation in coral populations compromised by other types of disturbance. PMID:26734500

  1. Thiamine absorption is not compromised in folate-deficient rats

    SciTech Connect

    Walzem, R.L.; Clifford, A.J.

    1988-11-01

    Thiamine absorption and excretion were assessed in rats with severe folate deficiency (FD) by determining the fate of oral TH-labeled and intravenous UC-labeled thiamine over a 6-h test period. Thiamine status was evaluated in these same rats by measuring transketolase activity levels of blood before (TKA) and after (TPPE) addition of thiamine pyrophosphate to the incubation mixture of the assay procedure. Two additional experiments assessed active transport of thiamine and the effect of dietary succinylsulfathiazole (SST) on TKA and TPPE in rats with moderate FD. Intestinal absorption in general and thiamine absorption in particular and thiamine status were unaltered in rats with severe FD. Inanition associated with severe FD may impair thiamine status. Thiamine absorption by active transport was not compromised in FD, and dietary succinylsulfathiazole did not affect thiamine status.

  2. Suppression of Mic60 compromises mitochondrial transcription and oxidative phosphorylation

    PubMed Central

    Yang, Rui-Feng; Sun, Li-Hong; Zhang, Ran; Zhang, Yuan; Luo, Yu-Xuan; Zheng, Wei; Zhang, Zhu-Qin; Chen, Hou-Zao; Liu, De-Pei

    2015-01-01

    Precise regulation of mtDNA transcription and oxidative phosphorylation (OXPHOS) is crucial for human health. As a component of mitochondrial contact site and cristae organizing system (MICOS), Mic60 plays a central role in mitochondrial morphology. However, it remains unclear whether Mic60 affects mitochondrial transcription. Here, we report that Mic60 interacts with mitochondrial transcription factors TFAM and TFB2M. Furthermore, we found that Mic60 knockdown compromises mitochondrial transcription and OXPHOS activities. Importantly, Mic60 deficiency decreased TFAM binding and mitochondrial RNA polymerase (POLRMT) recruitment to the mtDNA promoters. In addition, through mtDNA immunoprecipitation (mIP)-chromatin conformation capture (3C) assays, we found that Mic60 interacted with mtDNA and was involved in the architecture of mtDNA D-loop region. Taken together, our findings reveal a previously unrecognized important role of Mic60 in mtDNA transcription. PMID:25612828

  3. Protecting Privacy of Shared Epidemiologic Data without Compromising Analysis Potential

    PubMed Central

    Cologne, John; Grant, Eric J.; Nakashima, Eiji; Chen, Yun; Funamoto, Sachiyo; Katayama, Hiroaki

    2012-01-01

    Objective. Ensuring privacy of research subjects when epidemiologic data are shared with outside collaborators involves masking (modifying) the data, but overmasking can compromise utility (analysis potential). Methods of statistical disclosure control for protecting privacy may be impractical for individual researchers involved in small-scale collaborations. Methods. We investigated a simple approach based on measures of disclosure risk and analytical utility that are straightforward for epidemiologic researchers to derive. The method is illustrated using data from the Japanese Atomic-bomb Survivor population. Results. Masking by modest rounding did not adequately enhance security but rounding to remove several digits of relative accuracy effectively reduced the risk of identification without substantially reducing utility. Grouping or adding random noise led to noticeable bias. Conclusions. When sharing epidemiologic data, it is recommended that masking be performed using rounding. Specific treatment should be determined separately in individual situations after consideration of the disclosure risks and analysis needs. PMID:22505949

  4. Glycan Side Reaction May Compromise ETD-Based Glycopeptide Identification

    NASA Astrophysics Data System (ADS)

    Darula, Zsuzsanna; Medzihradszky, Katalin F.

    2014-06-01

    Tris(hydroxymethyl)aminomethane (Tris) is one of the most frequently used buffer ingredients. Among other things, it is recommended and is usually used for lectin-based affinity enrichment of glycopeptides. Here we report that sialic acid, a common `capping' unit in both N- and O-linked glycans may react with this chemical, and this side reaction may compromise glycopeptide identification when ETD spectra are the only MS/MS data used in the database search. We show that the modification may alter N- as well as O-linked glycans, the Tris-derivative is still prone to fragmentation both in `beam-type' CID (HCD) and ETD experiments, at the same time—since the acidic carboxyl group was `neutralized'—it will display a different retention time than its unmodified counterpart. We also suggest solutions that—when incorporated into existing search engines—may significantly improve the reliability of glycopeptide assignments.

  5. A curriculum on physician-patient sexual misconduct and teacher-learner mistreatment. Part 1: content.

    PubMed Central

    Robinson, G E; Stewart, D E

    1996-01-01

    Although health care professionals, licensing bodies, governments and the community are paying increasing attention to the negative consequences of sexual misconduct by physicians, education for professionals about this subject is rare and limited. Even less attention has been paid to the adverse effects of violations of boundaries between teachers and learners (students, residents, interns and other trainees). A curriculum now being used at the University of Toronto to teach faculty and students about these topics includes a didactic portion and a workshop component. The didactic portion consists of lectures on the definitions, causes and consequences of physician-patient sexual misconduct and teacher-learner mistreatment and harassment. Relationships after termination of treatment and the complaint and discipline procedures of the College of Physicians and Surgeons of Ontario are also discussed. This article reviews the topics covered in this portion of the curriculum. A subsequent article will discuss the workshop component of the course. PMID:8603320

  6. Review of antifungal therapy, part II: treatment rationale, including specific patient populations.

    PubMed

    Baran, Robert; Hay, Rod J; Garduno, Javier I

    2008-01-01

    This portion of the antifungal review focuses on treatment rationale and suggestions, including special populations such as the elderly, children, and pregnant and immunocompromised individuals. In elderly individuals, the pathogen may be associated with certain comorbidities; treatment should begin with local treatments such as debridement (mechanical or chemical) and a topical. In children, the pathogen most commonly isolated is Trichophyton rubrum. Children should be examined for concomitant tinea and treatment options can begin with a chemical debridement (non-painful) and a topical, with non-responders being treated with combination therapy as in adults. It is suggested that blood tests are monitored at baseline and every 4-8 weeks in children on systemic therapy. Terbinafine is the only systemic in category B and local therapies should be the primary treatment modalities in pregnancy. Prevalence of onychomycosis is high in immunocompromised patients with higher relapse rates after treatment. The same fungal infections that are seen in healthy populations are usually represented in the immunocompromised host. There is a stepwise approach that is suggested in the treatment of onychomycosis. Before treatment, several factors should be determined, which include risk for failure and compliance issues. Strategies for therapy include monotherapy, combination therapy, supplemental therapy, and intermittent therapy. Topical monotherapy is effective in early distal nail disease and for the prevention of reinfection of the cured nail. Combination therapy is an appropriate progression of therapy for patients who failed monotherapy or are at risk for failure. Combined therapies are shown to increase cure rates. Mechanical interventions are essential in reducing fungal burdens to allow other modalities to penetrate, especially in dermatophytomas and onycholysis. PMID:18569273

  7. Patient-reported outcomes in post-traumatic stress disorder Part II: Focus on pharmacological treatment

    PubMed Central

    Kapfhammer, Hans-Peter

    2014-01-01

    Post-traumatic stress disorder (PTSD) may be associated with long-lasting psychological suffering, distressing psychosocial disability, markedly reduced health-related quality of life, and increased morbidity and mortality in a subgroup of individuals in the aftermath of serious traumatic events. Both etiopathogenesis and treatment modalities of PTSD are best conceptualized within a biopsychosotial model. Pharmacotherapy may lay claim to a major role in the multimodal treatment approaches. Here we outline two different pharmacotherapeutic trends that aim to modify the encoding, consolidation, and rehearsal of traumatic memory in order to reduce the risk of PTSD immediately after trauma exposure on the one hand, and that endeavor to treat the clinical state of PTSD on the other. The theoretical rationales of both pharmacological strategies are the complex neurobiological underpinnings that characterize traumatic memory organization and clinical PTSD. Meanwhile, promising data from randomized controlled trials have been obtained for both approaches. Empirical evidence may inform clinicians in their clinical efforts for this special group of patients. The efficacy of several classes of drugs that have been investigated within a context of research should be evaluated critically and still have to stand the test of effectiveness in daily clinical practice. From a patient perspective, empirical results may serve as a psychoeducative guideline to what pharmacotherapeutic approaches may realistically achieve, what their risks and benefits are, and what their limits are in contributing to reducing the often major chronic suffering caused by serious traumatic events. Ethical issues have to be considered, particularly in the context of pharmacological strategies projected to prevent PTSD in the aftermath of traumatic exposure. PMID:25152660

  8. Mitigating Reptile Road Mortality: Fence Failures Compromise Ecopassage Effectiveness

    PubMed Central

    Baxter-Gilbert, James H.; Riley, Julia L.; Lesbarrères, David; Litzgus, Jacqueline D.

    2015-01-01

    Roadways pose serious threats to animal populations. The installation of roadway mitigation measures is becoming increasingly common, yet studies that rigorously evaluate the effectiveness of these conservation tools remain rare. A highway expansion project in Ontario, Canada included exclusion fencing and ecopassages as mitigation measures designed to offset detrimental effects to one of the most imperial groups of vertebrates, reptiles. Taking a multispecies approach, we used a Before-After-Control-Impact study design to compare reptile abundance on the highway before and after mitigation at an Impact site and a Control site from 1 May to 31 August in 2012 and 2013. During this time, radio telemetry, wildlife cameras, and an automated PIT-tag reading system were used to monitor reptile movements and use of ecopassages. Additionally, a willingness to utilize experiment was conducted to quantify turtle behavioral responses to ecopassages. We found no difference in abundance of turtles on the road between the un-mitigated and mitigated highways, and an increase in the percentage of both snakes and turtles detected dead on the road post-mitigation, suggesting that the fencing was not effective. Although ecopassages were used by reptiles, the number of crossings through ecopassages was lower than road-surface crossings. Furthermore, turtle willingness to use ecopassages was lower than that reported in previous arena studies, suggesting that effectiveness of ecopassages may be compromised when alternative crossing options are available (e.g., through holes in exclusion structures). Our rigorous evaluation of reptile roadway mitigation demonstrated that when exclusion structures fail, the effectiveness of population connectivity structures is compromised. Our project emphasizes the need to design mitigation measures with the biology and behavior of the target species in mind, to implement mitigation designs in a rigorous fashion, and quantitatively evaluate road

  9. Methamphetamine compromises gap junctional communication in astrocytes and neurons.

    PubMed

    Castellano, Paul; Nwagbo, Chisom; Martinez, Luis R; Eugenin, Eliseo A

    2016-05-01

    Methamphetamine (meth) is a central nervous system (CNS) stimulant that results in psychological and physical dependency. The long-term effects of meth within the CNS include neuronal plasticity changes, blood-brain barrier compromise, inflammation, electrical dysfunction, neuronal/glial toxicity, and an increased risk to infectious diseases including HIV. Most of the reported meth effects in the CNS are related to dysregulation of chemical synapses by altering the release and uptake of neurotransmitters, especially dopamine, norepinephrine, and epinephrine. However, little is known about the effects of meth on connexin (Cx) containing channels, such as gap junctions (GJ) and hemichannels (HC). We examined the effects of meth on Cx expression, function, and its role in NeuroAIDS. We found that meth altered Cx expression and localization, decreased GJ communication between neurons and astrocytes, and induced the opening of Cx43/Cx36 HC. Furthermore, we found that these changes in GJ and HC induced by meth treatment were mediated by activation of dopamine receptors, suggesting that dysregulation of dopamine signaling induced by meth is essential for GJ and HC compromise. Meth-induced changes in GJ and HC contributed to amplified CNS toxicity by dysregulating glutamate metabolism and increasing the susceptibility of neurons and astrocytes to bystander apoptosis induced by HIV. Together, our results indicate that connexin containing channels, GJ and HC, are essential in the pathogenesis of meth and increase the sensitivity of the CNS to HIV CNS disease. Methamphetamine (meth) is an extremely addictive central nervous system stimulant. Meth reduced gap junctional (GJ) communication by inducing internalization of connexin-43 (Cx43) in astrocytes and reducing expression of Cx36 in neurons by a mechanism involving activation of dopamine receptors (see cartoon). Meth-induced changes in Cx containing channels increased extracellular levels of glutamate and resulted in higher

  10. Blood–Retinal Barrier Compromise and Endogenous Staphylococcus aureus Endophthalmitis

    PubMed Central

    Coburn, Phillip S.; Wiskur, Brandt J.; Astley, Roger A.; Callegan, Michelle C.

    2015-01-01

    Purpose To test the hypothesis that blood–retinal barrier compromise is associated with the development of endogenous Staphylococcus aureus endophthalmitis. Methods To compromise the blood–retinal barrier in vivo, streptozotocin-induced diabetes was induced in C57BL/6J mice for 1, 3, or 5 months. Diabetic and age-matched nondiabetic mice were intravenously injected with 108 colony-forming units (cfu) of S. aureus, a common cause of endogenous endophthalmitis in diabetics. After 4 days post infection, electroretinography, histology, and bacterial counts were performed. Staphylococcus aureus–induced alterations in in vitro retinal pigment epithelial (RPE) cell barrier structure and function were assessed by anti–ZO-1 immunohistochemistry, FITC-dextran conjugate diffusion, and bacterial transmigration assays. Results We observed one bilateral infection in a control, nondiabetic animal (mean = 1.54 × 103 ± 1.78 × 102 cfu/eye, 7% incidence). Among the 1-month diabetic mice, we observed culture-confirmed unilateral infections in two animals (mean = 5.54 × 102 ± 7.09 × 102 cfu/eye, 12% incidence). Among the 3-month diabetic mice, infections were observed in 11 animals, three with bilateral infections (mean = 2.67 × 102 ± 2.49 × 102 cfu/eye, 58% incidence). Among the 5-month diabetic mice, we observed infections in five animals (mean = 7.88 × 102 ± 1.08 × 103 cfu/eye, 33% incidence). In vitro, S. aureus infection reduced ZO-1 immunostaining and disrupted the barrier function of cultured RPE cells, resulting in diffusion of fluorophore-conjugated dextrans and transmigration of live bacteria across a permeabilized RPE barrier. Conclusions Taken together, these results indicated that S. aureus is capable of inducing blood–retinal barrier permeability and causing endogenous bacterial endophthalmitis in normal and diabetic animals. PMID:26559476

  11. Ranking of CMIP5-based global climate models for India using compromise programming

    NASA Astrophysics Data System (ADS)

    Srinivasa Raju, K.; Sonali, P.; Nagesh Kumar, D.

    2016-01-01

    Thirty-six Coupled Model Intercomparison Project-5-based global climate models (GCMs) are explored to evaluate the performance of maximum (T max) and minimum (T min) temperature simulations for India covering 40 grid points. Three performance indicators used for evaluating GCMs are correlation coefficient (CC), normalised root mean square error (NRMSE) and skill score (SS). Entropy method is applied to compute the weights of the three indicators employed. However, equal weights are also considered as part of sensitivity analysis studies. Compromise programming (CP), a distance-based decision-making technique, is employed to rank the GCMs. Group decision-making approach is used to aggregate the ranking patterns obtained for individual grid points. A simple but effective ensemble approach is also suggested.

  12. Late, not early, stages of Kanizsa shape perception are compromised in schizophrenia

    PubMed Central

    Keane, Brian P.; Joseph, Jamie; Silverstein, Steven M.

    2014-01-01

    Background Schizophrenia is a devastating psychiatric disorder characterized by symptoms including delusions, hallucinations, and disorganized thought. Kanizsa shape perception is a basic visual process that builds illusory contour and shape representations from spatially segregated edges. Recent studies have shown that schizophrenia patients exhibit abnormal electrophysiological signatures during Kanizsa shape perception tasks, but it remains unclear how these abnormalities are manifested behaviorally and whether they arise from early or late levels in visual processing. Method To address this issue, we had healthy controls and schizophrenia patients discriminate quartets of sectored circles that either formed or did not form illusory shapes (illusory and fragmented conditions, respectively). Half of the trials in each condition incorporated distractor lines, which are known to disrupt illusory contour formation and thereby worsen illusory shape discrimination. Results Relative to their respective fragmented conditions, patients performed worse than controls in the illusory discrimination. Conceptually disorganized patients—characterized by their incoherent manner of speaking—were primarily driving the effect. Regardless of patient status or disorganization levels, distractor lines worsened discrimination more in the illusory than the fragmented condition, indicating that all groups could form illusory contours. Conclusion People with schizophrenia form illusory contours but are less able to utilize those contours to discern global shape. The impairment is especially related to the ability to think and speak coherently. These results suggest that Kanizsa shape perception incorporates an early illusory contour formation stage and a later, conceptually-mediated shape integration stage, with the latter being primarily compromised in schizophrenia. PMID:24513023

  13. Detection of respiratory compromise by acoustic monitoring, capnography, and brain function monitoring during monitored anesthesia care.

    PubMed

    Tanaka, Pedro P; Tanaka, Maria; Drover, David R

    2014-12-01

    Episodes of apnea in sedated patients represent a risk of respiratory compromise. We hypothesized that acoustic monitoring would be equivalent to capnography for detection of respiratory pauses, with fewer false alarms. In addition, we hypothesized that the patient state index (PSI) would be correlated with the frequency of respiratory pauses and therefore could provide information about the risk of apnea during sedation. Patients undergoing sedation for surgical procedures were monitored for respiration rate using acoustic monitoring and capnography and for depth of sedation using the PSI. A clinician blinded to the acoustic and sedation monitor observed the capnograph and patient to assess sedation and episodes of apnea. Another clinician retrospectively reviewed the capnography and acoustic waveform and sound files to identify true positive and false positive respiratory pauses by each method (reference method). Sensitivity, specificity, and likelihood ratio for detection of respiratory pause was calculated for acoustic monitoring and capnography. The correlation of PSI with respiratory pause events was determined. For the 51 respiratory pauses validated by retrospective analysis, the sensitivity, specificity, and likelihood ratio positive for detection were 16, 96 %, and 3.5 for clinician observation; 88, 7 %, and 1.0 for capnography; and 55, 87 %, and 4.1 for acoustic monitoring. There was no correlation between PSI and respiratory pause events. Acoustic monitoring had the highest likelihood ratio positive for detection of respiratory pause events compared with capnography and clinician observation and, therefore, may provide the best method for respiration rate monitoring during these procedures. PMID:24420342

  14. Protection characteristics of a Faraday cage compromised by lightning burnthrough.

    SciTech Connect

    Warne, Larry Kevin; Bystrom, Edward; Jorgenson, Roy Eberhardt; Montoya, Sandra L.; Merewether, Kimball O.; Coats, Rebecca Sue; Martinez, Leonard E.; Jojola, John M.

    2012-01-01

    A lightning flash consists of multiple, high-amplitude but short duration return strokes. Between the return strokes is a lower amplitude, continuing current which flows for longer duration. If the walls of a Faraday cage are made of thin enough metal, the continuing current can melt a hole through the metal in a process called burnthrough. A subsequent return stroke can couple energy through this newly-formed hole. This LDRD is a study of the protection provided by a Faraday cage when it has been compromised by burnthrough. We initially repeated some previous experiments and expanded on them in terms of scope and diagnostics to form a knowledge baseline of the coupling phenomena. We then used a combination of experiment, analysis and numerical modeling to study four coupling mechanisms: indirect electric field coupling, indirect magnetic field coupling, conduction through plasma and breakdown through the hole. We discovered voltages higher than those encountered in the previous set of experiments (on the order of several hundreds of volts).

  15. Physiologic assessment of fetal compromise: biomarkers of toxic exposure

    SciTech Connect

    Longo, L.D.

    1987-10-01

    Understanding the physiologic and endocrinologic basis of fetal development is a major goal of perinatal biology. During the past decade a number of technological developments have allowed more precise evaluation of the fetus in utero and diagnosis of abnormalities. Despite these methodological achievements, however, there are no specific biological markers currently available to indicate that exposure to a given xenobiotic is associated with a cellular, subcellular, or pharmacodynamic event. This paper evaluates the following issues: what are some of the unique physiologic and endocrinologic features of the fetal milieu interieur. What problems are peculiar to fetal assessment. What are some examples of validated biomarkers and their applicability. What promising biomarkers are on the horizon. How may molecular probes be of value as biological markers of fetal compromise. What are some of the major research gaps and needs, and how should research priorities be set. Some of these topics are addressed. Moreover, the more general role(s) that various diagnostic methods and biological markers can have in an understanding of the regulation of fetal growth and differentiation and the role of xenobiotics in affecting the normal course of events are discussed.

  16. Risk Factors for Uteroplacental Vascular Compromise and Inflammation

    PubMed Central

    BAKER, Arthur M.; BRAUN, Joe M.; SALAFIA, Carolyn M.; HERRING, Amy H.; DANIELS, Julie; RANKINS, Nicole; THORP, John M.

    2008-01-01

    Objective To identify potentially modifiable risk factors of placental injury reflecting maternal uteroplacental vascular compromise (UPVC) and acute and chronic placental inflammation. Study design A prospective epidemiologic study was conducted. A total of 1270 placentas were characterized by gross and microscopic examination. Placental pathology was coded for features of amniotic fluid infection syndrome (AFIS), chronic villitis, UPVC, and fetal vascular obstructive lesions. Odds ratios between UPVC, the acute and the chronic inflammatory lesions, and risk factors of interest were calculated. Results After adjusting for confounders, women with a history of preterm birth had 1.60 times the odds of chronic inflammation (95% CI: 1.10, 2.55). Women with a previous elective termination had 3.28 times the odds of acute inflammation (95% CI: 1.89, 5.70). The odds of chronic villitis increased with parity, while the odds of AFIS decreased with parity. Conclusion We have identified several predictors of UPVC, AFIS and chronic villitis. Further studies are needed to examine whether interventions to alter UPVC, AFIS and chronic villitis will lead to improved pregnancy outcomes. PMID:18771974

  17. Mechanisms-based classifications of musculoskeletal pain: part 2 of 3: symptoms and signs of peripheral neuropathic pain in patients with low back (± leg) pain.

    PubMed

    Smart, Keith M; Blake, Catherine; Staines, Anthony; Thacker, Mick; Doody, Catherine

    2012-08-01

    As a mechanisms-based classification of pain 'peripheral neuropathic pain' (PNP) refers to pain arising from a primary lesion or dysfunction in the peripheral nervous system. Symptoms and signs associated with an assumed dominance of PNP in patients attending for physiotherapy have not been extensively studied. The purpose of this study was to identify symptoms and signs associated with a clinical classification of PNP in patients with low back (± leg) pain. Using a cross-sectional, between-subjects design; four hundred and sixty-four patients with low back (± leg) pain were assessed using a standardised assessment protocol. Patients' pain was assigned a mechanisms-based classification based on experienced clinical judgement. Clinicians then completed a clinical criteria checklist specifying the presence or absence of various clinical criteria. A binary logistic regression analysis with Bayesian model averaging identified a cluster of two symptoms and one sign predictive of PNP, including: 'Pain referred in a dermatomal or cutaneous distribution', 'History of nerve injury, pathology or mechanical compromise' and 'Pain/symptom provocation with mechanical/movement tests (e.g. Active/Passive, Neurodynamic) that move/load/compress neural tissue'. This cluster was found to have high levels of classification accuracy (sensitivity 86.3%, 95% CI: 78.0-92.3; specificity 96.0%, 95% CI: 93.4-97.8; diagnostic odds ratio 150.9, 95% CI: 69.4-328.1). Pattern recognition of this empirically-derived cluster of symptoms and signs may help clinicians identify an assumed dominance of PNP mechanisms in patients with low back pain disorders in a way that might usefully inform subsequent patient management. PMID:22465002

  18. [Prosthetic rehabilitation of partially edentulous patients: fixed - removable - combined? Metal - ceramics - all - ceramics? Implants? Anything goes! Part 1: two example cases of a combined fixed-removable restoration].

    PubMed

    Schnabl, Dagmar

    2015-01-01

    After a careful diagnosis, treatment planning and pretreatment, two partially edentulous patients were restored partly by onlays, crowns and bridges, partly by removable prostheses. According to esthetic and functional demands all- and/or metal-ceramic restorations were used as well as cast frame prostheses with clasps or extracoronal attachments. PMID:25735004

  19. The process of recovery of people with mental illness: The perspectives of patients, family members and care providers: Part 1

    PubMed Central

    2010-01-01

    Background It is a qualitative design study that examines points of divergence and convergence in the perspectives on recovery of 36 participants or 12 triads. Each triad comprising a patient, a family member/friend, a care provider and documents the procedural, analytic of triangulating perspectives as a means of understanding the recovery process which is illustrated by four case studies. Variations are considered as they relate to individual characteristics, type of participant (patient, family, member/friend and care provider), and mental illness. This paper which is part of a larger study and is based on a qualitative research design documents the process of recovery of people with mental illness: Developing a Model of Recovery in Mental Health: A middle range theory. Methods Data were collected in field notes through semi-structured interviews based on three interview guides (one for patients, one for family members/friends, and one for caregivers). Cross analysis and triangulation methods were used to analyse the areas of convergence and divergence on the recovery process of all triads. Results In general, with the 36 participants united in 12 triads, two themes emerge from the cross-analysis process or triangulation of data sources (12 triads analysis in 12 cases studies). Two themes emerge from the analysis process of the content of 36 interviews with participants: (1) Revealing dynamic context, situating patients in their dynamic context; and (2) Relationship issues in a recovery process, furthering our understanding of such issues. We provide four case studies examples (among 12 cases studies) to illustrate the variations in the way recovery is perceived, interpreted and expressed in relation to the different contexts of interaction. Conclusion The perspectives of the three participants (patients, family members/friends and care providers) suggest that recovery depends on constructing meaning around mental illness experiences and that the process is

  20. Experimental nonalcoholic steatohepatitis compromises ureagenesis, an essential hepatic metabolic function.

    PubMed

    Thomsen, Karen Louise; Grønbæk, Henning; Glavind, Emilie; Hebbard, Lionel; Jessen, Niels; Clouston, Andrew; George, Jacob; Vilstrup, Hendrik

    2014-08-01

    Nonalcoholic steatohepatitis (NASH) is increasing in prevalence, yet its consequences for liver function are unknown. We studied ureagenesis, an essential metabolic liver function of importance for whole body nitrogen homeostasis, in a rodent model of diet-induced NASH. Rats were fed a high-fat, high-cholesterol diet for 4 and 16 wk, resulting in early and advanced experimental NASH, respectively. We examined the urea cycle enzyme mRNAs in liver tissue, the hepatocyte urea cycle enzyme proteins, and the in vivo capacity of urea-nitrogen synthesis (CUNS). Early NASH decreased all of the urea cycle mRNAs to an average of 60% and the ornithine transcarbamylase protein to 10%, whereas the CUNS remained unchanged. Advanced NASH further decreased the carbamoyl phosphate synthetase protein to 63% and, in addition, decreased the CUNS by 20% [from 5.65 ± 0.23 to 4.58 ± 0.30 μmol × (min × 100 g)(-1); P = 0.01]. Early NASH compromised the genes and enzyme proteins involved in ureagenesis, whereas advanced NASH resulted in a functional reduction in the capacity for ureagenesis. The pattern of urea cycle perturbations suggests a prevailing mitochondrial impairment by NASH. The decrease in CUNS has consequences for the ability of the body to adjust to changes in the requirements for nitrogen homeostasis e.g., at stressful events. NASH, thus, in terms of metabolic consequences, is not an innocuous lesion, and the manifestations of the damage seem to be a continuum with increasing disease severity. PMID:24924745

  1. Efficacy of New Adhesion Promoters on Compromised Hypocalcified Enamel

    PubMed Central

    Venkata, Kishore Mayakuntla Sai; Aileni, Kaladhar Reddy; Sashidhar, Nagam Reddy

    2015-01-01

    Introduction The amount of technological progress occurred in the last few years has brought an add up to the benefits of bonding in Orthodontics. Research-based findings have constantly led to the development of new materials that are aimed to simplify the clinical procedures like bonding of brackets to compromised enamel surfaces. Hence, the present study is aimed to assess the bond strength of orthodontic brackets on fluorosed enamel using adhesion promoters. Aim To evaluate the shear bond strength (SBS) of orthodontic brackets bonded on fluorosed enamel using conventional Transbond XT and new adhesion promoters such as Enhance LC and All Bond 3. Materials and Methods The study involved 90 non carious, extracted teeth with mild to moderate fluorosis randomly divided into 3 Groups. In Group - I (control group) the teeth were bonded with conventional Transbond XT and cured with LED light. In Group - II Enhance LC was applied to fluorosed enamel before bonding and in Group - III All Bond 3 was used. Shear bond strength was tested by using Universal testing Instron machine. ANOVA and Post-Hoc Tukey’s tests were used to compare shear bond strength. Adhesive remnant on the tooth was assessed and scored using adhesive remnant index (ARI). Results Results showed a reduced SBS values (9.43MPa ±3.03) with conventional Transbond XT on fluorosed enamel. Among the adhesion boosters used Enhance LC illustrated lesser SBS values (12.03 MPa ± 4.42) compared with All Bond 3 (14.38MPa ±4.92). ARI showed bond failure at bracket resin interface in group I & group II and at enamel resin interface in group III although statistically insignificant. Conclusion It was concluded that using adhesion boosters on fluorosed enamel showed higher bond strength compared to the control group. Among the two adhesion promoters used All Bond 3 expressed highest bond strength compared to Enhance LC although statistically insignificant. PMID:26393196

  2. Epigenetic Dysregulation Observed in Monosomy Blastocysts Further Compromises Developmental Potential

    PubMed Central

    Denomme, Michelle M.; McCallie, Blair R.; Parks, Jason C.; Schoolcraft, William B.; Katz-Jaffe, Mandy G.

    2016-01-01

    Epigenetic mechanisms such as DNA methylation regulate genomic imprinting and account for the distinct non-equivalence of the parental genomes in the embryo. Chromosomal aneuploidy, a major cause of infertility, distorts this highly regulated disparity by the presence or absence of chromosomes. The implantation potential of monosomy embryos is negligible compared to their trisomy counterparts, yet the cause for this is unknown. This study investigated the impact of chromosomal aneuploidy on strict epigenetically regulated domains, specifically imprinting control regions present on aneuploid chromosomes. Donated cryopreserved human IVF blastocysts of transferable quality, including trisomy 15, trisomy 11, monosomy 15, monosomy 11, and donor oocyte control blastocysts were examined individually for DNA methylation profiles by bisulfite mutagenesis and sequencing analysis of two maternally methylated imprinting control regions (ICRs), SNRPN (15q11.2) and KCNQ1OT1 (11p15.5), and one paternally methylated imprinting control region, H19 (11p15.5). Imprinted genes within the regions were also evaluated for transcript abundance by RT-qPCR. Overall, statistically significant hypermethylated and hypomethylated ICRs were found in both the trisomy and monosomy blastocysts compared to controls, restricted only to the chromosome affected by the aneuploidy. Increased expression was observed for maternally-expressed imprinted genes in trisomy blastocysts, while a decreased expression was observed for both maternally- and paternally-expressed imprinted genes in monosomy blastocysts. This epigenetic dysregulation and altered monoallelic expression observed at imprinting control regions in aneuploid IVF embryos supports euploid embryo transfer during infertility treatments, and may specifically highlight an explanation for the compromised implantation potential in monosomy embryos. PMID:27271036

  3. Transposition of brachiobasilic arteriovenous fistulae: improving the cosmetic effect without compromising patency.

    PubMed

    van Dellen, David; Junejo, Muneer; Khambalia, Hussein; Campbell, Babatunde

    2016-01-01

    Introduction Subjects who undergo haemodialysis are living longer, which necessitates increasingly complex procedures for formation of arteriovenous fistulas. Basilic veins provide valuable additional venous 'real estate' but surgical transposition of vessels is required, which required a cosmetically disfiguring incision. A minimally invasive transposition method provides an excellent aesthetic alternative without compromised outcomes. Methods A retrospective review was made of minimally invasive brachiobasilic fistula transpositions (using two short incisions of <4 cm) between February 2005 and July 2011. Primary endpoints were one-year patency as well as the perioperative and late complications of the procedure. Results Thirty-one patients underwent 32 transposition procedures (eight pre-dialysis cases; 24 haemodialysis patients). All patients were treated with a minimally invasive method. Thirty-one procedures resulted in primary patency, with the single failure refashioned successfully. The only indication for a more invasive approach was intraoperative complications (two haematomas). All other complications presented late and were amenable to intervention (one aneurysm, one peri-anastomotic stricture). Conclusion Formation of arteriovenous fistulae using minimally invasive methods is a novel approach that ensures fistula patency with improved aesthetic outcomes and without significant morbidity. PMID:26688395

  4. Canadian Association of Gastroenterology Indicators of Safety Compromise following Colonoscopy in Clinical Practice.

    PubMed

    Borgaonkar, Mark R; Pace, David; Lougheed, Muna; Marcoux, Curtis; Evans, Bradley; Hickey, Nikita; O'Leary, Meghan; McGrath, Jerry

    2016-01-01

    In 2012 the Canadian Association of Gastroenterology published 19 indicators of safety compromise. We studied the incidence of these indicators by reviewing all colonoscopies performed in St. John's, NL, between January 1, 2012, and June 30, 2012. Results. A total of 3235 colonoscopies were included. Adverse events are as follows. Medication-related includes use of reversal agents 0.1%, hypoxia 9.9%, hypotension 15.4%, and hypertension 0.9%. No patients required CPR or experienced allergic reactions or laryngospasm/bronchospasm. The indicator, "sedation dosages in patients older than 70," showed lower usage of fentanyl and midazolam in elderly patients. Procedure-related immediate includes perforation 0.2%, immediate postpolypectomy bleeding 0.3%, need for hospital admission or transfer to the emergency department 0.1%, and severe persistent abdominal pain proven not to be perforation 0.4%. Instrument impaction was not seen. Procedure-related delayed includes death within 14 days 0.1%, unplanned health care visit within 14 days of the colonoscopy 1.8%, unplanned hospitalization within 14 days of the colonoscopy 0.6%, bleeding within 14 days of colonoscopy 0.2%, infection 0.03%, and metabolic complication 0.03%. Conclusions. The most common adverse events were mild and sedation related. Rates of serious adverse events were in keeping with published reports. PMID:27446832

  5. Canadian Association of Gastroenterology Indicators of Safety Compromise following Colonoscopy in Clinical Practice

    PubMed Central

    Borgaonkar, Mark R.; Pace, David; Lougheed, Muna; Marcoux, Curtis; Evans, Bradley; Hickey, Nikita; O'Leary, Meghan; McGrath, Jerry

    2016-01-01

    In 2012 the Canadian Association of Gastroenterology published 19 indicators of safety compromise. We studied the incidence of these indicators by reviewing all colonoscopies performed in St. John's, NL, between January 1, 2012, and June 30, 2012. Results. A total of 3235 colonoscopies were included. Adverse events are as follows. Medication-related includes use of reversal agents 0.1%, hypoxia 9.9%, hypotension 15.4%, and hypertension 0.9%. No patients required CPR or experienced allergic reactions or laryngospasm/bronchospasm. The indicator, “sedation dosages in patients older than 70,” showed lower usage of fentanyl and midazolam in elderly patients. Procedure-related immediate includes perforation 0.2%, immediate postpolypectomy bleeding 0.3%, need for hospital admission or transfer to the emergency department 0.1%, and severe persistent abdominal pain proven not to be perforation 0.4%. Instrument impaction was not seen. Procedure-related delayed includes death within 14 days 0.1%, unplanned health care visit within 14 days of the colonoscopy 1.8%, unplanned hospitalization within 14 days of the colonoscopy 0.6%, bleeding within 14 days of colonoscopy 0.2%, infection 0.03%, and metabolic complication 0.03%. Conclusions. The most common adverse events were mild and sedation related. Rates of serious adverse events were in keeping with published reports. PMID:27446832

  6. Clonal types of Toxoplasma gondii among immune compromised and immune competent individuals in Accra, Ghana.

    PubMed

    Ayi, Irene; Kwofie, Kofi Dadzie; Blay, Emmanuel Awusah; Osei, Joseph Harold Nyarko; Frempong, Kwadwo Kyeremeh; Koku, Roberta; Ghansah, Anita; Lartey, Margaret; Suzuki, Takashi; Boakye, Daniel Adjei; Koram, Kwadwo Ansah; Ohta, Nobuo

    2016-06-01

    There are three major clonal lineages, types I, II, and III, of Toxoplasma gondii known to cause human toxoplasmosis worldwide. Toxoplasma gondii infections have, however, not been genotyped in Ghana. This study detected the clonal types infecting immune compromised and immune competent individuals in Accra, Ghana. Blood samples were obtained from 148 HIV seropositive pre-antiretroviral therapy individuals (0≤CD4(+) T-cell count/μl blood ≤200) at the Fevers Unit and 149 HIV seronegative apparently healthy blood donors at the blood bank, all of the Korle-Bu Teaching Hospital. Genomic DNA was extracted and multilocus genotyping conducted by nested PCR-RFLP analysis using GRA6, SAG3, and BTUB gene markers. Among the HIV seropositive participants, 54.7% (81/148) were T. gondii DNA positive for any of the markers. Out of the 81, 42.0% (34) were positive for SAG3 only, 30.9% (25) for GRA6 only, 24.7% (20) for both SAG3 and GRA6, and 2.5% (2) for SAG3, GRA6, and BTUB. Overall, 93.8% of the positives were of clonal type II, 1.2% type I, while 4.9% (4) were atypical or mixed types (I and II). In the healthy blood donors, prevalence of T. gondii DNA positivity was 3.4% (5/149) by SAG3 and/or GRA6; among them, 60.0% (3/5) were type I, and the remaining 40.0%, type II. This study showed a relatively high prevalence of active T. gondii infections in immune compromised patients and low prevalence in immune competent individuals in Accra. Type II was highly prevalent. Detection of T. gondii in blood donors raises public health concerns and screening for T. gondii should be considered. PMID:26775819

  7. Sustained NMDA receptor activation by spreading depolarizations can initiate excitotoxic injury in metabolically compromised neurons

    PubMed Central

    Aiba, Isamu; Shuttleworth, C William

    2012-01-01

    Spreading depolarizations (SDs) are slowly propagating waves of near-complete neuronal and glial depolarization. SDs have been recorded in patients with brain injury, and the incidence of SD significantly correlates with outcome severity. Although it is well accepted that the ionic dyshomeostasis of SD presents a severe metabolic burden, there is currently limited understanding of SD-induced injury processes at a cellular level. In the current study we characterized events accompanying SD in the hippocampal CA1 region of murine brain slices, using whole-cell recordings and single-cell Ca2+ imaging. We identified an excitatory phase that persisted for approximately 2 min following SD onset, and accompanied with delayed dendritic ionic dyshomeostasis. The excitatory phase coincided with a significant increase in presynaptic glutamate release, evidenced by a transient increase in spontaneous EPSC frequency and paired-pulse depression of evoked EPSCs. Activation of NMDA receptors (NMDARs) during this late excitatory phase contributed to the duration of individual neuronal depolarizations and delayed recovery of extracellular slow potential changes. Selectively targeting the NMDAR activation following SD onset (by delayed pressure application of a competitive NMDAR antagonist) significantly decreased the duration of cellular depolarizations. Recovery of dendritic Ca2+ elevations following SD were also sensitive to delayed NMDA antagonist application. Partial inhibition of neuronal energy metabolism converted SD into an irrecoverable event with persistent Ca2+ overload and membrane compromise. Delayed NMDAR block was sufficient to prevent these acute injurious events in metabolically compromised neurons. These results identify a significant contribution of a late component of SD that could underlie neuronal injury in pathological circumstances. PMID:22907056

  8. Accessory spleen compromising response to splenectomy for idiopathic thrombocytopenic purpura

    SciTech Connect

    Ambriz, P.; Munoz, R.; Quintanar, E.; Sigler, L.; Aviles, A.; Pizzuto, J.

    1985-06-01

    Accessory spleens were sought in 28 patients who had undergone splenectomy for chronic idiopathic thrombocytopenic purpura (ITP), using a variety of techniques. Abdominal scintigraphy with autologous erythrocytes labeled with Tc-99m and opsonized with anit-D IgG (radioimmune method) proved to be most useful, clearly demonstrating one or more accessory spleens in 12 cases (43%). Computed tomography (CT) was also helpful. Four out of five patients demonstrated an increased platelet count following surgery, the effectiveness of which was illustrated by the radioimmune scan. Patients who have had splenectomy for chronic ITP should be scanned using radioimmune techniques and CT to determine whether an accessory spleen is present.

  9. Gray matter structural compromise is equally distributed in left and right temporal lobe epilepsy.

    PubMed

    Liu, Min; Bernhardt, Boris C; Bernasconi, Andrea; Bernasconi, Neda

    2016-02-01

    In drug-resistant temporal lobe epilepsy (TLE), MRI studies have shown consistent mesiotemporal and neocortical structural alterations when comparing patients to healthy controls. It remains, however, relatively unclear whether the side of seizure focus differentially impacts the degree of structural damage. This work performed a comprehensive surface-based analysis of mesiotemporal and neocortical morphology on preoperative 1.5 T MRI in 25/35 LTLE/RTLE patients that achieved seizure freedom after surgery (i.e., Engel-I outcome; 7 ± 2 years follow-up), an imaging-independent confirmation of focus lateralization. Compared to 46 age- and sex-matched controls, both TLE groups displayed marked ipsilateral atrophy in mesiotemporal regions, while cortical thinning was bilateral. Direct contrasts between LTLE and RTLE did not reveal significant differences. Bootstrap simulations indicated low reproducibility of observing a between-cohort difference; power analysis revealed that more than 110 patients would be necessary to detect subtle differences. No difference between LTLE and RTLE was confirmed when using voxel-based morphometry, an independent proxy of gray matter volume. Similar results were obtained analyzing a separate 3 T dataset (15/15 LTLE/RTLE patients; Engel-I after 4 ± 2 years follow-up; 42 controls). Our results strongly support equivalent gray matter compromise in left and right TLE. The morphological profile of seizure-free patients, presenting with ipsilateral mesiotemporal and bilateral cortical atrophy, motivates the development of neuromarkers of outcome that consider both mesiotemporal and neocortical structures. Hum Brain Mapp 37:515-524, 2016. © 2015 Wiley Periodicals, Inc. PMID:26526187

  10. Adolescents engaging in unhealthy weight control behaviors: are they at risk for other health-compromising behaviors?

    PubMed Central

    Neumark-Sztainer, D; Story, M; Dixon, L B; Murray, D M

    1998-01-01

    OBJECTIVES: This study sought to determine whether adolescents engaging in weight control behaviors are at increased risk for tobacco, alcohol, and marijuana use; suicide ideation and attempts; and unprotected sexual activity. METHODS: Data were collected on a nationally representative sample of 16,296 adolescents taking part in the 1993 Youth Risk Behavior Survey. RESULTS: Adolescents using extreme weight control behaviors were at increased risk for health-compromising behaviors, while associations with other weight control behaviors were weak and inconsistent. CONCLUSIONS: The findings have relevance to clinical work with youth, provide a better understanding of disordered eating, and open up a number of opportunities for future research. PMID:9618628

  11. 22 CFR 304.7 - Authority to adjust, determine, compromise, and settle claims.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 22 Foreign Relations 2 2014-04-01 2014-04-01 false Authority to adjust, determine, compromise, and settle claims. 304.7 Section 304.7 Foreign Relations PEACE CORPS CLAIMS AGAINST GOVERNMENT UNDER FEDERAL TORT CLAIMS ACT Procedures § 304.7 Authority to adjust, determine, compromise, and settle claims....

  12. 22 CFR 304.7 - Authority to adjust, determine, compromise, and settle claims.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 22 Foreign Relations 2 2013-04-01 2009-04-01 true Authority to adjust, determine, compromise, and settle claims. 304.7 Section 304.7 Foreign Relations PEACE CORPS CLAIMS AGAINST GOVERNMENT UNDER FEDERAL TORT CLAIMS ACT Procedures § 304.7 Authority to adjust, determine, compromise, and settle claims....

  13. 22 CFR 304.7 - Authority to adjust, determine, compromise, and settle claims.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 22 Foreign Relations 2 2010-04-01 2010-04-01 true Authority to adjust, determine, compromise, and settle claims. 304.7 Section 304.7 Foreign Relations PEACE CORPS CLAIMS AGAINST GOVERNMENT UNDER FEDERAL TORT CLAIMS ACT Procedures § 304.7 Authority to adjust, determine, compromise, and settle claims....

  14. 22 CFR 304.7 - Authority to adjust, determine, compromise, and settle claims.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 22 Foreign Relations 2 2011-04-01 2009-04-01 true Authority to adjust, determine, compromise, and settle claims. 304.7 Section 304.7 Foreign Relations PEACE CORPS CLAIMS AGAINST GOVERNMENT UNDER FEDERAL TORT CLAIMS ACT Procedures § 304.7 Authority to adjust, determine, compromise, and settle claims....

  15. 13 CFR 108.1710 - SBA authority to collect or compromise its claims.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 13 Business Credit and Assistance 1 2011-01-01 2011-01-01 false SBA authority to collect or compromise its claims. 108.1710 Section 108.1710 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION...) Miscellaneous § 108.1710 SBA authority to collect or compromise its claims. SBA may, upon such conditions...

  16. 13 CFR 107.1710 - SBA authority to collect or compromise its claims.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 13 Business Credit and Assistance 1 2010-01-01 2010-01-01 false SBA authority to collect or compromise its claims. 107.1710 Section 107.1710 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION... § 107.1710 SBA authority to collect or compromise its claims. SBA may, upon such conditions and for...

  17. 13 CFR 107.1710 - SBA authority to collect or compromise its claims.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 13 Business Credit and Assistance 1 2011-01-01 2011-01-01 false SBA authority to collect or compromise its claims. 107.1710 Section 107.1710 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION... § 107.1710 SBA authority to collect or compromise its claims. SBA may, upon such conditions and for...

  18. 13 CFR 108.1710 - SBA authority to collect or compromise its claims.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 13 Business Credit and Assistance 1 2010-01-01 2010-01-01 false SBA authority to collect or compromise its claims. 108.1710 Section 108.1710 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION...) Miscellaneous § 108.1710 SBA authority to collect or compromise its claims. SBA may, upon such conditions...

  19. 32 CFR 2001.48 - Loss, possible compromise or unauthorized disclosure.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 32 National Defense 6 2010-07-01 2010-07-01 false Loss, possible compromise or unauthorized disclosure. 2001.48 Section 2001.48 National Defense Other Regulations Relating to National Defense... SECURITY INFORMATION Safeguarding § 2001.48 Loss, possible compromise or unauthorized disclosure....

  20. 46 CFR 502.604 - Compromise of penalties: Relation to assessment proceedings.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 46 Shipping 9 2010-10-01 2010-10-01 false Compromise of penalties: Relation to assessment... Civil Penalties § 502.604 Compromise of penalties: Relation to assessment proceedings. (a) Scope. Except... Commission may issue a public notice thereof, the terms and language of which are not subject to...

  1. 5 CFR 177.106 - Authority to adjust, determine, compromise, and settle.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 5 Administrative Personnel 1 2011-01-01 2011-01-01 false Authority to adjust, determine, compromise, and settle. 177.106 Section 177.106 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS ADMINISTRATIVE CLAIMS UNDER THE FEDERAL TORT CLAIMS ACT § 177.106 Authority to adjust, determine, compromise, and settle. (a)...

  2. 13 CFR 107.1710 - SBA authority to collect or compromise its claims.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 13 Business Credit and Assistance 1 2013-01-01 2013-01-01 false SBA authority to collect or compromise its claims. 107.1710 Section 107.1710 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION... § 107.1710 SBA authority to collect or compromise its claims. SBA may, upon such conditions and for...

  3. 13 CFR 108.1710 - SBA authority to collect or compromise its claims.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 13 Business Credit and Assistance 1 2012-01-01 2012-01-01 false SBA authority to collect or compromise its claims. 108.1710 Section 108.1710 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION...) Miscellaneous § 108.1710 SBA authority to collect or compromise its claims. SBA may, upon such conditions...

  4. 13 CFR 107.1710 - SBA authority to collect or compromise its claims.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 13 Business Credit and Assistance 1 2014-01-01 2014-01-01 false SBA authority to collect or compromise its claims. 107.1710 Section 107.1710 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION... § 107.1710 SBA authority to collect or compromise its claims. SBA may, upon such conditions and for...

  5. 13 CFR 108.1710 - SBA authority to collect or compromise its claims.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 13 Business Credit and Assistance 1 2014-01-01 2014-01-01 false SBA authority to collect or compromise its claims. 108.1710 Section 108.1710 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION...) Miscellaneous § 108.1710 SBA authority to collect or compromise its claims. SBA may, upon such conditions...

  6. 13 CFR 107.1710 - SBA authority to collect or compromise its claims.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 13 Business Credit and Assistance 1 2012-01-01 2012-01-01 false SBA authority to collect or compromise its claims. 107.1710 Section 107.1710 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION... § 107.1710 SBA authority to collect or compromise its claims. SBA may, upon such conditions and for...

  7. Compromise, Well-Being, and Action Behaviors in Young Adults in Career Transition

    ERIC Educational Resources Information Center

    Creed, Peter A.; Blume, Kellie

    2013-01-01

    The authors surveyed 186 first-year university students and assessed their level of career compromise associated with making the transition to university. Compromise was operationalized as the discrepancy between the job characteristics of ideal and expected occupations. The authors also assessed career well-being (satisfaction, distress), action…

  8. Successful bovine arch replacement for a type A acute aortic dissection in a pregnant woman with severe haemodynamic compromise

    PubMed Central

    Nonga, Bernadette Ngo; Pasquet, Agnès; Noirhomme, Philippe; El–Khoury, Gebrine

    2012-01-01

    Acute aortic dissection is very uncommon in pregnant women and the acute type A aortic dissection carries a high mortality rate outside specialized centres. There are a few cases reported with successful outcomes for the mother and the foetus from major cardiac centres. We are reporting our first experience of acute aortic dissection during the third trimester of pregnancy in a patient with Marfan features, profound haemodynamic compromise on arrival and a bovine aortic arch. Both the mother and the baby are doing well two years postoperatively. PMID:22547559

  9. Critical illness in pregnancy: part I: an approach to a pregnant patient in the ICU and common obstetric disorders.

    PubMed

    Guntupalli, Kalpalatha K; Hall, Nicole; Karnad, Dilip R; Bandi, Venkata; Belfort, Michael

    2015-10-01

    Managing critically ill obstetric patients in the ICU is a challenge because of their altered physiology, different normal ranges for laboratory and clinical parameters in pregnancy, and potentially harmful effects of drugs and interventions on the fetus. About 200 to 700 women per 100,000 deliveries require ICU admission. A systematic five-step approach is recommended to enhance maternal and fetal outcomes: (1) differentiate between medical and obstetric disorders with similar manifestations, (2) identify and treat organ dysfunction, (3) assess maternal and fetal risk from continuing pregnancy and decide if delivery/termination of pregnancy will improve outcome, (4) choose an appropriate mode of delivery if necessary, and (5) optimize organ functions for safe delivery. A multidisciplinary team including the intensivist, obstetrician, maternal-fetal medicine specialist, anesthesiologist, neonatologist, nursing specialist, and transfusion medicine expert is key to optimize outcomes. Severe preeclampsia and its complications, HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome, and amniotic fluid embolism, which cause significant organ failure, are reviewed. Obstetric conditions that were not so common in the past are increasingly seen in the ICU. Thrombotic thrombocytopenic purpura of pregnancy is being diagnosed more frequently. Massive hemorrhage from adherent placenta is increasing because of the large number of pregnant women with scars from previous cesarean section. With more complex fetal surgical interventions being performed for congenital disorders, maternal complications are increasing. Ovarian hyperstimulation syndrome is also becoming common because of treatment of infertility with assisted reproduction techniques. Part II will deal with common medical disorders and their management in critically ill pregnant women. PMID:26020613

  10. The Munsell Color System: a scientific compromise from the world of art.

    PubMed

    Cochrane, Sally

    2014-09-01

    Color systems make accurate color specification and matching possible in science, art, and industry by defining a coordinate system for all possible color perceptions. The Munsell Color System, developed by the artist Albert Henry Munsell in the early twentieth century, has influenced color science to this day. I trace the development of the Munsell Color System from its origins in the art world to its acceptance in the scientific community. Munsell's system was the first to accurately and quantitatively describe the psychological experience of color. By considering the problems that color posed for Munsell's art community and examining his diaries and published material, I conclude that Munsell arrived at his results by remaining agnostic as to the scientific definition of color, while retaining faith that color perceptions could be objectively quantified. I argue that Munsell was able to interest the scientific community in his work because color had become a controversial topic between physicists and psychologists. Parts of Munsell's system appealed to each field, making it a workable compromise. For contrast, I suggest that three contemporary scientists with whom Munsell had contact--Wilhelm Ostwald, Ogden Rood, and Edward Titchener--did not reach the same conclusions in their color systems because they started from scientific assumptions about the nature of color. PMID:25812356

  11. Heavy Cigarette Smokers in a Chinese Population Display a Compromised Permeability Barrier.

    PubMed

    Xin, Shujun; Ye, Li; Man, George; Lv, Chengzhi; Elias, Peter M; Man, Mao-Qiang

    2016-01-01

    Cigarette smoking is associated with various cutaneous disorders with defective permeability. Yet, whether cigarette smoking influences epidermal permeability barrier function is largely unknown. Here, we measured skin biophysical properties, including permeability barrier homeostasis, stratum corneum (SC) integrity, SC hydration, skin surface pH, and skin melanin/erythema index, in cigarette smokers. A total of 99 male volunteers were enrolled in this study. Smokers were categorized as light-to-moderate (<20 cigarettes/day) or heavy smokers (≥20 cigarettes/day). An MPA5 was used to measure SC hydration and skin melanin/erythema index on the dorsal hand, forehead, and cheek. Basal transepidermal water loss (TEWL) and barrier recovery rates were assessed on the forearm. A Skin-pH-Meter pH900 was used to measure skin surface pH. Our results showed that heavy cigarette smokers exhibited delayed barrier recovery after acute abrogation (1.02% ± 13.06 versus 16.48% ± 6.07), and barrier recovery rates correlated negatively with the number of daily cigarettes consumption (p = 0.0087). Changes in biophysical parameters in cigarette smokers varied with body sites. In conclusion, heavy cigarette smokers display compromised permeability barrier homeostasis, which could contribute, in part, to the increased prevalence of certain cutaneous disorders characterized by defective permeability. Thus, improving epidermal permeability barrier should be considered for heavy cigarette smokers. PMID:27437403

  12. Heavy Cigarette Smokers in a Chinese Population Display a Compromised Permeability Barrier

    PubMed Central

    Xin, Shujun; Ye, Li; Lv, Chengzhi; Elias, Peter M.

    2016-01-01

    Cigarette smoking is associated with various cutaneous disorders with defective permeability. Yet, whether cigarette smoking influences epidermal permeability barrier function is largely unknown. Here, we measured skin biophysical properties, including permeability barrier homeostasis, stratum corneum (SC) integrity, SC hydration, skin surface pH, and skin melanin/erythema index, in cigarette smokers. A total of 99 male volunteers were enrolled in this study. Smokers were categorized as light-to-moderate (<20 cigarettes/day) or heavy smokers (≥20 cigarettes/day). An MPA5 was used to measure SC hydration and skin melanin/erythema index on the dorsal hand, forehead, and cheek. Basal transepidermal water loss (TEWL) and barrier recovery rates were assessed on the forearm. A Skin-pH-Meter pH900 was used to measure skin surface pH. Our results showed that heavy cigarette smokers exhibited delayed barrier recovery after acute abrogation (1.02% ± 13.06 versus 16.48% ± 6.07), and barrier recovery rates correlated negatively with the number of daily cigarettes consumption (p = 0.0087). Changes in biophysical parameters in cigarette smokers varied with body sites. In conclusion, heavy cigarette smokers display compromised permeability barrier homeostasis, which could contribute, in part, to the increased prevalence of certain cutaneous disorders characterized by defective permeability. Thus, improving epidermal permeability barrier should be considered for heavy cigarette smokers. PMID:27437403

  13. Abnormal splicing switch of DMD's penultimate exon compromises muscle fibre maintenance in myotonic dystrophy.

    PubMed

    Rau, Frédérique; Lainé, Jeanne; Ramanoudjame, Laetitita; Ferry, Arnaud; Arandel, Ludovic; Delalande, Olivier; Jollet, Arnaud; Dingli, Florent; Lee, Kuang-Yung; Peccate, Cécile; Lorain, Stéphanie; Kabashi, Edor; Athanasopoulos, Takis; Koo, Taeyoung; Loew, Damarys; Swanson, Maurice S; Le Rumeur, Elisabeth; Dickson, George; Allamand, Valérie; Marie, Joëlle; Furling, Denis

    2015-01-01

    Myotonic Dystrophy type 1 (DM1) is a dominant neuromuscular disease caused by nuclear-retained RNAs containing expanded CUG repeats. These toxic RNAs alter the activities of RNA splicing factors resulting in alternative splicing misregulation and muscular dysfunction. Here we show that the abnormal splicing of DMD exon 78 found in dystrophic muscles of DM1 patients is due to the functional loss of MBNL1 and leads to the re-expression of an embryonic dystrophin in place of the adult isoform. Forced expression of embryonic dystrophin in zebrafish using an exon-skipping approach severely impairs the mobility and muscle architecture. Moreover, reproducing Dmd exon 78 missplicing switch in mice induces muscle fibre remodelling and ultrastructural abnormalities including ringed fibres, sarcoplasmic masses or Z-band disorganization, which are characteristic features of dystrophic DM1 skeletal muscles. Thus, we propose that splicing misregulation of DMD exon 78 compromises muscle fibre maintenance and contributes to the progressive dystrophic process in DM1. PMID:26018658

  14. Abnormal splicing switch of DMD's penultimate exon compromises muscle fibre maintenance in myotonic dystrophy

    PubMed Central

    Rau, Frédérique; Lainé, Jeanne; Ramanoudjame, Laetitita; Ferry, Arnaud; Arandel, Ludovic; Delalande, Olivier; Jollet, Arnaud; Dingli, Florent; Lee, Kuang-Yung; Peccate, Cécile; Lorain, Stéphanie; Kabashi, Edor; Athanasopoulos, Takis; Koo, Taeyoung; Loew, Damarys; Swanson, Maurice S.; Le Rumeur, Elisabeth; Dickson, George; Allamand, Valérie; Marie, Joëlle; Furling, Denis

    2015-01-01

    Myotonic Dystrophy type 1 (DM1) is a dominant neuromuscular disease caused by nuclear-retained RNAs containing expanded CUG repeats. These toxic RNAs alter the activities of RNA splicing factors resulting in alternative splicing misregulation and muscular dysfunction. Here we show that the abnormal splicing of DMD exon 78 found in dystrophic muscles of DM1 patients is due to the functional loss of MBNL1 and leads to the re-expression of an embryonic dystrophin in place of the adult isoform. Forced expression of embryonic dystrophin in zebrafish using an exon-skipping approach severely impairs the mobility and muscle architecture. Moreover, reproducing Dmd exon 78 missplicing switch in mice induces muscle fibre remodelling and ultrastructural abnormalities including ringed fibres, sarcoplasmic masses or Z-band disorganization, which are characteristic features of dystrophic DM1 skeletal muscles. Thus, we propose that splicing misregulation of DMD exon 78 compromises muscle fibre maintenance and contributes to the progressive dystrophic process in DM1. PMID:26018658

  15. Combined Adiponectin Deficiency and Resistance in Obese Patients: Can It Solve Part of the Puzzle in Nonalcoholic Steatohepatitis

    PubMed Central

    Salman, Ahmed; Hegazy, Mona; AbdElfadl, Soheir

    2015-01-01

    BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) has become the most prevalent cause of liver disease, nonalcoholic steatohepatitis (NASH) and fibrosis in obese patients identifies the risk group with increased incidence of liver-related deaths. AIM: To clarify the role of serum adiponectin and its receptor liver gene expression in the progression of liver damage in NAFLD. METHODS: Fifty four (54) obese patients with NAFLD preliminary diagnosed by liver ultra-sound were recruited. Full medical history, anthropometric measurement, biochemical studies, serum adiponectin level, liver biopsy for histological examination and NAS score to identify NASH patients, and assessment of adiponectin receptor gene expression by RT-PCR, were conducted for each patients. Fifteen ages matched average weight healthy adult had been chosen as a control for serum adiponectin level. RESULTS: According to NAS score, patients were divided into non- NASH (8 patients), and NASH (46 patients). Serum adiponectin level was significantly lower in NAFLD patients compared to normal participants (p < 0.004). Serum adiponectin level was lower in NASH patients (4.437 ± 2.569 ng/dl in NASH vs. 5.138 ± 2.841 ng/dl in non-NASH). Adiponectin receptor liver gene expression was lower in NASH patients (0.8459 ± 0.4671 vs. 1.0688 ± 0.3965 in non-NASH). CONCLUSION: Both adiponectin deficiency and resistance had a role in progression of simple liver steatosis to severe injury in obese patients. PMID:27275239

  16. Transient inhibition of cell proliferation does not compromise self-renewal of mouse embryonic stem cells

    SciTech Connect

    Wang, Ruoxing; Guo, Yan-Lin

    2012-10-01

    Embryonic stem cells (ESCs) have unlimited capacity for self-renewal and can differentiate into various cell types when induced. They also have an unusual cell cycle control mechanism driven by constitutively active cyclin dependent kinases (Cdks). In mouse ESCs (mESCs). It is proposed that the rapid cell proliferation could be a necessary part of mechanisms that maintain mESC self-renewal and pluripotency, but this hypothesis is not in line with the finding in human ESCs (hESCs) that the length of the cell cycle is similar to differentiated cells. Therefore, whether rapid cell proliferation is essential for the maintenance of mESC state remains unclear. We provide insight into this uncertainty through chemical intervention of mESC cell cycle. We report here that inhibition of Cdks with olomoucine II can dramatically slow down cell proliferation of mESCs with concurrent down-regulation of cyclin A, B and E, and the activation of the Rb pathway. However, mESCs display can recover upon the removal of olomoucine II and are able to resume normal cell proliferation without losing self-renewal and pluripotency, as demonstrated by the expression of ESC markers, colony formation, embryoid body formation, and induced differentiation. We provide a mechanistic explanation for these observations by demonstrating that Oct4 and Nanog, two major transcription factors that play critical roles in the maintenance of ESC properties, are up-regulated via de novo protein synthesis when the cells are exposed to olomoucine II. Together, our data suggest that short-term inhibition of cell proliferation does not compromise the basic properties of mESCs. -- Highlights: Black-Right-Pointing-Pointer Inhibition of Cdks slows down mESCs proliferation. Black-Right-Pointing-Pointer mESCs display remarkable recovery capacity from short-term cell cycle interruption. Black-Right-Pointing-Pointer Short-term cell cycle interruption does not compromise mESC self-renewal. Black

  17. Early Childhood Obesity is Associated with Compromised Cerebellar Development

    PubMed Central

    Miller, Jennifer L; Couch, Jessica; Schwenk, Krista; Long, Michelle; Towler, Stephen; Theriaque, Douglas W; He, Guojun; Liu, Yijun; Driscoll, Daniel J; Leonard, Christiana M

    2009-01-01

    As part of a study investigating commonalities between Prader-Willi syndrome (PWS — a genetic imprinting disorder) and early-onset obesity of unknown etiology (EMO) we measured total cerebral and cerebellar volume on volumetric MRI images. Individuals with PWS (n=16) and EMO (n=12) had smaller cerebellar volumes than a control group of 15 siblings (p=0.02 control vs. EMO; p=0.0005 control vs. PWS), although there was no difference among the groups in cerebral volume. Individuals with PWS and EMO also had impaired cognitive function: general intellectual ability (GIA): PWS 65 ± 25; EMO 81 ± 19; and Controls 112 ± 13 (p<0.0001 controls vs. PWS and controls vs. EMO). As both conditions are characterized by early-onset obesity and slowed cognitive development, these results raise the possibility that early childhood obesity retards both cerebellar and cognitive development. PMID:19437203

  18. Measurement scales in clinical research of the upper extremity, part 1: general principles, measures of general health, pain, and patient satisfaction.

    PubMed

    Badalamente, Marie; Coffelt, Laureen; Elfar, John; Gaston, Glenn; Hammert, Warren; Huang, Jerry; Lattanza, Lisa; Macdermid, Joy; Merrell, Greg; Netscher, David; Panthaki, Zubin; Rafijah, Greg; Trczinski, Douglas; Graham, Brent

    2013-02-01

    Measurement is a fundamental cornerstone in all aspects of scientific discovery, including clinical research. To be useful, measurement instruments must meet several key criteria, the most important of which are satisfactory reliability, validity, and responsiveness. Part 1 of this article reviews the general concepts of measurement instruments and describes the measurement of general health, pain, and patient satisfaction. PMID:23351912

  19. Intensified autophagy compromises the efficacy of radiotherapy against prostate cancer

    SciTech Connect

    Koukourakis, Michael I.

    2015-05-29

    Introduction: Radiotherapy is an equivalent alternative or complement to radical prostatectomy, with high therapeutic efficacy. High risk patients, however, experience high relapse rates, so that research on radio-sensitization is the most evident route to improve curability of this common disease. Materials and methods: In the current study we investigated the autophagic activity in a series of patients with localized prostate tumors treated with radical radiotherapy, using the LC3A and the LAMP2a proteins as markers of autophagosome and lysosome cellular content, respectively. The role of autophagy on prostate cancer cell line resistance to radiation was also examined. Results: Using confocal microscopy on tissue biopsies, we showed that prostate cancer cells have, overall, high levels of LC3A and low levels of LAMP2a compared to normal prostate glands. Tumors with a ‘highLC3A/lowLAMP2a’ phenotype, suggestive of intensified lysosomal consumption, had a significantly poorer biochemical relapse free survival. The PC3 radioresistant cell line sustained remarkably its autophagic flux ability after radiation, while the DU145 radiosensitive one experiences a prolonged blockage of the autophagic process. This was assessed with aggresome accumulation detection and LC3A/LAMP2a double immunofluorescence, as well as with sequestrosome/p62 protein detection. By silencing the LC3A or LAMP2a expression, both cell lines became more sensitive to escalated doses of radiation. Conclusions: High base line autophagy activity and cell ability to sustain functional autophagy define resistance of prostate cancer cells to radiotherapy. This can be reversed by blocking up-regulated components of the autophagy pathway, which may prove of importance in the field of clinical radiotherapy. - Highlights: • High LC3A and low LAMP2a levels is a frequent expression pattern of prostate carcinoma. • This pattern of intensified autophagic flux relates with high relapse rates after

  20. Cigarette Smoke Exposure Exacerbates Lung Inflammation and Compromises Immunity to Bacterial Infection

    PubMed Central

    Lugade, Amit A.; Bogner, Paul N.; Thatcher, Thomas H.; Sime, Patricia J.; Phipps, Richard P.; Thanavala, Yasmin

    2014-01-01

    The detrimental impact of tobacco on human health is clearly recognized and despite aggressive efforts to prevent smoking, close to one billion individuals worldwide continue to smoke. People with chronic obstructive pulmonary disease (COPD) are susceptible to recurrent respiratory infections with pathogens, including non-typeable Haemophilus influenzae (NTHI), yet the reasons for this increased susceptibility are poorly understood. As mortality rapidly increases with multiple exacerbations, development of protective immunity is critical to improving patient survival. Acute NTHI infection has been studied in the context of cigarette smoke exposure, but this is the first study to investigate chronic infection and the generation of adaptive immune responses to NTHI following chronic smoke exposure. After chronic NTHI infection, mice that had previously been exposed to cigarette smoke developed increased lung inflammation and compromised adaptive immunity relative to air-exposed controls. Importantly, NTHI-specific T cells from mice exposed to cigarette smoke produced lower levels of IFN-γ and IL-4, and B cells produced reduced levels of antibodies against outer membrane lipoprotein P6, with impaired IgG1, IgG2a and IgA class-switching. However, production of IL-17, which is associated with neutrophilic inflammation, was enhanced. Interestingly, cigarette smoke exposed mice exhibited a similar defect in the generation of adaptive immunity following immunization with P6. Our study has conclusively demonstrated that cigarette smoke exposure has a profound suppressive effect on the generation of adaptive immune responses to NTHI and suggests the mechanism by which prior cigarette smoke exposure predisposes COPD patients to recurrent infections, leading to exacerbations and contributing to mortality. PMID:24752444

  1. Successful Kidney Transplantation in Children With a Compromised Inferior Vena Cava

    PubMed Central

    Shishido, Seiichiro; Kawamura, Takeshi; Hamasaki, Yuko; Takahashi, Yusuke; Itabashi, Yoshihiro; Muramatsu, Masaki; Satoh, Hiroyuki; Aikawa, Atsushi

    2016-01-01

    Background Children with a compromised inferior vena cava (IVC) were previously considered unsuitable for kidney transplantation because of the technical difficulties and the increased risk of graft thrombosis secondary to inadequate renal venous outflow. Methods We conducted a retrospective study of 11 transplants in 9 patients with end-stage renal disease and thrombosed IVCs who received adult kidney allografts between 2000 and 2015. The mean age at transplantation was 7.5 ± 3.5 years. A pretransplant diagnosis of the IVC thrombosis was made in 7 patients by magnetic resonance imaging and computerized tomography, whereas there were 2 instances of intraoperative discovery of the IVC thrombosis. Results In the early cases, a kidney was placed intraperitoneally at the right iliac fossa with a venous anastomosis to the patent segment of the suprarenal IVC. After 2008, however, 6 adult-sized kidneys were subsequently placed in the left orthotopic position. Venous drainage was attained to the infrahepatic IVC (n = 3), left native renal vein (n = 2), and ascending lumbar vein (n = 1). Moreover, a venous bypass was created between the graft and the splenic vein in 2 children who showed high return pressure after the vessel was declamped. The mean glomerular filtration rate of the functioning 8 grafts 1 year posttransplant was 73.4 ± 20.4 mL/min per 1.73 m2. Of note, 6 of the grafts have been functioning well, with a mean follow-up of 66 months. Both 1- and 5-year graft survival were 81.8%. Conclusions Transplantation into the left orthotopic position and the revascularization methods are an effective set of surgical techniques that could potentially be adopted as safe and reliable transplant approaches in children with IVC thrombosis. PMID:27500272

  2. Cigarette smoke exposure exacerbates lung inflammation and compromises immunity to bacterial infection.

    PubMed

    Lugade, Amit A; Bogner, Paul N; Thatcher, Thomas H; Sime, Patricia J; Phipps, Richard P; Thanavala, Yasmin

    2014-06-01

    The detrimental impact of tobacco on human health is clearly recognized, and despite aggressive efforts to prevent smoking, close to one billion individuals worldwide continue to smoke. People with chronic obstructive pulmonary disease are susceptible to recurrent respiratory infections with pathogens, including nontypeable Haemophilus influenzae (NTHI), yet the reasons for this increased susceptibility are poorly understood. Because mortality rapidly increases with multiple exacerbations, development of protective immunity is critical to improving patient survival. Acute NTHI infection has been studied in the context of cigarette smoke exposure, but this is the first study, to our knowledge, to investigate chronic infection and the generation of adaptive immune responses to NTHI after chronic smoke exposure. After chronic NTHI infection, mice that had previously been exposed to cigarette smoke developed increased lung inflammation and compromised adaptive immunity relative to air-exposed controls. Importantly, NTHI-specific T cells from mice exposed to cigarette smoke produced lower levels of IFN-γ and IL-4, and B cells produced reduced levels of Abs against outer-membrane lipoprotein P6, with impaired IgG1, IgG2a, and IgA class switching. However, production of IL-17, which is associated with neutrophilic inflammation, was enhanced. Interestingly, cigarette smoke-exposed mice exhibited a similar defect in the generation of adaptive immunity after immunization with P6. Our study has conclusively demonstrated that cigarette smoke exposure has a profound suppressive effect on the generation of adaptive immune responses to NTHI and suggests the mechanism by which prior cigarette smoke exposure predisposes chronic obstructive pulmonary disease patients to recurrent infections, leading to exacerbations and contributing to mortality. PMID:24752444

  3. GGGGCC repeat expansion in C9ORF72 compromises nucleocytoplasmic transport

    PubMed Central

    Freibaum, Brian D.; Lu, Yubing; Lopez-Gonzalez, Rodrigo; Kim, Nam Chul; Almeida, Sandra; Lee, Kyung-Ha; Badders, Nisha; Valentine, Marc; Miller, Bruce L.; Wong, Philip C.; Petrucelli, Leonard; Kim, Hong Joo; Gao, Fen-Biao; Taylor, J. Paul

    2015-01-01

    GGGGCC (G4C2) repeat expansion in a noncoding region of C9ORF72 is the most common cause of sporadic and familial forms of amyotrophic lateral sclerosis (ALS) and frontotemporal dementia (FTD)1,2. The basis for pathogenesis is unknown. To capture the consequences of G4C2 repeat expansion in a tractable genetic system, we generated transgenic fly lines expressing 8, 28 or 58 G4C2 repeat-containing transcripts that do not have a translation start site (AUG) but contain an open-reading frame for green fluorescent protein (GFP) to detect repeat-associated non-AUG (RAN) translation. These transgenic animals show dosage-dependent, repeat length-dependent degeneration in neuronal tissues and RAN translation of dipeptide repeat (DPR) proteins as observed in patients. This model was used in a large-scale, unbiased genetic screen ultimately leading to the identification of 18 genetic modifiers that encode components of the nuclear pore complex (NPC) as well as the machinery that coordinates the export of nuclear RNA and the import of nuclear proteins. Consistent with these results we found morphological abnormalities in the architecture of the nuclear envelope in cells expressing expanded G4C2 repeats in vitro and in vivo. Moreover, we identified a substantial defect in RNA export resulting in retention of RNA in the nuclei of Drosophila cells expressing expanded G4C2 repeats and also in mammalian cells, including aged iPSC-derived neurons from C9ORF72 patients. These studies show that a primary consequence of G4C2 repeat expansion is the compromise of nucleocytoplasmic transport through the nuclear pore, revealing a novel mechanism of neurodegeneration. PMID:26308899

  4. Platelet Transfusion – the Art and Science of Compromise

    PubMed Central

    Cid, Joan; Harm, Sarah K.; Yazer, Mark H.

    2013-01-01

    Summary Many modern therapies depend on platelet (PLT) transfusion support. PLTs have a 4- to 7-day shelf life and are frequently in short supply. In order to optimize the inventory PLTs are often transfused to adults without regard for ABO compatibility. Hemolytic reactions are infrequent despite the presence of ‘high titer’ anti-A and anti-B antibodies in some of the units. Despite the low risk for hemolysis, some centers provide only ABO identical PLTs to their recipients; this practice might have other beneficial outcomes that remain to be proven. Strategies to mitigate the risk of hemolysis and the clinical and laboratory outcomes following ABO-matched and mismatched transfusions will be discussed. Although the PLTs themselves do not carry the D antigen, a small number of RBCs are also transfused with every PLT dose. The quantity of RBCs varies by the type of PLT preparation, and even a small quantity of D+ RBCs can alloimmunize a susceptible D− host. Thus PLT units are labeled as D+/–, and most transfusion services try to prevent the transfusion of D+ PLTs to D– females of childbearing age. A similar policy for patients with hematological diseases is controversial, and the elements and mechanisms of anti-D alloimmunization will be discussed. PMID:23922541

  5. Compromised paraspeckle formation as a pathogenic factor in FUSopathies

    PubMed Central

    Shelkovnikova, Tatyana A.; Robinson, Hannah K.; Troakes, Claire; Ninkina, Natalia; Buchman, Vladimir L.

    2014-01-01

    Paraspeckles are nuclear bodies formed by a set of specialized proteins assembled on the long non-coding RNA NEAT1; they have a role in nuclear retention of hyperedited transcripts and are associated with response to cellular stress. Fused in sarcoma (FUS) protein, linked to a number of neurodegenerative disorders, is an essential paraspeckle component. We have shown that its recruitment to these nuclear structures is mediated by the N-terminal region and requires prion-like activity. FUS interacts with p54nrb/NONO, a major constituent of paraspeckles, in an RNA-dependent manner and responds in the same way as other paraspeckle proteins to alterations in cellular homeostasis such as changes in transcription rates or levels of protein methylation. FUS also regulates NEAT1 levels and paraspeckle formation in cultured cells, and FUS deficiency leads to loss of paraspeckles. Pathological gain-of-function FUS mutations might be expected to affect paraspeckle function in human diseases because mislocalized amyotrophic lateral sclerosis (ALS)-linked FUS variants sequester other paraspeckle proteins into aggregates formed in cultured cells and into neuronal inclusions in a transgenic mouse model of FUSopathy. Furthermore, we detected abundant p54nrb/NONO-positive inclusions in motor neurons of patients with familial forms of ALS caused by FUS mutations, but not in other ALS cases. Our results suggest that both loss and gain of FUS function can trigger disruption of paraspeckle assembly, which may impair protective responses in neurons and thereby contribute to the pathogenesis of FUSopathies. PMID:24334610

  6. Online resources for culturally and linguistically appropriate services for home healthcare and hospice, part 5: resources for African patients.

    PubMed

    Young, Judith S

    2013-05-01

    Providing culturally and linguistically appropriate home healthcare and hospice care to patients who have emigrated from the African continent can be a challenge. This article reviews Web sites that provide introductions to some of the predominant cultures in Africa. Web sites providing patient education material in 13 African languages are also discussed. PMID:23652979

  7. [Isoniazid content of lungs in patients with pulmonary tuberculosis depending on the method of its administration as part of a comprehensive preoperative preparation].

    PubMed

    Strelis, A K; Blinov, V Iu; Gubina, N A

    1992-01-01

    Isoniazid concentration in the resected areas of a lung was studied in 47 patients with tuberculosis. It has been proved that galvanization of the chest against the background of intermittent intravenous chemotherapy allows to create a high concentration of the preparation in the damaged part of a lung situated at the interelectrode space. Isoniazid content in the wall of the caverna and paracavernous tissues in patients after the direct current influencing was (5.3 +/- 1.0) and (15.2 +/- 1.2) mukg/g. These indices were significantly higher than in patients, who sustained enteral, or intravenous drip administration of the preparation 3 times a week. Intravenous intermittent chemotherapy in combination with galvanization is indicated at the time of preoperative preparation of the patients. PMID:1619872

  8. Prevalence of occult HBV among hemodialysis patients in two districts in the northern part of the West Bank, Palestine.

    PubMed

    Dumaidi, Kamal; Al-Jawabreh, Amer

    2014-10-01

    Occult hepatitis B infection is the case with undetectable HBsAg, but positive for HBV DNA in liver tissue and/or serum. Occult hepatitis B infection among hemodialysis patients in Palestine has been understudied. In this study, 148 hemodialysis patients from 2 northern districts in Palestine, Jenin (89) and Tulkarem (59), were investigated for occult hepatitis B, HBV, HCV infections with related risk factors. ELISA and PCR were used for the detection of anti-HBc and viral DNA, respectively. The overall prevalence of occult hepatitis B infection among the study group was 12.5% (16/128). Occult hepatitis B infection is more prevalent among males with most cases (15/16) from Jenin District. About one-third (42/132) of the hemodialysis patients were anti-HBc positive. Approximately 27% of the hemodialysis patients were infected with HCV. Around 20% (28/140) were positive for HBV DNA, but only 8.2% (12/146) of the hemodialysis patients were positive for HBsAg. The comparison between hemodialysis patients with occult hepatitis B infection and those without occult hepatitis B infection for selected risk factors and parameters as liver Enzyme, age, sex, HCV infection, blood transfusion, kidney transplant, anti-HBc, and vaccination showed no statistical significance between both categories. Duration of hemodialysis significantly affected the rate of HCV infection. HCV is significantly higher in hemodialysis patients with both Diabetes mellitus and hypertension. The prevalence of occult hepatitis B infection among hemodialysis patients is high; requiring stringent control policies. HBsAg assay is insufficient test for accurate diagnosis of HBV infection among hemodialysis patients. PMID:24992542

  9. On the recognition of compromise in sensing systems: rewired acoustic arrays and distorted route estimation and classification

    NASA Astrophysics Data System (ADS)

    Thornley, David J.; Damarla, Thyagaraju; Srivastava, Mani B.; Mylaraswami, Dinkar

    2009-09-01

    A group of acoustic arrays that provide direction of approach estimates also support classification of vehicles using the beams formed during that estimation. Successful simultaneous tracking and classification has demonstrated the value of such a sensing resource as a UGS installation. We now consider potential attacks on the integrity of such an installation, describing the effect of compromised acoustic arrays in the data analysis and tracking and classification results. We indicate how these can be automatically recognized, and note that calibration methods intended for deployment time can be used for recovery during operation, which opens the door to methods for recovery from the compromise without re-configuring the equipment, using abductive reasoning to discover the necessary re-processing structure. By rotating an acoustic array, the tracking stability and implied path of a tracked entity can be distorted while leaving the data and analysis from individual arrays self-consistent. Less structured modifications, such as unstructured re-ordering of microphone connections, impact the basic data analysis. We examine the effect of these classes of attack on the integrity of a set of unattended acoustic arrays, and consider the steps necessary for detection, diagnosis, and recovering an effective sensing system. Understaning these steps plays an important part in reasoning in support of balance of investment, planning, operation and post-hoc analysis.

  10. Surgical Re-entry of an Intentionally Replanted Periodontally Compromised Tooth Treated with Platelet Rich Fibrin (PRF): Hopeless to Hopeful.

    PubMed

    Ryana, Haneet Kour; Srinath, Rashmi; Prakash, Shobha

    2016-06-01

    Intentional replantation is generally contraindicated in periodontally compromised teeth however, there are reports suggesting that it can be a successful treatment alternative for periodontally involved hopeless teeth. Currently there is dearth of evidence regarding the success of this therapy, especially evidence for the effectiveness of autologous platelet rich fibrin is lacking. We present a case report of a 23-year-old male patient with periodontally hopeless left maxillary central incisor having bone loss extending beyond root apex. The tooth was gently extracted and replanted utilizing root conditioning and combined regenerative therapy (Xenograft, PRF and Type I Collagen Membrane). Surgical re-entry at nine months revealed bone formation in the apical third of the tooth. At one year, 87% radiographic bone gain was accomplished. The improvement in the clinical and radiographic parameters reinforced by the re-entry surgery findings strongly suggest that intentional replantation may be a cost-effective substitute to implants and tooth supported prosthesis in situations where conventional periodontal therapy would yield compromised outcomes. PMID:27504421

  11. Compromised Catalysis and Potential Folding Defects in in Vitro Studies of Missense Mutants Associated with Hereditary Phosphoglucomutase 1 Deficiency*

    PubMed Central

    Lee, Yingying; Stiers, Kyle M.; Kain, Bailee N.; Beamer, Lesa J.

    2014-01-01

    Recent studies have identified phosphoglucomutase 1 (PGM1) deficiency as an inherited metabolic disorder in humans. Affected patients show multiple disease phenotypes, including dilated cardiomyopathy, exercise intolerance, and hepatopathy, reflecting the central role of the enzyme in glucose metabolism. We present here the first in vitro biochemical characterization of 13 missense mutations involved in PGM1 deficiency. The biochemical phenotypes of the PGM1 mutants cluster into two groups: those with compromised catalysis and those with possible folding defects. Relative to the recombinant wild-type enzyme, certain missense mutants show greatly decreased expression of soluble protein and/or increased aggregation. In contrast, other missense variants are well behaved in solution, but show dramatic reductions in enzyme activity, with kcat/Km often <1.5% of wild-type. Modest changes in protein conformation and flexibility are also apparent in some of the catalytically impaired variants. In the case of the G291R mutant, severely compromised activity is linked to the inability of a key active site serine to be phosphorylated, a prerequisite for catalysis. Our results complement previous in vivo studies, which suggest that both protein misfolding and catalytic impairment may play a role in PGM1 deficiency. PMID:25288802

  12. Surgical Re-entry of an Intentionally Replanted Periodontally Compromised Tooth Treated with Platelet Rich Fibrin (PRF): Hopeless to Hopeful

    PubMed Central

    Srinath, Rashmi; Prakash, Shobha

    2016-01-01

    Intentional replantation is generally contraindicated in periodontally compromised teeth however, there are reports suggesting that it can be a successful treatment alternative for periodontally involved hopeless teeth. Currently there is dearth of evidence regarding the success of this therapy, especially evidence for the effectiveness of autologous platelet rich fibrin is lacking. We present a case report of a 23-year-old male patient with periodontally hopeless left maxillary central incisor having bone loss extending beyond root apex. The tooth was gently extracted and replanted utilizing root conditioning and combined regenerative therapy (Xenograft, PRF and Type I Collagen Membrane). Surgical re-entry at nine months revealed bone formation in the apical third of the tooth. At one year, 87% radiographic bone gain was accomplished. The improvement in the clinical and radiographic parameters reinforced by the re-entry surgery findings strongly suggest that intentional replantation may be a cost-effective substitute to implants and tooth supported prosthesis in situations where conventional periodontal therapy would yield compromised outcomes. PMID:27504421

  13. An instrument for theory and research development using the behavioral systems model for nursing: the cancer patient. Part II.

    PubMed

    Derdiarian, A K; Forsythe, A B

    1983-01-01

    The purpose of the Derdiarian Behavioral System Model (DBSM) instrument was to measure and describe, within the Johnson Behavioral System Model (JBSM) perspective, the perceived behavioral changes of the cancer patient. Based on Johnson's (1968, 1980) premise that illness as a noxious stimulus effects imbalance in the behavioral system of the human being, it was extrapolated that changes that occur in a patient's behavioral patterns would be perceived by the patient. Thus, changes would reflect the description of the imbalance in the patient's behavioral system, which needs to be identified and described in a systematic way. The description of change was envisioned in terms of (1) the perceived existence of change; (2) the direction of change--increase or decrease; (3) the quality of change--positive or negative; (4) the importance of change--its significance; and (5) the physical, psychological, or emotional effect(s) of the illness perceived as causally associated with the change. PMID:6554614

  14. The Adult Patient with Eisenmenger Syndrome: A Medical Update After Dana Point Part I: Epidemiology, Clinical Aspects and Diagnostic Options

    PubMed Central

    Kaemmerer, Harald; Mebus, Siegrun; Schulze-Neick, Ingram; Eicken, Andreas; Trindade, Pedro T; Hager, Alfred; Oechslin, Erwin; Niwa, Koichiro; Lang, Irene; Hess, John

    2010-01-01

    Eisenmenger syndrome is the most severe form of pulmonary arterial hypertension and arises on the basis of congenital heart disease with a systemic-to-pulmonary shunt. Due to the chronic slow progressive hypoxemia with central cyanosis, adult patients with the Eisenmenger syndrome suffer from a complex and multisystemic disorder including coagulation disorders (bleeding complications and paradoxical embolisms), renal dysfunction, hypertrophic osteoarthropathy, heart failure, reduced quality of life and premature death. For a long time, therapy has been limited to symptomatic options or lung or combined heart-lung transplantation. As new selective pulmonary vasodilators have become available and proven to be beneficial in various forms of pulmonary arterial hypertension, this targeted medical treatment has been expected to show promising effects with a delay of deterioration also in Eisenmenger patients. Unfortunately, data in Eisenmenger patients suffer from small patient numbers and a lack of randomized controlled studies. To optimize the quality of life and the outcome, referral of Eisenmenger patients to spezialized centers is required. In such centers, specific interdisciplinary management strategies of physicians specialized on congenital heart diseases and PAH should be warranted. This medical update emphasizes the current diagnostic and therapeutic options for Eisenmenger patients with particularly focussing on epidemiology, clinical aspects and specific diagnostic options. PMID:22043211

  15. Transient Inhibition of Cell Proliferation does not Compromise Self-Renewal of Mouse Embryonic Stem Cells

    PubMed Central

    Wang, Ruoxing; Guo, Yan-Lin

    2012-01-01

    Embryonic stem cells (ESCs) have unlimited capacity for self-renewal and can differentiate into various cell types when induced. They also have an unusual cell cycle control mechanism driven by constitutively active cyclin dependent kinases (Cdks). In mouse ESCs (mESCs). It is proposed that the rapid cell proliferation could be a necessary part of mechanisms that maintain mESC self-renewal and pluripotency, but this hypothesis is not in line with the finding in human ESCs (hESCs) that the length of the cell cycle is similar to differentiated cells. Therefore, whether rapid cell proliferation is essential for the maintenance of mESC state remains unclear. We provide insight into this uncertainty through chemical intervention of mESC cell cycle. We report here that inhibition of Cdks with olomoucine II can dramatically slow down cell proliferation of mESCs with concurrent down-regulation of cyclin A, B and E, and the activation of the Rb pathway. However, mESCs display can recover upon the removal of olomoucine II and are able to resume normal cell proliferation without losing self-renewal and pluripotency, as demonstrated by the expression of ESC markers, colony formation, embryoid body formation, and induced differentiation. We provide a mechanistic explanation for these observations by demonstrating that Oct4 and Nanog, two major transcription factors that play critical roles in the maintenance of ESC properties, are up-regulated via de novo protein synthesis when the cells are exposed to olomoucine II. Together, our data suggest that short-term inhibition of cell proliferation does not compromise the basic properties of mESCs. PMID:22705123

  16. High stability of microRNAs in tissue samples of compromised quality.

    PubMed

    Peiró-Chova, Lorena; Peña-Chilet, María; López-Guerrero, José Antonio; García-Giménez, José Luis; Alonso-Yuste, Elisa; Burgues, Octavio; Lluch, Ana; Ferrer-Lozano, Jaime; Ribas, Gloria

    2013-12-01

    Degradation of tissue samples limits performing RNA-based molecular studies, but little is known about the potential usefulness of samples of compromised quality for studies focused on miRNAs. In this work we analyze a series of cryopreserved tissue samples (n = 14), frozen samples that underwent a severe thawing process (n = 10), and their paired formalin-fixed paraffin-embedded (FFPE) tissue samples (n = 24) from patients with breast cancer obtained during primary surgical resection and collected in 2011. Quality and integrity analyses of the total and small fraction of RNA were carried out. Recovery of specific RNA molecules (miRNAs hsa-miR-21, hsa-miR-125b, and hsa-miR-191; snoRNA RNU6B; and mRNAs GAPDH and HPRT1) was also analyzed by quantitative RT-PCR. Our results suggest that visualisation of the small RNA electrophoretic profiles obtained using the Agilent 2100 bioanalyzer makes it possible to differentiate between the three groups of samples (optimally frozen, thawed, and FFPE). We demonstrate that specific miRNA molecules can be similarly recovered from different tissue sample sources, which supports their high degree of stability. We conclude that miRNAs are robustly detected irrespective of the quality of the tissue sample. In this regard, a word of caution should be raised before degraded samples are discarded: although prior quality assessment of the biological material to be analyzed is recommended, our work demonstrates that degraded tissue samples are also suitable for miRNA studies. PMID:24197449

  17. Host lung immunity is severely compromised during tropical pulmonary eosinophilia: role of lung eosinophils and macrophages.

    PubMed

    Sharma, Pankaj; Sharma, Aditi; Vishwakarma, Achchhe Lal; Agnihotri, Promod Kumar; Sharma, Sharad; Srivastava, Mrigank

    2016-04-01

    Eosinophils play a central role in the pathogenesis of tropical pulmonary eosinophilia, a rare, but fatal, manifestation of filariasis. However, no exhaustive study has been done to identify the genes and proteins of eosinophils involved in the pathogenesis of tropical pulmonary eosinophilia. In the present study, we established a mouse model of tropical pulmonary eosinophilia that mimicked filarial manifestations of human tropical pulmonary eosinophilia pathogenesis and used flow cytometry-assisted cell sorting and real-time RT-PCR to study the gene expression profile of flow-sorted, lung eosinophils and lung macrophages during tropical pulmonary eosinophilia pathogenesis. Our results show that tropical pulmonary eosinophilia mice exhibited increased levels of IL-4, IL-5, CCL5, and CCL11 in the bronchoalveolar lavage fluid and lung parenchyma along with elevated titers of IgE and IgG subtypes in the serum. Alveolar macrophages from tropical pulmonary eosinophilia mice displayed decreased phagocytosis, attenuated nitric oxide production, and reduced T-cell proliferation capacity, and FACS-sorted lung eosinophils from tropical pulmonary eosinophilia mice upregulated transcript levels of ficolin A and anti-apoptotic gene Bcl2,but proapoptotic genes Bim and Bax were downregulated. Similarly, flow-sorted lung macrophages upregulated transcript levels of TLR-2, TLR-6, arginase-1, Ym-1, and FIZZ-1 but downregulated nitric oxide synthase-2 levels, signifying their alternative activation. Taken together, we show that the pathogenesis of tropical pulmonary eosinophilia is marked by functional impairment of alveolar macrophages, alternative activation of lung macrophages, and upregulation of anti-apoptotic genes by eosinophils. These events combine together to cause severe lung inflammation and compromised lung immunity. Therapeutic interventions that can boost host immune response in the lungs might thus provide relief to patients with tropical pulmonary eosinophilia. PMID

  18. Medical educational culture: introducing patients to applicants as part of the medical school interview: feasibility and initial impact show and tell

    PubMed Central

    Sims, Shireen Madani; Lynch, James W.

    2016-01-01

    Introduction The College of Medicine at our institution underwent a major curricular revision in order to develop a patient-centered context for learning. The admission process was revised to reflect this change, adopting a holistic review process, with the hope of attracting students who were particularly well suited to a patient-centered curriculum and learning culture. Methods Patients from a single practitioner, who were accustomed to working with medical students, were asked if they would like to select the next generation of physicians. The patient's experience included a brief didactic presentation related to the patient's diagnosis and treatment. This was followed by an informal session with the applicants and the physician, where they shared their story in a small group setting. They were encouraged to share their experiences with the healthcare system, both positive and negative. The goal was to allow applicants to glean the importance of the human aspects of disease in our institutional culture of learning. Results The response and experience were overwhelmingly positive for the patients who donated their time to participate and for our applicants. Follow-up surveys indicated that our applicants found the experience to be unique and positive. Many of the students who chose to attend our university cited the interview experience and learning culture as factors that influenced their choice of medical schools. In addition, the Liaison Committee on Medical Education cited the favorability of the admission process in their recent site visit. Discussion Now in its fifth year, we can say that the inclusion of patients as part of the interview day is feasible as part of our admission process. We continue to make changes and monitor our progress, and we have added several other faculty members and specialties in order to ensure the program is sustainable. PMID:27520404

  19. Risk factors associated with catheter-related upper extremity deep vein thrombosis in patients with peripherally inserted central venous catheters: a prospective observational cohort study: part 2.

    PubMed

    Maneval, Rhonda E; Clemence, Bonnie J

    2014-01-01

    This is the second part of a 2-part series that reports on the results of a prospective observational cohort study designed to examine risk factors associated with symptomatic upper extremity deep vein thrombosis (UEDVT) in patients with peripherally inserted central catheters (PICCs). Part 1, published in the May/June 2014 issue of the Journal of Infusion Nursing, provided an extensive review and critique of the literature regarding risk factors associated with catheter-related UEDVT and identified 28 suspected risk factors. A study was undertaken to examine each of the risk factors among 203 acute care patients with PICCs, 13 of whom experienced a UEDVT, yielding an incidence of 6.4%. The most common reason for admission was infection (33.5%), and the primary reason for insertion of the PICC was venous access (58.6%). Hypertension (P = .022) and obesity (P = .008), defined as a body mass index ≥30, were associated with UEDVT. The clinical symptoms of edema (P < .001) and a 3-cm or more increase in arm circumference (P < .001) in the PICC arm after PICC placement were associated with UEDVT. All other variables were not statistically significant. The results suggest that patients who are obese and hypertensive may be at greater risk for the development of UEDVT and that the physical finding of edema and increased arm circumference in the PICC arm are possibly suggestive of UEDVT. PMID:24983259

  20. Use of treatment log files in spot scanning proton therapy as part of patient-specific quality assurance

    SciTech Connect

    Li Heng; Sahoo, Narayan; Poenisch, Falk; Suzuki, Kazumichi; Li Yupeng; Li Xiaoqiang; Zhang Xiaodong; Gillin, Michael T.; Zhu, X. Ronald; Lee, Andrew K.

    2013-02-15

    Purpose: The purpose of this work was to assess the monitor unit (MU) values and position accuracy of spot scanning proton beams as recorded by the daily treatment logs of the treatment control system, and furthermore establish the feasibility of using the delivered spot positions and MU values to calculate and evaluate delivered doses to patients. Methods: To validate the accuracy of the recorded spot positions, the authors generated and executed a test treatment plan containing nine spot positions, to which the authors delivered ten MU each. The spot positions were measured with radiographic films and Matrixx 2D ion-chambers array placed at the isocenter plane and compared for displacements from the planned and recorded positions. Treatment logs for 14 patients were then used to determine the spot MU values and position accuracy of the scanning proton beam delivery system. Univariate analysis was used to detect any systematic error or large variation between patients, treatment dates, proton energies, gantry angles, and planned spot positions. The recorded patient spot positions and MU values were then used to replace the spot positions and MU values in the plan, and the treatment planning system was used to calculate the delivered doses to patients. The results were compared with the treatment plan. Results: Within a treatment session, spot positions were reproducible within {+-}0.2 mm. The spot positions measured by film agreed with the planned positions within {+-}1 mm and with the recorded positions within {+-}0.5 mm. The maximum day-to-day variation for any given spot position was within {+-}1 mm. For all 14 patients, with {approx}1 500 000 spots recorded, the total MU accuracy was within 0.1% of the planned MU values, the mean (x, y) spot displacement from the planned value was (-0.03 mm, -0.01 mm), the maximum (x, y) displacement was (1.68 mm, 2.27 mm), and the (x, y) standard deviation was (0.26 mm, 0.42 mm). The maximum dose difference between calculated

  1. Challenges relating to solid tumour brain metastases in clinical trials, part 1: patient population, response, and progression. A report from the RANO group.

    PubMed

    Lin, Nancy U; Lee, Eudocia Q; Aoyama, Hidefumi; Barani, Igor J; Baumert, Brigitta G; Brown, Paul D; Camidge, D Ross; Chang, Susan M; Dancey, Janet; Gaspar, Laurie E; Harris, Gordon J; Hodi, F Stephen; Kalkanis, Steven N; Lamborn, Kathleen R; Linskey, Mark E; Macdonald, David R; Margolin, Kim; Mehta, Minesh P; Schiff, David; Soffietti, Riccardo; Suh, John H; van den Bent, Martin J; Vogelbaum, Michael A; Wefel, Jeffrey S; Wen, Patrick Y

    2013-09-01

    Therapeutic outcomes for patients with brain metastases need to improve. A critical review of trials specifically addressing brain metastases shows key issues that could prevent acceptance of results by regulatory agencies, including enrolment of heterogeneous groups of patients and varying definitions of clinical endpoints. Considerations specific to disease, modality, and treatment are not consistently addressed. Additionally, the schedule of CNS imaging and consequences of detection of new or progressive brain metastases in trials mainly exploring the extra-CNS activity of systemic drugs are highly variable. The Response Assessment in Neuro-Oncology (RANO) working group is an independent, international, collaborative effort to improve the design of trials in patients with brain tumours. In this two-part series, we review the state of clinical trials of brain metastases and suggest a consensus recommendation for the development of criteria for future clinical trials. PMID:23993384

  2. Undiagnosed Bipolar Disorders in Patients with Major Depressive Episode: Iran's part of a Multicenter Cross-Sectional Study

    PubMed Central

    Sadeghi, Majid; Ardestani, Seyed Mehdi Samimi; Semnani, Yousef; Mirsepassi, Gholamreza; Sadr, Seyed Saeed; Kamaloo, Atefe; Ahadi, Morvarid; Pourmirza, Behin; Mir, Elham

    2013-01-01

    Objective Bipolar spectrum disorders may often go undiagnosed or unrecognized. The aim of this study was to determine the proportion of bipolar disorder symptoms in Iranian patients with a major depressive episode. Methods 313 patients with a current DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders 4th ed. Text rev.) diagnosed with a major depressive episode entered this cross-sectional study. Thirty two items revised Hypomania/ mania Symptoms Checklist (HCL-32) was used to determine the frequency of bipolar episodes. Results Considerable proportion of patients (53.9%) previously diagnosed as major depressive disorder fulfilled the criteria for bipolar disorder by Bipolarity Specifier. The Bipolarity Specifier additionally identified significant association for manic / hypomanic states during antidepressants therapy (p<0.0003) and current mixed mood symptoms (p<0.0001) Conclusion Bipolar symptoms meeting the criteria for bipolar disorders in depressed patients who have not been previously diagnosed with bipolar disorder are frequent. Current DSM criteria may not be sufficient to diagnose more subtle or atypical forms of bipolar disorders. PMID:23682245

  3. Advancing Virtual Patient Simulations through Design Research and InterPLAY: Part I--Design and Development

    ERIC Educational Resources Information Center

    Hirumi, Atsusi; Kleinsmith, Andrea; Johnsen, Kyle; Kubovec, Stacey; Eakins, Michael; Bogert, Kenneth; Rivera-Gutierrez, Diego J.; Reyes, Ramsamooj Javier; Lok, Benjamin; Cendan, Juan

    2016-01-01

    Systematic reviews and meta-analyses of randomized controlled studies conclude that virtual patient simulations are consistently associated with higher learning outcomes compared to other educational methods. However, we cannot assume that students will learn from simply exposing students to the simulations. The instructional features that are…

  4. Bodily ownership modulation in defensive responses: physiological evidence in brain-damaged patients with pathological embodiment of other's body parts.

    PubMed

    Fossataro, C; Gindri, P; Mezzanato, T; Pia, L; Garbarini, F

    2016-01-01

    Do conscious beliefs about the body affect defensive mechanisms within the body? To answer this question we took advantage from a monothematic delusion of bodily ownership, in which brain-damaged patients misidentify alien limbs as their own. We investigated whether the delusional belief that an alien hand is their own hand modulates a subcortical defensive response, such as the hand-blink reflex. The blink, dramatically increases when the threated hand is inside the defensive peripersonal-space of the face. In our between-subjects design, including patients and controls, the threat was brought near the face either by the own hand or by another person's hand. Our results show an ownership-dependent modulation of the defensive response. In controls, as well as in the patients' intact-side, the response enhancement is significantly greater when the threat was brought near the face by the own than by the alien hand. Crucially, in the patients' affected-side (where the pathological embodiment occurs), the alien (embodied) hand elicited a response enhancement comparable to that found when the threat is brought near the face by the real hand. These findings suggest the existence of a mutual interaction between our conscious beliefs about the body and the physiological mechanisms within the body. PMID:27292285

  5. Human autonomy and the frontal lobes. Part II: Patient behavior in complex and social situations: the "environmental dependency syndrome".

    PubMed

    Lhermitte, F

    1986-04-01

    Imitation and utilization behavior have previously been described in terms of a simple interaction between an examiner and a patient, and were interpreted as an excessive dependence on environmental cues. In this study, patient dependence was observed in complex situations of everyday life. Two patients with focal unilateral frontal lobe lesions were observed while in a doctor's office, a lecture room, a car, and a garden, while visiting an apartment where various activities were possible, and while in a gift shop. The patients' behavior was striking, as though implicit in the environment was an order to respond to the situation in which they found themselves. The term environmental dependency syndrome is proposed for this condition. It implies a disorder in personal autonomy. Individual psychological traits influenced the way in which loss of autonomy was manifested. This study does not offer a physiological model of autonomy, but it does provide clinical and behavioral observations on the loss of autonomy secondary to unilateral lesions of the frontal lobe. PMID:3707085

  6. Mitochondrial energy-dissipation pathway and cellular redox disruption compromises Arabidopsis resistance to turnip crinkle virus infection.

    PubMed

    Pu, Xiao-Jun; Li, Ya-Nan; Wei, Li-Jie; Xi, De-Hui; Lin, Hong-Hui

    2016-04-29

    Members of the plant mitochondrial energy-dissipation pathway (MEDP) coordinate cellular energy metabolism, redox homeostasis and the balance of ROS production. However, the roles of MEDP members, particularly uncoupling protein (UCP), in resistance to turnip crinkle virus infection (TCV) are poorly understood. Here, we showed that disrupting some MEDP genes compromises plant resistance to TCV viral infection and this is partly associated with damaged photosynthetic characteristics, altered cellular redox and increased ROS production. Experiments using mutant plants with impaired cellular compartment redox poising further demonstrated that impaired chloroplast/mitochondria and cystosol redox increases the susceptibility of plants to viral infection. Our results illustrate a mechanism by which MEDP and cellular compartment redox act in concert to regulate plant resistance to viral infections. PMID:26987718

  7. Robust Public Key Cryptography — A New Cryptosystem Surviving Private Key Compromise

    NASA Astrophysics Data System (ADS)

    Shaik, Cheman

    A weakness of the present-day public key cryptosystems is that these cryptosystems do not survive private-key compromise attacks resulting from an internal breach of trust. In a competitive business environment, private key compromise is a common incident that voids the strength of public key cryptosystems such as RSA and ECC. Bribing corporate employees to disclose their secret keys and inadvertently disclosing secret information are among a plethora of practical attacks that occur at the implementation level. Once a breach of trust takes place and subsequently the private key is revealed, any public key cryptosystem fails to secure electronic data in Internet communications. The revealed key may be used by an attacker to decipher the intercepted data at an intermediary router. This weakness of public key cryptography calls for an additional security measure that enables encryptions to survive private key compromise attacks.

  8. Towards A Theory of Autonomous Reconstitution of Compromised Cyber-Systems

    SciTech Connect

    Ramuhalli, Pradeep; Halappanavar, Mahantesh; Coble, Jamie B.; Dixit, Mukul

    2013-11-12

    The ability to maintain mission-critical operations in cyber-systems in the face of disruptions is critical. Faults in cyber systems can come from accidental sources (e.g., natural failure of a component) or deliberate sources (e.g., an intelligent adversary). Natural and intentional manipulation of data, computing, or coordination are the most impactful ways that an attacker can prevent an infrastructure from realizing its mission goals. Under these conditions, the ability to reconstitute critical infrastructure becomes important. Specifically, the question is: Given an intelligent adversary, how can cyber systems respond to keep critical infrastructure operational? In cyber systems, the distributed nature of the system poses serious difficulties in maintaining operations, in part due to the fact that a centralized command and control apparatus is unlikely to provide a robust framework for resilience. Resilience in cyber-systems, in general, has several components, and requires the ability to anticipate and withstand attacks or faults, as well as recover from faults and evolve the system to improve future resilience. The recovery effort (and any subsequent evolution) may require significant reconfiguration of the system (at all levels – hardware, software, services, permissions, etc.) if the system is to be made resilient to further attack or faults. This is especially important in the case of ongoing attacks, where reconfiguration decisions must be taken with care to avoid further compromising the system while maintaining continuity of operations. Collectively, we will label this recovery and evolution process as “reconstitution”. Currently, reconstitution is performed manually, generally after-the-fact, and usually consists of either standing up redundant systems, check-points (rolling back the configuration to a “clean” state), or re-creating the system using “gold-standard” copies. For enterprise systems, such reconstitution may be performed

  9. The issue of legal protection of the intensive care unit physician within the context of patient consent to treatment. Part I: conscious patient, refusing treatment.

    PubMed

    Siewiera, Jacek; Trnka, Jakub; Kübler, Andrzej

    2014-01-01

    In daily clinical practice, physicians working in intensive care units (ICUs) face situations when their professional duty to protect the patient's life is in conflict with the obligation to respect the will of the patient and to assess his or her chances of treatment. Although the mere fact of conflict between these fundamental values for the ICU physician is a natural and obvious element in the chosen specialisation, many 'non-medical' circumstances make the given conflict not only very difficult but also dangerous for the physician. So far, the ethical and legal aspects of dying have been commented upon by a large group of lawyers and experts involved in the interpretation of the Polish regulations. The authors believe that a detailed analysis of the regulations should be carried out by persons of legal education, possessing a genuine medical experience associated with the specificity of end of life care in ICUs. In this paper, the authors have compared the current regulations of legislative acts of the common law relating to medical activities at anaesthesiology and intensive care units as well as based on the judgements of the common court of law over the past ten years. In the act of dissuading an ICU doctor from a medical procedure, all factors influencing the doctor's responsibility should be taken into account in accordance with the criminal law. In the case of a patient's death due to a refusal of treatment with the patient's full awareness, and given proper notification as to the consequences of refusing treatment, the doctor's responsibility lies under article 150 of the Polish penal code. PMID:24643929

  10. Compromise Approach-Based Genetic Algorithm for Constrained Multiobjective Portfolio Selection Model

    NASA Astrophysics Data System (ADS)

    Li, Jun

    In this paper, fuzzy set theory is incorporated into a multiobjective portfolio selection model for investors’ taking into three criteria: return, risk and liquidity. The cardinality constraint, the buy-in threshold constraint and the round-lots constraints are considered in the proposed model. To overcome the difficulty of evaluation a large set of efficient solutions and selection of the best one on non-dominated surface, a compromise approach-based genetic algorithm is presented to obtain a compromised solution for the proposed constrained multiobjective portfolio selection model.

  11. Development of a biomechanical model of the wrist joint for patient-specific model guided surgical therapy planning: Part 1.

    PubMed

    Eschweiler, Jörg; Stromps, Jan-Philipp; Fischer, Maximilian; Schick, Fabian; Rath, Björn; Pallua, Norbert; Radermacher, Klaus

    2016-04-01

    An enhanced musculoskeletal biomechanical model of the wrist joint is presented in this article. The developed computational model features the two forearm bones radius and ulna, the eight wrist bones, the five metacarpal bones, and a soft tissue apparatus. Validation of the model was based on information taken from the literature as well as own experimental passive in vitro motion analysis of eight cadaver specimens. The computational model is based on the multi-body simulation software AnyBody. A comprehensive ligamentous apparatus was implemented allowing the investigation of ligament function. The model can easily patient specific personalized on the basis of image information. The model enables simulation of individual wrist motion and predicts trends correctly in the case of changing kinematics. Therefore, patient-specific multi-body simulation models are potentially valuable tools for surgeons in pre- and intraoperative planning of implant placement and orientation. PMID:26994117

  12. [Ultrasonographic study on kidneys in patients with chronic renal failure. Part II. Acquired cystic disease of the kidneys].

    PubMed

    Yamaguchi, S; Fujii, H; Kaneko, S; Yachiku, S; Anzai, T; Inada, F; Kobayashi, T; Furuta, K; Ishida, H

    1990-08-01

    Ultrasonic examination of the kidney was performed on 280 patients undergoing chronic dialysis. Acquired cystic disease of the kidney (ACDK) was detected in 107 of 529 kidneys (20.2%). This paper presents an analysis of ultrasonotomograms of ACDK. Ultrasonic measurement of the size of ACDK was 72.5 +/- 15.2 mm in length and 41.7 +/- 9.8 mm in thickness. The size of ACDK was significantly greater than that of contracted kidneys by ultrasonographic diagnosis. With regard to sex distinction the length and thickness of ACDK were significantly greater in males than in females. As for laboratory data, patients with ACDK showed significantly higher values of red blood cell count, hematocrit and serum creatinine concentration compared with contracted kidneys. Prolongation of the dialysis peirod increased the incidence of ACDK. The size of ACDK showed a tendency to increase with duration of dialysis. However, no correlation was noted statistically between the incidence of ACDK and duration of dialysis and between the size of ACDK and duration of dialysis. There was a significantly lower incidence of ACDK in patients with diabetic nephropathy than those with chronic glomerulonephritis. A sonographic feature of ACDK is irregularity of the renal contour because of cystic transformation. Renal imaging, identification of the corticomedullary border, identification of the central echoes and increased parenchymal echogenicity were similar to other dialyzed kidneys. The main complications of ACDK are hemorrhage and tumor formation. We observed two retroperitoneal hematomas and one renal cell carcinoma developed within two years after this examination. The incidence of complications of ACDK was 5.1 per cent. We believe that patients with ACDK should be watched carefully by regular ultrasonic examination for early diagnosis and treatment of these complications. PMID:2232409

  13. Preparing your patients to travel abroad safely. Part 3: Reducing the risk of malaria and dengue fever.

    PubMed Central

    Thomas, R. E.

    2000-01-01

    OBJECTIVE: To provide evidence-based recommendations for family physicians advising travelers on how to reduce their risk of malaria and dengue fever. QUALITY OF EVIDENCE: A search of MEDLINE from 1990 to November 1998 found 671 articles; randomized controlled trials and systematic reviews were sought. The Cochrane Collaboration was searched for studies relevant to family physicians; meta-analyses of impregnating bed nets with permethrin were found. Health Canada's evidence-based publications were searched; 10 recommendations based on at least one well-conducted randomized trial were found. MAIN MESSAGE: Good evidence-based advice about the efficacy of mefloquine in chloroquine-resistant areas and for pregnant women and children is available, as is advice on the effectiveness of permethrin-impregnated bed nets. CONCLUSIONS: Family physicians can use evidence-based recommendations to advise their patients on how to prevent malaria. The ways in which patients neglect malaria precautions are well-known. For prevention of both malaria and dengue fever, family physicians should counsel their patients to reduce the risk of being bitten by insects. PMID:10845139

  14. Spectrum and frequency of GJB2, GJB6 and SLC26A4 gene mutations among nonsyndromic hearing loss patients in eastern part of India.

    PubMed

    Adhikary, Bidisha; Ghosh, Sudakshina; Paul, Silpita; Bankura, Biswabandhu; Pattanayak, Arup Kumar; Biswas, Subhradev; Maity, Biswanath; Das, Madhusudan

    2015-12-01

    Genetically caused nonsyndromic hearing loss is highly heterogeneous. Inspite of this large heterogeneity, mutations in the genes GJB2, GJB6 and SLC26A4 are major contributors. The mutation spectrum of these genes varies among different ethnic groups. Only a handful of studies focused on the altered genetic signature of these genes in different demographic regions of India but never focused on the eastern part of the country. Our study for the first time aimed to characterize the mutation profile of these genes in hearing loss patients of West Bengal state, India. Mutations in GJB2, GJB6 and SLC26A4 genes were screened by bidirectional sequencing from 215 congenital nonsyndromic hearing loss patients. Radiological diagnosis was performed in patients with SLC26A4 mutations by temporal bone CT scan. The study revealed that 4.65% and 6.97% patients had monoallelic and biallelic GJB2 mutations respectively. Six mutations were identified, p.W24X being the most frequent one accounting for 71.05% of the mutated alleles. Mutations in GJB6 including the previously identified deletion mutation (GJB6-D13S1830) were not identified in our study. Further, no patients harbored biallelic mutations in the SLC26A4 gene or the common inner ear malformation Enlarged Vestibular Aqueduct (EVA). The mutation profile of GJB2 in our study is distinct from other parts of India, suggesting that the mutation spectrum of this gene varies with ethnicity and geographical origin. The absence of GJB6 mutations and low frequency of SLC26A4 mutations suggest that additional genetic factors may also contribute to this disease. PMID:26188157

  15. Chiari malformation Type I surgery in pediatric patients. Part 1: validation of an ICD-9-CM code search algorithm.

    PubMed

    Ladner, Travis R; Greenberg, Jacob K; Guerrero, Nicole; Olsen, Margaret A; Shannon, Chevis N; Yarbrough, Chester K; Piccirillo, Jay F; Anderson, Richard C E; Feldstein, Neil A; Wellons, John C; Smyth, Matthew D; Park, Tae Sung; Limbrick, David D

    2016-05-01

    OBJECTIVE Administrative billing data may facilitate large-scale assessments of treatment outcomes for pediatric Chiari malformation Type I (CM-I). Validated International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code algorithms for identifying CM-I surgery are critical prerequisites for such studies but are currently only available for adults. The objective of this study was to validate two ICD-9-CM code algorithms using hospital billing data to identify pediatric patients undergoing CM-I decompression surgery. METHODS The authors retrospectively analyzed the validity of two ICD-9-CM code algorithms for identifying pediatric CM-I decompression surgery performed at 3 academic medical centers between 2001 and 2013. Algorithm 1 included any discharge diagnosis code of 348.4 (CM-I), as well as a procedure code of 01.24 (cranial decompression) or 03.09 (spinal decompression or laminectomy). Algorithm 2 restricted this group to the subset of patients with a primary discharge diagnosis of 348.4. The positive predictive value (PPV) and sensitivity of each algorithm were calculated. RESULTS Among 625 first-time admissions identified by Algorithm 1, the overall PPV for CM-I decompression was 92%. Among the 581 admissions identified by Algorithm 2, the PPV was 97%. The PPV for Algorithm 1 was lower in one center (84%) compared with the other centers (93%-94%), whereas the PPV of Algorithm 2 remained high (96%-98%) across all subgroups. The sensitivity of Algorithms 1 (91%) and 2 (89%) was very good and remained so across subgroups (82%-97%). CONCLUSIONS An ICD-9-CM algorithm requiring a primary diagnosis of CM-I has excellent PPV and very good sensitivity for identifying CM-I decompression surgery in pediatric patients. These results establish a basis for utilizing administrative billing data to assess pediatric CM-I treatment outcomes. PMID:26799412

  16. Patient-practitioner-remedy (PPR) entanglement. Part 2: Extending the metaphor for homeopathy using molecular quantum theory.

    PubMed

    Milgrom, L R

    2003-01-01

    A quantum metaphor developed previously for homeopathy, involving triadic patient-practitioner-remedy (PPR) entanglement, is extended by importing concepts used in chemistry to describe the electronic structures of molecules. In particular, the electronic energy states of triangular tri-atomic molecules are used metaphorically to predict that (a) the more a homeopathic medicine is potentised, the deeper the level of cure is likely to be, and (b) the practitioner can be included as a beneficiary of the therapeutic process. The model also predicts that remedy attenuation and degree of PRR interaction could (in the quantum theoretical sense) represent a pair of complementary conjugate variables. PMID:12587993

  17. Integrated concurrent utilization quality review, Part one.

    PubMed

    Caterinicchio, R P

    1987-01-01

    This article is the first of a two-part series which argues for the concurrent management of the appropriateness, necessity, and quality of patient care. Intensifying scrutiny by the credentialing groups, the PROs and all third-party payors underscores the vital need to implement cost-effective information systems which integrate the departmentalized functions of patient-physician profiling, DRG case-mix analyses, length of stay monitoring, pre-admission/admission and continued stay review, discharge planning, risk management, incident reporting and quality review. In the domain of physician performance regarding admitting and practice patterns, the ability to exercise concurrent utilization-quality review means early detection and prevention of events which would otherwise result in denials of payment and/or compromised patient care. Concurrent utilization-quality review must, by definition, be managerially invasive and focused; hence, it is integral to maintaining the integrity of the services and product lines offered by the provider. In fact, if PPO status is a marketing agenda, then the institutional objectives of cost-effectiveness, productivity, value, and competitiveness can only be achieved through concurrent utilization-quality review. PMID:10291443

  18. A biomechanical model of the wrist joint for patient-specific model guided surgical therapy: Part 2.

    PubMed

    Eschweiler, Jörg; Stromps, Jan-Philipp; Fischer, Maximilian; Schick, Fabian; Rath, Björn; Pallua, Norbert; Radermacher, Klaus

    2016-04-01

    An enhanced musculoskeletal biomechanical model of the wrist joint is presented in this article. The computational model is based on the multi-body simulation software AnyBody. Multi body dynamic musculoskeletal models capable of predicting muscle forces and joint contact pressures simultaneously would be valuable for studying clinical issues related to wrist joint degeneration and restoration. In this study, the simulation model of the wrist joint was used for investigating deeper the biomechanical function of the wrist joint. In representative physiological scenarios, the joint behavior and muscle forces were computed. Furthermore, the load transmission of the proximal wrist joint was investigated. The model was able to calculate the parameters of interest that are not easily obtainable experimentally, such as muscle forces and proximal wrist joint forces. In the case of muscle force investigation, the computational model was able to accurately predict the computational outcome for flexion and extension motion. In the case of force distribution of the proximal wrist joint, the model was able to predict accurately the computational outcome for an axial load of 140 N. The presented model and approach of using a multi-body simulation model are anticipated to have value as a predictive clinical tool including effect of injuries or anatomical variations and initial outcome of surgical procedures for patient-specific planning and custom implant design. Therefore, patient-specific multi-body simulation models are potentially valuable tools for surgeons in pre- and intraoperative planning of implant placement and orientation. PMID:26994118

  19. 38 CFR 1.955 - Regional office Committees on Waivers and Compromises.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2011-07-01 2011-07-01 false Regional office Committees on Waivers and Compromises. 1.955 Section 1.955 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS GENERAL PROVISIONS Referrals to Gao, Department of Justice, Or Irs §...

  20. 38 CFR 1.955 - Regional office Committees on Waivers and Compromises.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Regional office Committees on Waivers and Compromises. 1.955 Section 1.955 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS GENERAL PROVISIONS Referrals to Gao, Department of Justice, Or Irs §...

  1. Compromise - An effective approach for the hierarchical design of structural systems

    NASA Technical Reports Server (NTRS)

    Shupe, J. A.; Mistree, F.; Sobieszczanski-Sobieski, J.

    1987-01-01

    The use of the compromise decision support problem in hierarchical design of structural systems is described. The mathematical template that supports the underlying precepts of hierarchical design in the context of the decision support problem technique is presented. A structural example that demonstrates the efficacy of the approach is included.

  2. ENDOGENOUS FECAL LOSSES OF CALCIUM COMPROMISE CALCIUM BALANCE IN GIRLS WITH CYSTIC FIBROSIS

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Bone mineral density is compromised in individuals with cystic fibrosis (CF); calcium (Ca) is the major bone mineral. This study examined the impact of endogenous fecal calcium (Vendo) on calcium balance in girls with CF. Vendo was measured in 12 girls with CF (ages 7-18 y). Volunteers made up tw...

  3. Interleukin-13 promotes expression of Alix to compromise renal tubular epithelial barrier function.

    PubMed

    Xu, Chen; Sun, Guangdong; Yang, Jie; Sun, Qianmei; Tong, Zhaohui

    2015-05-01

    The epithelial barrier dysfunction plays a critical role in a number of kidney diseases. The mechanism is unclear. Alix is a protein involving in protein degradation in epithelial cells. This study aims to investigate that interleukin (IL)-13 inhibits Alix to compromise the kidney epithelial barrier function. In this study, the murine collecting duct cell line (M-1) was cultured in Transwell inserts to investigate the significance of Alix in compromising the epithelial barrier functions. T cell (Teff cells) proliferation assay was employed to assess the antigenicity of ovalbumin (OVA) that was transported across the M-1 monolayer barrier. The results showed that M-1 cells express Alix. Exposure to interleukin (IL)-13 markedly decreased the expression of Alix in M-1 cells, which compromised the M-1 monolayer barrier functions by showing the increases in the permeability to OVA. Over-expression of Alix abolished the IL-13-induced M-1 monolayer barrier dysfunction. Knockdown of Alix significantly increased M-1 monolayer permeability. The OVA collected from the Transwell basal chambers induced the OVA-specific T cell proliferation. We conclude that IL-13 compromises M-1 epithelial barrier functions via inhibiting Alix expression. PMID:25597757

  4. 78 FR 72016 - User Fees for Processing Installment Agreements and Offers in Compromise

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-12-02

    ... processing installment agreements and offers in compromise was published in the Federal Register (78 FR 53702... Appropriations Act (IOAA), which is codified at 31 U.S.C. 9701. Under the IOAA and OMB Circular A-25, 58 FR 38142... into currently-not-collectible (CNC) status rather than enter into an installment agreement....

  5. TEMPORAL ASSOCIATION BETWEEN PULMONARY AND SYSTEMIC EFFECTS OF PARTICULATE MATTER IN HEALTHY AND CARDIOVASCULAR COMPROMISED RATS

    EPA Science Inventory

    Temporal association between pulmonary and systemic effects of particulate matter in healthy and cardiovascular compromised rats

    Urmila P. Kodavanti, Mette C. Schladweiler, Allen D. Ledbetter, Russ Hauser*, David C. Christiani*, John McGee, Judy R. Richards, Daniel L. Co...

  6. Does Low Self-Esteem Predict Health Compromising Behaviours among Adolescents?

    ERIC Educational Resources Information Center

    McGee, Rob; Williams, Sheila

    2000-01-01

    Study examined the predictive association for both global and academic self esteem among students ages 9-13 in a large sample of New Zealanders. Results showed levels of global self esteem significantly predicted adolescent reports of problem eating, suicidal ideation, and multiple compromising behaviors. Implications are discussed for the…

  7. 48 CFR 239.7102-2 - Compromising emanations-TEMPEST or other standard.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ...-TEMPEST or other standard. 239.7102-2 Section 239.7102-2 Federal Acquisition Regulations System DEFENSE... INFORMATION TECHNOLOGY Security and Privacy for Computer Systems 239.7102-2 Compromising emanations—TEMPEST or....e., an established National TEMPEST standard (e.g., NACSEM 5100, NACSIM 5100A) or a standard used...

  8. 48 CFR 239.7102-2 - Compromising emanations-TEMPEST or other standard.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 48 Federal Acquisition Regulations System 3 2013-10-01 2013-10-01 false Compromising emanations-TEMPEST or other standard. 239.7102-2 Section 239.7102-2 Federal Acquisition Regulations System DEFENSE ACQUISITION REGULATIONS SYSTEM, DEPARTMENT OF DEFENSE SPECIAL CATEGORIES OF CONTRACTING ACQUISITION OF INFORMATION TECHNOLOGY Security and...

  9. 48 CFR 239.7102-2 - Compromising emanations-TEMPEST or other standard.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 48 Federal Acquisition Regulations System 3 2012-10-01 2012-10-01 false Compromising emanations-TEMPEST or other standard. 239.7102-2 Section 239.7102-2 Federal Acquisition Regulations System DEFENSE ACQUISITION REGULATIONS SYSTEM, DEPARTMENT OF DEFENSE SPECIAL CATEGORIES OF CONTRACTING ACQUISITION OF INFORMATION TECHNOLOGY Security and...

  10. 32 CFR 2001.48 - Loss, possible compromise or unauthorized disclosure.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 32 National Defense 6 2011-07-01 2011-07-01 false Loss, possible compromise or unauthorized disclosure. 2001.48 Section 2001.48 National Defense Other Regulations Relating to National Defense INFORMATION SECURITY OVERSIGHT OFFICE, NATIONAL ARCHIVES AND RECORDS ADMINISTRATION CLASSIFIED...

  11. 20 CFR 410.565 - Collection and compromise of claims for overpayment.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Collection and compromise of claims for overpayment. 410.565 Section 410.565 Employees' Benefits SOCIAL SECURITY ADMINISTRATION FEDERAL COAL MINE HEALTH AND SAFETY ACT OF 1969, TITLE IV-BLACK LUNG BENEFITS (1969- ) Payment of Benefits §...

  12. Inadequate satellite cell replication compromises muscle regrowth following postnatal nutrient restriction

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Perinatal growth impairment permanently compromises skeletal muscle mass. The present study assessed the contribution of muscle satellite cell replicative capacity to this deficit. Mouse dams were fed either a low protein (LP, n=7) or control (C, n=6) diet during lactation. Pups were weaned at 21 d ...

  13. 20 CFR 410.565 - Collection and compromise of claims for overpayment.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 20 Employees' Benefits 2 2011-04-01 2011-04-01 false Collection and compromise of claims for overpayment. 410.565 Section 410.565 Employees' Benefits SOCIAL SECURITY ADMINISTRATION FEDERAL COAL MINE HEALTH AND SAFETY ACT OF 1969, TITLE IV-BLACK LUNG BENEFITS (1969- ) Payment of Benefits §...

  14. Happenstance and Compromise: A Gendered Analysis of Students' Computing Degree Course Selection

    ERIC Educational Resources Information Center

    Lang, Catherine

    2010-01-01

    The number of students choosing to study computing at university continues to decline this century, with an even sharper decline in female students. This article presents the results of a series of interviews with university students studying computing courses in Australia that uncovered the influence of happenstance and compromise on course…

  15. 76 FR 17843 - Intent To Compromise Claim Against the District of Columbia Public Schools

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-03-31

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF EDUCATION Intent To Compromise Claim Against the District of Columbia Public Schools AGENCY: Department of... Columbia Public Schools (DCPS) now pending before the Office of Administrative Law Judges (OALJ), Docket...

  16. Near-infrared spectroscopy provides continuous monitoring of compromised lower extremity perfusion during cardiac surgery.

    PubMed

    Prkic, Ivana; Stuth, Eckehard A E

    2016-06-01

    Near-infrared spectroscopy (NIRS) is more frequently used to monitor regional oxygenation/perfusion of the cerebral and somatorenal vascular bed during congenital heart surgery. However, NIRS probes can be placed elsewhere to assess regional perfusion. We report the intraoperative use of NIRS probes on both calves of an infant to continuously monitor changes in the regional oxygenation/perfusion of a lower extremity whose perfusion was compromised after femoral arterial line placement. The NIRS trend of the compromised limb was compared with the contralateral limb throughout congenital heart surgery including the period on cardiopulmonary bypass (CPB). Our case report illustrates that NIRS technology can be used to monitor ongoing lower extremity vascular compromise during congenital heart surgery when it is not practical to directly access and continuously assess the limb. Transient vascular compromise after invasive femoral arterial line or sheath placement for cardiac catheterization in small infants is not infrequent. NIRS technology in such circumstances may help to decide whether watchful waiting is acceptable or immediate interventions are indicated. Continuous NIRS monitoring showed that limb regional oxygenation remained depressed during CPB but dramatically increased in the post-CPB period. PMID:27185674

  17. Using Emergence Theory-Based Curriculum to Teach Compromise Skills to Students with Autistic Spectrum Disorders

    ERIC Educational Resources Information Center

    Fein, Lance; Jones, Don

    2015-01-01

    This study addresses the compromise skills that are taught to students diagnosed with autistic spectrum disorders (ASD) and related social and communication deficits. A private school in the southeastern United States implemented an emergence theory-based curriculum to address these skills, yet no formal analysis was conducted to determine its…

  18. 32 CFR 310.14 - Notification when information is lost, stolen, or compromised.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... purposes, such as identity theft, fraud, stalking, etc. The personal impact on the affected individual may... the Federal Trade Commission's public Web site on identity theft at http://www.consumer.gov/idtheft... the individual of any loss, theft, or compromise (See also, § 310.50 for reporting of the breach...

  19. 32 CFR 310.14 - Notification when information is lost, stolen, or compromised.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... purposes, such as identity theft, fraud, stalking, etc. The personal impact on the affected individual may... the Federal Trade Commission's public Web site on identity theft at http://www.consumer.gov/idtheft... the individual of any loss, theft, or compromise (See also, § 310.50 for reporting of the breach...

  20. 32 CFR 310.14 - Notification when information is lost, stolen, or compromised.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... purposes, such as identity theft, fraud, stalking, etc. The personal impact on the affected individual may... the Federal Trade Commission's public Web site on identity theft at http://www.consumer.gov/idtheft... the individual of any loss, theft, or compromise (See also, § 310.50 for reporting of the breach...

  1. 32 CFR 310.14 - Notification when information is lost, stolen, or compromised.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 32 National Defense 2 2012-07-01 2012-07-01 false Notification when information is lost, stolen, or compromised. 310.14 Section 310.14 National Defense Department of Defense (Continued) OFFICE OF THE SECRETARY OF DEFENSE (CONTINUED) PRIVACY PROGRAM DOD PRIVACY PROGRAM Systems of Records § 310.14 Notification when information is lost, stolen,...

  2. Career Development Strategies as Moderators between Career Compromise and Career Outcomes in Emerging Adults

    ERIC Educational Resources Information Center

    Creed, Peter A.; Hughes, Trinette

    2013-01-01

    The authors surveyed 130 first-year university students (80% female; mean age 20.5) and assessed (a) the level of career compromise they reported between their ideal and enrolled university programs, (b) their career-related strategies, (c) their perceptions of employability, and (d) their career-related distress. The authors tested a model that…

  3. 78 FR 65932 - User Fees for Processing Installment Agreements and Offers in Compromise; Hearing Cancellation

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-11-04

    ... that appeared in the Federal Register on Friday August 30, 2013 (78 FR 53702) announced that a public... Offers in Compromise; Hearing Cancellation AGENCY: Internal Revenue Service (IRS), Treasury. ACTION... hearing on proposed regulations that amend the provider user fees for installment agreements and offers...

  4. 48 CFR 239.7102-2 - Compromising emanations-TEMPEST or other standard.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ...-TEMPEST or other standard. 239.7102-2 Section 239.7102-2 Federal Acquisition Regulations System DEFENSE... INFORMATION TECHNOLOGY Security and Privacy for Computer Systems 239.7102-2 Compromising emanations—TEMPEST or....e., an established National TEMPEST standard (e.g., NACSEM 5100, NACSIM 5100A) or a standard used...

  5. 48 CFR 239.7102-2 - Compromising emanations-TEMPEST or other standard.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ...-TEMPEST or other standard. 239.7102-2 Section 239.7102-2 Federal Acquisition Regulations System DEFENSE... INFORMATION TECHNOLOGY Security and Privacy for Computer Systems 239.7102-2 Compromising emanations—TEMPEST or....e., an established National TEMPEST standard (e.g., NACSEM 5100, NACSIM 5100A) or a standard used...

  6. Tragic Choices and Moral Compromise: The Ethics of Allocating Kidneys for Transplantation

    PubMed Central

    Hoffmaster, Barry; Hooker, Cliff

    2013-01-01

    Context For almost a decade, the Kidney Transplantation Committee of the United Network for Organ Sharing has been striving to revise its approach to allocating kidneys from deceased donors for transplantation. Two fundamental values, equality and efficiency, are central to distributing this scarce resource. The prevailing approach gives primacy to equality in the temporal form of first-come, first-served, whereas the motivation for a new approach is to redeem efficiency by increasing the length of survival of transplanted kidneys and their recipients. But decision making about a better way of allocating kidneys flounders because it is constrained by the amorphous notion of “balancing” values. Methods This article develops a more fitting, productive approach to resolving the conflict between equality and efficiency by embedding the notion of compromise in the analysis of a tragic choice provided by Guido Calabresi and Philip Bobbitt. For Calabresi and Bobbitt, the goals of public policy with respect to tragic choices are to limit tragedy and to deal with the irreducible minimum of tragedy in the least offensive way. Satisfying the value of efficiency limits tragedy, and satisfying the value of equality deals with the irreducible minimum of tragedy in the least offensive way. But both values cannot be completely satisfied simultaneously. Compromise is occasioned when not all the several obligations that exist in a situation can be met and when neglecting some obligations entirely in order to fulfill others entirely is improper. Compromise is amalgamated with the notion of a tragic choice and then used to assess proposals for revising the allocation of kidneys considered by the Kidney Transplantation Committee. Findings Compromise takes two forms in allocating kidneys: it occurs within particular approaches to allocating kidneys because neither equality nor efficiency can be fully satisfied, and it occurs over the course of sequential approaches to allocating

  7. Risk factors associated with catheter-related upper extremity deep vein thrombosis in patients with peripherally inserted central venous catheters: literature review: part 1.

    PubMed

    Clemence, Bonnie J; Maneval, Rhonda E

    2014-01-01

    This is part 1 of a 2-part series of articles that report on the results of a prospective observational cohort study designed to examine the risk factors associated with symptomatic upper extremity deep vein thrombosis (UEDVT) in patients with peripherally inserted central catheters. This article provides an extensive review and critique of the literature that serves to explicate what is currently known about risk factors associated with catheter-related UEDVT. Risk factors such as anticoagulant use, cancer, infection, hypertension, catheter tip placement, and catheter size were identified most frequently in the literature as being associated with UEDVT development. Other risk factors--such as obesity, smoking history, surgery, and presence of pain or edema--were examined in a limited number of studies and lacked consistent evidence of their impact on UEDVT development. The subsequent study that evolved from the review of the literature investigates the relationship between identified risk factors and UEDVT development. PMID:24694512

  8. Evidence-based neurosurgery. Basic concepts for the appraisal and application of scientific information to patient care (Part II).

    PubMed

    Esene, Ignatius N; Baeesa, Saleh S; Ammar, Ahmed

    2016-07-01

    Medical evidence is obtainable from approaches, which might be descriptive, analytic and integrative and ranked into levels of evidence, graded according to quality and summarized into strengths of recommendation. Sources of evidence range from expert opinions through well-randomized control trials to meta-analyses. The conscientious, explicit, and judicious use of current best evidence in making decisions related to the care of individual patients defines the concept of evidence-based neurosurgery (EBN). We reviewed reference books of clinical epidemiology, evidence-based practice and other previously related articles addressing principles of evidence-based practice in neurosurgery. Based on existing theories and models and our cumulative years of experience and expertise conducting research and promoting EBN, we have synthesized and presented a holistic overview of the concept of EBN. We have also underscored the importance of clinical research and its relationship to EBN. Useful electronic resources are provided. The concept of critical appraisal is introduced. PMID:27356649

  9. Can exome scans be expected to be part of real-time decision-making in patients with haematological cancers?

    PubMed

    Hokland, Peter; Cotter, Finbarr E; Hansen, Marcus C

    2016-08-01

    The laboratory aspects of diagnosis of patients with haematological malignancies are forever changing. Microscopic examination of blood and bone marrow smears, cytogenetics, flow cytometry and single-assay molecular diagnostics have been and are still essential tools in cancer diagnostics. Flow cytometry has brought the unprecedented possibility of rapid multiplexing and characterization of complex immunophenotypic patterns. However, the advent of next generation sequencing in the haematology laboratory brings a whole new perspective on multiplexing and potentially lowers the cost per analysis effectively. These informative methods still require skilled technicians and bioinformaticians, evolve at a rapid pace, and call for clinical guidelines and best practice. Here, we discuss the potential and caveats of whole exome sequencing as it moves closer to routine laboratory practice. The question is: Will exome sequencing be performed, real-time, in the standard haemodiagnostic laboratory? PMID:27351467

  10. Influence of political opposition and compromise on conservation outcomes in the Tongass National Forest, Alaska.

    PubMed

    Beier, Colin M

    2008-12-01

    To understand how a highly contentious policy process influenced a major conservation effort, I examined the origins, compromises, and outcomes of the Alaska National Interest Lands Conservation Act of 1980 (ANILCA) for the Tongass National Forest. Tongass wilderness designation was among the most controversial issues in the ANILCA debate, and it faced strong opposition from influential lawmakers, land managers, and Alaska residents. To investigate the influence of this opposition on Tongass conservation outcomes, I conducted a gap analysis of Tongass reserves and a policy analysis of the ANILCA debate and traced the influence of specific interests through the amendments, negotiations, and resulting compromises needed to enact ANILCA. Overall, I found that Tongass reserves comprise a broadly representative cross-section of ecosystems and species habitats in southeastern Alaska. Redrawn reserve boundaries, industry subsidies, and special access regulations reflected compromises to minimize the impact of wilderness conservation on mining, timber, and local stakeholder interests, respectively. Fragmentation of the Admiralty Island National Monument-the most ecologically valuable and politically controversial reserve-resulted from compromises with Alaskan Native (indigenous peoples of Alaska) corporations and timber interests. Despite language to accommodate "reasonable access" to wilderness reserves, ongoing access limitations highlight the concerns of Alaska residents that opposed ANILCA several decades ago. More broadly, the Tongass case suggests that early and ambitious conservation action may offset strong political opposition; compromises needed to establish key reserves often exacerbate development impacts in unprotected areas; and efforts to minimize social conflicts are needed to safeguard the long-term viability of conservation measures. PMID:18847443

  11. 'Violence is not part of our job': a thematic analysis of psychiatric mental health nurses' experiences of patient assaults from a New Zealand perspective.

    PubMed

    Baby, Maria; Glue, Paul; Carlyle, Dave

    2014-09-01

    This paper describes psychiatric mental health nurses' (PMHN) experiences of patient assaults within mental healthcare settings using a thematic analytical approach. The aim of the study was to explore and describe psychiatric mental health nurses' experiences of patient assaults. The major findings of the study related to the nature and impact of assaults and supportive strategies associated with violence perpetrated by patients against psychiatric mental health nurses. Perpetrator risk factors for patients include mental health disorders, alcohol and drug use and the inability to deal with situational crises. The injuries sustained by nurses in the context of the study include lacerations, head injuries, dislocations and bruises. Psychological harm has also occurred, including quite severe mental health problems, such as post-traumatic stress disorder. Protective strategies for combating negative consequences of workplace violence include practice of self-defence, social support and a supportive and consultative workplace culture with access to counselling services and assistance in all aspects, including finances. The paper concludes that while healthcare employers need to provide better support services to the healthcare professionals who are assaulted, the legal system also needs to acknowledge that assaults against nurses are a violation of human rights and violence should not to be tolerated as part of working in mental healthcare settings. PMID:25162186

  12. Two-phase treatment of patients with crossbite and tendency toward skeletal Class III malocclusion*

    PubMed Central

    Bayerl, Maria de Lourdes Machado

    2014-01-01

    Angle Class III malocclusion is characterized by an inadequate anteroposterior dental relationship which may or may not be accompanied by skeletal changes. In general, patients are distressed by a significantly compromised facial aspect which, when associated with a deficient middle third, encourages patients to seek treatment. This article reports a two-phase treatment carried out in a female patient aged six years and six months with a tendency towards a Class III skeletal pattern. This case was presented to the Brazilian Board of Orthodontics and Facial Orthopedics (BBO). It is representative of the Discrepancy Index (DI) category, and fulfills part of the requirements for obtaining BBO Diploma. PMID:25279531

  13. Electronic Symptom Reporting Between Patient and Provider for Improved Health Care Service Quality: A Systematic Review of Randomized Controlled Trials. Part 1: State of the Art

    PubMed Central

    Henriksen, Eva; Horsch, Alexander; Schuster, Tibor; Berntsen, Gro K Rosvold

    2012-01-01

    Background Over the last two decades, the number of studies on electronic symptom reporting has increased greatly. However, the field is very heterogeneous: the choices of patient groups, health service innovations, and research targets seem to involve a broad range of foci. To move the field forward, it is necessary to build on work that has been done and direct further research to the areas holding most promise. Therefore, we conducted a comprehensive review of randomized controlled trials (RCTs) focusing on electronic communication between patient and provider to improve health care service quality, presented in two parts. Part 2 investigates the methodological quality and effects of the RCTs, and demonstrates some promising benefits of electronic symptom reporting. Objective To give a comprehensive overview of the most mature part of this emerging field regarding (1) patient groups, (2) health service innovations, and (3) research targets relevant to electronic symptom reporting. Methods We searched Medline, EMBASE, PsycINFO, Cochrane Central Register of Controlled Trials, and IEEE Xplore for original studies presented in English-language articles published from 1990 to November 2011. Inclusion criteria were RCTs of interventions where patients or parents reported health information electronically to the health care system for health care purposes and were given feedback. Results Of 642 records identified, we included 32 articles representing 29 studies. The included articles were published from 2002, with 24 published during the last 5 years. The following five patient groups were represented: respiratory and lung diseases (12 studies), cancer (6), psychiatry (6), cardiovascular (3), and diabetes (1). In addition to these, 1 study had a mix of three groups. All included studies, except 1, focused on long-term conditions. We identified four categories of health service innovations: consultation support (7 studies), monitoring with clinician support (12), self

  14. Patient-specific spine models. Part 1: Finite element analysis of the lumbar intervertebral disc--a material sensitivity study.

    PubMed

    Fagan, M J; Julian, S; Siddall, D J; Mohsen, A M

    2002-01-01

    If patient-specific finite element models of the spine could be developed, they would offer enormous opportunities in the diagnosis and management of back problems. Several generic models have been developed in the past, but there has been very little detailed examination of the sensitivity of these models' characteristics to the input parameters. This relationship must be thoroughly understood if representative patient-specific models are to be realized and used with confidence. In particular, the performance of the intervertebral discs are central to any spine model and need detailed investigation first. A generic non-linear model of an intervertebral disc was developed and subjected to compressive, flexion and torsional loading regimes. The effects of both material and geometric non-linearities were investigated for the three loading schemes and the results compared with experimental data. The basic material properties of the fibres, annulus and nucleus were then varied and the effects on the stiffness, annulus bulge and annulus stresses analysed. The results showed that the non-linear geometry assumption had a significant effect on the compression characteristics, whereas the non-linear material option did not. In contrast, the material non-linearity was more important for the flexural and torsional loading schemes. Thus, the inclusion of non-linear material and geometry analysis options in finite element models of intervertebral discs is necessary to predict in vivo load-deflection characteristics accurately. When the influence of the material properties was examined in detail, it was found that the fibre properties did not have a significant effect on the compressive stiffness of the disc but did affect the flexural and torsional stiffnesses by up to +/-20 per cent. All loading modes were sensitive to the annulus properties with stiffnesses varying by up to +/-16 per cent. The model also revealed that for a particular compressive deformation or flexural or

  15. Current approaches to treatments for schizophrenia spectrum disorders, part II: psychosocial interventions and patient-focused perspectives in psychiatric care

    PubMed Central

    Chien, Wai Tong; Leung, Sau Fong; Yeung, Frederick KK; Wong, Wai Kit

    2013-01-01

    exception of patient relapse, the longer-term (eg, >2 years) effects of these approaches on most psychosocial outcomes are not well-established among these patients. Despite the fact that patients’ perspectives on treatment and care have been increasingly concerned, not many studies have evaluated the effect of interventions on this perspective, and where they did, the findings were inconclusive. To conclude, current approaches to psychosocial interventions for schizophrenia have their strengths and weaknesses, particularly indicating limited evidence on long-term effects. To improve the longer-term outcomes of people with schizophrenia, future treatment strategies should focus on risk identification, early intervention, person-focused therapy, partnership with family caregivers, and the integration of evidence-based psychosocial interventions into existing services. PMID:24109184

  16. Military medical advances resulting from the conflict in Korea, Part I: Systems advances that enhanced patient survival.

    PubMed

    Baker, Michael S

    2012-04-01

    The Korean War started several years after the World War II had ended and no recognition of the threat or preparation was made for this possibility. The military and its medical service had been downsized after World War II and had to quickly ramp up to meet the surprise attack. The war provided the laboratory for trials and experimentation with the new technological developments of the era. The Korean conflict led to numerous advances in medical systems and patient care. The Mobile Army Surgical Hospital came of age, and was instrumental in saving many lives. Helicopters saw their first regular use as flying ambulances to take the injured to definitive care in a timely fashion. The national blood banking program was rapidly geared up and new techniques such as plastic bags for collection and delivery resulted. Body armor was developed that would allow mobility while offering protection and was widely used for the first time. Each of these systems improvements saved the lives of soldiers in combat and were soon to be used in the civilian sector to save and improve lives around the world. PMID:22594133

  17. Cytophotometry of granulocytes in chronic granulocytic leukemia patients. Part I. Cell cycle distribution, S-phase transition and quantitative cytochemistry.

    PubMed

    Kotelnikov, V M; Lishmanova, N G; Khoroshko, N D; Dultsyna, S M; Alieva, T M; Khrust YuR; Kozinets, G I

    1987-01-01

    In the chronic phase of CGL the proportion of granulocytes in S + G2 was lower (18.7 +/- 1.3% in marrow and 16.7 +/- 2.4% in blood) than in normal bone marrow (42.4 +/- 2.9%) as studied by Feulgen-DNA cytophotometry. During the blast crisis the percentage of S + G2 blasts was 39.3 +/- 8.4 in marrow and 38.7 +/- 7.8 in blood which was much higher than in acute myeloblastic leukemia patients (10.8 +/- 1.4 and 5.1 +/- 1.0). Thymidine labelling index values were lower than the percentage of cytophotometrically detected S-phase cells: up to 28% of cells with Feulgen-DNA content corresponding to S-phase did not incorporate 3H-thymidine. The rate of DNA synthesis remained constant during the S-phase but 3H-thymidine uptake increases towards the end of the S-phase. Morphometric parameters and quantitative cytochemical (PAS, Sudan, myeloperoxidase activity) characteristics of polymorphonuclear neutrophils were altered during the chronic phase of the disease but remained in the normal range during the blast crisis. Mature neutrophils in the blast crisis are assumed to originate from normal granulocyte progenitors. PMID:2448196

  18. Does prior transurethral resection of prostate compromise brachytherapy quality: A dosimetric analysis

    SciTech Connect

    Cesaretti, Jamie A. . E-mail: Jamie.Cesaretti@msnyuhealth.org; Stone, Nelson N.; Stock, Richard G.

    2004-10-01

    Purpose: To evaluate, in a retrospective review, prostate brachytherapy dosimetry outcomes relative to the transurethral resection of the prostate (TURP) cavity size to address the theoretical concern that an intraprostatic cavity may hinder adequate radioactive source placement. Methods and materials: A total of 73 patients who underwent prostate brachytherapy as part of their treatment of localized prostate cancer had a history of a prior TURP. Of these 73 patients, 37 underwent {sup 125}I implantation, 19 {sup 103}Pd implantation, and 17 partial {sup 103}Pd implantation. The dose was calculated using the dose to 90% of the prostate gland (D{sub 90}) from the 1-month post-implant dosimetric analysis. The doses were normalized relative to 100% of the prescription dose. Archived transrectal ultrasound images were used to determine the maximal length and width of the visible residual TURP cavities. The prolate spheroid or symmetric egg shape was used to calculate each residual cavity volume. The derived volume of the TURP cavity was divided by the measured ultrasound volume of the prostate at brachytherapy, creating a percentage of volume measurement for each prostate. All p values, unless otherwise specified, were generated by comparing patients without a visible TURP defect with the subgroups of patients with a visible defect using the Student t test. Results: A visible residual TURP defect was noted on the operative transrectal ultrasound images of 55 (75%) of the 73 patients with a history of TURP before brachytherapy. The 18 patients without a visible TURP defect had a median D{sub 90} of 96% and were used for subsequent statistical comparison. Thirty-six patients with a TURP defect <10% of the entire prostate volume had a median D{sub 90} of 109% (p = 0.02). Thirteen patients with a TURP defect between 10% and 20% of the prostate volume had a median D{sub 90} of 112% (p = 0.03). Six patients with a TURP defect >20% of the prostate volume had a D{sub 90} of 89

  19. Physician-industry relations. Part 1: individual physicians.

    PubMed

    Coyle, Susan L

    2002-03-01

    This is part 1 of a 2-part paper on ethics and physician-industry relationships. Part 1 offers advice to individual physicians; part 2 gives recommendations to medical education providers and medical professional societies. Physicians and industry have a shared interest in advancing medical knowledge. Nonetheless, the primary ethic of the physician is to promote the patient's best interests, while the primary ethic of industry is to promote profitability. Although partnerships between physicians and industry can result in impressive medical advances, they also create opportunities for bias and can result in unfavorable public perceptions. Many physicians and physicians-in-training think they are impervious to commercial influence. However, recent studies show that accepting industry hospitality and gifts, even drug samples, can compromise judgment about medical information and subsequent decisions about patient care. It is up to the physician to judge whether a gift is acceptable. A very general guideline is that it is ethical to accept modest gifts that advance medical practice. It is clearly unethical to accept gifts or services that obligate the physician to reciprocate. Conflicts of interest can arise from other financial ties between physicians and industry, whether to outside companies or self-owned businesses. Such ties include honorariums for speaking or writing about a company's product, payment for participating in clinic-based research, and referrals to medical resources. All of these relationships have the potential to influence a physician's attitudes and practices. This paper explores the ethical quandaries involved and offers guidelines for ethical business relationships. PMID:11874314

  20. Oral toxicity management in head and neck cancer patients treated with chemotherapy and radiation: Xerostomia and trismus (Part 2). Literature review and consensus statement.

    PubMed

    Buglione, Michela; Cavagnini, Roberta; Di Rosario, Federico; Maddalo, Marta; Vassalli, Lucia; Grisanti, Salvatore; Salgarello, Stefano; Orlandi, Ester; Bossi, Paolo; Majorana, Alessandra; Gastaldi, Giorgio; Berruti, Alfredo; Trippa, Fabio; Nicolai, Pietro; Barasch, Andrei; Russi, Elvio G; Raber-Durlacher, Judith; Murphy, Barbara; Magrini, Stefano M

    2016-06-01

    Radiotherapy alone or in combination with chemotherapy and/or surgery is a well-known radical treatment for head and neck cancer patients. Nevertheless acute side effects (such as moist desquamation, skin erythema, loss of taste, mucositis etc.) and in particular late toxicities (osteoradionecrosis, xerostomia, trismus, radiation caries etc.) are often debilitating and underestimated. A multidisciplinary group of head and neck cancer specialists from Italy met in Milan with the aim of reaching a consensus on a clinical definition and management of these toxicities. The Delphi Appropriateness method was used for this consensus and external experts evaluated the conclusions. The paper contains 20 clusters of statements about the clinical definition and management of stomatological issues that reached consensus, and offers a review of the literature about these topics. The review was split into two parts: the first part dealt with dental pathologies and osteo-radionecrosis (10 clusters of statements), whereas this second part deals with trismus and xerostomia (10 clusters of statements). PMID:27061883

  1. Oral toxicity management in head and neck cancer patients treated with chemotherapy and radiation: Dental pathologies and osteoradionecrosis (Part 1) literature review and consensus statement.

    PubMed

    Buglione, Michela; Cavagnini, Roberta; Di Rosario, Federico; Sottocornola, Lara; Maddalo, Marta; Vassalli, Lucia; Grisanti, Salvatore; Salgarello, Stefano; Orlandi, Ester; Paganelli, Corrado; Majorana, Alessandra; Gastaldi, Giorgio; Bossi, Paolo; Berruti, Alfredo; Pavanato, Giovanni; Nicolai, Piero; Maroldi, Roberto; Barasch, Andrei; Russi, Elvio G; Raber-Durlacher, Judith; Murphy, Barbara; Magrini, Stefano M

    2016-01-01

    Radiotherapy alone or in combination with chemotherapy and/or surgery is the typical treatment for head and neck cancer patients. Acute side effects (such as oral mucositis, dermatitis, salivary changes, taste alterations, etc.), and late toxicities in particular (such as osteo-radionecrosis, hypo-salivation and xerostomia, trismus, radiation caries etc.), are often debilitating. These effects tend to be underestimated and insufficiently addressed in the medical community. A multidisciplinary group of head and neck cancer specialists met in Milan with the aim of reaching a consensus on clinical definitions and management of these toxicities. The Delphi Appropriateness method was used for developing the consensus, and external experts evaluated the conclusions. This paper contains 10 clusters of statements about the clinical definitions and management of head and neck cancer treatment sequels (dental pathologies and osteo-radionecroses) that reached consensus, and offers a review of the literature about these topics. The review was split into two parts: the first part dealt with dental pathologies and osteo-radionecroses (10 clusters of statements), whereas this second part deals with trismus and xerostomia. PMID:26318095

  2. Reducing radiation dose without compromising image quality in preoperative perforator flap imaging with CTA using ASIR technology.

    PubMed

    Niumsawatt, Vachara; Debrotwir, Andrew N; Rozen, Warren Matthew

    2014-01-01

    Computed tomographic angiography (CTA) has become a mainstay in preoperative perforator flap planning in the modern era of reconstructive surgery. However, the increased use of CTA does raise the concern of radiation exposure to patients. Several techniques have been developed to decrease radiation dosage without compromising image quality, with varying results. The most recent advance is in the improvement of image reconstruction using an adaptive statistical iterative reconstruction (ASIR) algorithm. We sought to evaluate the image quality of ASIR in preoperative deep inferior epigastric perforator (DIEP) flap surgery, through a direct comparison with conventional filtered back projection (FBP) images. A prospective review of 60 consecutive ASIR and 60 consecutive FBP CTA images using similar protocol (except for radiation dosage) was undertaken, analyzed by 2 independent reviewers. In both groups, we were able to accurately identify axial arteries and their perforators. Subjective analysis of image quality demonstrated no statistically significant difference between techniques. ASIR can thus be used for preoperative imaging with similar image quality to FBP, but with a 60% reduction in radiation delivery to patients. PMID:25058789

  3. Mechanism-based management for mucositis: option for treating side effects without compromising the efficacy of cancer therapy

    PubMed Central

    Kwon, Youngjoo

    2016-01-01

    Mucositis is a major side effect induced by chemotherapy and radiotherapy. Although mucositis is a leading cause of morbidity and mortality in cancer patients, management is largely limited to controlling symptoms, and few therapeutic agents are available for treatment. Since mucositis could be inhibited by the modulation of radiotherapy- or chemotherapy-induced pathways independently of cancer treatment, there is an opportunity for the development of more targeted therapies and interventions. This article examined potential therapeutic agents that have been investigated for the prevention and/or inhibition of mucositis induced by conventional chemotherapy and radiotherapy. They can be classified according to their mechanisms of action: scavenging reactive oxygen species, inhibition of specific cytokine production or inflammation, and inhibition of apoptosis. These early events may be good target pathways for preventing the pathogenesis of mucositis. Considering that both cancer therapy and therapeutic agents for mucositis act on both normal and cancer cells, agents that inhibit mucositis should act through mechanisms that selectively protect normal cells without compromising cancer treatment. Therefore, mechanism-based guidance for the treatment of mucositis is critical to prevent risky treatments for cancer patients and to relieve detrimental side effects effectively from cancer therapy. PMID:27103826

  4. Reducing Radiation Dose Without Compromising Image Quality in Preoperative Perforator Flap Imaging With CTA Using ASIR Technology

    PubMed Central

    Niumsawatt, Vachara; Debrotwir, Andrew N.; Rozen, Warren Matthew

    2014-01-01

    Computed tomographic angiography (CTA) has become a mainstay in preoperative perforator flap planning in the modern era of reconstructive surgery. However, the increased use of CTA does raise the concern of radiation exposure to patients. Several techniques have been developed to decrease radiation dosage without compromising image quality, with varying results. The most recent advance is in the improvement of image reconstruction using an adaptive statistical iterative reconstruction (ASIR) algorithm. We sought to evaluate the image quality of ASIR in preoperative deep inferior epigastric perforator (DIEP) flap surgery, through a direct comparison with conventional filtered back projection (FBP) images. A prospective review of 60 consecutive ASIR and 60 consecutive FBP CTA images using similar protocol (except for radiation dosage) was undertaken, analyzed by 2 independent reviewers. In both groups, we were able to accurately identify axial arteries and their perforators. Subjective analysis of image quality demonstrated no statistically significant difference between techniques. ASIR can thus be used for preoperative imaging with similar image quality to FBP, but with a 60% reduction in radiation delivery to patients. PMID:25058789

  5. Mechanism-based management for mucositis: option for treating side effects without compromising the efficacy of cancer therapy.

    PubMed

    Kwon, Youngjoo

    2016-01-01

    Mucositis is a major side effect induced by chemotherapy and radiotherapy. Although mucositis is a leading cause of morbidity and mortality in cancer patients, management is largely limited to controlling symptoms, and few therapeutic agents are available for treatment. Since mucositis could be inhibited by the modulation of radiotherapy- or chemotherapy-induced pathways independently of cancer treatment, there is an opportunity for the development of more targeted therapies and interventions. This article examined potential therapeutic agents that have been investigated for the prevention and/or inhibition of mucositis induced by conventional chemotherapy and radiotherapy. They can be classified according to their mechanisms of action: scavenging reactive oxygen species, inhibition of specific cytokine production or inflammation, and inhibition of apoptosis. These early events may be good target pathways for preventing the pathogenesis of mucositis. Considering that both cancer therapy and therapeutic agents for mucositis act on both normal and cancer cells, agents that inhibit mucositis should act through mechanisms that selectively protect normal cells without compromising cancer treatment. Therefore, mechanism-based guidance for the treatment of mucositis is critical to prevent risky treatments for cancer patients and to relieve detrimental side effects effectively from cancer therapy. PMID:27103826

  6. A compromise method to facilitate under-represented minority admissions to medical school.

    PubMed

    Reiter, Harold; Maccoon, Kathryn

    2007-05-01

    Ranked purely on the basis of the available reliable and valid measures, the demographic composition of incoming medical students fails to meet societal concerns regarding under-represented minorities (URM). Admissions offices are squeezed, administratively and legally, between honouring objectively measured individual merit and addressing societal needs. Until more successful recruitment and preparation of URM applicants closes that gap, compromise methods balancing those discordant ideals can be applied. Indeed, as progress over time decreases the relative societal need for affirmative action, compromise methods are mandated by no less a voice than that of the United States Supreme Court. This article proffers one such method, based upon the work of Hofstee, and demonstrates how it can be practically applied to a specific URM challenge. As perspective, past and present philosophical approaches to this discordance are categorized. PMID:17041785

  7. Tail loss compromises immunity in the many-lined skink, Eutropis multifasciata

    NASA Astrophysics Data System (ADS)

    Kuo, Chi-Chien; Yao, Chiou-Ju; Lin, Te-En; Liu, Hsu-Che; Hsu, Yu-Cheng; Hsieh, Ming-Kun; Huang, Wen-San

    2013-04-01

    Tail autotomy incurs energetic costs, and thus, a trade-off in resource allocation may lead to compromised immunity in lizards. We tested the hypothesis that tailless lizards will favor constitutive innate immunity responses over an energetically costly inflammatory response. The influence of fasting and colorful ornamentation was also investigated. We experimentally induced tail autotomy in the lizard Eutropis multifasciata and found that inflammation was suppressed by tail loss, but not further affected by fasting; the suppressive effect of colorful ornamentation was manifested only in males, but not in females. Constitutive innate immunity was not affected by any of these factors. As expected, only costly inflammation was compromised, and a less expensive constitutive innate immunity might be favored as a competent first-line defense during energetically demanding periods. After considering conventional trade-offs among tail regeneration and reproduction, further extending these studies to incorporate disease risk and how this influences escape responses to predators and future reproduction would make worthwhile studies.

  8. A libertarian perspective on the stem cell debate: compromising the uncompromisible.

    PubMed

    Block, Walter

    2010-08-01

    The present paper attempts to forge a compromise between those who maintain that stem cell research is out-and-out murder of young helpless human beings and those who favor this practice. The compromise is predicated upon the libertarian theory of private property rights. Starting out with the premise that not only the fetus but even the fertilized egg is a human being, with all rights thereto, it offers a competition between those who fertilize eggs for research and those who wish to adopt them. If and only if the former win this competition will they be allowed to use these very young human beings for the purposes they have constructed them. This is justified on grounds of avoiding child abuse. PMID:20624766

  9. The use of bonded partial ceramic restorations to recover heavily compromised teeth.

    PubMed

    Politano, Gianfranco; Fabianelli, Andrea; Papacchini, Federica; Cerutti, Antonio

    2016-01-01

    Restorative procedures are accompanied by a reduction of tooth stability, a decrease of fracture resistance, and an increase in deflection of weakened cusps. The choice between a direct or an indirect restorative technique, mainly in posterior areas, is a challenge, and involves biomechanical, anatomical, functional, esthetic, and financial considerations. In this article, the pros and cons of direct restorations are examined, as well as an analysis of indirect restorations and an overview of dental ceramics. In particular, several clinical uses of lithium disilicate overlays with a circumferential adhesive ferrule effect are proposed: heavily compromised vital teeth with thin walls, cracked teeth, and endodontically treated molars. Clinical procedures are described step by step on the basis of data from scientific literature. In conclusion, the use of lithium disilicate in combination with adhesive technologies can lead to a more conservative, economic, and esthetic approach in the restoration of heavily compromised teeth. PMID:27433548

  10. Early visual deprivation severely compromises the auditory sense of space in congenitally blind children.

    PubMed

    Vercillo, Tiziana; Burr, David; Gori, Monica

    2016-06-01

    A recent study has shown that congenitally blind adults, who have never had visual experience, are impaired on an auditory spatial bisection task (Gori, Sandini, Martinoli, & Burr, 2014). In this study we investigated how thresholds for auditory spatial bisection and auditory discrimination develop with age in sighted and congenitally blind children (9 to 14 years old). Children performed 2 spatial tasks (minimum audible angle and space bisection) and 1 temporal task (temporal bisection). There was no impairment in the temporal task for blind children but, like adults, they showed severely compromised thresholds for spatial bisection. Interestingly, the blind children also showed lower precision in judging minimum audible angle. These results confirm the adult study and go on to suggest that even simpler auditory spatial tasks are compromised in children, and that this capacity recovers over time. (PsycINFO Database Record PMID:27228448

  11. A widely displaced Galeazzi-equivalent lesion with median nerve compromise

    PubMed Central

    Galanopoulos, Ilias; Fogg, Quentin; Ashwood, Neil; Fu, Katherine

    2012-01-01

    We present the case of a 14-year-old boy with a right distal radial fracture accompanied by a severely displaced complete distal ulnar physeal separation and associated median nerve compromise. This injury is known as Galeazzi-equivalent lesion in children and is an extremely rare injury associated with growth arrest. Recognition of the lesion can be difficult but wide displacement may be associated with other significant injuries such as neurovascular compromise. Prompt intervention reversed the neurological symptoms. At 10-month postoperation there was neither growth arrest nor loss of motion. Complete separation of the ulna physis remains often because of soft tissue interposition or capsule problems and prompt reduction is recommended in the literature as a priority. PMID:22907852

  12. Rescue of a periodontally compromised tooth by non-surgical treatment: a case report

    PubMed Central

    2016-01-01

    Purpose This article describes a case of the successful non-surgical management of a periodontally compromised maxillary premolar. Methods A combination therapy, including root planing, occlusal adjustment, and tooth splinting, was applied. Clinical and radiographic examinations were performed during the 16-month follow-up period. Results All periodontal parameters were improved. There were dramatic decreases (3–6 mm) in the probing pocket depth, tooth mobility, and marginal bone loss. Interestingly, gradual resolution of the periapical radiolucency and alveolar bone regeneration were observed in the radiographs, and the periodontal condition was maintained during the follow-up period. Conclusions Within the limits of this study, these results demonstrate the importance of natural tooth preservation through proper periodontal treatment and occlusal adjustment of the periodontally compromised tooth, which is typically targeted for tooth extraction and dental implantation. PMID:27127693

  13. Human Milk for Ill and Medically Compromised Infants: Strategies and Ongoing Innovation.

    PubMed

    DiLauro, Sara; Unger, Sharon; Stone, Debbie; O'Connor, Deborah L

    2016-08-01

    The use of human milk (mother's own milk and/or donor milk) in ill or medically compromised infants frequently requires some adaptation to address medical diagnoses and/or altered nutrition requirements. This tutorial describes the nutrition and immunological benefits of breast milk as well as provides evidence for the use of donor milk when mother's own milk is unavailable. Several strategies used to modify human milk to meet the medical and nutrition needs of an ill or medically compromised infant are reviewed. These strategies include (1) the standard fortification of human milk to support adequate growth, (2) the novel concept of target fortification in preterm infants, (3) instructions on how to alter maternal diet to address cow's milk protein intolerance and/or allergy in breast milk-fed infants, and (4) the removal and modification of the fat in breast milk used in infants diagnosed with chylothorax. PMID:26903304

  14. Corporate corruption of the environment: sustainability as a process of compromise.

    PubMed

    Nyberg, Daniel; Wright, Christopher

    2013-09-01

    A key response to environmental degradation, climate change and declining biodiversity has been the growing adoption of market principles in an effort to better value the social good of nature. Through concepts such as 'natural capitalism' and 'corporate environmentalism', nature is increasingly viewed as a domain of capitalist endeavour. In this article, we use convention theory and a pluralist understanding of social goods to investigate how the social good of the environment is usurped by the alternate social good of the market. Through analysis of interviews with sustainability managers and corporate documentation, we highlight how organizational actors employ compromise to temporally settle disputes between competing claims about environmental activities. Our findings contribute to an understanding of the processes of empirically grounded critique and the under-theorized concept of compromise between social goods. Rather than protecting the environment, the corporate promotion of sustainability facilitates the corruption of the social good of the environment and its conversion into a market commodity. PMID:23998318

  15. Diffuse elevated MIBG activity in the renal parenchyma caused by compromised renal blood flow.

    PubMed

    Liu, Bin; Codreanu, Ion; Yang, Jigang; Servaes, Sabah; Zhuang, Hongming

    2014-11-01

    Increased metaiodobenzylguanidine (MIBG) activity in the kidneys is usually focal and commonly attributed to radioactive urine accumulation in the renal pelvis. Hereby, we present 2 cases of abnormal diffuse MIBG activity in the kidneys caused by compromised renal blood flow. The patterns should be differentiated from physiologic renal MIBG activity, especially when the uptake is relatively symmetric as well as from regional MIBG-avid disease. PMID:24999702

  16. Loss of GSNOR1 Function Leads to Compromised Auxin Signaling and Polar Auxin Transport.

    PubMed

    Shi, Ya-Fei; Wang, Da-Li; Wang, Chao; Culler, Angela Hendrickson; Kreiser, Molly A; Suresh, Jayanti; Cohen, Jerry D; Pan, Jianwei; Baker, Barbara; Liu, Jian-Zhong

    2015-09-01

    Cross talk between phytohormones, nitric oxide (NO), and auxin has been implicated in the control of plant growth and development. Two recent reports indicate that NO promoted auxin signaling but inhibited auxin transport probably through S-nitrosylation. However, genetic evidence for the effect of S-nitrosylation on auxin physiology has been lacking. In this study, we used a genetic approach to understand the broader role of S-nitrosylation in auxin physiology in Arabidopsis. We compared auxin signaling and transport in Col-0 and gsnor1-3, a loss-of-function GSNOR1 mutant defective in protein de-nitrosylation. Our results showed that auxin signaling was impaired in the gsnor1-3 mutant as revealed by significantly reduced DR5-GUS/DR5-GFP accumulation and compromised degradation of AXR3NT-GUS, a useful reporter in interrogating auxin-mediated degradation of Aux/IAA by auxin receptors. In addition, polar auxin transport was compromised in gsnor1-3, which was correlated with universally reduced levels of PIN or GFP-PIN proteins in the roots of the mutant in a manner independent of transcription and 26S proteasome degradation. Our results suggest that S-nitrosylation and GSNOR1-mediated de-nitrosylation contribute to auxin physiology, and impaired auxin signaling and compromised auxin transport are responsible for the auxin-related morphological phenotypes displayed by the gsnor1-3 mutant. PMID:25917173

  17. Patterns of health-compromising behaviors among Minnesota adolescents: sociodemographic variations.

    PubMed Central

    Neumark-Sztainer, D; Story, M; French, S; Cassuto, N; Jacobs, D R; Resnick, M D

    1996-01-01

    OBJECTIVES: This study compared prevalence rates of health-compromising behaviors among boys and girls from different ethnic backgrounds in early, middle, and late adolescence and compared co-occurrences of such behaviors across gender and ethnic groups. METHODS: The study population included 123 132 adolescents in grades 6, 9, and 12. Adolescents completed a classroom-administered statewide survey focusing on high-risk behaviors, including unhealthy weight loss, substance abuse, suicide risk, delinquency, and sexual activity. RESULTS: Prevalence rates of most health-compromising behaviors differed by gender, increased with age, and tended to be highest among American Indian youth and lowest among Asian Americans. Strong associations were found between substance abuse and delinquency across all ethnic groups. Substance abuse and delinquency were associated with suicide risk across most ethnic groups. Covariations with sexual activity and unhealthy weight loss behaviors showed more ethnic variation. CONCLUSIONS: Prevention interventions should take into account the tendency for health-compromising behaviors to co-occur and should be sensitive to demographic and socioeconomic differences in behavior patterns. PMID:8916527

  18. Development of an in vitro model for studying the penetration of chemicals through compromised skin.

    PubMed

    Davies, Diane J; Heylings, Jon R; McCarthy, Timothy J; Correa, Catherine M

    2015-02-01

    The conventional safety approach that includes dermal absorption of pharmaceutical or consumer products uses models that are based on intact skin. However, when products are intended for application to skin with a less effective barrier, such as in new-born infants, or in cases where the skin is mildly damaged or diseased, there are instances where absorption through compromised skin is also important. A tape stripping procedure was investigated using dermatomed pig skin to assess if an in vitro model could replicate the typical changes in barrier function observed in humans with compromised skin. The relationship between Trans-Epidermal Water Loss (TEWL), Electrical Resistance (ER) and Tritiated Water Flux(TWF), markers of skin barrier function in OECD 428 studies was investigated. There was a step-wise reduction in ER from normal (control) skin following 5, 10, 15 or 20 tape strips. This was mirrored by increases in both TWF and TEWL. An in vitro experimental protocol using 5 tape strips, ER and dermatomed pig skin provided a rapid, robust and reproducible approach equivalent to the 3–4-fold increases in TEWL observed clinically in compromised skin. PMID:25450748

  19. Deficiencies in mitochondrial DNA compromise the survival of yeast cells at critically high temperatures.

    PubMed

    Zubko, Elena I; Zubko, Mikhajlo K

    2014-01-01

    To address possible roles of mitochondrial genes in adaptation of eukaryotic cells to critical temperatures, we compared thermotolerance of mitochondrial rho mutants and wild type cells of six rho positive yeast species: Candida glabrata, Saccharomyces bayanus, Saccharomyces cerevisiae, Saccharomyces eubayanus, Saccharomyces paradoxus and Saccharomyces pastorianus. All rho mutants manifested compromised thermotolerance as a common phenotype. Analysis of viabilities at critical temperatures (32-45 °C) showed the reduction of maximum permissive temperatures (MPTs) in all rho mutants in comparison to their wild type counterparts. Degrees of the compromised thermotolerance depended on maximum permissive temperatures for wild type cells: the highest levels of MPT reductions for rho mutants took place in species and strains with highest MPTs for wild types. Short term exposures of S. cerevisiae cells (up to 3.5h) at non-permissive temperatures (45 °C and 50 °C) also lead to more rapid cell death of rho mutants as compared to wild type cells. We conclude that: (1) compromised thermotolerance could be a generic phenotypic property of rho mutants; (2) the enhanced thermotolerance of cells possessing mitochondrial genomes could be one of selective advantages in adaptation to environmental factors, in particular to enhanced temperatures. PMID:23890722

  20. Changes of skin temperature of parts of the body and serum asymmetric dimethylarginine (ADMA) in type-2 diabetes mellitus Indian patients.

    PubMed

    Anburajan, M; Sivanandam, S; Bidyarasmi, S; Venkatraman, B; Menaka, M; Raj, Baldev

    2011-01-01

    In India, number of people with type 2 Diabetes Mellitus (DM) would be 87 million by the year 2030. DM disturbs autonomic regulation of skin micro-circulation, and causes decrease in resting blood flows through the skin. The skin blood flow has a major effect on its temperature. The aim of the study was to evaluate changes of skin temperature of all parts of the body and serum asymmetric dimethylarginine, ADMA (μmol/L) in type-2 DM Indian patients. Group-I: Normal (n = 17; M/F: 10/15, mean ± SD = 43.2 ± 9.4 years); Group-II: Type-2 DM without cardiovascular (CV) complications (n = 15; M/F: 10/7, mean ± SD = 46.3 ± 14.0 years); Thermograms of all parts of the body were acquired using a non-contact infrared (IR) thermography camera (ThermaCAM T400, FLIR Systems, Sweden). Blood parameters and thyroid hormone were measured biochemically. Indian diabetic risk score (IDRS) was calculated for each subject. In type-2 DM patients without CV group (n = 15), there was a statistically significant (p = 0.01) negative correlations between HbA(1c) and skin temperature of eye and nose (r = -0.57 and r = -0.55 respectively). ADMA was correlated significantly (p = 0.01) with HbA(1c) (r = 0.65) and estimated average glucose, eAG (r = 0.63). In normal subjects, mean minimum and maximum values of skin temperatures were observed at posterior side of sole (26.89 °C) and ear (36.85 °C) respectively. In type-2 DM without CV, mean values of skin temperature in different parts of the body from head to toe were lesser than those values in control group; but this decreases were statistically significant in nose (32.66 Vs 33.99 °C, p = 0.024) as well as in tibia (32.78 Vs 33.13 °C, p = 0.036) regions. PMID:22255768

  1. Electronic Symptom Reporting Between Patient and Provider for Improved Health Care Service Quality: A Systematic Review of Randomized Controlled Trials. Part 2: Methodological Quality and Effects

    PubMed Central

    Berntsen, Gro K Rosvold; Schuster, Tibor; Henriksen, Eva; Horsch, Alexander

    2012-01-01

    Background We conducted in two parts a systematic review of randomized controlled trials (RCTs) on electronic symptom reporting between patients and providers to improve health care service quality. Part 1 reviewed the typology of patient groups, health service innovations, and research targets. Four innovation categories were identified: consultation support, monitoring with clinician support, self-management with clinician support, and therapy. Objective To assess the methodological quality of the RCTs, and summarize effects and benefits from the methodologically best studies. Methods We searched Medline, EMBASE, PsycINFO, Cochrane Central Register of Controlled Trials, and IEEE Xplore for original studies presented in English-language articles between 1990 and November 2011. Risk of bias and feasibility were judged according to the Cochrane recommendation, and theoretical evidence and preclinical testing were evaluated according to the Framework for Design and Evaluation of Complex Interventions to Improve Health. Three authors assessed the risk of bias and two authors extracted the effect data independently. Disagreement regarding bias assessment, extraction, and interpretation of results were resolved by consensus discussions. Results Of 642 records identified, we included 32 articles representing 29 studies. No articles fulfilled all quality requirements. All interventions were feasible to implement in a real-life setting, and theoretical evidence was provided for almost all studies. However, preclinical testing was reported in only a third of the articles. We judged three-quarters of the articles to have low risk for random sequence allocation and approximately half of the articles to have low risk for the following biases: allocation concealment, incomplete outcome data, and selective reporting. Slightly more than one fifth of the articles were judged as low risk for blinding of outcome assessment. Only 1 article had low risk of bias for blinding of

  2. Genome-scale definition of the transcriptional programme associated with compromised PU.1 activity in acute myeloid leukaemia.

    PubMed

    Sive, J I; Basilico, S; Hannah, R; Kinston, S J; Calero-Nieto, F J; Göttgens, B

    2016-01-01

    Transcriptional dysregulation is associated with haematological malignancy. Although mutations of the key haematopoietic transcription factor PU.1 are rare in human acute myeloid leukaemia (AML), they are common in murine models of radiation-induced AML, and PU.1 downregulation and/or dysfunction has been described in human AML patients carrying the fusion oncogenes RUNX1-ETO and PML-RARA. To study the transcriptional programmes associated with compromised PU.1 activity, we adapted a Pu.1-mutated murine AML cell line with an inducible wild-type PU.1. PU.1 induction caused transition from leukaemia phenotype to monocytic differentiation. Global binding maps for PU.1, CEBPA and the histone mark H3K27Ac with and without PU.1 induction showed that mutant PU.1 retains DNA-binding ability, but the induction of wild-type protein dramatically increases both the number and the height of PU.1-binding peaks. Correlating chromatin immunoprecipitation (ChIP) Seq with gene expression data, we found that PU.1 recruitment coupled with increased histone acetylation induces gene expression and activates a monocyte/macrophage transcriptional programme. PU.1 induction also caused the reorganisation of a subgroup of CEBPA binding peaks. Finally, we show that the PU.1 target gene set defined in our model allows the stratification of primary human AML samples, shedding light on both known and novel AML subtypes that may be driven by PU.1 dysfunction. PMID:26126967

  3. Genome-scale definition of the transcriptional programme associated with compromised PU.1 activity in acute myeloid leukaemia

    PubMed Central

    Sive, J I; Basilico, S; Hannah, R; Kinston, S J; Calero-Nieto, F J; Göttgens, B

    2016-01-01

    Transcriptional dysregulation is associated with haematological malignancy. Although mutations of the key haematopoietic transcription factor PU.1 are rare in human acute myeloid leukaemia (AML), they are common in murine models of radiation-induced AML, and PU.1 downregulation and/or dysfunction has been described in human AML patients carrying the fusion oncogenes RUNX1-ETO and PML-RARA. To study the transcriptional programmes associated with compromised PU.1 activity, we adapted a Pu.1-mutated murine AML cell line with an inducible wild-type PU.1. PU.1 induction caused transition from leukaemia phenotype to monocytic differentiation. Global binding maps for PU.1, CEBPA and the histone mark H3K27Ac with and without PU.1 induction showed that mutant PU.1 retains DNA-binding ability, but the induction of wild-type protein dramatically increases both the number and the height of PU.1-binding peaks. Correlating chromatin immunoprecipitation (ChIP) Seq with gene expression data, we found that PU.1 recruitment coupled with increased histone acetylation induces gene expression and activates a monocyte/macrophage transcriptional programme. PU.1 induction also caused the reorganisation of a subgroup of CEBPA binding peaks. Finally, we show that the PU.1 target gene set defined in our model allows the stratification of primary human AML samples, shedding light on both known and novel AML subtypes that may be driven by PU.1 dysfunction. PMID:26126967

  4. Live Attenuated S. Typhimurium Vaccine with Improved Safety in Immuno-Compromised Mice

    PubMed Central

    Periaswamy, Balamurugan; Maier, Lisa; Vishwakarma, Vikalp; Slack, Emma; Kremer, Marcus; Andrews-Polymenis, Helene L.; McClelland, Michael; Grant, Andrew J.; Suar, Mrutyunjay; Hardt, Wolf-Dietrich

    2012-01-01

    Live attenuated vaccines are of great value for preventing infectious diseases. They represent a delicate compromise between sufficient colonization-mediated adaptive immunity and minimizing the risk for infection by the vaccine strain itself. Immune defects can predispose to vaccine strain infections. It has remained unclear whether vaccine safety could be improved via mutations attenuating a vaccine in immune-deficient individuals without compromising the vaccine's performance in the normal host. We have addressed this hypothesis using a mouse model for Salmonella diarrhea and a live attenuated Salmonella Typhimurium strain (ssaV). Vaccination with this strain elicited protective immunity in wild type mice, but a fatal systemic infection in immune-deficient cybb−/−nos2−/− animals lacking NADPH oxidase and inducible NO synthase. In cybb−/−nos2−/− mice, we analyzed the attenuation of 35 ssaV strains carrying one additional mutation each. One strain, Z234 (ssaV SL1344_3093), was >1000-fold attenuated in cybb−/−nos2−/− mice and ≈100 fold attenuated in tnfr1−/− animals. However, in wt mice, Z234 was as efficient as ssaV with respect to host colonization and the elicitation of a protective, O-antigen specific mucosal secretory IgA (sIgA) response. These data suggest that it is possible to engineer live attenuated vaccines which are specifically attenuated in immuno-compromised hosts. This might help to improve vaccine safety. PMID:23029007

  5. Neogene and Quaternary coexisting in the geological time scale: The inclusive compromise

    NASA Astrophysics Data System (ADS)

    McGowran, Brian; Berggren, Bill; Hilgen, Frits; Steininger, Fritz; Aubry, Marie-Pierre; Lourens, Lucas; Van Couvering, John

    2009-11-01

    Removing the Tertiary and Quaternary Periods whilst conserving the Paleogene and Neogene Periods in The Geological Timescale 2004 caused a storm of protest. One response was to advocate restoring an enlarged Quaternary and consigning the Neogene to a minor role within the Tertiary. Amongst an array of practical, traditional, sentimental and anthropocentric reasons for this response, the one hard-core justification was that the rigidly nested hierarchy of the geological timescale must be preserved. The central objective of this paper is conserving the historically legitimate, Miocene-present, Neogene Period and System. There are two options for conserving the Quaternary concurrently with the Neogene: (i) an inclusive compromise in a flexible hierarchy, and (ii) an upgrading of Pliocene and Pleistocene divisions to the level of epoch. In the inclusive compromise there coexist alternative pathways through the hierarchical ranks. Thus geohistorians and biohistorians have two options for traversing the hierarchy from era to age, as in this example using the hierarchical positioning of the Calabrian Age and Stage: either Cenozoic [era]↔Neogene [period]↔Pleistocene [epoch]↔Calabrian [age], or Cenozoic [era]↔Quaternary [subera]↔Pleistocene [epoch]↔Calabrian [age]. We reaffirm that the inclusive compromise is entirely viable. In so doing we (i) challenge the necessity of the rigidly nested hierarchy, which should be capable of a little flexibility; (ii) reject all analogies of the arbitrary and conventional chronostratigraphic hierarchy with three natural biological hierarchies; (iii) reaffirm the integrity of the Neogene extending to the present; and (iv) see no reason to doubt the harmonious coexistence of the two options preserving the Quaternary and Neogene traditions in an orderly working and stable time scale. In the alternative schema conserving the Neogene, divisions of the Pliocene and Pleistocene are upgraded, so that the Late Pleistocene, Early

  6. Arsenic promotes centrosome abnormalities and cell colony formation in p53 compromised human lung cells

    SciTech Connect

    Liao Weiting; Lin Pinpin; Cheng, T.-S.; Yu, H.-S.; Chang, Louis W.

    2007-12-01

    Epidemiological evidence indicated that residents, especially cigarette smokers, in arseniasis areas had significantly higher lung cancer risk than those living in non-arseniasis areas. Thus, an interaction between arsenic and cigarette smoking in lung carcinogenesis was suspected. p53 dysfunction or mutation in lung epithelial cells was frequently observed in cigarette smokers. Our present study was to explore the differential effects by arsenic on H1355 cells (human lung adenocarcinoma cell line with mutation in p53), BEAS-2B (immortalized lung epithelial cell with functional p53) and pifithrin-{alpha}-treated BEAS-2B cells (p53-inhibited cells). These cells were treated with different doses of sodium arsenite (0, 0.1, 1, 5 and 10 {mu}M) for 48 h. A greater reduction in cell viability was observed in the BEAS-2B cells vs. p53 compromised cells (H1355 or p53-inhibited BEAS-2B). Similar observation was also made on 7-day cell survival (growth) study. TUNEL analysis confirmed that there was indeed a significantly reduced arsenite-induced apoptosis found in p53-compromised cells. Centrosomal abnormality has been attributed to eventual chromosomal missegregation, aneuploidy and tumorigenesis. In our present study, reduced p21 and Gadd45a expressions and increased centrosomal abnormality (atopic and multiple centrosomes) were observed in both arsenite-treated H1355 and p53-inhibited BEAS-2B cells as compared with similarly treated BEAS-2B cells. Increased anchorage-independent growth (colony formation) of BEAS-2B cells co-treated with pifithrin-{alpha} and 5 {mu}M sodium arsenite was also observed in soft agar. Our present investigation demonstrated that arsenic would act specifically on p53 compromised cells (either with p53 dysfunction or inhibited) to induce centrosomal abnormality and colony formation. These findings provided strong evidence on the carcinogenic promotional role of arsenic, especially under the condition of p53 dysfunction.

  7. Risky Driving, Mental Health, and Health-Compromising Behaviors: Risk Clustering in Late Adolescents and Adults

    PubMed Central

    Sommers, Marilyn S.; Fargo, Jamison D.

    2014-01-01

    Background Health-compromising behaviors in adolescents and adults co-occur. Because motor vehicle crashes are the leading cause of death and disability for these age groups, understanding the association between risky driving and other health compromising behaviors is critical. Methods We performed a secondary analysis of data from a randomized controlled trial of an intervention for participants who screened positive for risky driving and problem drinking. Using baseline data, we examined relationships among conduct behavior problems before and after age 15, depressive symptoms, sleep, problem drinking, and risky driving (hostile, reckless and drinking and driving) in late adolescents ages 18–24 (n= 110) and adults ages 25–44 (n= 202). We developed a measurement model for the entire sample using confirmatory factor analysis, which was then specified as a multi-group structural equation model. Results Late adolescents and adults had some similar associations for pathways through problem drinking to drinking and driving; depression to reckless driving; and conduct behavior problems after 15 to hostile driving. Late adolescents, however, had more complex relationships: depressive symptoms and conduct behavior problems before 15 were associated with more risky driving behaviors through multiple pathways and males reported more risky driving. Conclusions Risky driving is associated with other health-compromising behaviors and mental health factors. It is a multidimensional phenomenon more pronounced in late adolescence than adulthood. In order to promote safe driving, the findings support the need to consider behaviors that are a health threat in the late adolescent population during driving training and licensure. PMID:24814717

  8. Novel Mechanisms of Compromised Lymphatic Endothelial Cell Homeostasis in Obesity: The Role of Leptin in Lymphatic Endothelial Cell Tube Formation and Proliferation

    PubMed Central

    Kawata, Koji; Kawada, Masaya; Jitsukawa, Sumito; Yamashita, Keiji; Sato, Noriyuki; Himi, Tetsuo; Ichimiya, Shingo

    2016-01-01

    Leptin is a hormone produced by adipose tissue that regulates various physiological processes. Recent studies have shown that the level of circulating leptin is elevated in obese patients and have suggested a relationship between obesity and postoperative lymphedema. However, the mechanisms by which postoperative lymphedema develops in obese patients and the mechanisms by which leptin regulates lymphatic endothelial cell homeostasis such as tube formation and cell proliferation remain unknown. Here we report that leptin regulates tube formation and cell proliferation in human dermal lymphatic endothelial cells (HDLECs) by activation of the signal transducer and activator of transcription 3 pathway, which is downstream signaling of the leptin receptor. Additionally, we found that upregulation of suppressor of cytokine signaling 3 underlies the mechanisms by which a high dose of leptin inhibits cell proliferation and tube formation. Leptin also enhanced expression of the proinflammatory cytokine IL-6 in HDLECs. Interestingly, IL-6 rescues the compromised cell proliferation and tube formation caused by treatment with a high dose of leptin in an autocrine or paracrine manner. Taken together, our findings reveal a novel mechanism by which compromised HDLECs maintain their homeostasis during inflammation mediated by leptin and IL-6. Thus, regulating the level of leptin or IL-6 may be a viable strategy to reduce the incidence of postoperative lymphedema. PMID:27366905

  9. Keloids in rural black South Africans. Part 2: dietary fatty acid intake and total phospholipid fatty acid profile in the blood of keloid patients.

    PubMed

    Louw, L; Dannhauser, A

    2000-11-01

    In the second part of this study, emphasis is placed on nutritional intakes (fatty acids and micronutrients) and fatty acid intake and metabolism in the blood, respectively, according to a combined 24 h recall and standardized food frequency questionnaire analyses of keloid prone patients (n=10), compared with normal black South Africans (n=80), and total phospholipid blood (plasma and red blood cell ) analyses of keloid patients (n=20), compared with normal individuals (n=20). Lipid extraction and fractionation by standard procedures, total phospholipid (TPL) separation with thin layer chromatography, and fatty acid methyl ester analyses with gas liquid chromatography techniques were used. Since nutrition may play a role in several disease disorders, the purpose of this study was to confirm or refute a role for essential fatty acids (EFAs) in the hypothesis of keloid formations stated in part 1 of this study. (1)According to the Canadian recommendation (1991), we observed that in keloid patients linoleic acid (LA) and arachidonic acid (AA) dietary intakes, as EFAs of the omega-6-series, are higher than the recommended 7-11 g/d. However, the a-linolenic acid (ALA), eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) dietary intakes, as EFAs of the omega-3 series, are lower than the recommendation of 1.1-1.5 g/d. This was also the case in the control group, where a higher dietary intake of the omega-6 fatty acids and a slightly lower dietary intake of the omega-3 fatty acids occurred. Thus, we confirm a high dietary intake of LA (as a product of organ meats, diary products and many vegetable oils) and AA (as a product of meats and egg yolks), as well as lower dietary intakes of ALA (as a product of grains, green leafy vegetables, soy oil, rapeseed oil and linseed), and EPA and DHA (as products of marine oils). Lower micronutrient intakes than the recommended dietary allowances were observed in the keloid group that may influence EFA metabolism and/or collagen

  10. Cervical Sagittal Alignment Parameters of Patients Admitted to Neurosurgery and Emergency Clinics in a State Hospital at Eastern Part of Turkey

    PubMed Central

    Kaplan, Sümeyye Çoruh

    2015-01-01

    Objective Cervical spine encompasses a bridge role between the head and the lower parts of the spine and therefore has unique properties. Our aim in this study was to evaluate the cervical sagittal alignment parameters in pediatric and adult non-surgical patients and to find any differences in respect of age, sex and admission type. Methods All patients who were admitted to emergency and neurosurgery clinics of Diyarbakir Bismil State Hospital due to cervical spine problems (trauma, radiculopathy, paraspinal pain) in 2014 were enrolled retrospectively into the study. Cervical anterior-posterior and lateral X-rays were obtained. Our exclusion criteria were cervical coronal deformity, multitrauma, Glasgow Coma Scale <15, traumatic disruption of the cervical spine, history of malignancy, spinal infection, metabolic or rheumatologic diseases. Results There were 44 female and 55 male patients (n=99) in the study. Thirty-five (35.35%) of the patients were younger than 18 years of age. Mean cervical spinal alignment parameters were as follows: -42.81±11.23° (OC2), -17.15±11.48° (C2-C7), -29.82±7.60° (T1 slope), -3.62±3.05° (C3), -3.14±3.05 (C4), -3.80±2.74° (C5), -3.12±2.36° (C6), -3.43±2.53° (C7). Positive correlations were observed between age-C2C7 angle, C2C7 angle-T1 slope, C3 angle-C4 angle, C4 angle-OC2 angle, C4 angle-T1 slope, C4 angle-C5 angle. The one only negative correlation was between OC2 angle-C2C7 angle. Conclusion In this regional study, it has been observed that global cervical lordosis increases as age increases. C4 vertebra is in the middle of this evaluation as it has many correlations with other cervical segments, which should be kept in mind when making surgical plans for this delicate spine region. PMID:26217386

  11. Put a Face to a Name (Part A): The Effects of Photographic Aids on Patient Satisfaction, Clinician Communication, and Quality of Care

    ClinicalTrials.gov

    2014-04-04

    Effects of Photographic Aids (Photos of Faces) on Patient Recall of Their Clinical Care Team; Effects of Photographic Aids (Photos of Faces) on Clinician-patient Communication; Effects of Photographic Aids (Photos of Faces) on Overall Patient Satisfaction

  12. Determining Whether a Definitive Causal Relationship Exists Between Aripiprazole and Tardive Dyskinesia and/or Dystonia in Patients With Major Depressive Disorder, Part 3: Clinical Trial Data.

    PubMed

    Preskorn, Sheldon H; Macaluso, Matthew

    2016-03-01

    three, 14-week studies involving 1088 subjects, 409 of whom were elderly like the 76-year-old individual presented in the case in the first column of this series. Finally, 3 short-term studies evaluated the use of aripiprazole in patients with psychosis associated with Alzheimer disease, a population who would be considered a relatively higher risk group for developing TD when exposed to antipsychotics and that also closely matches the patient in the case presented at the beginning of this series in terms of age. No incidence of TD was reported in this sample and mean scores on the Abnormal Involuntary Movement Scale decreased in individuals exposed to aripiprazole compared with those on placebo. On the basis of results of this review and data from registration trials of aripiprazole for all indications, the potential (or raw) incidence of what was termed TD occurred at rates ranging from 0.004 (4/987) based on long-term safety data from the program investigating aripiprazole augmentation treatment in MDD, to 0.0016 (19/11,897) based on the total safety database from aripiprazole registration trials for all indications, to 0 in trials in elderly individuals with Alzheimer disease. The confidence intervals for all of these potential incidence rates overlap with zero. The next column in this 5-part series reviews 37 case reports that reported TD in association with aripiprazole treatment and 27 case reports that suggested an improvement in preexisting TD with aripiprazole treatment. The fifth and final column in this series will discuss the types of prohibitively expensive and logistically difficult studies that would be needed to determine whether a definitive causal relationship between aripiprazole and TD exists. PMID:27138080

  13. Proof of concept for low-dose molecular breast imaging with a dual-head CZT gamma camera. Part II. Evaluation in patients

    PubMed Central

    Hruska, Carrie B.; Weinmann, Amanda L.; Tello Skjerseth, Christina M.; Wagenaar, Eric M.; Conners, Amy L.; Tortorelli, Cindy L.; Maxwell, Robert W.; Rhodes, Deborah J.; O’Connor, Michael K.

    2012-01-01

    Purpose: Molecular breast imaging (MBI) has shown promise as an adjunct screening technique to mammography for women with dense breasts. The demonstration of reliable lesion detection with MBI performed at low administered doses of Tc-99 m sestamibi, comparable in effective radiation dose to screening mammography, is essential to adoption of MBI for screening. The concept of performing low-dose MBI with dual-head cadmium zinc telluride (CZT) gamma cameras has been investigated in phantoms in Part I. In this work, the objectives were to evaluate the impact of the count sensitivity improvement methods on image quality in patient MBI exams and to determine if adequate lesion detection could be achieved at reduced doses. Methods: Following the implementation of two count sensitivity improvement methods, registered collimation optimized for near-field imaging and energy acceptance window optimized for CZT, MBI exams were performed in the course of clinical care. Clinical image count density (counts/cm2) was compared between standard MBI [740 MBq (20 mCi) Tc-99 m sestamibi, standard collimation, standard energy window] and low-dose MBI [296 MBq (8 mCi) Tc-99 m sestamibi, optimized collimation, wide energy window] in a cohort of 50 patients who had both types of MBI exams performed. Lesion detection at low doses was evaluated in a separate cohort of 32 patients, in which low-dose MBI was performed following 296 MBq injection and acquired in dynamic mode, allowing the generation of images acquired for 2.5, 5, 7.5, and 10 min/breast view with proportionately reduced count densities. Diagnostic accuracy at each count density level was compared and kappa statistic was used to assess intrareader agreement between 10 min acquisitions and those at shorter acquisition durations. Results: In patient studies, low-dose MBI performed with 296 MBq Tc-99 m sestamibi and new optimal collimation/wide energy window resulted in an average relative gain in count density of 4

  14. Compromised Prefrontal Cognitive Control Over Emotional Interference in Adolescents with Internet Gaming Disorder.

    PubMed

    Lee, Junghan; Lee, Seojung; Chun, Ji Won; Cho, Hyun; Kim, Dai-jin; Jung, Young-Chul

    2015-11-01

    Increased reports of impulsivity and aggression in male adolescents with Internet gaming might reflect their dysfunction in emotion regulation, particularly in suppression of negative emotions, which should affect the various stages of Internet gaming disorder. This study tested the hypothesis that adolescents with Internet gaming disorder would be more disturbed by the emotional interference and demonstrate compromised dorsal anterior cingulate cortex (dACC) activation during a Stroop Match-to-Sample task. In addition, functional connectivity analysis was conducted to examine the interplays between neural correlates involved in emotional processing and how they were altered in adolescents with Internet gaming disorder. The Internet gaming disorder group demonstrated weaker dACC activation and stronger insular activations to interfering angry facial stimuli compared with the healthy control group. Negative functional connectivity between stronger insular activation and weaker dorsolateral prefrontal activation correlated with higher cognitive impulsivity in adolescents with Internet gaming disorder. These findings provide evidence of the compromised prefrontal cognitive control over emotional interference in adolescents with Internet gaming disorder. PMID:26430731

  15. Scanning electron microscopic analysis of the effect of Carisolv gel on periodontally compromised human root surfaces.

    PubMed

    Grisi, Daniela Corrêa; Theodoro, Letícia Helena; Sampaio, José Eduardo César; Grisi, Márcio Fernando de Moraes; Salvador, Sérgio Luiz de Souza

    2006-01-01

    The aim of this study was to analyze, under scanning electron microscopy (SEM), the morphologic characteristics of root surfaces after application of Carisolv gel in association with scaling and root planing (SRP). Sixty periodontally compromised extracted human teeth were randomly assigned to 6 groups: 1) SRP alone; 2) passive topical application of Carisolv + SRP; 3) active topical application of Carisolv + SRP; 4) multiple applications of Carisolv + SRP; 5) SRP + 24% EDTA; 6) topical application of Carisolv + SRP + 24% EDTA. Carisolv gel was applied to root surfaces for 30 s, followed by scaling and root planing, consisting of 50 strokes with Gracey curettes in an apical-coronal direction, parallel to the long axis of the tooth. The only exception was group 4, in which the roots were instrumented until a smooth, hard and glass-like surface was achieved. All specimens were further analyzed by SEM. The results showed that the treatment with Carisolv caused significant changes in root surface morphology of periodontally compromised teeth only when the chemical agent was actively applied (burnishing technique). Carisolv failed to remove the smear layer completely, especially with a single application, independently of the method of application. Multiple applications of Carisolv were necessary to achieve a smear layer reduction comparable to that obtained with 24% EDTA conditioning. PMID:16924336

  16. 2-Sulfonylpyrimidines: Mild alkylating agents with anticancer activity toward p53-compromised cells.

    PubMed

    Bauer, Matthias R; Joerger, Andreas C; Fersht, Alan R

    2016-09-01

    The tumor suppressor p53 has the most frequently mutated gene in human cancers. Many of p53's oncogenic mutants are just destabilized and rapidly aggregate, and are targets for stabilization by drugs. We found certain 2-sulfonylpyrimidines, including one named PK11007, to be mild thiol alkylators with anticancer activity in several cell lines, especially those with mutationally compromised p53. PK11007 acted by two routes: p53 dependent and p53 independent. PK11007 stabilized p53 in vitro via selective alkylation of two surface-exposed cysteines without compromising its DNA binding activity. Unstable p53 was reactivated by PK11007 in some cancer cell lines, leading to up-regulation of p53 target genes such as p21 and PUMA. More generally, there was cell death that was independent of p53 but dependent on glutathione depletion and associated with highly elevated levels of reactive oxygen species and induction of endoplasmic reticulum (ER) stress, as also found for the anticancer agent PRIMA-1(MET)(APR-246). PK11007 may be a lead for anticancer drugs that target cells with nonfunctional p53 or impaired reactive oxygen species (ROS) detoxification in a wide variety of mutant p53 cells. PMID:27551077

  17. Pathogen associated molecular pattern (PAMP)-triggered immunity is compromised under C-limited growth.

    PubMed

    Park, Hyeong Cheol; Lee, Shinyoung; Park, Bokyung; Choi, Wonkyun; Kim, Chanmin; Lee, Sanghun; Chung, Woo Sik; Lee, Sang Yeol; Sabir, Jamal; Bressan, Ray A; Bohnert, Hans J; Mengiste, Tesfaye; Yun, Dae-Jin

    2015-01-31

    In the interaction between plants and pathogens, carbon (C) resources provide energy and C skeletons to maintain, among many functions, the plant immune system. However, variations in C availability on pathogen associated molecular pattern (PAMP) triggered immunity (PTI) have not been systematically examined. Here, three types of starch mutants with enhanced susceptibility to Pseudomonas syringae pv. tomato DC3000 hrcC were examined for PTI. In a dark period-dependent manner, the mutants showed compromised induction of a PTI marker, and callose accumulation in response to the bacterial PAMP flagellin, flg22. In combination with weakened PTI responses in wild type by inhibition of the TCA cycle, the experiments determined the necessity of C-derived energy in establishing PTI. Global gene expression analyses identified flg22 responsive genes displaying C supply-dependent patterns. Nutrient recycling-related genes were regulated similarly by C-limitation and flg22, indicating re-arrangements of expression programs to redirect resources that establish or strengthen PTI. Ethylene and NAC transcription factors appear to play roles in these processes. Under C-limitation, PTI appears compromised based on suppression of genes required for continued biosynthetic capacity and defenses through flg22. Our results provide a foundation for the intuitive perception of the interplay between plant nutrition status and pathogen defense. PMID:25387755

  18. Mixed-species Biofilm Compromises Wound Healing by Disrupting Epidermal Barrier Function

    PubMed Central

    Sinha, Mithun; Ganesh, Kasturi; Chaney, Sarah; Mann, Ethan; Miller, Christina; Khanna, Savita; Bergdall, Valerie K.; Powell, Heather M.; Cook, Charles H.; Gordillo, Gayle M.; Wozniak, Daniel J.; Sen, Chandan K.

    2015-01-01

    In chronic wounds, biofilm infects host tissue for extended periods of time. This work establishes the first chronic pre-clinical model of wound biofilm infection aimed at addressing long-term host response. Although biofilm infected wounds did not show marked differences in wound closure, the repaired skin demonstrated compromised barrier function. This observation is clinically significant because it leads to the notion that even if a biofilm infected wound is closed as observed visually, it may be complicated by the presence of failed skin which is likely to be infected and or further complicated post-closure. Study of underlying mechanisms recognized for the first time biofilm-inducible miR-146a and miR-106b in the host skin wound-edge tissue. These miRs silenced ZO-1 and ZO-2 to compromise tight junction function resulting in leaky skin as measured by transepidermal water loss. Intervention strategies aimed at inhibiting biofilm-inducible miRNAs may be productive in restoring barrier function of host skin. PMID:24771509

  19. Metabolic engineering of lipid catabolism increases microalgal lipid accumulation without compromising growth

    PubMed Central

    Trentacoste, Emily M.; Shrestha, Roshan P.; Smith, Sarah R.; Glé, Corine; Hartmann, Aaron C.; Hildebrand, Mark; Gerwick, William H.

    2013-01-01

    Biologically derived fuels are viable alternatives to traditional fossil fuels, and microalgae are a particularly promising source, but improvements are required throughout the production process to increase productivity and reduce cost. Metabolic engineering to increase yields of biofuel-relevant lipids in these organisms without compromising growth is an important aspect of advancing economic feasibility. We report that the targeted knockdown of a multifunctional lipase/phospholipase/acyltransferase increased lipid yields without affecting growth in the diatom Thalassiosira pseudonana. Antisense-expressing knockdown strains 1A6 and 1B1 exhibited wild-type–like growth and increased lipid content under both continuous light and alternating light/dark conditions. Strains 1A6 and 1B1, respectively, contained 2.4- and 3.3-fold higher lipid content than wild-type during exponential growth, and 4.1- and 3.2-fold higher lipid content than wild-type after 40 h of silicon starvation. Analyses of fatty acids, lipid classes, and membrane stability in the transgenic strains suggest a role for this enzyme in membrane lipid turnover and lipid homeostasis. These results demonstrate that targeted metabolic manipulations can be used to increase lipid accumulation in eukaryotic microalgae without compromising growth. PMID:24248374

  20. Hippocampal function is compromised in an animal model of multiple sclerosis.

    PubMed

    Novkovic, T; Shchyglo, O; Gold, R; Manahan-Vaughan, D

    2015-11-19

    Multiple sclerosis (MS) is a progressive inflammatory autoimmune disease that is characterized by demyelination and axonal damage in the nervous system. One obvious consequence is a cumulative loss of muscle control. However, cognitive dysfunction affects roughly half of MS sufferers, sometimes already early in the disease course. Although long-term (remote) memory is typically unaffected, the ability to form new declarative memories becomes compromised. A major structure for the encoding of new declarative memories is the hippocampus. Encoding is believed to be mediated by synaptic plasticity in the form of long-term potentiation (LTP) and long-term depression (LTD) of synaptic strength. Here, in an animal model of MS we explored whether disease symptoms are accompanied by a loss of functional neuronal integrity, synaptic plasticity, or hippocampus-dependent learning ability. In mice that developed MOG35-55-induced experimental autoimmune encephalomyelitis (EAE), passive properties of CA1 pyramidal neurons were unaffected, although the ability to fire action potentials became reduced in the late phase of EAE. LTP remained normal in the early phase of MOG35-55-induced EAE. However, in the late phase, LTP was impaired and LTP-related spatial memory was impaired. In contrast, LTD and hippocampus-dependent object recognition memory were unaffected. These data suggest that in an animal model of MS hippocampal function becomes compromised as the disease progresses. PMID:25795599

  1. Fibre reinforcement in a structurally compromised endodontically treated molar: a case report.

    PubMed

    Soares, Renita; de Ataide, Ida de Noronha; Fernandes, Marina; Lambor, Rajan

    2016-05-01

    The reconstruction of structurally compromised posterior teeth is a rather challenging procedure. The tendency of endodontically treated teeth (ETT) to fracture is considerably higher than vital teeth. Although posts and core build-ups followed by conventional crowns have been generally employed for the purpose of reconstruction, this procedure entails sacrificing a considerable amount of residual sound enamel and dentin. This has drawn the attention of researchers to fibre reinforcement. Fibre-reinforced composite (FRC), designed to replace dentin, enables the biomimetic restoration of teeth. Besides improving the strength of the restoration, the incorporation of glass fibres into composite resins leads to favorable fracture patterns because the fibre layer acts as a stress breaker and stops crack propagation. The following case report presents a technique for reinforcing a badly broken-down ETT with biomimetic materials and FRC. The proper utilization of FRC in structurally compromised teeth can be considered to be an economical and practical measure that may obviate the use of extensive prosthetic treatment. PMID:27200283

  2. Compromised zinc status of experimental rats as a consequence of prolonged iron & calcium supplementation

    PubMed Central

    Jayalakshmi, S.; Platel, Kalpana

    2016-01-01

    Background & objectives: Iron supplementation is usually given to pregnant and lactating women who may also have marginal deficiency of zinc. The negative impact of supplemental iron and calcium on zinc status is a cause of concern. The present investigation was undertaken to examine the effect of inclusion of iron and calcium in the diet at supplementary levels on zinc status of experimental rats. Methods: Groups of experimental rats were maintained on diets supplemented with iron (Molar ratio - Zn:Fe 1:30) and calcium (Molar ratio - Zn:Ca 1:667) both individually and in combination for six weeks. Zinc status of these rats was assessed by determining zinc concentration in circulation and in organs, and the activities of zinc containing enzymes in serum and liver. Results: The zinc status of experimental rats receiving supplemental levels of iron and calcium was significantly compromised. Zinc concentration in serum, kidney, spleen and liver was reduced significantly by both these minerals. Six weeks of supplementation of iron and calcium individually, significantly reduced the activity of liver and serum superoxide dismutase and alkaline phosphatase. Activity of liver alcohol dehydrogenase was lowered in calcium supplemented group and in calcium + iron supplemented group, while that of carbonic anhydrase was significantly reduced by iron, calcium and their combination. Interpretation & conclusions: Supplemental levels of iron and calcium, both individually and in combination, significantly compromised the zinc status of experimental rats. This negative effect of these two minerals was more prominent when these were supplemented for a period of six weeks. PMID:27121523

  3. Can Neglected Tropical Diseases Compromise Human Wellbeing in Sex-, Age-, and Trait-Specific Ways?

    PubMed Central

    Geary, David C.

    2016-01-01

    Traits that facilitate competition for reproductive resources or that influence mate choice have evolved to signal resilience to infectious disease and other stressors. As a result, the dynamics of competition and choice can, in theory, be used to generate predictions about sex-, age-, and trait-specific vulnerabilities for any sexually reproducing species, including humans. These dynamics and associated vulnerabilities are reviewed for nonhuman species, focusing on traits that are compromised by exposure to parasites. Using the same approach, sex-, age-, and trait-specific vulnerabilities to parasitic disease are illustrated for children’s and adolescent’s physical growth and fitness. Suggestions are then provided for widening the assessment of human vulnerabilities to include age-appropriate measures of behavioral (e.g., children’s play) and cognitive (e.g., language fluency) traits. These are traits that are likely to be compromised by infection in age- and sex-specific ways. Inclusion of these types of measures in studies of neglected tropic diseases has the potential to provide a more nuanced understanding of how these diseases undermine human wellbeing and may provide a useful means to study the efficacy of associated treatments. PMID:27077746

  4. Fibre reinforcement in a structurally compromised endodontically treated molar: a case report

    PubMed Central

    de Ataide, Ida de Noronha; Fernandes, Marina; Lambor, Rajan

    2016-01-01

    The reconstruction of structurally compromised posterior teeth is a rather challenging procedure. The tendency of endodontically treated teeth (ETT) to fracture is considerably higher than vital teeth. Although posts and core build-ups followed by conventional crowns have been generally employed for the purpose of reconstruction, this procedure entails sacrificing a considerable amount of residual sound enamel and dentin. This has drawn the attention of researchers to fibre reinforcement. Fibre-reinforced composite (FRC), designed to replace dentin, enables the biomimetic restoration of teeth. Besides improving the strength of the restoration, the incorporation of glass fibres into composite resins leads to favorable fracture patterns because the fibre layer acts as a stress breaker and stops crack propagation. The following case report presents a technique for reinforcing a badly broken-down ETT with biomimetic materials and FRC. The proper utilization of FRC in structurally compromised teeth can be considered to be an economical and practical measure that may obviate the use of extensive prosthetic treatment. PMID:27200283

  5. Specific loss of CatSper function is sufficient to compromise fertilizing capacity of human spermatozoa

    PubMed Central

    Williams, Hannah L.; Mansell, Steven; Alasmari, Wardah; Brown, Sean G.; Wilson, Stuart M.; Sutton, Keith A.; Miller, Melissa R.; Lishko, Polina V.; Barratt, Christopher L.R.; Publicover, Steven J.; Martins da Silva, Sarah

    2015-01-01

    STUDY QUESTION Are significant abnormalities of CatSper function present in IVF patients with normal sperm concentration and motility and if so what is their functional significance for fertilization success? SUMMARY ANSWER Sperm with a near absence of CatSper current failed to respond to activation of CatSper by progesterone and there was fertilization failure at IVF. WHAT IS KNOWN ALREADY In human spermatozoa, Ca2+ influx induced by progesterone is mediated by CatSper, a sperm-specific Ca2+ channel. A suboptimal Ca2+ influx is significantly associated with, and more prevalent in, men with abnormal semen parameters, and is associated with reduced fertilizing capacity. However, abnormalities in CatSper current can only be assessed directly using electrophysiology. There is only one report of a CatSper-deficient man who showed no progesterone potentiated CatSper current. A CatSper 2 genetic abnormality was present but there was no information on the [Ca2+]i response to CatSper activation by progesterone. Additionally, the semen samples had indicating significant abnormalities (oligoasthenoteratozoospermia) multiple suboptimal functional responses in the spermatozoon. As such it cannot be concluded that impaired CatSper function alone causes infertility or that CatSper blockade is a potential safe target for contraception. STUDY DESIGN, SIZE, DURATION Spermatozoa were obtained from donors and subfertile IVF patients attending a hospital assisted reproductive techniques clinic between January 2013 and December 2014. In total 134 IVF patients, 28 normozoospermic donors and 10 patients recalled due to a history of failed/low fertilization at IVF took part in the study. PARTICIPANTS/MATERIALS, SETTING, METHODS Samples were primarily screened using the Ca2+ influx induced by progesterone and, if cell number was sufficient, samples were also assessed by hyperactivation and penetration into viscous media. A defective Ca2+ response to progesterone was defined using the 99

  6. 42 CFR 405.376 - Suspension and termination of collection action and compromise of claims for overpayment.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... CFR 404.515. (b) Definitions. As used in this section, debtor means a provider of services or a... necessary evidence, and related pragmatic considerations, for compromise under paragraph (d)(3) of...

  7. 42 CFR 405.376 - Suspension and termination of collection action and compromise of claims for overpayment.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... CFR 404.515. (b) Definitions. As used in this section, debtor means a provider of services or a... necessary evidence, and related pragmatic considerations, for compromise under paragraph (d)(3) of...

  8. Association of TNF-α Promoter Polymorphism with HBV Associated Disease Outcome Among HBV Infected Patients from Orissa, Southern Part of East India

    PubMed Central

    Panigrahi, Rajesh; Sarkar, Neelakshi; Biswas, Avik; Pal, Ananya; Saha, Debraj; Singh, Shivaram P.; Panigrahi, Manas K.; Bandopadhyay, Manikanana; Chakrabarti, Sekhar; Chakravarty, Runu

    2014-01-01

    Background TNF-α promoter polymorphism has been known to be a potential predictive factor in patients with HBV infection. We therefore tried to investigate whether the TNF-α promoter polymorphism at position −238, −857 and −863 was associated with the outcome of HBV infection in a population from Orissa, southern part of East India. Methods A total of 195 patients recruited for the study were classified into 85 controls and 110 HBV infected cases, which included 34 IC, 30 CLD, 32 LC and 14 HCC patients. The polymorphisms at the respective sites were detected by a PCR-RFLP followed by statistical analysis. Results The frequency of the genotype −238 GG and the allele −238G in the cases (89.0% and 92.7% respectively) was significantly higher than that in the controls (68.2% and 82.2% respectively) (P < 0.001, OR = 3.8 and P = 0.001, OR = 2.73). Whereas the −238 GA genotype was significantly high in the control group (28.2%) when compared to the cases (7.2%) (P < 0.001, OR = 0.2). Similarly, the frequency of −863CC and the allele −863C was significantly higher among the cases (24.5% and 49.5%) compared to controls (1.17% and 34.7%), (P < 0.001, OR = 27.32 and P = 0.003, OR = 1.85), whereas the −863CA genotype was significantly high in the controls (67.0%) when compared to the cases (50.0%) (P = 0.01, OR = 0.49). Haplotype −863C/−857C/−238G in cases was significantly higher than controls (P = 0.002). Multivariate logistic regression analysis indicates that the genotype −863CC bears a negative association with liver disease progression. Conclusion The present study established an association of polymorphisms at site −238 and −863 of the TNF-α promoter with the outcome HBV infection and disease progression. PMID:25755561

  9. The role of abdominal compliance, the neglected parameter in critically ill patients - a consensus review of 16. Part 2: measurement techniques and management recommendations.

    PubMed

    Malbrain, Manu L N G; De Laet, Inneke; De Waele, Jan J; Sugrue, Michael; Schachtrupp, Alexander; Duchesne, Juan; Van Ramshorst, Gabrielle; De Keulenaer, Bart; Kirkpatrick, Andrew W; Ahmadi-Noorbakhsh, Siavash; Mulier, Jan; Pelosi, Paolo; Ivatury, Rao; Pracca, Francisco; David, Marcelo; Roberts, Derek J

    2014-01-01

    The recent definitions on intra-abdominal pressure (IAP), intra-abdominal volume (IAV) and abdominal compliance (Cab) are a step forward in understanding these important concepts. They help our understanding of the pathophysiology, aetiology, prognosis, and treatment of patients with low Cab. However, there is still a relatively poor understanding of the different methods used to measure IAP, IAV and Cab and how certain conditions may affect the results. This review will give a concise overview of the different methods to assess and estimate Cab; it will list important conditions that may affect baseline values and suggest some therapeutic options. Abdominal compliance (Cab), defined as a measure of the ease of abdominal expansion, is measured differently than IAP. The compliance of the abdominal wall is only a part of the total abdominal pressure-volume (PV) relationship. Measurement or estimation of Cab is difficult at the bedside and can only be done in a case of change (removal or addition) in IAV. The different measurement techniques will be discussed in relation to decreases (ascites drainage, haematoma evacuation, gastric suctioning) or increases in IAV (gastric insufflation, laparoscopy with CO₂ pneumoperitoneum, peritoneal dialysis). More specific techniques using the interactions between the thoracic and abdominal compartment during positive pressure ventilation will also be discussed (low flow PV loop, respiratory IAP variations, respiratory abdominal variation test, mean IAP and abdominal pressure variation), together with the concept of the polycompartment model. The relation between IAV and IAP is linear at low IAV and becomes curvilinear and exponential at higher volumes. Specific conditions in relation to increased (previous pregnancy or laparoscopy, gynoid fat distribution, ellipse-shaped internal abdominal perimeter) or decreased Cab (obesity, fluid overload, android fat distribution, sphere-shaped internal abdominal perimeter) will be discussed

  10. Quality of Care Is Improved by Rapid Short Incubation MALDI-ToF Identification from Blood Cultures as Measured by Reduced Length of Stay and Patient Outcomes as Part of a Multi-Disciplinary Approach to Bacteremia in Pediatric Patients

    PubMed Central

    Armstrong, Amanda; Schaus, David

    2016-01-01

    the patients where the empirical therapy was considered to be optimal were similar with respect to length of stay; 13.04 and 10.93 days (p = 0.34). In the 2012 group there was a significant increase in the length of stay in the group needing change in excess of 30 days (p = 0.02) compared to the group where empirical therapy was considered to be optimal, this clearly showed an improvement in the quality of care received after the rapid identification was instituted in 2014. The 2012 group had a four times overall increased sepsis associated mortality risk compared to the 2014 group and when empirical antibiotics needed to be optimized this risk was 7 times compared to the 2014 group. We conclude that rapid identification of bacterial pathogens in pediatric blood cultures with a rapid incubation MALDI-TOF identification protocol plays an important role in improving quality of care as part of a multidisciplinary approach to pediatric bacteremia and sepsis. PMID:27513860

  11. Alveolar soft part sarcoma presenting as a breast metastasis in a patient with a history of thyroid cancer: a case report

    PubMed Central

    Bychkov, Andrey; Sampatanukul, Pichet

    2015-01-01

    Metastases to the breast are uncommon, accounting for 0.5% of breast tumors, and most of them are originated from lymphoma, melanoma and carcinomas of various organs. Alveolar soft part sarcoma (ASPS) is a very rare neoplasm that is usually found in the lower extremities. Lungs are the common site of dissemination and may represent initial manifestation of disease. We report a clinically unsuspected case of ASPS presenting as a breast metastasis in a 25-year-old woman. The patient’s medical history was notable for a thyroid cancer treated by surgery and radioiodine ablation 2 years ago. Core needle biopsy of slowly growing breast mass yielded polygonal cells with abundant eosinophilic cytoplasm arranged into solid pattern. Differential diagnosis between apocrine cell carcinoma, paraganglioma, granular cell tumor, neuroendocrine carcinoma, ASPS and metastatic hepatocellular and renal cell carcinoma was rendered by immunohistochemistry. Strong nuclear TFE3 immunoreactivity confirmed a diagnosis of ASPS. Retrospectively a primary tumor was found in the thigh. Most likely, ASPS and thyroid cancer in the patient were growing synchronously and independently. PMID:26464747

  12. 36 CFR 1011.1 - What definitions apply to the regulations in this part?

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... published by the Departments of the Treasury and Justice and codified at 31 CFR parts 900-904. FMS means the.... Compromise means the settlement or forgiveness of all or a portion of a debt. Creditor agency means...

  13. 36 CFR 1011.1 - What definitions apply to the regulations in this part?

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... published by the Departments of the Treasury and Justice and codified at 31 CFR parts 900-904. FMS means the.... Compromise means the settlement or forgiveness of all or a portion of a debt. Creditor agency means...

  14. 36 CFR 1011.1 - What definitions apply to the regulations in this part?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... published by the Departments of the Treasury and Justice and codified at 31 CFR parts 900-904. FMS means the.... Compromise means the settlement or forgiveness of all or a portion of a debt. Creditor agency means...

  15. 36 CFR 1011.1 - What definitions apply to the regulations in this part?

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... published by the Departments of the Treasury and Justice and codified at 31 CFR parts 900-904. FMS means the.... Compromise means the settlement or forgiveness of all or a portion of a debt. Creditor agency means...

  16. Cytokines and olfactory bulb microglia in response to bacterial challenge in the compromised primary olfactory pathway

    PubMed Central

    2012-01-01

    Background The primary olfactory pathway is a potential route through which microorganisms from the periphery could potentially access the central nervous system. Our previous studies demonstrated that if the olfactory epithelium was damaged, bacteria administered into the nasal cavity induced nitric oxide production in olfactory ensheathing cells. This study investigates the cytokine profile of olfactory tissues as a consequence of bacterial challenge and establishes whether or not the bacteria are able to reach the olfactory bulb in the central nervous system. Methods The olfactory epithelium of C57BL/6 mice was damaged by unilateral Triton X-100 nasal washing, and Staphylococcus aureus was administered ipsilaterally 4 days later. Olfactory mucosa and bulb were harvested 6 h, 24 h and 5 days after inoculation and their cytokine profile compared to control tissues. The fate of S. aureus and the response of bulbar microglia were examined using fluorescence microscopy and transmission electron microscopy. Results In the olfactory mucosa, administered S. aureus was present in supporting cells of the olfactory epithelium, and macrophages and olfactory nerve bundles in the lamina propria. Fluorescein isothiocyanate-conjugated S. aureus was observed within the olfactory mucosa and bulb 6 h after inoculation, but remained restricted to the peripheral layers up to 5 days later. At the 24-h time point, the level of interleukin-6 (IL-6) and tumour necrosis factor-α in the compromised olfactory tissues challenged with bacteria (12,466 ± 956 pg/ml and 552 ± 193 pg/ml, respectively) was significantly higher than that in compromised olfactory tissues alone (6,092 ± 1,403 pg/ml and 80 ± 2 pg/ml, respectively). Immunohistochemistry confirmed that IL-6 was present in several cell types including olfactory ensheathing cells and mitral cells of the olfactory bulb. Concurrently, there was a 4.4-, 4.5- and 2.8-fold increase in the density of i

  17. Determining Whether a Definitive Causal Relationship Exists Between Aripiprazole and Tardive Dyskinesia and/or Dystonia in Patients With Major Depressive Disorder, Part 4: Case Report Data.

    PubMed

    Macaluso, Matthew; Flynn, Alexandra; Preskorn, Sheldon

    2016-05-01

    preexisting TD with aripiprazole treatment. On the basis of the case reports from the medical literature, the potential or raw incidence of TD during "real-world" treatment with aripiprazole was 0.0000062 (37 out of the 6 million individuals who had been treated with aripiprazole in the United States as of 2013 according to a report from Otsuka). A query of the FAERS yielded 312 cases of TD in which aripiprazole was the primary suspect. On the basis of the FAERS data and again assuming 6 million individuals exposed to aripiprazole, this yields a raw incidence of 0.000052 (312 out of 6 million) for TD in patients treated with aripiprazole. However, these estimates have limitations because they are based on anecdotal reports and pharmacovigilance data and, thus, the events themselves were not confirmed or verified in a systematic way. Further, the figure of 6 million people exposed to aripiprazole was based on data reported to the authors by the drug's manufacturer and only applies to exposure in the United States. The final column in this 5-part series will discuss the types of prohibitively expensive and logistically difficult studies that would be needed to determine whether a definitive causal relationship between aripiprazole and TD exists. PMID:27123800

  18. Impaired blood supply in the colonic anastomosis in mice compromises healing.

    PubMed

    Pommergaard, Hans-Christian; Achiam, Michael Patrick; Burcharth, Jakob; Rosenberg, Jacob

    2015-01-01

    Colon anastomotic leakage has a multifactorial etiology and ischemia is considered one of the most important single factors. However, no existing animal models have established a direct link between ischemia and anastomotic leakage. The aim of this study was to establish a model of colon anastomotic leakage as a result of tissue ischemia. In colon anastomoses of 53 C57BL/6 mice, varying degrees of ischemia were induced. Supplying vessels were divided with bipolar coagulation in order to reduce anastomotic breaking strength and create clinical anastomotic leakage. Breaking strength of all the ischemic anastomoses were significantly lower compared with controls. Increasing ischemia resulted in higher rates of large bowel obstruction without creating anastomotic leakage. Healing was compromised as a result of impaired blood supply. However, clinical leakage was absent. Pure ischemia in otherwise healthy experimental animals may be too simple of an approach to create clinical leakage. PMID:25594642

  19. Bringing stakeholders together for urban health equity: hallmarks of a compromised process.

    PubMed

    Katz, Amy S; Cheff, Rebecca M; O'Campo, Patricia

    2015-01-01

    There is a global trend towards the use of ad hoc participation processes that seek to engage grassroots stakeholders in decisions related to municipal infrastructure, land use and services. We present the results of a scholarly literature review examining 14 articles detailing specific cases of these processes to contribute to the discussion regarding their utility in advancing health equity. We explore hallmarks of compromised processes, potential harms to grassroots stakeholders, and potential mitigating factors. We conclude that participation processes often cut off participation following the planning phase at the point of implementation, limiting convener accountability to grassroots stakeholders, and, further, that where participation processes yield gains, these are often due to independent grassroots action. Given the emphasis on participation in health equity discourse, this study seeks to provide a real world exploration of the pitfalls and potential harms of participation processes that is relevant to health equity theory and practice. PMID:26590020

  20. The potential for sexual transmission to compromise control of Ebola virus outbreaks.

    PubMed

    Vinson, John E; Drake, John M; Rohani, Pejman; Park, Andrew W

    2016-06-01

    Recent evidence suggests that sexual contact may give rise to transmission of Ebola virus long after infection has been cleared from blood. We develop a simple mathematical model that incorporates contact transmission and sexual transmission parametrized from data relating to the 2013-2015 West African Ebola epidemic. The model explores scenarios where contact transmission is reduced following infection events, capturing behaviour change, and quantifies how these actions reducing transmission may be compromised by sexual transmission in terms of increasing likelihood, size and duration of outbreaks. We characterize the extent to which sexual transmission operates in terms of the probability of initial infection resolving to sexual infectiousness and the sexual transmission rate, and relate these parameters to the overall case burden. We find that sexual transmission can have large effects on epidemic dynamics (increasing attack ratios from 25% in scenarios without sexual transmission but with contact-transmission-reducing behaviour, up to 80% in equivalent scenarios with sexual transmission). PMID:27277951

  1. Is conceptual understanding compromised by a problem-solving emphasis in an introductory physics course?

    NASA Astrophysics Data System (ADS)

    Ridenour, J.; Feldman, G.; Teodorescu, R.; Medsker, L.; Benmouna, N.

    2013-01-01

    Developing competency in problem solving and enhancing conceptual understanding are primary objectives in introductory physics, and many techniques and tools are available to help instructors achieve them. Pedagogically, we use an easy-to-implement intervention, the ACCESS protocol, to develop and assess problem-solving skills in our SCALE-UP classroom environment for algebra-based physics. Based on our research and teaching experience, an important question has emerged: while primarily targeting improvements in problem-solving and cognitive development, is it necessary that conceptual understanding be compromised? To address this question, we gathered and analyzed information about student abilities, backgrounds, and instructional preferences. We report on our progress and give insights into matching the instructional tools to student profiles in order to achieve optimal learning in group-based active learning. The ultimate goal of our work is to integrate individual student learning needs into a pedagogy that moves students closer to expert-like status in problem solving.

  2. Five-Year Volumetric Evaluation of Periodontally Compromised Sites Restored by Immediate Implant Restorations.

    PubMed

    Tripodakis, Aris Petros; Gousias, Hercules; Mastoris, Michael; Likouresis, Dionysios

    2016-01-01

    The aim of the present study was the retrospective evaluation of the distance of the labial hard and soft tissue margins from the implant shoulder in 24 periodontally compromised sites that were restored by immediate implant restorations. Volumetric analysis was performed 5 years postoperatively using cone beam computed tomography with limited field of view. In all cases, a labial radiopaque plate component was apparent 5 years postoperatively coronal to the implant shoulder (3.1 ± 0.6 mm), supporting the soft tissue margin, which was extending above this level (5.2 ± 1.1 mm). In 12 of the sites, preoperative evaluation showed that this plate was missing at the time of implant placement. PMID:27560669

  3. [Strategies of power and leadership for the development of nurses' social compromise].

    PubMed

    Alberdi Castell, R

    1998-01-01

    This article presents an analysis about power and leadership regarding the nursing profession in Spain and poses some strategies which, from the aforementioned perspective, allow the compromise nurses have with society to develop. This article has three sections: one which defines terms such as power, leadership, representative, corporation, ...; a second section which analyzes and makes proposals, wherein the current situation of the nursing profession is described in relation with the elements defined as the shapers of professional power, and proposals are posed along the lines of one to demand clear guidelines for nurses' professional role, to act in a "corporational" way, in positive terms, or to recognize the importance "informal" power networks hold; and finally, a section of conclusions. PMID:9739285

  4. Natural physical and biological processes compromise the long-term performance of compacted soil caps

    SciTech Connect

    Smith, E.D.

    1995-12-01

    Compacted soil barriers are components of essentially all caps placed on closed waste disposal sites. The intended functions of soil barriers in waste facility caps include restricting infiltration of water and release of gases and vapors, either independently or in combination with synthetic membrane barriers, and protecting other manmade or natural barrier components. Review of the performance of installed soil barriers and of natural processes affecting their performance indicates that compacted soil caps may function effectively for relatively short periods (years to decades), but natural physical and biological processes can be expected to cause them to fail in the long term (decades to centuries). This paper addresses natural physical and biological processes that compromise the performance of compacted soil caps and suggests measures that may reduce the adverse consequences of these natural failure mechanisms.

  5. Artemisinin mimics calorie restriction to trigger mitochondrial biogenesis and compromise telomere shortening in mice

    PubMed Central

    Wu, Ming; Li, Si-Ming; Gao, Qian

    2015-01-01

    Calorie restriction is known to extend lifespan among organisms by a debating mechanism underlying nitric oxide-driven mitochondrial biogenesis. We report here that nitric oxide generators including artemisinin, sodium nitroprusside, and L-arginine mimics calorie restriction and resembles hydrogen peroxide to initiate the nitric oxide signaling cascades and elicit the global antioxidative responses in mice. The large quantities of antioxidant enzymes are correlated with the low levels of reactive oxygen species, which allow the down-regulation of tumor suppressors and accessory DNA repair partners, eventually leading to the compromise of telomere shortening. Accompanying with the up-regulation of signal transducers and respiratory chain signatures, mitochondrial biogenesis occurs with the elevation of adenosine triphosphate levels upon exposure of mouse skeletal muscles to the mimetics of calorie restriction. In conclusion, calorie restriction-triggered nitric oxide provides antioxidative protection and alleviates telomere attrition via mitochondrial biogenesis, thereby maintaining chromosomal stability and integrity, which are the hallmarks of longevity. PMID:25780774

  6. Airway compromise in the fetus and neonate: Prenatal assessment and perinatal management.

    PubMed

    Ryan, Greg; Somme, Stig; Crombleholme, Timothy M

    2016-08-01

    The fetus with a potentially obstructed airway can be identified on routine antenatal imaging. These cases should be referred to fetal care centers, which have the necessary expertise to fully evaluate and manage these fetuses and neonates appropriately. Complete airway obstruction may result in fetal hydrops and intrauterine demise. If a newborn infant has a compromised airway at delivery, the inability to secure its airway quickly may result in a hypoxic cerebral insult or death. In the most severely affected cases, prenatal, perinatal, or postnatal surgical intervention may be necessary. The timing of such an intervention will depend on the exact cause of the airway obstruction, other associated findings and the anticipated difficulty in establishing an airway at delivery. Fetal ultrasound and magnetic resonance imaging can differentiate between intrinsic and extrinsic airway obstruction, which allows for the optimal planning and management of the delivery and neonatal resuscitation. PMID:27084444

  7. β-Cell Ca(2+) dynamics and function are compromised in aging.

    PubMed

    Barker, Christopher J; Li, Luosheng; Köhler, Martin; Berggren, Per-Olof

    2015-01-01

    Defects in pancreatic β-cell function and survival are key components in type 2 diabetes (T2D). An age-dependent deterioration in β-cell function has also been observed, but little is known about the molecular mechanisms behind this phenomenon. Our previous studies indicate that the regulation of cytoplasmic free Ca(2+) concentration ([Ca(2+)]i) may be critical and that this is dependent on the proper function of the mitochondria. The [Ca(2+)]i dynamics of the pancreatic β-cell are driven by an interplay between glucose-induced influx of extracellular Ca(2+) via voltage-dependent Ca(2+) channels and the inositol 1,4,5-trisphosphate (Ins(1,4,5)P3)-mediated liberation of Ca(2+) from intracellular stores. Our previous work has indicated a direct relationship between disruption of Ins(1,4,5)P3-mediated Ca(2+) regulation and loss of β-cell function, including disturbed [Ca(2+)]i dynamics and compromised insulin secretion. To investigate these processes in aging we used three mouse models, a premature aging mitochondrial mutator mouse, a mature aging phenotype (C57BL/6) and an aging-resistant phenotype (129). Our data suggest that age-dependent impairment in mitochondrial function leads to modest changes in [Ca(2+)]i dynamics in mouse β-cells, particularly in the pattern of [Ca(2+)]i oscillations. These changes are driven by modifications in both PLC/Ins(1,4,5)P3-mediated Ca(2+) mobilization from intracellular stores and decreased β-cell Ca(2+) influx over the plasma membrane. Our findings underscore an important concept, namely that even relatively small, time-dependent changes in β-cell signal-transduction result in compromised insulin release and in a diabetic phenotype. PMID:25282681

  8. Do low-income lone mothers compromise their nutrition to feed their children?

    PubMed Central

    McIntyre, Lynn; Glanville, N. Theresa; Raine, Kim D.; Dayle, Jutta B.; Anderson, Bonnie; Battaglia, Noreen

    2003-01-01

    Background Women who live in disadvantaged circumstances in Canada exhibit dietary intakes below recommended levels, but their children often do not. One reason for this difference may be that mothers modify their own food intake to spare their children nutritional deprivation. The objective of our study was to document whether or not low-income lone mothers compromise their own diets to feed their children. Methods We studied 141 low-income lone mothers with at least 2 children under the age of 14 years who lived in Atlantic Canada. Women were identified through community organizations using a variety of recruitment strategies. The women were asked weekly for 1 month to recall their food intake over the previous 24 hours; they also reported their children's (n = 333) food intake. Mothers also completed a questionnaire about “food insecurity,” that is, a lack of access to adequate, nutritious food through socially acceptable means, during each interview. Results Household food insecurity was reported by 78% of mothers during the study month. Mothers' dietary intakes and the adequacy of intake were consistently poorer than their children's intake overall and over the course of a month. The difference in adequacy of intake between mothers and children widened from Time 1, when the family had the most money to purchase food, to Time 4, when the family had the least money. The children experienced some improvement in nutritional intake at Time 3, which was possibly related to food purchases for them associated with receipt of the Child Tax Benefit Credit or the Goods and Services Tax Credit. Interpretation Our study demonstrates that low-income lone mothers compromise their own nutritional intake in order to preserve the adequacy of their children's diets. PMID:12642423

  9. Ionoregulatory Aspects of the Osmorespiratory Compromise during Acute Environmental Hypoxia in 12 Tropical and Temperate Teleosts.

    PubMed

    Robertson, Lisa M; Val, Adalberto Luis; Almeida-Val, Vera F; Wood, Chris M

    2015-01-01

    In the traditional osmorespiratory compromise, as seen in the hypoxia-intolerant freshwater rainbow trout (Oncorhynchus mykiss), the branchial modifications that occur to improve O2 uptake during hypoxia result in unfavorable increases in the fluxes of ions and water. However, at least one hypoxia-tolerant freshwater species, the Amazonian oscar (Astronotus ocellatus), shows exactly the opposite: decreased branchial flux rates of ions, water, and nitrogenous wastes during acute hypoxia. In order to find out whether the two strategies were widespread, we used a standard 2-h normoxia, 2-h hypoxia (20%-30% saturation), 2-h normoxic recovery protocol to survey 10 other phylogenetically diverse tropical and temperate species. Unidirectional influx and efflux rates of Na(+) and net flux rates of K(+), ammonia, and urea-N were measured. The flux reduction strategy was seen only in one additional species, the Amazonian tambaqui (Colossoma macropomum), which is similarly hypoxia tolerant and lives in the same ion-poor waters as the oscar. However, five other species exhibited evidence of the increased flux rates typical of the traditional osmorespiratory compromise in the trout: the rosaceu tetra (Hyphessobrycon bentosi rosaceus), the moenkhausia tetra (Moenkhausia diktyota), the bluegill sunfish (Lepomis macrochirus), the zebra fish (Danio rerio), and the goldfish (Carassius auratus). Four other species exhibited no marked flux changes during hypoxia: the cardinal tetra (Paracheirodon axelrodi), the hemigrammus tetra (Hemigrammus rhodostomus), the pumpkinseed sunfish (Lepomis gibbosus), and the Atlantic killifish (Fundulus heteroclitus). Overall, a diversity of strategies exist; we speculate that these may be linked to differences in habitat and/or lifestyle. PMID:26052633

  10. The impact of nurse prescribing on patients with osteoarthritis.

    PubMed

    Creedon, Rena; Weathers, Elizabeth

    2011-08-01

    Osteoarthritis (OA) is now considered one of the ten most disabling diseases in developed countries and it is estimated that worldwide, 18% of women and 9.6% of men aged over 60, suffer from OA. It is, therefore, vital to take into consideration the demographics of this disorder, including the health needs of this age group and associated problems, such as reduced mobility or immobility and the inability to perform everyday tasks associated with chronic pain. Older patients, however, are sometimes able to accept their condition and adopt a positive outlook towards their OA as a coping strategy. This association with and acceptance of pain by the patient as a normal part of the ageing process may compromise the patient's ability to undertake activities of daily living and impact their psychological wellbeing. PMID:21841633

  11. Compromising economic cost and air pollutant emissions of municipal solid waste management strategies by fuzzy multiobjective optimization model.

    PubMed

    Chang, Yao-Jen; Lin, Min-Der

    2013-06-01

    Municipal solid waste management (MSWM) is an important environmental challenge and subject in urban planning. A sustainable MSWM strategy should consider not only economic efficiency but also life-cycle assessment of environmental impact. This study employs the fuzzy multiobjective linear programming (FMOLP) technique to find the optimal compromise between economic optimization and pollutant emission reduction for the MSWM strategy. Taichung City in Taiwan is evaluated as a case study. The results indicate that the optimal compromise MSWM strategy can reduce significant amounts of pollutant emissions and still achieve positive net profits. Minimization of the sulfur oxide (SOx) and nitrogen oxide (NOx) emissions are the two major priorities in achieving this optimal compromise strategy when recyclables recovery rate is lower; however minimization of the carbon monoxide (CO) and particulate matter (PM) emissions become priority factors when recovery rate is higher. PMID:23858997

  12. 38 CFR 1.903 - Settlement, waiver, or compromise under other statutory or regulatory authority.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Code (Claims of the United States Government) and the standards in Title 31 CFR parts 900 through 904... regulations, 28 CFR part 43. In such cases, the laws and regulations that are specifically applicable to claims collection activities of VA generally take precedence over 31 CFR parts 900 through...

  13. 38 CFR 1.903 - Settlement, waiver, or compromise under other statutory or regulatory authority.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... Code (Claims of the United States Government) and the standards in Title 31 CFR parts 900 through 904... regulations, 28 CFR part 43. In such cases, the laws and regulations that are specifically applicable to claims collection activities of VA generally take precedence over 31 CFR parts 900 through...

  14. 38 CFR 1.903 - Settlement, waiver, or compromise under other statutory or regulatory authority.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... Code (Claims of the United States Government) and the standards in Title 31 CFR parts 900 through 904... regulations, 28 CFR part 43. In such cases, the laws and regulations that are specifically applicable to claims collection activities of VA generally take precedence over 31 CFR parts 900 through...

  15. 38 CFR 1.903 - Settlement, waiver, or compromise under other statutory or regulatory authority.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... Code (Claims of the United States Government) and the standards in Title 31 CFR parts 900 through 904... regulations, 28 CFR part 43. In such cases, the laws and regulations that are specifically applicable to claims collection activities of VA generally take precedence over 31 CFR parts 900 through...

  16. 38 CFR 1.903 - Settlement, waiver, or compromise under other statutory or regulatory authority.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... Code (Claims of the United States Government) and the standards in Title 31 CFR parts 900 through 904... regulations, 28 CFR part 43. In such cases, the laws and regulations that are specifically applicable to claims collection activities of VA generally take precedence over 31 CFR parts 900 through...

  17. Sirukumab, a human anti-interleukin-6 monoclonal antibody: a randomised, 2-part (proof-of-concept and dose-finding), phase II study in patients with active rheumatoid arthritis despite methotrexate therapy

    PubMed Central

    Smolen, Josef S; Weinblatt, Michael E; Sheng, Shihong; Zhuang, Yanli; Hsu, Benjamin

    2014-01-01

    Objectives The safety and efficacy of sirukumab, an anti-interleukin-6 (IL-6) monoclonal antibody, were evaluated in a 2-part, placebo-controlled phase II study of patients with active rheumatoid arthritis (RA) despite methotrexate therapy. Methods In Part A (proof-of-concept), 36 patients were randomised to placebo or sirukumab 100 mg every 2 weeks (q2w) through week 10, with crossover treatment during weeks 12–22. In Part B (dose finding), 151 patients were randomised to sirukumab (100 mg q2w, 100 mg q4w, 50 mg q4w, or 25 mg q4w) through week 24, or placebo through week 10 with crossover to sirukumab 100 mg q2w (weeks 12–24). The proportion of patients with an American College of Rheumatology 50 (ACR50) response and the change from baseline in the 28-joint count disease activity score using C-reactive protein (DAS28-CRP) were determined. Safety was evaluated through week 38 in both parts. Results The primary endpoint (ACR50 at week 12 in Part B) was achieved only with sirukumab 100 mg q2w versus placebo (26.7% vs 3.3%; p=0.026). Greater improvements in mean DAS28-CRP at week 12 were observed with sirukumab 100 mg q2w versus placebo in Parts A (2.1 vs 0.6, p<0.001) and B (2.2 vs 1.1; p<0.001). The incidence of adverse events (AEs) was similar for sirukumab-treated and placebo-treated patients through week 12 in Part A (70.6% and 63.2%, respectively) and B (67.8% and 66.7%, respectively). Infections were the most common type of AE; one death occurred (Part B, sirukumab 100 mg q2w, brain aneurysm). Conclusions Sirukumab-treated patients experienced improvements in the signs/symptoms of RA. Safety results through 38 weeks were consistent with other IL-6 inhibitors. Trial registration number NCT00718718. PMID:24699939

  18. The Immediate Aesthetic and Functional Restoration of Maxillary Incisors Compromised by Periodontitis Using Short Implants with Single Crown Restorations: A Minimally Invasive Approach and Five-Year Follow-Up

    PubMed Central

    Marincola, Mauro; Lombardo, Giorgio; Pighi, Jacopo; Corrocher, Giovanni; Mascellaro, Anna; Lehrberg, Jeffrey; Nocini, Pier Francesco

    2015-01-01

    The functional and aesthetic restoration of teeth compromised due to aggressive periodontitis presents numerous challenges for the clinician. Horizontal bone loss and soft tissue destruction resulting from periodontitis can impede implant placement and the regeneration of an aesthetically pleasing gingival smile line, often requiring bone augmentation and mucogingival surgery, respectively. Conservative approaches to the treatment of aggressive periodontitis (i.e., treatments that use minimally invasive tools and techniques) have been purported to yield positive outcomes. Here, we report on the treatment and five-year follow-up of patient suffering from aggressive periodontitis using a minimally invasive surgical technique and implant system. By using the methods described herein, we were able to achieve the immediate aesthetic and functional restoration of the maxillary incisors in a case that would otherwise require bone augmentation and extensive mucogingival surgery. This technique represents a conservative and efficacious alternative to the aesthetic and functional replacement of teeth compromised due to aggressive periodontitis. PMID:26649207

  19. Compromising the 19S proteasome complex protects cells from reduced flux through the proteasome

    PubMed Central

    Tsvetkov, Peter; Mendillo, Marc L; Zhao, Jinghui; Carette, Jan E; Merrill, Parker H; Cikes, Domagoj; Varadarajan, Malini; van Diemen, Ferdy R; Penninger, Josef M; Goldberg, Alfred L; Brummelkamp, Thijn R; Santagata, Sandro; Lindquist, Susan

    2015-01-01

    Proteasomes are central regulators of protein homeostasis in eukaryotes. Proteasome function is vulnerable to environmental insults, cellular protein imbalance and targeted pharmaceuticals. Yet, mechanisms that cells deploy to counteract inhibition of this central regulator are little understood. To find such mechanisms, we reduced flux through the proteasome to the point of toxicity with specific inhibitors and performed genome-wide screens for mutations that allowed cells to survive. Counter to expectation, reducing expression of individual subunits of the proteasome's 19S regulatory complex increased survival. Strong 19S reduction was cytotoxic but modest reduction protected cells from inhibitors. Protection was accompanied by an increased ratio of 20S to 26S proteasomes, preservation of protein degradation capacity and reduced proteotoxic stress. While compromise of 19S function can have a fitness cost under basal conditions, it provided a powerful survival advantage when proteasome function was impaired. This means of rebalancing proteostasis is conserved from yeast to humans. DOI: http://dx.doi.org/10.7554/eLife.08467.001 PMID:26327695

  20. An adaptive compromise programming method for multi-objective path optimization

    NASA Astrophysics Data System (ADS)

    Li, Rongrong; Leung, Yee; Lin, Hui; Huang, Bo

    2013-04-01

    Network routing problems generally involve multiple objectives which may conflict one another. An effective way to solve such problems is to generate a set of Pareto-optimal solutions that is small enough to be handled by a decision maker and large enough to give an overview of all possible trade-offs among the conflicting objectives. To accomplish this, the present paper proposes an adaptive method based on compromise programming to assist decision makers in identifying Pareto-optimal paths, particularly for non-convex problems. This method can provide an unbiased approximation of the Pareto-optimal alternatives by adaptively changing the origin and direction of search in the objective space via the dynamic updating of the largest unexplored region till an appropriately structured Pareto front is captured. To demonstrate the efficacy of the proposed methodology, a case study is carried out for the transportation of dangerous goods in the road network of Hong Kong with the support of geographic information system. The experimental results confirm the effectiveness of the approach.