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Sample records for committee current concepts

  1. Non-contact ACL injuries in female athletes: an International Olympic Committee current concepts statement

    PubMed Central

    Renstrom, P; Ljungqvist, A; Arendt, E; Beynnon, B; Fukubayashi, T; Garrett, W; Georgoulis, T; Hewett, T E; Johnson, R; Krosshaug, T; Mandelbaum, B; Micheli, L; Myklebust, G; Roos, E; Roos, H; Schamasch, P; Shultz, S; Werner, S; Wojtys, E; Engebretsen, L

    2014-01-01

    The incidence of anterior cruciate ligament (ACL) injury remains high in young athletes. Because female athletes have a much higher incidence of ACL injuries in sports such as basketball and team handball than male athletes, the IOC Medical Commission invited a multidisciplinary group of ACL expert clinicians and scientists to (1) review current evidence including data from the new Scandinavian ACL registries; (2) critically evaluate high-quality studies of injury mechanics; (3) consider the key elements of successful prevention programmes; (4) summarise clinical management including surgery and conservative management; and (5) identify areas for further research. Risk factors for female athletes suffering ACL injury include: (1) being in the preovulatory phase of the menstrual cycle compared with the postovulatory phase; (2) having decreased intercondylar notch width on plain radiography; and (3) developing increased knee abduction moment (a valgus intersegmental torque) during impact on landing. Well-designed injury prevention programmes reduce the risk of ACL for athletes, particularly women. These programmes attempt to alter dynamic loading of the tibiofemoral joint through neuromuscular and proprioceptive training. They emphasise proper landing and cutting techniques. This includes landing softly on the forefoot and rolling back to the rearfoot, engaging knee and hip flexion and, where possible, landing on two feet. Players are trained to avoid excessive dynamic valgus of the knee and to focus on the “knee over toe position” when cutting. PMID:18539658

  2. Non-contact ACL injuries in female athletes: an International Olympic Committee current concepts statement.

    PubMed

    Renstrom, P; Ljungqvist, A; Arendt, E; Beynnon, B; Fukubayashi, T; Garrett, W; Georgoulis, T; Hewett, T E; Johnson, R; Krosshaug, T; Mandelbaum, B; Micheli, L; Myklebust, G; Roos, E; Roos, H; Schamasch, P; Shultz, S; Werner, S; Wojtys, E; Engebretsen, L

    2008-06-01

    The incidence of anterior cruciate ligament (ACL) injury remains high in young athletes. Because female athletes have a much higher incidence of ACL injuries in sports such as basketball and team handball than male athletes, the IOC Medical Commission invited a multidisciplinary group of ACL expert clinicians and scientists to (1) review current evidence including data from the new Scandinavian ACL registries; (2) critically evaluate high-quality studies of injury mechanics; (3) consider the key elements of successful prevention programmes; (4) summarise clinical management including surgery and conservative management; and (5) identify areas for further research. Risk factors for female athletes suffering ACL injury include: (1) being in the preovulatory phase of the menstrual cycle compared with the postovulatory phase; (2) having decreased intercondylar notch width on plain radiography; and (3) developing increased knee abduction moment (a valgus intersegmental torque) during impact on landing. Well-designed injury prevention programmes reduce the risk of ACL for athletes, particularly women. These programmes attempt to alter dynamic loading of the tibiofemoral joint through neuromuscular and proprioceptive training. They emphasise proper landing and cutting techniques. This includes landing softly on the forefoot and rolling back to the rearfoot, engaging knee and hip flexion and, where possible, landing on two feet. Players are trained to avoid excessive dynamic valgus of the knee and to focus on the "knee over toe position" when cutting.

  3. Current Concepts in Conception Control

    PubMed Central

    Ringrose, C. A. Douglas

    1963-01-01

    The progressive increase in world population has become a most urgent global problem in recent years. Man has, however, been interested in controlling his reproductivity at the family level for many centuries. Historical aspects of this saga are reviewed. The modern era of conception control was ushered in by Makepeace et al. in 1937 when ovulation inhibition by progesterone was demonstrated. Confirmation of this by Pincus and associates, and development of the potent oral progestational agents, the 19-norsteroids, have made efficient reliable contraception a reality. Experience with one of these agents (Ortho-Novum, 2 mg.) in 115 patients through 805 cycles is presented. Conception control was 100% effective at this dosage. Side effects were minimal. Only three of the women discontinued the tablets because of these effects. All but five in this group of 115 preferred the oral contraceptives to methods previously employed. PMID:13973987

  4. Football injuries: current concepts.

    PubMed

    Olson, David E; Sikka, Robby Singh; Hamilton, Abigail; Krohn, Austin

    2011-01-01

    Football is one of the most popular sports in the United States and is the leading cause of sports-related injury. A large focus in recent years has been on concussions, sudden cardiac death, and heat illness, all thought to be largely preventable health issues in the young athlete. Injury prevention through better understanding of injury mechanisms, education, proper equipment, and practice techniques and preseason screening may aid in reducing the number of injuries. Proper management of on-field injuries and health emergencies can reduce the morbidity associated with these injuries and may lead to faster return to play and reduced risk of future injury. This article reviews current concepts surrounding frequently seen football-related injuries.

  5. HIV Disease: Current Concepts.

    ERIC Educational Resources Information Center

    Keeling, Richard P.

    1993-01-01

    Describes human immunodeficiency virus (HIV), newly characterized human retrovirus which causes chronic, progressive, immune deficiency disease, the most severe phase of which is Acquired Immune Deficiency Syndrome (AIDS). Reviews most important current epidemiologic, clinical, and virologic information about HIV and HIV disease and provides…

  6. HIV Disease: Current Concepts.

    ERIC Educational Resources Information Center

    Keeling, Richard P.

    1993-01-01

    Describes human immunodeficiency virus (HIV), newly characterized human retrovirus which causes chronic, progressive, immune deficiency disease, the most severe phase of which is Acquired Immune Deficiency Syndrome (AIDS). Reviews most important current epidemiologic, clinical, and virologic information about HIV and HIV disease and provides…

  7. Transgender youth: current concepts

    PubMed Central

    2016-01-01

    In many countries throughout the world, increasing numbers of gender nonconforming/transgender youth are seeking medical services to enable the development of physical characteristics consistent with their experienced gender. Such medical services include use of agents to block endogenous puberty at Tanner stage II with subsequent use of cross-sex hormones, and are based on longitudinal studies demonstrating that those individuals who were first identified as gender dysphoric in early or middle childhood and continue to meet the mental health criteria for being transgender at early puberty are likely to be transgender as adults. This review addresses terms and definitions applicable to gender nonconforming youth, studies that shed light on the biologic determinants of gender identity, current clinical practice guidelines for transgender youth, challenges to optimal care, and priorities for research. PMID:28164070

  8. Current concepts in anal fissures.

    PubMed

    Ayantunde, Abraham A; Debrah, Samuel A

    2006-12-01

    Anal fissure is a common and distressing problem the true incidence of which is probably higher than recorded. There is a progressive understanding of the etiopathogenesis of this entity and the changing trend in its management approach. This is a systematic review of available published literature looking at current management options in anal fissures. A MEDLINE-based search of the relevant literature from 1970 to 2004 was performed on the current concepts in etiopathogenesis and management of anal fissure. The current opinion is a drift toward conservative measures as the first- and second-line approaches rather than surgery for treatment of anal fissure. Simple and readily available measures with less complication, good patient compliance, and satisfaction requiring no hospitalization should first be considered. Most anal fissures heal with medical therapy, but their limitations include side effects, poor compliance, and recurrence of the fissure. A cautious surgical approach is required to treat those who do not respond to medical therapy.

  9. Current Concepts of Maternal Nutrition

    PubMed Central

    Lowensohn, Richard I.; Stadler, Diane D.; Naze, Christie

    2016-01-01

    Background A nutrient-rich maternal diet before and during pregnancy is associated with improved fetal health, more appropriate birth weight, and increased rates of maternal and infant survival. Physicians need a better understanding of the role of diet in shaping fetal outcomes. Given this background, we reviewed and summarized articles on maternal nutrition found in MEDLINE since 1981, written in English, and limited to human subjects. For the Offspring Maternal diets high in sugar and fat lead to an increased incidence of metabolic syndrome, diabetes, and cardiovascular disease later in life. Folic acid should be supplemented prior to conception and continued through at least the first 28 days of fetal life to prevent neural tube defects, and vitamin C should be given to women who smoke to lower the incidence of asthma and wheezing in the children. Iodine deficiency is increasing, and iodine should be included in prenatal supplements. If the maternal hemoglobin is 7 g/dL or more, there is no evidence that iron supplementation is needed. Fish intake during pregnancy is protective against atopic outcomes, whereas high-meat diets contribute to elevated adult blood pressure and hypersecretion of cortisol. For the Mother Calcium supplementation lowers the risk of preeclampsia and hypertensive disease in pregnancy. Conclusions Given the limits of our current knowledge, a diet rich in whole grains, fruits, vegetables, and selected fish is desirable for the best outcomes. Diets high in sugar and fat lead to higher rates of diabetes, metabolic syndrome, and cardiovascular disease. Folic acid, iodine, and calcium in all pregnant women and vitamin C in smokers are the only supplements so far shown to be of value for routine use. The physician treating a pregnant woman should be ready to advise a healthy diet for the benefit of the fetus. Target Audience Obstetricians and gynecologists, family physicians Learning Objectives After participating in this activity, the

  10. Current concepts in rectal cancer.

    PubMed

    Fleshman, James W; Smallwood, Nathan

    2015-03-01

    The history of rectal cancer management informs current therapy and points us in the direction of future improvements. Multidisciplinary team management of rectal cancer will move us to personalized treatment for individuals with rectal cancer in all stages.

  11. Marijuana: current concepts(†).

    PubMed

    Greydanus, Donald E; Hawver, Elizabeth K; Greydanus, Megan M; Merrick, Joav

    2013-10-10

    Marijuana (cannabis) remains a controversial drug in the twenty-first century. This paper considers current research on use of Cannabis sativa and its constituents such as the cannabinoids. Topics reviewed include prevalence of cannabis (pot) use, other drugs consumed with pot, the endocannabinoid system, use of medicinal marijuana, medical adverse effects of cannabis, and psychiatric adverse effects of cannabis use. Treatment of cannabis withdrawal and dependence is difficult and remains mainly based on psychological therapy; current research on pharmacologic management of problems related to cannabis consumption is also considered. The potential role of specific cannabinoids for medical benefit will be revealed as the twenty-first century matures. However, potential dangerous adverse effects from smoking marijuana are well known and should be clearly taught to a public that is often confused by a media-driven, though false message and promise of benign pot consumption.

  12. Current concepts of severe asthma.

    PubMed

    Ray, Anuradha; Raundhal, Mahesh; Oriss, Timothy B; Ray, Prabir; Wenzel, Sally E

    2016-07-01

    The term asthma encompasses a disease spectrum with mild to very severe disease phenotypes whose traditional common characteristic is reversible airflow limitation. Unlike milder disease, severe asthma is poorly controlled by the current standard of care. Ongoing studies using advanced molecular and immunological tools along with improved clinical classification show that severe asthma does not identify a specific patient phenotype, but rather includes patients with constant medical needs, whose pathobiologic and clinical characteristics vary widely. Accordingly, in recent clinical trials, therapies guided by specific patient characteristics have had better outcomes than previous therapies directed to any subject with a diagnosis of severe asthma. However, there are still significant gaps in our understanding of the full scope of this disease that hinder the development of effective treatments for all severe asthmatics. In this Review, we discuss our current state of knowledge regarding severe asthma, highlighting different molecular and immunological pathways that can be targeted for future therapeutic development.

  13. Current NASA lunar base concepts

    NASA Technical Reports Server (NTRS)

    Roberts, Barney B.; Connolly, John F.

    1990-01-01

    The NASA Office of Aeronautics, Exploration, and Technology has completed a Systems Engineering and Integration effort to define a point design for an evolving lunar base that supports substantial science, exploration, and resource production objectives. This study addressed the following: systems level design; element requirements and conceptual design; assessments of precursor and technology needs; and operations concepts. The central base is assumed to be located equatorially on the lunar nearside north of the crater Moltke in Mare Tranquilliatis. The study considers an aggressive case with three main phases. The initial Man-Tended Phase established basic enabling facilities that include a modular habitat that periodically houses a crew of four. During the Experimental Phase, the base becomes permanently manned with the construction of a larger habitat that provides augmented workshop and laboratory volumes and housing for crew. The Operational Phase expands base capabilities to a substantially mature level while reducing reliance on Earth. The analysis classifies base characteristics into several major functional areas: Human Systems; Assembly and Construction; Energy Management; Launch and Landing; Surface Transportation; In-Situ Resources Utilization; User Accommodations; and Telecommunications, Navigation, and Information Management. Results of various NASA-sponsored studies were synthesized to meet requirements. The system level architecture was determined, the physical layout was developed from a set of proximity criteria and related functions, and the evlotuionary path of the base was analyzed. Conclusions include a summary of technology needs, design drivers, high leverage items, and important issues.

  14. [Current Concepts of Human Microsporidiosis].

    PubMed

    Timofeev, S A

    2015-01-01

    Microsporidiosis is an ubiquitous opportunistic disease that usually appears in immunocompromised patients: AIDS patients or organ-transplant recipients. The infectious agents of disease are fungi-related obligate intracellular parasites - microsporidia. Alongside with Cryptosporidium and Cytomegalovirus, these parasites are the most common causative agents of diarrhea in HIV-infected patients. Intestinalform of microsporidiosis has been mostfrequently observed, but microsporidia can affect almost any organs of the human body, eyes, lungs, muscles, organs of the nervous system. The present paper overviews the current data on the etiology, pathogenesis, epidemiology, clinical presentation, diagnosis and treatment methods of microsporidiosis.

  15. Myasthenia Gravis—Current Concepts

    PubMed Central

    Herrmann, Christian; Lindstrom, Jon M.; Keesey, John C.; Mulder, Donald G.

    1985-01-01

    An edited summary of an Interdepartmental Conference arranged by the Department of Medicine of the UCLA School of Medicine, Los Angeles. The Director of Conferences is William M. Pardridge, MD, Associate Professor of Medicine. Current findings indicate that autoimmune myasthenia gravis is an acquired immune complex disorder of neuromuscular transmission in voluntary striated muscle. There is a break in immunologic tolerance leading to blocking and degradation of acetylcholine receptors, together with widening of the synaptic cleft associated with partial destruction, simplification and shortening of the postjunctional membrane. Thymic hyperplasia and thymoma may be present. A decremental response to nerve-muscle stimulation, blocking and jitter on single-fiber electromyography and circulating antibodies to acetylcholine receptor are detectable in most patients with generalized weakness. Although the cause of this abnormal immunologic mechanism remains to be discovered, anticholinesterases, corticosteroids, immunosuppressants, plasmapheresis or thymectomy (individually or in combination) provide control and better prognosis in most patients. ImagesFigure 1. PMID:3895751

  16. Burning mouth syndrome: Current concepts.

    PubMed

    Nasri-Heir, Cibele; Zagury, Julyana Gomes; Thomas, Davis; Ananthan, Sowmya

    2015-01-01

    Burning mouth syndrome (BMS) is a chronic pain condition. It has been described by the International Headache Society as "an intra-oral burning or dysesthetic sensation, recurring daily for more than 2 h/day for more than 3 months, without clinically evident causative lesions." BMS is frequently seen in women in the peri-menopausal and menopausal age group in an average female/male ratio of 7:1. The site most commonly affected is the anterior two-thirds of the tongue. The patient may also report taste alterations and oral dryness along with the burning. The etiopathogenesis is complex and is not well-comprehended. The more accepted theories point toward a neuropathic etiology, but the gustatory system has also been implicated in this condition. BMS is frequently mismanaged, partly because it is not well-known among healthcare providers. Diagnosis of BMS is made after other local and systemic causes of burning have been ruled out as then; the oral burning is the disease itself. The management of BMS still remains a challenge. Benzodiazepines have been used in clinical practice as the first-line medication in the pharmacological management of BMS. Nonpharmacological management includes cognitive behavioral therapy and complementary and alternative medicine (CAM). The aim of this review is to familiarize healthcare providers with the diagnosis, pathogenesis, and general characteristics of primary BMS while updating them with the current treatment options to better manage this group of patients.

  17. Burning mouth syndrome: Current concepts

    PubMed Central

    Nasri-Heir, Cibele; Zagury, Julyana Gomes; Thomas, Davis; Ananthan, Sowmya

    2015-01-01

    Burning mouth syndrome (BMS) is a chronic pain condition. It has been described by the International Headache Society as “an intra-oral burning or dysesthetic sensation, recurring daily for more than 2 h/day for more than 3 months, without clinically evident causative lesions.” BMS is frequently seen in women in the peri-menopausal and menopausal age group in an average female/male ratio of 7:1. The site most commonly affected is the anterior two-thirds of the tongue. The patient may also report taste alterations and oral dryness along with the burning. The etiopathogenesis is complex and is not well-comprehended. The more accepted theories point toward a neuropathic etiology, but the gustatory system has also been implicated in this condition. BMS is frequently mismanaged, partly because it is not well-known among healthcare providers. Diagnosis of BMS is made after other local and systemic causes of burning have been ruled out as then; the oral burning is the disease itself. The management of BMS still remains a challenge. Benzodiazepines have been used in clinical practice as the first-line medication in the pharmacological management of BMS. Nonpharmacological management includes cognitive behavioral therapy and complementary and alternative medicine (CAM). The aim of this review is to familiarize healthcare providers with the diagnosis, pathogenesis, and general characteristics of primary BMS while updating them with the current treatment options to better manage this group of patients. PMID:26929531

  18. Frontal Sinus Fractures: Current Concepts

    PubMed Central

    Strong, E. Bradley

    2009-01-01

    Frontal sinus injuries may range from isolated anterior table fractures resulting in a simple aesthetic deformity to complex fractures involving the frontal recess, orbits, skull base, and intracranial contents. The risk of long-term morbidity can be significant. Optimal treatment strategies for the management of frontal sinus fractures remain controversial. However, it is critical to have a thorough understanding of frontal sinus anatomy as well as the current treatment strategies used to manage these injuries. A thorough physical exam and thin-cut, multiplanar (axial, coronal, and sagittal) computed tomography scan should be performed in all patients suspected of having a frontal sinus fracture. The most appropriate treatment strategy can be determined by assessing five anatomic parameters including the: frontal recess, anterior table integrity, posterior table integrity, dural integrity, and presence of a cerebrospinal fluid leak. A well thought out management strategy and meticulous surgical techniques are critical to success. The primary surgical goal is to provide a safe sinus while minimizing patient morbidity. This article offers an anatomically based treatment algorithm for the management of frontal sinus fractures and highlights the key steps to surgical repair. PMID:22110810

  19. Oxygen therapeutics--current concepts.

    PubMed

    Hill, S E

    2001-04-01

    In an effort to develop agents that enhance the oxygen-delivery capability of blood without the risks associated with allogeneic blood transfusions, several products are undergoing development and clinical trials. These oxygen transport agents can be divided into two main groups, perfluorocarbon (PFC) emulsions and modified hemoglobin solutions. Articles from the literature on the development and clinical trials of oxygen therapeutic agents were reviewed. PFCs are synthetic fluorinated hydrocarbons that increase dissolved oxygen in the fluid phase of the blood without binding the oxygen molecule. They enhance oxygen delivery significantly and may be used to augment the technique of intraoperative autologous donation. Two PFC products have been tested in Phase III clinical trials. Hemoglobin-based oxygen carriers (HBOCs) are either cross-linked or microencapsulated hemoglobin molecules. Modification of the human hemoglobin molecule with intra- and inter-molecular cross-linking eliminates renal toxicity and improves the oxygen dissociation characteristics of the molecule. These modifications are necessary because stroma-free hemoglobin (Hb) does not release oxygen in the physiologic range and dissociates into dimers which can be rapidly filtered by the kidney, leading to renal toxicity. In addition to human Hb, bovine hemoglobin is another source of raw material for HBOC products. Recombinant human Hb has also been produced, using an E. coli expression system, for HBOC manufacturing. Four cross-linked hemoglobin products have been tested in Phase III clinical trials. While no product has yet been approved for clinical use, preliminary studies with oxygen therapeutics show promising results, with effective oxygen carrying capacity and acceptable side effect profiles. In the future, the formation of a hybrid product which combines the best features from several of the products currently undergoing development may yield the ideal oxygen therapeutic agent.

  20. Salivary Gland Tumors: Current Concepts and Controversies.

    PubMed

    Seethala, Raja R

    2017-03-01

    This current review focuses on current concepts and controversies for select key salivary gland epithelial neoplasms. Rather than the traditional organization of benign and malignant tumors, this review is structured around select key topics: biphasic tumors, mammary analogue secretory carcinoma, and the controversy surrounding polymorphous low-grade adenocarcinoma and cribriform adenocarcinoma of (minor) salivary gland origin.

  1. Current projects of the National Wind Coordinating Committee

    SciTech Connect

    Rhoads, H.

    1997-12-31

    This paper summarizes the activities of the National Wind Coordinating Committee (NWCC), a multi-stakeholder collaborative formed in 1994 to support the responsible use of wind power in the USA. The NWCC`s vision is a self-sustaining commercial market for wind power - environmentally, economically, and politically sustainable. Current NWCC activities include: outreach initiatives, disseminating information about wind energy to regulators and legislators through the Wind Energy Issue Paper Series, researching distributed wind energy models, producing a wind facility permitting handbook, improving avian research, addressing transmission and resource assessment issues, and exploring sustainable development and marketing approaches.

  2. [Transjugular portosystemic shunt. The current concepts].

    PubMed

    Ferral, H; Alcántara-Peraza, A; Kimura-Fujikami, Y; Castañeda-Zúñiga, W

    1994-01-01

    The transjugular intrahepatic portosystemic shunt (TIPS) is an alternative therapeutic approach in the treatment of hemorrhagic portal hypertension. The use of this procedure was established in 1988 and since then, its use has extended impressively. Currently, the accepted indication for TIPS is the variceal bleeding secondary to portal hypertension refractory to medical management or sclerotherapy. In this paper the basic concepts of the TIPS procedure are reviewed, including historical perspective, technical aspects, indications, contraindications and complications.

  3. Aphasia: Current Concepts in Theory and Practice

    PubMed Central

    Tippett, Donna C.; Niparko, John K.; Hillis, Argye E.

    2014-01-01

    Recent advances in neuroimaging contribute to a new insights regarding brain-behavior relationships and expand understanding of the functional neuroanatomy of language. Modern concepts of the functional neuroanatomy of language invoke rich and complex models of language comprehension and expression, such as dual stream networks. Increasingly, aphasia is seen as a disruption of cognitive processes underlying language. Rehabilitation of aphasia incorporates evidence based and person-centered approaches. Novel techniques, such as methods of delivering cortical brain stimulation to modulate cortical excitability, such as repetitive transcranial magnetic stimulation and transcranial direct current stimulation, are just beginning to be explored. In this review, we discuss the historical context of the foundations of neuroscientific approaches to language. We sample the emergent theoretical models of the neural substrates of language and cognitive processes underlying aphasia that contribute to more refined and nuanced concepts of language. Current concepts of aphasia rehabilitation are reviewed, including the promising role of cortical stimulation as an adjunct to behavioral therapy and changes in therapeutic approaches based on principles of neuroplasticity and evidence-based/person-centered practice to optimize functional outcomes. PMID:24904925

  4. Citrin deficiency and current treatment concepts.

    PubMed

    Saheki, Takeyori; Inoue, Kanako; Tushima, Anmi; Mutoh, Kozo; Kobayashi, Keiko

    2010-01-01

    In this paper, we describe the historical aspects of citrin and citrin deficiency, characteristic food preference and food aversion of citrin-deficient subjects, and carbohydrate toxicity in relation to ureogenesis and issues of the conventional treatment procedures for hyperammonemia in citrin deficiency, leading to current treatment concepts for citrin deficiency. We also emphasize the importance of a citrin deficiency mouse model in elucidating the pathophysiology and developing novel therapeutics based on the pathophysiology, such as sodium pyruvate. Copyright 2010 Elsevier Inc. All rights reserved.

  5. Dementia with Lewy bodies: current concepts.

    PubMed

    Buracchio, Teresa; Arvanitakis, Zoe; Gorbien, Martin

    2005-01-01

    As life expectancy continues to increase over time, dementia is becoming an increasingly more common problem and a major cause of disability in older persons. It is now more important than ever to identify and manage common causes of dementia given variations in disease course, treatments and the possibility for modification of risk factors. Dementia with Lewy bodies (DLB) is a dementia syndrome characterized by progressive cognitive decline, with fluctuating cognition, recurrent detailed and well-formed hallucinations, and parkinsonism. This article aims to provide an overview of current concepts of DLB, including a description of the key clinical features and neuropathology, neurochemistry, and genetics of DLB, then a discussion of the relationship of DLB with Alzheimer's disease and Parkinson's disease, and, finally, a summary of current management strategies available for this disorder.

  6. Carotid Endarterectomy: Current Concepts and Practice Patterns

    PubMed Central

    Saha, Sibu P.; Saha, Subhajit; Vyas, Krishna S.

    2015-01-01

    Background Stroke is the number one cause of disability and third leading cause of death among adults in the United States. A major cause of stroke is carotid artery stenosis (CAS) caused by atherosclerotic plaques. Randomized trials have varying results regarding the equivalence and perioperative complication rates of stents versus carotid endarterectomy (CEA) in the management of CAS. Objectives We review the evidence for the current management of CAS and describe the current concepts and practice patterns of CEA. Methods A literature search was conducted using PubMed to identify relevant studies regarding CEA and stenting for the management of CAS. Results The introduction of CAS has led to a decrease in the percentage of CEA and an increase in the number of CAS procedures performed in the context of all revascularization procedures. However, the efficacy of stents in patients with symptomatic CAS remains unclear because of varying results among randomized trials, but the perioperative complication rates exceed those found after CEA. Conclusions Vascular surgeons are uniquely positioned to treat carotid artery disease through medical therapy, CEA, and stenting. Although data from randomized trials differ, it is important for surgeons to make clinical decisions based on the patient. We believe that CAS can be adopted with low complication rate in a selected subgroup of patients, but CEA should remain the standard of care. This current evidence should be incorporated into practice of the modern vascular surgeon. PMID:26417192

  7. Safety pharmacology--current and emerging concepts.

    PubMed

    Hamdam, Junnat; Sethu, Swaminathan; Smith, Trevor; Alfirevic, Ana; Alhaidari, Mohammad; Atkinson, Jeffrey; Ayala, Mimieveshiofuo; Box, Helen; Cross, Michael; Delaunois, Annie; Dermody, Ailsa; Govindappa, Karthik; Guillon, Jean-Michel; Jenkins, Rosalind; Kenna, Gerry; Lemmer, Björn; Meecham, Ken; Olayanju, Adedamola; Pestel, Sabine; Rothfuss, Andreas; Sidaway, James; Sison-Young, Rowena; Smith, Emma; Stebbings, Richard; Tingle, Yulia; Valentin, Jean-Pierre; Williams, Awel; Williams, Dominic; Park, Kevin; Goldring, Christopher

    2013-12-01

    Safety pharmacology (SP) is an essential part of the drug development process that aims to identify and predict adverse effects prior to clinical trials. SP studies are described in the International Conference on Harmonisation (ICH) S7A and S7B guidelines. The core battery and supplemental SP studies evaluate effects of a new chemical entity (NCE) at both anticipated therapeutic and supra-therapeutic exposures on major organ systems, including cardiovascular, central nervous, respiratory, renal and gastrointestinal. This review outlines the current practices and emerging concepts in SP studies including frontloading, parallel assessment of core battery studies, use of non-standard species, biomarkers, and combining toxicology and SP assessments. Integration of the newer approaches to routine SP studies may significantly enhance the scope of SP by refining and providing mechanistic insight to potential adverse effects associated with test compounds.

  8. Diabetic foot infections: current concept review

    PubMed Central

    Hobizal, Kimberlee B.; Wukich, Dane K.

    2012-01-01

    The purpose of this manuscript is to provide a current concept review on the diagnosis and management of diabetic foot infections which are among the most serious and frequent complications encountered in patients with diabetes mellitus. A literature review on diabetic foot infections with emphasis on pathophysiology, identifiable risk factors, evaluation including physical examination, laboratory values, treatment strategies and assessing the severity of infection has been performed in detail. Diabetic foot infections are associated with high morbidity and risk factors for failure of treatment and classification systems are also described. Most diabetic foot infections begin with a wound and once an infection occurs, the risk of hospitalization and amputation increases dramatically. Early identification of infection and prompt treatment may optimize the patient's outcome and provide limb salvage. PMID:22577496

  9. Current concepts of rotator cuff tendinopathy.

    PubMed

    Factor, David; Dale, Barry

    2014-04-01

    Tendinopathies are a broad topic that can be examined from the lab to their impact upon function. Improved understanding will serve to bring this pathology to the forefront of discussion, whether in the clinic or the classroom. The purpose of this current concepts clinical commentary is to explore intrinsic and extrinsic mechanisms of rotator cuff (RC) tendinopathy in order to improve clinical and research understanding. Pubmed, Medline, Cinahl, PEDro, and Cochrane databases were searched, limiting results to those published in the English language, between the years of 2005 and 2012. The key search terms utilized were intrinsic mechanisms, tendinopathy, stem cells, biologics, platelet-rich plasma (PRP), healing, rotator cuff tears, full-thickness tears, tests, impingement, imaging, ultrasound, Magnetic Resonance Imaging (MRI), radiograph, shoulder advances, treatment, diagnoses, tendon disorders, pathogenesis, matrix metalloproteinase, injections, and RC repair. Over 150 abstracts were reviewed and 43 articles were analyzed for quality and relevance using the University of Alberta Evidence Based Medicine Toolkit. Current evidence suggests that tendinopathies arise from a multivariate etiology.It is increasingly evident that intrinsic mechanisms play a greater role than extrinsic mechanisms in this process. Emphasis should be placed on patient information (i.e. background information and personal description of symptoms) and imaging/ injection techniques in order to aid in diagnosis. Future treatment technologies such as cell therapy and biological engineering offer the hope of improving patient outcomes and quality of life. Level 5 - Clinical Commentary Related to a Review of Literature.

  10. [Food allergies in paediatrics: Current concepts].

    PubMed

    Plaza-Martin, Ana María

    2016-07-01

    The concept of allergic reaction currently includes all those where an immunological reaction depends on a reaction mediated by IgE, as well as those that involve other immune mechanisms, such as T-cell regulators. There are many different clinical situations, like the classic immediate reactions (IgE mediated) such as urticaria, angioedema, immediate vomiting, abdominal pain, both upper respiratory (aphonia or rhinitis) and lower (wheezing or dyspnoea) symptom, and cardiovascular symptoms. The reactions that involve more than one organ, such as anaphylaxis, which could be an anaphylactic shock if there is cardiovascular involvement. The clinical signs and symptoms produced by non-IgE mediated reactions are usually more insidious in how they start, such as vomiting hours after the ingestion of food in enterocolitis, diarrhoea after days or weeks from starting food, dermatitis sometime after starting food. In these cases it is more difficult to associate these clinical symptoms directly with food. In this article, we attempt to clarify some concepts such as sensitisation/allergy, allergen/allergenic source, or the relationship of different clinical situations with food allergy, in order to help the paediatrician on the one hand, to prescribe strict diets in case of a suspicion based on the cause/effect relationship with the food, and on the other hand not to introduce unnecessary diets that very often have to last an excessively long time, and could lead to nutritional deficiencies in the children. Copyright © 2016 Asociación Española de Pediatría. Published by Elsevier España, S.L.U. All rights reserved.

  11. Current therapeutic concepts in peripartum cardiomyopathy.

    PubMed

    Krejci, Jan; Poloczkova, Hana; Nemec, Petr

    2015-01-01

    Peripartum cardiomyopathy (PPCM) is a relatively rare disease characterized by systolic heart failure occuring towards the end of pregnancy or during the months following birth. It is most often seen in women of African descent, and its incidence seems to be slightly increasing in recent years. Other etiologies of heart failure should be excluded to determine the diagnosis of PPCM. The clinical picture corresponds to systolic heart failure. The rapid onset of the symptoms in relation to pregnancy is striking. The essential diagnostic procedures such as echocardiography, cardiac magnetic resonance imaging and endomyocardial biopsy may be beneficial in certain situations. The etiology of the disease remains unclear. Speculated causes include myocarditis, autoimmune disorders, cardiotropic virus infection, and abnormal responses to hemodynamic and hormonal changes during pregnancy. Particular attention is currently given to the concept of increased oxidative stress inducing production of proapoptotic, angiostatic and proinflammatory mediators. Recovery of left ventricular systolic function occurs in about half of the cases. Mortality has been decreasing in recent years, especially in the United States, but is still between 10-15% in less developed countries where therapeutic possibilities are limited. In addition to standard heart failure therapy, specific treatments (pentoxyfilline, bromocriptine, immunomodulatory therapy) have been tested. Mechanical circulatory support is sometimes needed. Heart transplantation is the therapeutic option for the most severe heart failure and is used in about 10% of the cases. Recurrence in subsequent pregnancy is common and therefore, another pregnancy is not recommended in many cases.

  12. Current Biomechanical Concepts for Rotator Cuff Repair

    PubMed Central

    2013-01-01

    For the past few decades, the repair of rotator cuff tears has evolved significantly with advances in arthroscopy techniques, suture anchors and instrumentation. From the biomechanical perspective, the focus in arthroscopic repair has been on increasing fixation strength and restoration of the footprint contact characteristics to provide early rehabilitation and improve healing. To accomplish these objectives, various repair strategies and construct configurations have been developed for rotator cuff repair with the understanding that many factors contribute to the structural integrity of the repaired construct. These include repaired rotator cuff tendon-footprint motion, increased tendon-footprint contact area and pressure, and tissue quality of tendon and bone. In addition, the healing response may be compromised by intrinsic factors such as decreased vascularity, hypoxia, and fibrocartilaginous changes or aforementioned extrinsic compression factors. Furthermore, it is well documented that torn rotator cuff muscles have a tendency to atrophy and become subject to fatty infiltration which may affect the longevity of the repair. Despite all the aforementioned factors, initial fixation strength is an essential consideration in optimizing rotator cuff repair. Therefore, numerous biomechanical studies have focused on elucidating the strongest devices, knots, and repair configurations to improve contact characteristics for rotator cuff repair. In this review, the biomechanical concepts behind current rotator cuff repair techniques will be reviewed and discussed. PMID:23730471

  13. Safety pharmacology — Current and emerging concepts

    SciTech Connect

    Hamdam, Junnat; Sethu, Swaminathan; Smith, Trevor; Alfirevic, Ana; Alhaidari, Mohammad; Atkinson, Jeffrey; Ayala, Mimieveshiofuo; Box, Helen; Cross, Michael; Delaunois, Annie; Dermody, Ailsa; Govindappa, Karthik; Guillon, Jean-Michel; Jenkins, Rosalind; Kenna, Gerry; Lemmer, Björn; Meecham, Ken; Olayanju, Adedamola; Pestel, Sabine; Rothfuss, Andreas; and others

    2013-12-01

    Safety pharmacology (SP) is an essential part of the drug development process that aims to identify and predict adverse effects prior to clinical trials. SP studies are described in the International Conference on Harmonisation (ICH) S7A and S7B guidelines. The core battery and supplemental SP studies evaluate effects of a new chemical entity (NCE) at both anticipated therapeutic and supra-therapeutic exposures on major organ systems, including cardiovascular, central nervous, respiratory, renal and gastrointestinal. This review outlines the current practices and emerging concepts in SP studies including frontloading, parallel assessment of core battery studies, use of non-standard species, biomarkers, and combining toxicology and SP assessments. Integration of the newer approaches to routine SP studies may significantly enhance the scope of SP by refining and providing mechanistic insight to potential adverse effects associated with test compounds. - Highlights: • SP — mandatory non-clinical risk assessments performed during drug development. • SP organ system studies ensure the safety of clinical participants in FiH trials. • Frontloading in SP facilitates lead candidate drug selection. • Emerging trends: integrating SP-Toxicological endpoints; combined core battery tests.

  14. The current state of clinical ethics and healthcare ethics committees in Belgium

    PubMed Central

    Meulenbergs, T; Vermylen, J; Schotsmans, P

    2005-01-01

    Ethics committees are the most important practical instrument of clinical ethics in Belgium and fulfil three tasks: the ethical review of experimental protocols, advising on the ethical aspects of healthcare practice, and ethics consultation. In this article the authors examine the current situation of ethics committees in Belgium from the perspective of clinical ethics. Firstly, the most important steps which thus far have been taken in Belgium are examined. Secondly, recent opinion by the Belgian Advisory Committee on Bioethics with regard to ethics committees is presented and the activities of Belgian ethics committees are discussed. Finally, the option to bring research ethics and clinical ethics under the roof of just one committee is criticised using a pragmatic and a methodological argument. Concomitantly, the authors build an argument in favour of the further development of ethics consultation. PMID:15923477

  15. Current concepts and future directions of CELSS

    NASA Technical Reports Server (NTRS)

    Macelroy, R. D.; Bredt, J.

    1984-01-01

    The components of a bioregenerative life-support system intended for use in space are described and the requirements for system control are discussed. Concepts of such systems include the use of higher plants and/or micro-algae as sources of oxygen, CO2 absorption, potable water, and food. In order to focus on the specific problem of reservoirs and buffers, bioregenerative life support in space is contrasted to terrestrial ecological concepts. Some of the future directions of the NASA CELSS (controlled ecological life-support system) program are outlined.

  16. The pathogenesis of Charcot neuroarthropathy: current concepts.

    PubMed

    Larson, Shelly A M; Burns, Patrick R

    2012-01-01

    The pathogenesis of Charcot neuroarthropathy (CN) has been poorly understood by clinicians and scientists alike. Current researchers have made progress toward understanding the cause of CN and possible treatment options. The authors review the current literature on the pathogenesis of this debilitating disorder and attempt to explain the roles of inflammation, bone metabolism, and advanced glycation end products.

  17. Current Concepts and Future Directions of CELSS

    NASA Technical Reports Server (NTRS)

    Macelroy, R. D.; Bredt, J.

    1985-01-01

    Bioregenerative life support systems for use in space were studied. Concepts of such systems include the use of higher plants and/or microalgae as sources of food, potable water and oxygen, and as sinks for carbon dioxide and metabolic wastes. Recycling of materials within the system will require processing of food organism and crew wastes using microbiological and/or physical chemical techniques. The dynamics of material flow within the system will require monitoring, control, stabilization and maintenance imposed by computers. Studies included higher plant and algal physiology, environmental responses, and control; flight experiments for testing responses of organisms to weightlessness and increased radiation levels; and development of ground based facilities for the study of recycling within a bioregenerative life support system.

  18. Cardiovascular calcification: current controversies and novel concepts.

    PubMed

    Ruiz, Jessica L; Hutcheson, Joshua D; Aikawa, Elena

    2015-01-01

    Cardiovascular calcification is a commonly observed but incompletely understood mechanism of increased atherosclerotic plaque instability and accelerated aortic valve stenosis. Traditional histological staining and imaging techniques are nonspecific for the type of mineral present in calcified tissues, information that is critical for proper validation of in vitro and in vivo models. This review highlights current gaps in our understanding of the biophysical implications and the cellular mechanisms of valvular and vascular calcification and how they may differ between the two tissue types. We also address the hindrances of current cell culture systems, discussing novel platforms and important considerations for future studies of cardiovascular calcification. Copyright © 2015 Elsevier Inc. All rights reserved.

  19. Anticoagulation in Atrial Fibrillation – Current Concepts

    PubMed Central

    Katritsis, Demosthenes G; Gersh, Bernard J; Camm, A John

    2015-01-01

    This article presents the current status of the use of anticoagulation for the treatment of AF, particularly with the use of non-vitamin K-dependent anticoagulants. Comparisons between these agents and warfarin are made and methods for assessment of anticoagulant activity and reversal are discussed. PMID:26835109

  20. Chordoma: current concepts, management, and future directions.

    PubMed

    Walcott, Brian P; Nahed, Brian V; Mohyeldin, Ahmed; Coumans, Jean-Valery; Kahle, Kristopher T; Ferreira, Manuel J

    2012-02-01

    Chordoma is a rare bone cancer that is aggressive, locally invasive, and has a poor prognosis. Chordomas are thought to arise from transformed remnants of notochord and have a predilection for the axial skeleton, with the most common sites being the sacrum, skull base, and spine. The gold standard treatment for chordomas of the mobile spine and sacrum is en-bloc excision with wide margins and postoperative external-beam radiation therapy. Treatment of clival chordomas is unique from other locations with an enhanced emphasis on preservation of neurological function, typified by a general paradigm of maximally safe cytoreductive surgery and advanced radiation delivery techniques. In this Review, we highlight current standards in diagnosis, clinical management, and molecular characterisation of chordomas, and discuss current research.

  1. [Arm rehabilitation : Current concepts and therapeutic options].

    PubMed

    Platz, T; Schmuck, L

    2016-10-01

    Arm paralysis after a stroke is a major cause of impairment. Presentation of therapeutic options and the efficacy in arm rehabilitation after stroke. Based on a systematic critical appraisal of randomized controlled trials (RCT) the therapeutic procedures for arm paralysis after stroke in the context of their effectiveness are introduced, including robotic therapy, mirror therapy, constraint-induced movement therapy (CIMT), arm basis training, arm ability training, neuromuscular electrical stimulation, bilateral and task-specific training, mental training and transcranial stimulation techniques, such as repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS). Several therapeutic procedures with proven efficacy are currently available for arm rehabilitation after stroke. Their differential indications are presented and associated with conclusions for clinical practice.

  2. A Report on Current Logistics System Concepts.

    DTIC Science & Technology

    1985-12-01

    This modernization represents a quantum improvement over current systems, that have a 6- hour lag between movement and management visibility. NAVY...Unified Material Management System 0 DSSC - Direct Support Stock Control 0 SASSY-Supported Activities Supply System 0 Base Property Control Office...support contract has been awarded and Phase I and II completed (I -establish the M3S standard data structure, and [I-convert SASSY/ DSSC to a DBMS at the

  3. Alzheimer disease: current concepts & future directions.

    PubMed

    Musiek, Erik S; Schindler, Suzanne E

    2013-01-01

    Alzheimer disease (AD) is the most common cause of dementia in individuals over age 65, and is expected to cause a major public health crisis as the number of older Americans rapidly expands in the next three decades. Herein, we review current strategies for diagnosis and management of AD, and discuss ongoing clinical research and future therapeutic directions in the battle against this devastating disease.

  4. Pediatric asthma self-management: current concepts.

    PubMed Central

    Robinson, L. D.

    1999-01-01

    The concept of asthma self-management began in asthma camps in the 1970s. Today all asthma camps are required to provide an educational asthma self-management program. The interaction between children and educators is brief, and if the children do not continue in an associated program after camp, the benefits may be lost. Open Airways, the first program developed specifically for minority children, has been the prototype for community asthma self-management. School-based intervention programs have incorporated asthma education into the health curriculum. Some asthma education programs include an emphasis on the environment. Another approach is to develop intervention projects with parents, as in the Head Start program. This program has been very effective in increasing early recognition of asthma and decreasing recidivism in a high-risk population. Another type of project addressed the reading ability and reading comprehension of asthmatic children. Improvement in reading skills resulted in a 47% decrease in asthma recidivism. After 18 months, there were only two hospitalizations among the enrolled participants. Asthma self-management programs that are most effective for inner-city children provide an interactive, culturally relevant form of asthma education and address issues such as literacy and continuity. PMID:12653391

  5. Cancer symptom clusters: current concepts and controversies.

    PubMed

    Aktas, Aynur

    2013-03-01

    Cluster research examines complex interrelationships between multiple concurrent symptoms and their mechanisms. An individual's varying understanding of the cluster concept and variations in assessment tools results in discrepancies. This article will focus on the conceptual and methodological issues associated with definitions, symptom interrelationships, and outcomes of cancer symptom clusters. An important issue in symptom cluster research is to clarify the definition of a cluster. Some evidence suggests that 'symptom pairs' should be treated as clusters. There is substantial evidence (both qualitative and quantitative) to support a psychoneurological symptom cluster in cancer patients. It has been proposed that consistent clusters are those that have similar 'core' symptoms over time. Research has also shown that a 'sentinel' symptom can predict the presence of other relevant symptoms within a cluster. Identification of patient subgroups with higher symptom severity may be useful in targeting the most needy individuals for intervention. Symptom clusters are predictors of patient outcomes, including decreased functional performance and shorter cancer survival. Additional efforts should refine the cluster definition and elucidate the cluster stability and sentinel symptom. Both conceptual and empirical contributions should advance symptom cluster research. The qualitative approaches can explore the experience of symptom clusters and provide a conceptual basis for future research.

  6. Boundary cartilage lubrication: review of current concepts.

    PubMed

    Daniel, Matej

    2014-03-01

    Effective lubrication of synovial joints is important to prevent cartilage degeneration and to keep the joints healthy. This paper sets out the basics of engineering lubrication with respect to the composition and properties of synovial fluid constituents. Two basic types of boundary lubrication are discussed: the presence of highly hydrophilic proteoglycans that provide a water liquid film, and the existence of multilamellar phospholipids lubricating layers at the surface ofarticular cartilage. Based on current knowledge, we may conclude that no single mechanism of boundary lubrication exists, and that effective boundary lubrication of synovial joints is maintained by the synergic effect of all synovial fluid constituents.

  7. Bone regeneration: current concepts and future directions

    PubMed Central

    2011-01-01

    Bone regeneration is a complex, well-orchestrated physiological process of bone formation, which can be seen during normal fracture healing, and is involved in continuous remodelling throughout adult life. However, there are complex clinical conditions in which bone regeneration is required in large quantity, such as for skeletal reconstruction of large bone defects created by trauma, infection, tumour resection and skeletal abnormalities, or cases in which the regenerative process is compromised, including avascular necrosis, atrophic non-unions and osteoporosis. Currently, there is a plethora of different strategies to augment the impaired or 'insufficient' bone-regeneration process, including the 'gold standard' autologous bone graft, free fibula vascularised graft, allograft implantation, and use of growth factors, osteoconductive scaffolds, osteoprogenitor cells and distraction osteogenesis. Improved 'local' strategies in terms of tissue engineering and gene therapy, or even 'systemic' enhancement of bone repair, are under intense investigation, in an effort to overcome the limitations of the current methods, to produce bone-graft substitutes with biomechanical properties that are as identical to normal bone as possible, to accelerate the overall regeneration process, or even to address systemic conditions, such as skeletal disorders and osteoporosis. PMID:21627784

  8. Status epilepticus. Current concepts and management.

    PubMed Central

    Starreveld, E.; Starreveld, A. A.

    2000-01-01

    OBJECTIVE: To inform primary care physicians about current issues around generalized convulsive status epilepticus (GCSE) emphasizing definition, pathophysiology, treatment, and prognosis. QUALITY OF EVIDENCE: MEDLINE (1994 to 1999) provided 479 references using the MeSH terms "status epilepticus" and "treatment." From these we selected 30 English-language articles covering clinical aspects, treatment, and animal research. Key source documents from previous years and information from modern textbooks and recent symposia were also included. MAIN MESSAGE: Generalized convulsive status epilepticus continues to be a medical emergency with high morbidity and mortality. It must be managed promptly and effectively. The operational definition of GCSE is a seizure that lasts longer than 5 minutes or two or more seizures between which patients do not recover. Main differential diagnosis is nonepileptic status. Intravenous therapy with combined lorazepam and phenytoin is the initial treatment of choice. Other preferred medications are diazepam, midazolam, and propofol. Some of these medications should be considered before arrival at hospital. Prognosis of GCSE is determined by underlying cause, delay in adequate treatment, and comorbidity. Patients with GCSE lasting longer than 30 minutes require intensive care and electroencephalogram monitoring. CONCLUSION: Intravenous lorazepam and phenytoin are currently the most effective drugs for initial management of GCSE. Timely administration of antiepileptic medication can prevent development of GCSE in some patients with known epilepsy. Main differential diagnosis is nonepileptic status. PMID:11013800

  9. Current concepts on airborne particles and health

    SciTech Connect

    Mauderly, J.L.

    1994-11-01

    Epidemiological evidence of associations between environmental particulate concentrations and both acute and chronic health effects has grown with numerous recent studies conducted in the US and other countries. An association between short-term changes in particulate levels and acute mortality now seems certain. The association is consistent among studies and coherent among indicators of mortality and morbidity. Effects observed at surprisingly low pollution levels have raised concern for current exposures even in modestly polluted cities. Toxicology did not predict the acute mortality effect, and causal mechanisms are difficult to rationalize. Present data suggest that the fine fraction of particulate pollution is more toxic than larger particles, but the contribution of specific particulate species is poorly understood.

  10. Medial thighplasty: Current concepts and practices.

    PubMed

    Bertheuil, N; Carloni, R; De Runz, A; Herlin, C; Girard, P; Watier, E; Chaput, B

    2016-02-01

    Medial thighplasty, also known as medial thigh lift, is a procedure that has been carried out for five decades. The original "Lewis" technique has undergone many changes, and thereby been rendered widely available to plastic surgeons. Given the increasingly high number of surgical reconstructions after massive weight loss, this technique is now an integral part of a surgeon's therapeutic arsenal as he strives to meet the evolving demands of patients. The objective of this article, which is based on a comprehensive review of the literature, is to summarize current knowledge on medial thighplasty and thereby allow plastic surgeons to adopt the operating technique best suited to the deformations presented by their patients and to the overall context. The different techniques, outcomes and complications are successively discussed. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  11. Neck dissection: current concepts and future directions.

    PubMed

    Rigual, Nestor R; Wiseman, Sam M

    2004-01-01

    For individuals diagnosed with head and neck cancer, neck dissection may be performed for therapy or disease staging. The classification of neck dissection and the definition of precise anatomic landmarks have allowed for this operation, and its many variations, to become standardized world-wide. SLNBX shows promise in its ability to accurately stage NO head and neck cancer and may allow patients with no micro metastatic disease to avoid neck dissection. Before this technique becomes adopted into routine clinical practice, however, it must first be prospectively scrutinized in large patient populations. Regardless of the future role of SLNBX in the management of head and neck cancer, currently it is only through a complete understanding of the clinical, theoretic, and technical aspects of neck dis-section that surgeons may benefit individual patients and the head and neck cancer patient population as a whole.

  12. Partial Thickness Rotator Cuff Tears: Current Concepts

    PubMed Central

    Matthewson, Graeme; Beach, Cara J.; Nelson, Atiba A.; Woodmass, Jarret M.; Ono, Yohei; Boorman, Richard S.; Lo, Ian K. Y.; Thornton, Gail M.

    2015-01-01

    Partial thickness rotator cuff tears are a common cause of pain in the adult shoulder. Despite their high prevalence, the diagnosis and treatment of partial thickness rotator cuff tears remains controversial. While recent studies have helped to elucidate the anatomy and natural history of disease progression, the optimal treatment, both nonoperative and operative, is unclear. Although the advent of arthroscopy has improved the accuracy of the diagnosis of partial thickness rotator cuff tears, the number of surgical techniques used to repair these tears has also increased. While multiple repair techniques have been described, there is currently no significant clinical evidence supporting more complex surgical techniques over standard rotator cuff repair. Further research is required to determine the clinical indications for surgical and nonsurgical management, when formal rotator cuff repair is specifically indicated and when biologic adjunctive therapy may be utilized. PMID:26171251

  13. Current concepts of ocular adnexal surgery

    PubMed Central

    Borrelli, Maria; Geerling, Gerd

    2013-01-01

    Ophthalmic Plastic and Reconstructive Surgery is a specialized area of ophthalmology that deals with the management of deformities and abnormalities of the eyelids, lacrimal system and the orbit. An ophthalmoplastic surgeon is able to identify and correct abnormalities of the ocular adnexae such as ectropion, lid retraction, conjunctival scarring with severe entropion, that can cause secondary ocular surface disorders; manage patients with watering eye, and when needed intervene with a dacryocystorhinostomy by external or endonasal approach and moreover minimize disfigurement following enucleation or evisceration and prevent further corneal damage, alleviate complains of tearing and grittiness, but also cosmetic complaints in patients with Graves’ orbitopathy. Aim of this manuscript was to review current established and recently evolving surgical procedures. PMID:26504698

  14. Current Concepts in Sports-Related Concussion.

    PubMed

    Chatterjee, Dipal; Frumberg, David B; Mulchandani, Neil B; Eldib, Ahmed M; Xavier, Fred; Barbash, Scott E; Saha, Subrata; Urban, William P

    2015-01-01

    Traumatic brain injury, specifically concussion, is prevalent in contact sports. In the United States (US) each year, 170 million adults participate in physical recreational activities, and 38 million children and adolescents participate in organized sports. The Centers for Disease Control estimate that in this group ~1.6 to 3.8 million concussions occur annually. Recent class-action lawsuits in the US filed by professional athletes against their respective leagues allege negligence in protecting them from concussions, and this has contributed to the attention received in the popular media. In response, concussion-related publications have increased exponentially during the past several years. Recent studies have challenged earlier assumptions that the effects of concussion are transient. Stronger links between concussion and neurodegenerative processes such as Alzheimer's disease-like conditions, depression, and heightened risk for suicide are being elucidated. In this article, we explore the current knowledge on concussion, including pathophysiology, management, and long-term effects. We conclude that more evidence-based results regarding guidelines for diagnosis, treatment, and return to play (RTP) are needed and should be the focus of future investigations. Attributing the etiology of certain neurodegenerative conditions to a history of concussion has been suggested in the current literature, but additional quantitative data regarding the pathophysiology and causality are needed as well. Bioengineers can have an important role in measuring the dynamic forces encountered during head impacts and their effects on the brain. These results can be effective in designing better helmets as well as improved playing surfaces to reduce the impact of such injuries. At this time, we believe that groups of people with heightened risk for concussion should be followed closely during longer periods of time and compared to matched controls. Such long-term studies are urgently

  15. Current Concepts in Disorders of Sexual Development

    PubMed Central

    2011-01-01

    Disorders of sex development (DSD) with or without ambiguous genitalia require medical attention to reach a definite diagnosis. Advances in identification of molecular causes of abnormal sex, heightened awareness of ethical issues and this necessitated a re-evaluation of nomenclature. The term DSD was proposed for congenital conditions in which chromosomal, gonadal or anatomical sex is atypical. In general, factors influencing sex determination are transcriptional regulators, whereas factors important for sex differentiation are secreted hormones and their receptors.The current intense debate on the management of patients with intersexuality and related conditions focus on four major issues: 1) aetiological diagnosis, 2) assignment of gender, 3) indication for and timing of genital surgery, 4) the disclosure of medical information to the patient and his/her parents. The psychological and social implications of gender assignment require a multidisciplinary approach and a team which includes ageneticist, neonatologist, endocrinologist, gynaecologist, psychiatrist, surgeon and a social worker. Each patient should be evaluated individually by multidisciplinary approach. Conflict of interest:None declared. PMID:21911322

  16. Nonulcer dyspepsia. Current concepts and management.

    PubMed

    Mc Namara, D A; Buckley, M; O'Morain, C A

    2000-12-01

    NUD is a common heterogeneous condition with a multifactorial cause. NUD is a cause of considerable morbidity with an annual incidence of 8% and similar incidence of spontaneous resolution. Its economic effects are considerable. The estimated annual cost to the community of NUD is $431 per patient for the initial 6 months after diagnosis. The annual Health Maintenance Organization (HMO) expenditure on acid-related disorders in one Northern California HMO was estimated to be $59.4 million, of which NUD represented a significant proportion. The association of H. pylori infection with NUD is controversial. There are strong epidemiologic evidence and supportive pathophysiological mechanisms to implicate H. pylori causally in a subset of cases. Treatment studies are likewise conflicting. Evidence suggests that treatment cannot guarantee improvement in all cases of H. pylori-related NUD but that a subset would benefit with complete symptom resolution in the long term. It is not possible currently to predict which patients would or would not respond to eradication therapy. The strength of evidence is such that empiric eradication therapy, based on noninvasive H. pylori testing, can be advocated in young patients with dyspepsia safely and effectively with resultant financial savings.

  17. Medications and breast-feeding: Current concepts.

    PubMed

    Nice, Frank J; Luo, Amy C

    2012-01-01

    To describe the various factors that come into play when a breast-feeding mother is taking medications, including use of prescription drugs, over-the-counter medications, recreational drugs, galactogogues, and herbal remedies and to provide a framework used for counseling breast-feeding women. Community and hospital pharmacy and health care settings. Consultative services provided to breast-feeding mothers who had been prescribed or were using medications. Use of pharmacokinetic factors, maternal and child factors, a list of questions to ask breast-feeding mothers, and a stepwise approach to counsel breast-feeding mothers on the compatibility of using medications while breast-feeding. By positive intervention of pharmacists and health care providers, up to 1 million breast-feeding mothers, who must use medications, can continue to breast-feed while taking medications. Objectively weighing the benefits of drugs and breast-feeding versus the risks of drugs and not breast-feeding, in most cases, allows for pharmacists to give current and practical advice to mothers and other health professionals who counsel mothers.

  18. Managing the injured tendon: current concepts.

    PubMed

    Evans, Roslyn B

    2012-01-01

    Despite advances in understanding of the mechanical aspects of tendon management with improved suture technique and early stress application with postoperative therapy, clinical results remain inconsistent after repair, especially within the synovial regions. Complementary research to enhance the intrinsic pathway of healing, suppress the extrinsic pathway of healing, and manipulate frictional resistance to tendon gliding is now the focus of current basic science research on tendons. In the future, application of these new biologic therapies may increase the "safety zone" (or tolerance for load and excursion without dysfunctional gapping) as therapists apply stress to healing tendons and may alter future rehabilitation protocols by allowing greater angles of motion (and thus tendon excursion), increased external load, and decreased time in protective orthoses (splints). However, at this time, the stronger repair techniques and the application of controlled stress remain the best and most well-supported intervention after tendon injury and repair in the recovery of functional tendon excursion and joint range of motion. The hand therapist's role in this process remains a critical component contributing to satisfactory outcomes. Copyright © 2012 Hanley & Belfus. Published by Elsevier Inc. All rights reserved.

  19. Current Concepts for PrEP Adherence

    PubMed Central

    Haberer, Jessica E.

    2016-01-01

    Purpose of review This review describes 1) the current understanding of adherence to oral PrEP, 2) methods for adherence measurement, 3) approaches to supporting PrEP adherence, and 4) guidance for defining PrEP adherence goals within the larger context of HIV prevention. Recent findings PrEP adherence has generally been higher in recent trials, open-label extensions, and demonstration projects compared to the initial clinical trials; potential explanations include known PrEP efficacy and different motivations to take PrEP. Recent studies have explored adherence monitoring through electronic pill containers, short message service (SMS), and drug concentrations in hair and dried blood spots. The few PrEP adherence interventions developed to date include combinations of enhanced counseling, feedback of objective adherence measurement, and SMS. Conceptualization of PrEP adherence is evolving. The goal is not 100% adherence indefinitely, as it was in clinical trials. PrEP adherence should be defined with respect to HIV exposure, which varies over time by sexual behavior and use of other prevention strategies. Summary PrEP adherence beyond clinical trials has generally been high enough to achieve reliable HIV prevention. Future efforts to measure and support PrEP adherence should focus on the context of risk for HIV acquisition, accounting for dynamic behaviors and choices among HIV prevention options. PMID:26633638

  20. Mastocytosis: current concepts in diagnosis and treatment.

    PubMed

    Escribano, L; Akin, C; Castells, M; Orfao, A; Metcalfe, D D

    2002-12-01

    Mastocytosis consists of a group of disorders characterized by a pathologic increase in mast cells in tissues including skin, bone marrow, liver, spleen, and lymph nodes. Mastocytosis is a rare disease. Because of this, general practitioners have limited exposure to its clinical manifestations, diagnosis, classification, and management. Diagnosis of mastocytosis is suspected on clinical grounds and is established by histopathologic examination of involved tissues such as skin and bone marrow. The most common clinical sign of mastocytosis is the presence of typical skin lesions of urticaria pigmentosa. Most patients experience symptoms related to mast cell mediator release, and prevention of the effects of these mediators on tissues constitutes the major therapeutic goal in the management of mastocytosis. Despite recent advances in knowledge about the pathophysiology, diagnosis, and classification of mastocytosis, a curative treatment for mastocytosis does not now exist. Management of patients within all categories of mastocytosis includes: (1) a careful counseling of patients (parents in pediatric cases) and care providers, (2) avoidance of factors triggering acute mediator release, (3) treatment of acute mast cell mediator release, (4) treatment of chronic mast cell mediator release, and if indicated (5) an attempt to treat organ infiltration by mast cells. The goal of this manuscript is to provide an overview of the mediators produced and released by mast cells, the diagnostic criteria for the different variants of mastocytosis, and the treatment options currently available.

  1. Airway epithelial cells: current concepts and challenges.

    PubMed

    Crystal, Ronald G; Randell, Scott H; Engelhardt, John F; Voynow, Judith; Sunday, Mary E

    2008-09-15

    The adult human bronchial tree is covered with a continuous layer of epithelial cells that play a critical role in maintaining the conduit for air, and which are central to the defenses of the lung against inhaled environmental concomitants. The epithelial sheet functions as an interdependent unit with the other lung components. Importantly, the structure and/or function of airway epithelium is deranged in major lung disorders, including chronic obstructive pulmonary disease, asthma, and bronchogenic carcinoma. Investigations regarding the airway epithelium have led to many advances over the past few decades, but new developments in genetics and stem cell/progenitor cell biology have opened the door to understanding how the airway epithelium is developed and maintained, and how it responds to environmental stress. This article provides an overview of the current state of knowledge regarding airway epithelial stem/progenitor cells, gene expression, cell-cell interactions, and less frequent cell types, and discusses the challenges for future areas of investigation regarding the airway epithelium in health and disease.

  2. Tuberculosis of hip: A current concept review

    PubMed Central

    Saraf, Shyam Kumar; Tuli, Surendra Mohan

    2015-01-01

    Tuberculosis (TB) of the hip is second to spine only hence a good number of cases are visiting the medical facilities every year. Many present in the advanced stage of the disease due to delayed diagnosis. In early stages of TB of hip, there is a diagnostic dilemma when plain X-rays are negative. In the present time, diagnostic modalities have improved from the days when diagnosis was based essentially on clinicoradiological presentation alone. By the time definite radiological changes appear on plain X-ray, the disease has moderately advanced. The modern diagnostic facilities like ultrasonography (USG) or magnetic resonance imaging of the hip joint, USG guided aspiration of synovial fluid and obtaining the material for polymerase chain reaction and tissue diagnosis must be utilized. In the treatment, current emphasis is more on mobility with stability at hip. Joint debridement, skeletal traction, and mobilization exercises may give more satisfying results as compared to the immobilization by hip spica. Adults with advanced arthritis and healed infection should be informed and discussed the various treatment modalities including the joint replacement. More and more surgeons are taking up the challenge of putting the total hip replacement in the active stage of the disease. Until the long term results in active disease are well established, we recommend it for the healed disease only in selected cases. PMID:25593352

  3. Committees

    NASA Astrophysics Data System (ADS)

    Williams, Gwyn P.; Revesz, Peter; Arp, Uwe

    2014-03-01

    Conference Chairs NameOrganization Gwyn Williams Jefferson Lab Peter ReveszCornell High Energy Synchrotron Source Uwe ArpSynchrotron Ultraviolet Radiation Facility Programme Committee NameOrganization Alastair MacDowellAdvanced Light Source Tom ToellnerAdvanced Photon Source Amitava D RoyCenter for Advanced Microstructures and Devices Tom EllisCanadian Light Source Roberta SantarosaLaboratório Nacional de Luz Síncrotron Jerry (Jerome) HastingsLinac Coherent Light Source Steven HulbertNational Synchrotron Light Source Thomas A RabedeauStanford Synchrotron Radiation Lightsource Mark BissenSynchrotron Radiation Center Gwyn WilliamsJefferson Lab Peter ReveszCornell High Energy Synchrotron Source Uwe ArpSynchrotron Ultraviolet Radiation Facility

  4. PS1-20: VDW Operational Committee: Current Activities and Future Directions

    PubMed Central

    Brown, Jeffrey; McDonald, Sarah; Moore, Kristen; Saylor, Gwyn; Hart, Gene; Hornbrook, Mark; Magid, David; Go, Alan

    2010-01-01

    Background/Aims: The Virtual Data Warehouse (VDW) is the HMO Research Network (HMORN) approach for facilitating multisite research while protecting the privacy of members and proprietary corporate information. A valid and sustainable VDW is critical to the success of the HMORN, and is needed for HMORN’s inclusion in many of the most important public health initiatives planned for the next few years. Methods: In November 2007 the HMORN Governing Board approved the VDW 5-Year Strategic Plan, including creation of a VDW Operational Committee (VOC), reporting to the Assets Stewardship Committee (ASC) and providing coordinated oversight of the development, maintenance, and enhancement of the VDW. The seven members of the VOC are investigators and analysts representing HMORN’s major consortia projects: CERT, CVRN and CRN. Results: In 2008, the VOC accomplished two major short term goals: Creation of a comprehensive data quality checking system, implemented by seven content area expert Working Groups (WGs) consisting of 23 investigators and 23 programmer\\analysts. The content areas of the WGs are enrollment and demographics, pharmacy, utilization, tumor, vital signs, laboratory, and census. The WGs assessed data availability and completeness for their content area and reported findings to the VOC and ASC, including recommendations for changes and enhancements. WG reports will form the basis for ongoing VDW documentation that will be used to standardize HMORN VDW descriptions for grants and proposals; Development of a budget, staffing plan and priorities for 2009. The 2009 priorities include development of VOC standard operating procedures for creating new data content areas and changing current data areas/definitions, documenting policies for use of the VDW, promoting use of the VDW, and creation of additional WGs for death (new VDW content area), informatics, implementation, and data documentation. The documentation WG will oversee issues such as data dictionaries

  5. Committees

    NASA Astrophysics Data System (ADS)

    2012-11-01

    Leadership Team of the IAHR Committee for Hydraulic Machinery and Systems Eduard EGUSQUIZA, UPC Barcelona, Spain, Chair François AVELLAN, EPFL-LMH, Switzerland, Past Chair Richard K FISHER, Voith Hydro Inc., USA, Past Chair Fidel ARZOLA, Edelca, Venezuela Michel COUSTON, Alstom Hydro, France Niklas DAHLBÄCKCK, Vatenfall, Sweden Normand DESY, Andritz VA TECH Hydro Ltd., Canada Chisachi KATO, University of Tokyo, Japan Andrei LIPEJ, Turboinstitut, Slovenija Torbjørn NIELSEN, NTNU, Norway Romeo SUSAN-RESIGA, 'Politehnica' University Timisoara, Romania Stefan RIEDELBAUCH, Stuggart University, Germany Albert RUPRECHT, Stuttgart University, Germany Qing-Hua SHI, Dong Fang Electrical Machinery Co., China Geraldo TIAGO, Universidade Federal de Itajubá, Brazil International Advisory Committee Shouqi YUAN (principal) Jiangsu University China QingHua SHI (principal) Dong Fang Electrical Machinery Co. China Fidel ARZOLA EDELCA Venezuela Thomas ASCHENBRENNER Voith Hydro GmbH & Co. KG Germany Anton BERGANT Litostroj Power doo Slovenia B C BHAOYAL Research & Technology Centre India Hermod BREKKE NTNU Norway Stuart COULSON Voith Hydro Inc. USA Paul COOPER Fluid Machinery Research Inc USA V A DEMIANOV Power Machines OJSC Russia Bart van ESCH Technische Universiteit Eindhoven Netherland Arno GEHRER Andritz Hydro Graz Austria Akira GOTO Ebara Corporation Japan Adiel GUINZBURG The Boeing Company USA D-H HELLMANN KSB AG Germany Ashvin HOSANGADI Combustion Research and Flow Technology USA Byung-Sun HWANG Korea Institute of Material Science Korea Toshiaki KANEMOTO Kyushu Institute of Technology Japan Mann-Eung KIM Korean Register of Shipping Korea Jiri KOUTNIK Voith Hydro GmbH & Co. KG Germany Jinkook LEE Eaton Corporation USA Young-Ho LEE Korea Maritime University Korea Woo-Seop LIM Hyosung Goodsprings Inc Korea Jun MATSUI Yokohama National University Japan Kazuyoshi Mitsubishi H I Ltd, Japan MIYAGAWA Christophe NICOLET Power Vision Engineering Srl Switzerland Maryse PAGE Hydro

  6. Current concepts in wound management and wound healing products.

    PubMed

    Davidson, Jacqueline R

    2015-05-01

    Current concepts in wound management are summarized. The emphasis is on selection of the contact layer of the bandage to promote a moist wound environment. Selection of an appropriate contact layer is based on the stage of wound healing and the amount of wound exudate. The contact layer can be used to promote autolytic debridement and enhance wound healing.

  7. Tinnitus--Current Concepts in Diagnosis and Management.

    ERIC Educational Resources Information Center

    Epstein, Stephen

    1997-01-01

    This article discusses the causes of tinnitus, sound or noise in the ears or head without any external stimulation. Classification of tinnitus, the essentials of medical evaluation of a patient with tinnitus, essential test procedures, and current concepts in the management of tinnitus are addressed. (CR)

  8. Current Concepts and Terms in Adult ESL. ERIC Q & A.

    ERIC Educational Resources Information Center

    Florez, MaryAnn Cunningham

    Terms and concepts currently in use in adult English-as-a-Second-Language (ESL) instruction are defined and explained. They include: authentic or alternative assessment; computer-assisted language learning; critical literacy theory; family and intergenerational literacy; multiple intelligences and learning styles; practitioner inquiry, reflective…

  9. Syringomyelia: current concepts in pathogenesis, diagnosis, and treatment.

    PubMed

    Rusbridge, Clare; Greitz, Dan; Iskandar, Bermans J

    2006-01-01

    Syringomyelia is a condition that results in fluid-containing cavities within the parenchyma of the spinal cord as a consequence of altered cerebrospinal fluid dynamics. This review discusses the history and the classification of the disorder, the current theories of pathogenesis, and the advanced imaging modalities used in the diagnosis. The intramedullary pulse pressure theory (a new pathophysiologic concept of syringomyelia) also is presented. In addition, the current understanding of the painful nature of this condition is discussed and the current trends in medical and surgical management are reviewed.

  10. Trial Steering Committees in randomised controlled trials: A survey of registered clinical trials units to establish current practice and experiences.

    PubMed

    Conroy, Elizabeth J; Harman, Nicola L; Lane, J Athene; Lewis, Steff C; Murray, Gordon; Norrie, John; Sydes, Matt R; Gamble, Carrol

    2015-12-01

    The Medical Research Council Guidelines for Good Clinical Practice outlines a three-committee trial oversight structure--the day-to-day Trial Management Group, the Data Monitoring Committee and the Trial Steering Committee. In this model, the Trial Steering Committee is the executive committee that oversees the trial and considers the recommendations from the Data Monitoring Committee. There is yet to be in-depth consideration establishing the Trial Steering Committee's role and functionality. A survey to establish Trial Steering Committee's current practices, role and the use and opinion on the Medical Research Council guidelines was undertaken within UK Clinical Research Collaborative registered Clinical Trials Units. Completed surveys were obtained from 38 of 47 fully and partially registered Units. Individual items in the survey were analysed and reported spanning current Trial Steering Committee practices including its role, requirement and experience required for membership; methods to identify members; and meeting frequency. Terms (a document describing the committee's remit, objectives and functionality) were obtained and analysed from 21 of 33 Units with documents in place at their Unit. A total of 20 responders suggested aspects of the current Medical Research Council Guidelines that need improvement. We present the first survey reporting on practices within UK Clinical Research Collaborative registered Clinical Trials Units on the experience and remits of Trial Steering Committees. We have identified a widespread adoption of Medical Research Council Guidelines for Trial Steering Committees in the United Kingdom, but limitations in this existing provision have been identified that need to be addressed. © The Author(s) 2015.

  11. Thirty Meter Telescope: current operations concepts and plans

    NASA Astrophysics Data System (ADS)

    Silva, David R.

    2008-07-01

    The Thirty Meter Telescope (TMT) will be a ground-based, 30-m optical-IR telescope with a highly segmented primary mirror located in a remote location. From the start of operations, TMT will provide a rich and diverse mix of seeing-limited and diffraction-limited instrumentation. Initially, only classical observing will be supported, although remote observing will follow almost immediately. Queue (or service) observing may be supported at a later date. TMT users will expect high facility uptime and observing efficiency as well as effective user support for planning and execution of observations. Those expectations are captured in the high-level Operations Concept Definition (OCD) document. The services and staffing needed to implement those concepts are described in the TMT Operations Plan. In this paper, high-level TMT operational concepts are summarized followed by a description of the current operations plan, including staffing model.

  12. CURRENT CONCEPTS IN MUSCLE STRETCHING FOR EXERCISE AND REHABILITATION

    PubMed Central

    2012-01-01

    Stretching is a common activity used by athletes, older adults, rehabilitation patients, and anyone participating in a fitness program. While the benefits of stretching are known, controversy remains about the best type of stretching for a particular goal or outcome. The purpose of this clinical commentary is to discuss the current concepts of muscle stretching interventions and summarize the evidence related to stretching as used in both exercise and rehabilitation. PMID:22319684

  13. Transport distraction osteogenesis for maxillomandibular reconstruction: current concepts and applications.

    PubMed

    Neelakandan, R S; Bhargava, Darpan

    2012-09-01

    Reconstruction of the facial skeleton remains a herculean task for a reconstructive surgeon, even with the availability of ample reconstructive options. Transport distraction osteogenesis is a novel reconstructive modality in the armamentarium of a maxillofacial reconstructive surgeon with obvious advantages of osteogenesis and histogenesis from the residual host tissues after tumor ablative surgeries or trauma and also, precludes donor site morbidity. This paper reviews the current concepts, principles involved and applications of transport distraction osteogenesis in maxillomandibular reconstruction.

  14. Tropical and travel-associated norovirus: current concepts

    PubMed Central

    Ballard, Sarah-Blythe; Saito, Mayuko; Mirelman, Andrew J.; Bern, Caryn; Gilman, Robert H.

    2015-01-01

    Purpose of review We highlight recent advances relevant to understanding norovirus infections in the tropics, both in populations living in developing settings and travelers to these regions. Recent findings Because of the decrease in diarrheal disease associated with the global rollout of vaccines against rotavirus, norovirus is emerging as the predominant cause of diarrhea morbidity among children in the tropics, and evidence suggests that it contributes to adult disease in endemic populations and travelers. In addition to identifying potential target populations for preventive measures, we provide an update on norovirus vaccine development and concepts related to their implementation in low-income and middle-income countries. Summary These current concepts related to norovirus-attributable disease burden, clinical significance, and economic impact can potentially be applied to tailoring efforts to prevent and mitigate the effects of this important enteropathogen. PMID:26237546

  15. Current Concepts in the Management of Meconium Aspiration Syndrome.

    PubMed

    Chettri, Subhash; Bhat, B Vishnu; Adhisivam, B

    2016-10-01

    In developing countries, meconium aspiration syndrome (MAS) is an important cause of morbidity and mortality among neonates. The concepts of pathophysiology and management of meconium stained amniotic fluid (MSAF) and meconium aspiration syndrome have undergone tremendous change in recent years. Routine intranatal and postnatal endotracheal suctioning of meconium in vigorous infants is no longer recommended. Recent studies have challenged its role even in non-vigorous infants. Supportive therapy like oxygen supplementation, mechanical ventilation and intravenous fluids are the cornerstone in the management of meconium aspiration syndrome. Availability of surfactant, inhaled nitric oxide, high frequency ventilators and extracorporeal membrane oxygenation has made it possible to salvage more infants with meconium aspiration syndrome. In this review the authors have discussed the current concepts in the pathophysiology and management of MAS. Drugs in trials and future therapeutic targets are also discussed briefly.

  16. Safe direct current stimulator 2: concept and design.

    PubMed

    Fridman, Gene Y; Della Santina, Charles C

    2013-01-01

    Essentially all neuroprostheses use alternating biphasic current pulses to stimulate neural tissue. While this method can effectively excite neurons, it is not very effective for inhibiting them. In contrast, direct current (DC) can excite, inhibit, and modulate sensitivity of neurons. However, DC stimulation is biologically unsafe because it violates safe charge injection criteria. We have previously described the concept of a safe direct current stimulator (SDCS) that overcomes this constraint. The SDCS drives DC ionic current into the tissue by switching fluid valves in phase with biphasic current pulses delivered to the metal electrodes within the device. The original prototype of this device, SDCS1, could both suppress and excite the vestibular nerve with DC stimulation delivered by the device. In the process of building the SDCS1 we identified several problems that must be addressed to further develop this technology. Consequently, we designed the SDCS2, which eliminates periodic interruptions in stimulation current flow observed in the original SDCS1 design and is small enough for head-mounted use in chronic animal studies.

  17. [Bioethics committees].

    PubMed

    Lanzilota, Alicia

    2007-01-01

    The present paper exposes a brief historical route showing the context of the Ethics Committee developing. The moral conflicts in clinical care that doctors had to face with the introduction of the new technologies, the creation of the first clinical committees in USA and the abuses in the biomedical investigations, determined the establishment of ethical guidelines and settled institutional review committees for its control. First Bioethics Committees in Argentina were established by adopting the US Ethic Committees model. The proliferation of hospital ethics committees was related to local regulations requirements. Current regulations. Bioethics Committees in Buenos Aires City, through the data of a survey.

  18. Current treatment concepts for "terrible triad" injuries of the elbow.

    PubMed

    Bohn, Kevin; Ipaktchi, Kyros; Livermore, Meryl; Cao, Jue; Banegas, Rodrigo

    2014-12-01

    Elbow fracture-dislocations destabilize the elbow, preventing functional rehabilitation. If left untreated, they commonly result in functional compromise and poor outcomes. The "terrible triad" injury is classically described as a combination of a coronoid process and radial head fractures, as well as a posterolateral elbow dislocation. Surgical treatment to restore stable elbow range of motion has evolved in the past few decades based on increased understanding of elbow biomechanics and the anatomy of these injuries. This article highlights current concepts in the treatment of these complicated injuries.

  19. Applications of Tissue Engineering in Joint Arthroplasty: Current Concepts Update.

    PubMed

    Zeineddine, Hussein A; Frush, Todd J; Saleh, Zeina M; El-Othmani, Mouhanad M; Saleh, Khaled J

    2017-07-01

    Research in tissue engineering has undoubtedly achieved significant milestones in recent years. Although it is being applied in several disciplines, tissue engineering's application is particularly advanced in orthopedic surgery and in degenerative joint diseases. The literature is full of remarkable findings and trials using tissue engineering in articular cartilage disease. With the vast and expanding knowledge, and with the variety of techniques available at hand, the authors aimed to review the current concepts and advances in the use of cell sources in articular cartilage tissue engineering. Copyright © 2017 Elsevier Inc. All rights reserved.

  20. Current concepts of gunshot wound treatment: a trauma surgeon's perspective.

    PubMed

    Cornwell, Edward E

    2003-03-01

    Trauma remains a significant and persistent public health problem, accounting for 90,000 deaths and 20 million people disabled annually. Current concepts of appropriate triage and emergency treatment of gunshot wounds are addressed from a trauma surgeon's perspective. Recent studies regarding prehospital transport policy, and acute diagnostic studies allow optimal treatment guidelines to be formulated. Specifically, rapid transport rather than prolonged on-scene treatment (including maneuvers such as formal thoracolumbar immobilization) should be given the highest priority. Also, routine arteriography (another time-consuming and invasive procedure) in the treatment of gunshot wounds to the extremity is no longer the standard of care.

  1. [Current concepts of polytrauma management: from ATLS to "damage control"].

    PubMed

    Stahel, P F; Heyde, C E; Wyrwich, W; Ertel, W

    2005-09-01

    In recent years, the implementation of standardized protocols for polytrauma management has led to a significant improvement in trauma care as well as to a decrease in post-traumatic morbidity and mortality. As such, the "Advanced Trauma Life Support" (ATLS) protocol of the American College of Surgeons for the acute management of severely injured patients has been established as a gold standard in most European countries since the 1990s. Continuative concepts to the ATLS program include the "Definitive Surgical Trauma Care" (DSTC) algorithm and the concept of "damage control" surgery for polytraumatized patients with immediate life-threatening injuries. These phase-oriented therapeutic strategies appraise the injured patient of the whole extent of the sustained injuries and are in sharp contrast to previous modalities of "early total care" which advocate immediate definitive surgical intervention. The approach of "damage control" surgery takes into account the influence of systemic post-traumatic inflammatory and metabolic reactions of the organism and is aimed at reducing both the primary and the secondary, delayed, mortality in severely injured patients. The present paper provides an overview of the current state of management algorithms for polytrauma patients, with a focus on the standard concepts of ATLS and "damage control".

  2. Microbial biofilm modulation by ultrasound: current concepts and controversies.

    PubMed

    Erriu, Matteo; Blus, Cornelio; Szmukler-Moncler, Serge; Buogo, Silvano; Levi, Raffaello; Barbato, Giulio; Madonnaripa, Daniele; Denotti, Gloria; Piras, Vincenzo; Orrù, Germano

    2014-01-01

    Biofilm elimination is often necessary during antimicrobial therapy or industrial medical manufacturing decontamination. In this context, ultrasound treatment has been frequently described in the literature for its antibiofilm effectiveness, but at the same time, various authors have described ultrasound as a formidable enhancer of bacterial viability. This discrepancy has found no solution in the current literature for around 9 years; some works have shown that every time bacteria are exposed to an ultrasonic field, both destruction and stimulation phenomena co-exist. This co-existence proves to have different final effects based on various factors such as: ultrasound frequency and intensity, the bacterial species involved, the material used for ultrasound diffusion, the presence of cavitation effects and the forms of bacterial planktonic or biofilm. The aim of this work is to analyze current concepts regarding ultrasound effect on prokaryotic cells, and in particular ultrasound activity on bacterial biofilm.

  3. Current Concepts of Mechanisms in Drug-Induced Hepatotoxicity

    PubMed Central

    Russmann, Stefan; Kullak-Ublick, Gerd A; Grattagliano, Ignazio

    2009-01-01

    Drug-induced liver injury (DILI) has become a leading cause of severe liver disease in Western countries and therefore poses a major clinical and regulatory challenge. Whereas previously drug-specific pathways leading to initial injury of liver cells were the main focus of mechanistic research and classifications, current concepts see these as initial upstream events and appreciate that subsequent common downstream pathways and their attenuation by drugs and other environmental and genetic factors also have a profound impact on the risk of an individual patient to develop overt liver disease. This review summarizes current mechanistic concepts of DILI in a 3-step model that limits its principle mechanisms to three main ways of initial injury, i.e. direct cell stress, direct mitochondrial impairment, and specific immune reactions. Subsequently, initial injury initiates further downstream events, i.e. direct and death receptor-mediated pathways leading to mitochondrial permeability transition, which then results in apoptotic or necrotic cell death. For all mechanisms, mitochondria play a central role in events leading to apoptotic vs. necrotic cell death. New treatment targets consequently focus on interference with downstream pathways that mediate injury and therefore determine the ultimate outcome of DILI. Genome wide and targeted pharmacogenetic as well as metabonomic approaches are now used in order to reach the key goals of a better understanding of mechanisms in hepatotoxicity, and to develop new strategies for its prediction and treatment. However, the complexity of interactions between genetic and environmental risk factors is considerable, and DILI therefore currently remains unpredictable for most hepatotoxins. PMID:19689281

  4. Rumination syndrome: a review of current concepts and treatments.

    PubMed

    Hejazi, Reza A; McCallum, Richard W

    2014-10-01

    Rumination is a normal and common phenomenon among ruminant animals; but in humans, it is always regarded as symptom indicative of abnormal function of the upper gastrointestinal tract, and understanding of the mechanisms explaining this event are still evolving. Learning-based theories, organic factors such as gastroesophageal reflux disease and psychological disturbances (eg, depression, anxiety) and the role of life stresses have been postulated as potential mechanisms of rumination. In this review, we take the approach that rumination syndrome is a distinct and discrete functional gastroduodenal disorder. We review current concepts of the pathophysiology of this entity and diagnostic approaches, then detail the treatment paradigms that have been pursued in rumination syndrome in adults. Patients with rumination syndrome have a very distinct set of symptoms. It was focused on the immediate postprandial period, but recently, there is an awareness of an expanding spectrum of the clinical presentation. This includes the concept of "conditioned vomiting" occurring in the setting of delayed gastric emptying (gastroparesis). Physicians' awareness of rumination syndrome is essential in the diagnosis and management of this disorder. Stress and psychological aspects in rumination syndrome are invariably in the background and have to be addressed. The crucial steps in the treatment strategy for rumination syndrome rely on reassurance, education and a physiologic explanation to the patient and family that this is not a "disease," followed by behavioral and relaxation programs and addressing stress factors.

  5. Persistent hyperinsulinemic hypoglycemia of infancy: An overview of current concepts

    PubMed Central

    Goel, Prabudh; Choudhury, Subhasis Roy

    2012-01-01

    Persistent hyperinsulinemic hypoglycemia of infancy (PHHI) is relatively rare but one of the most important causes of severe neonatal hypoglycemia. Recognition of this entity becomes important due to the fact that the hypoglycemia is so severe and frequent that it may lead to severe neurological damage in the infant manifesting as mental or psychomotor retardation or even a life-threatening event if not recognized and treated effectively in time. Near-total pancreatectomy may be required for patients with intractable hypoglycemia despite medical treatment; however, that may result in diabetes mellitus or recurrent postoperative hypoglycemia. This review aims to consolidate the traditional concepts and current information related to the pathogenesis and management of PHHI. PMID:22869973

  6. Current Concepts in Orthopedic Management of Multiple Trauma

    PubMed Central

    Kucukdurmaz, Fatih; Alijanipour, Pouya

    2015-01-01

    Multiple trauma patients frequently present challenging clinical scenarios with musculoskeletal injuries being the most common indications for surgical procedures in these patients. Despite our substantial knowledge, a universally approved objective definition for “multiple trauma” is yet to be delineated. Several controversial aspects of economics, pathophysiology, animal models, diagnosis, management and outcome of patients with multiple trauma have recently been explored and although some progress has been made, it seems that the available evidence is still inconclusive in some occasions. This manuscript revisits several current concepts of multiple trauma that have been the focus of recent investigation. We aim to provide the reader with an updated perspective based on the most recently published literature in the field of multiple trauma. PMID:26312111

  7. Current concepts of shockwave therapy in stress fractures.

    PubMed

    Leal, Carlos; D'Agostino, Cristina; Gomez Garcia, Santiago; Fernandez, Arnold

    2015-12-01

    Stress fractures are common painful conditions in athletes, usually associated to biomechanical overloads. Low risk stress fractures usually respond well to conservative treatments, but up to one third of the athletes may not respond, and evolve into high-risk stress fractures. Surgical stabilization may be the final treatment, but it is a highly invasive procedure with known complications. Shockwave treatments (ESWT), based upon the stimulation of bone turnover, osteoblast stimulation and neovascularization by mechanotransduction, have been successfully used to treat delayed unions and avascular necrosis. Since 1999 it has also been proposed in the treatment of stress fractures with excellent results and no complications. We have used focused shockwave treatments in professional athletes and military personnel with a high rate of recovery, return to competition and pain control. We present the current concepts of shockwave treatments for stress fractures, and recommend it as the primary standard of care in low risk patients with poor response to conventional treatments.

  8. International Commission on Radiological Protection Committee 1: Current Status and Future Directions

    SciTech Connect

    Morgan, William F.

    2015-05-19

    The International Commission on Radiological Protection (ICRP), Committee 1 (C1) considers the risk of induction of cancer and heritable disease (stochastic effects) together with the underlying mechanisms of radiation action. C1 also considers the risks, severity, and mechanisms of induction of tissue/organ damage and developmental defects (deterministic effects). The committee was significantly revamped in 2013 and last met in Abu Dhabi in October of 2013. C1 evaluated progress on two ongoing Task Groups (TG’s); TG 64 “Cancer Risk from Alpha Emitters” and TG 75 “Stem Cell Radiobiology”. Following approval from the Main Commission (MC), C1 established two new TG’s; TG 91 “Radiation Risk Inference at Low Dose and Low Dose Rate Exposure for Radiological Protection Purposes”, and TG 92 “Terminology and Definitions”. Here I will present a synopsis of the current status of C1 and outline the tasks C1 may undertake in the future.

  9. Current Concepts in the Neurophysiologic Basis of Sleep; a Review

    PubMed Central

    Ezenwanne, EB

    2011-01-01

    Background: Sleep is a very vital physiological mechanism, which involves complex interactions in the nervous system. These interactions are not well understood and have been a subject of controversy in contemporary medical practice. Objectives: To review of the neurophysiological factors in the subject of sleep, and recent research findings that forms the basis for the current knowledge on sleep. Methods: Information sources consulted included, published works of past researchers, current articles on sleep in conference papers, recent editions of textbooks on neuroscience, articles in seminar papers, reports extracted from newspaper and magazine articles on sleep, reports accessed from the Internet using Google Search Engines and lecture notes. Results: It was noted that emphasis has now shifted from the concept that sleep was predominantly the product of activities in the neural systems in phylogenetically old reticular core of the brain through withdrawal of sensory input, to emphasis on the role of neurotransmitter systems, especially - Ach, serotonin and GABA. This review also noted that, among others, emphasis is further shifting to the PGO waves which is fast gaining prominence as the mechanism involved in the production of REM sleep and dreams in particular. Conclusion: It became obvious from this review, that full knowledge of the neurophysiological processes involved in sleep production appear generally to still be more of speculative, and are yet far from full understanding. PMID:23209972

  10. Current concepts in the management of tendon disorders.

    PubMed

    Rees, J D; Wilson, A M; Wolman, R L

    2006-05-01

    Primary disorders of tendons are common and constitute a high proportion of referrals to rheumatologists. Certain tendons are particularly vulnerable to degenerative pathology; these include the Achilles, patella, elements of the rotator cuff, forearm extensors, biceps brachi and tibialis posterior tendons. Disorders of these tendons are often chronic and can be difficult to manage successfully in the long term. Significant advances have been made in understanding the pathophysiology of these conditions. Histopathological evidence, together with advances in imaging techniques, has made us more appreciative of the degenerative (rather that inflammatory) nature of these conditions. Additionally the presence of neovascularization is now well-recognized in long-standing tendinopathy. We review the mechanical, vascular and developing neural theories that attempt to explain the aetiology of degenerative tendinopathy. We also explore theories of why specific tendons (such as the Achilles and supraspinatus tendons) are particularly prone to degenerative pathology. Traditionally, treatments have placed a heavy emphasis on anti-inflammatory strategies, which are often inappropriate. Recently, however, significant advances in the practical management of tendon disorders have been made. In particular the advent of 'eccentric loading' training programmes has revolutionized the treatment of Achilles tendinopathy in some patients. This concept is currently being extended to include other commonly injured tendons. Other current treatments are reviewed, as are potential future treatments.

  11. Current concepts and future approaches to vestibular rehabilitation.

    PubMed

    Tjernström, Fredrik; Zur, Oz; Jahn, Klaus

    2016-04-01

    Over the last decades methods of vestibular rehabilitation to enhance adaptation to vestibular loss, habituation to changing sensory conditions, and sensory reweighting in the compensation process have been developed. However, the use of these techniques still depends to a large part on the educational background of the therapist. Individualized assessment of deficits and specific therapeutic programs for different disorders are sparse. Currently, vestibular rehabilitation is often used in an unspecific way in dizzy patients irrespective of the clinical findings. When predicting the future of vestibular rehabilitation, it is tempting to foretell advances in technology for assessment and treatment only, but the current intense exchange between clinicians and basic scientists also predicts advances in truly understanding the complex interactions between the peripheral senses and central adaptation mechanisms. More research is needed to develop reliable techniques to measure sensory dependence and to learn how this knowledge can be best used--by playing off the patient's sensory strength or working on the weakness. To be able using the emerging concepts, the neuro-otological community must strive to educate physicians, physiotherapists and nurses to perform the correct examinations for assessment of individual deficits and to look for factors that might impede rehabilitation.

  12. Isolated Robin sequence in siblings: review of current concepts.

    PubMed

    Nunes da Costa, João; Matias, Júlio

    2014-11-01

    Robin sequence is a condition that includes the triad of micrognathia, glossoptosis and upper airway obstruction, although many authors now consider that cleft palate is also an important part of the sequence. It can be classified as isolated, syndromic or associated with other anomalies without an identifiable syndrome. A possible genetic cause for isolated Robin sequence is yet under preliminary investigation, and the finding of siblings with the same condition, as are the two children we present in this work, is extremely rare, with only nine similar cases previously described. Our article includes the description of the treatment plan and outcome for both children. We review the current concepts and trends of epidemiology, genetics, diagnosis and different treatment options available. We conclude that in cases of failure of more conservative measures in the first weeks, mandibular distraction osteogenesis may be a good and rational option for the management of isolated Robin sequence, as is currently supported in recent literature, providing a reliable way of avoiding tracheostomy.

  13. Current projects of ISO Technical Committee 201 on Surface Chemical Analysis

    NASA Astrophysics Data System (ADS)

    Powell, C. J.

    2001-01-01

    An overview is given of current work projects of Technical Committee 201 on Surface Chemical Analysis of the International Organization for Standardization (ISO). ISO/TC 201 has subcommittees for Auger electron spectroscopy (AES), secondary ion mass spectrometry, X-ray photoelectron spectroscopy (XPS), and glow discharge spectroscopy, and a working group for total reflection X-ray fluorescence spectroscopy. There are work projects for these analytical techniques and for sputter depth profiling, data management and treatment, specimen preparation, reference materials, and terminology. As an example of these projects, a description is given of a new procedure for the calibration of the binding-energy (BE) scales of XPS instruments that enables a laboratory to demonstrate that BE measurements have been made within user-specified tolerance limits. A similar procedure has been developed for the calibration of the kinetic-energy scales of AES instruments.

  14. Current concepts and techniques in complete denture final impression procedures.

    PubMed

    Petropoulos, Vicki C; Rashedi, Behnoush

    2003-12-01

    In 2001, a survey of U.S. dental schools was conducted to determine which concepts, techniques and materials are currently prevalent in the teaching of final impression procedures for complete dentures in the predoctoral clinical curriculum. The questionnaire was mailed to the chairperson of the prosthodontic/restorative departments of 54 U.S. dental schools. Of these, 44 schools returned the completed survey resulting in a response rate of 82%. Results from this survey show that the majority of schools (71%) teach the selective-pressure technique for final impression making; the majority of the schools (64%) use modeling plastic impression compound for border molding the final impression tray; 39% of the schools do not place vent holes in the final impression tray, 30% of schools place more than one hole and 27% place one hole only; the majority of the schools (98%) are using custom trays for final impressions. Ninety-eight percent of the schools are border molding the custom tray and 70% of schools are using a visible light-cured (VLC) composite resin material to make the trays. Thirty-six percent of the schools are teaching the Boucher impression technique and 34% are teaching the modified Boucher impression technique. Predoctoral clinical complete denture educational programs agree on many aspects of final impression making, however, there is variability in their teachings regarding the impression philosophy and the materials used.

  15. The Unstable Elbow: Current Concepts in Diagnosis and Treatment.

    PubMed

    Tashjian, Robert Z; Wolf, Brian R; van Riet, Roger P; Steinmann, Scott P

    2016-01-01

    Elbow instability is common and may occur after a variety of injuries, including falls or direct blows. Instability can be classified as either acute or chronic. Acute instability is classified as simple (without fracture) or complex (with associated fracture). Chronic instability is classified as a chronically dislocated or recurrently unstable elbow. Recurrent instability commonly presents as isolated medial or lateral collateral ligament insufficiency. A chronically dislocated elbow is often more complex, involving both osseous and ligamentous injuries. The treatment of simple dislocations typically involves closed reduction and nonsurgical management. Chronic recurrent lateral and medial collateral ligament insufficiencies have very different clinical characteristics, but definitive treatment frequently involves ligament reconstruction. Complex instability usually requires surgery, which includes open reduction and internal fixation of coronoid and olecranon fractures, repair or replacement of radial head fractures, and lateral collateral ligament repair. Medial collateral ligament repair and/or external fixation are rarely required to restore stability. It is important for surgeons to understand current concepts in the diagnosis and management of acute and chronic elbow instability as well as the preferred surgical treatments and techniques for the management of these injuries.

  16. Current pharmacotherapeutic concepts for the treatment of obesity in adults.

    PubMed

    Idelevich, Evgeny; Kirch, Wilhelm; Schindler, Christoph

    2009-02-01

    Obesity is one of the greatest public health challenges of the twenty-first century. The World Health Organization (WHO) reports that in 2005 approximately 1.6 billion adults were overweight and at least 400 million adults were obese. The prevalence of obesity is still continuing to increase dramatically. Overweight and obese people carry a higher risk for a variety of cardiovascular diseases including hypertension, coronary heart disease, stroke and peripheral occlusive artery disease. Weight loss is considered to be the initial step which helps to prevent or to control the clinical consequences of obesity. In a great number of patients who are not able to reduce weight by means of non-pharmacological measures, drug therapy can assist in reaching the weight management targets. Drug treatment should only be considered as part of a systematic weight management program including dietary and lifestyle changes. This review summarizes current pharmacotherapeutic concepts for the treatment of obesity in adults focusing on efficacy and safety of anti-obesity drugs.

  17. [Current treatment concepts for olecranon and prepatellar bursitis in Austria].

    PubMed

    Baumbach, S F; Michel, M; Wyen, H; Buschmann, C T; Kdolsky, R; Kanz, K-G

    2013-04-01

    The limited evidence available on the diagnosis and treatment of olecranon and prepatellar bursitis indicates nationally varying treatment approaches. Therefore the aim of this study was to survey the current treatment concepts of olecranon and prepatellar bursitis in Austria. An online questionnaire comprising of demographic data, questions regarding diagnostics and differentiation between septic bursitis (SB) and non-septic bursitis (NSB) as well as two case reports for therapy appraisal were sent to members of the Austrian Society of Orthopaedics and Orthopaedic Surgery (ÖGO) and the Austrian Society of Traumatology (ÖGU). The overall response rates were 46 % (ÖGU)/12 % (ÖGO). Differentiation between SB and NSB was predominantly based on medical history/clinical presentation (ÖGU: 100 %/ÖGO: 84 %) and blood sampling (ÖGU: 82 %/ÖGO: 77 %). 64/36 % of surveyed members of ÖGO/OGU performed a bursal aspiration. 95/55 % of Austrian ÖGU opinion leaders favoured a surgical treatment approach in cases of SB/NSB. Conversely, ÖGO members rather favoured a conservative treatment approach (28/27 %). Significant differences were found between ÖGO and ÖGU, with the latter favouring a surgical treatment approach in cases of SB and NSB. However, the international literature argues for a conservative treatment approach. Further high quality research is needed to establish an evidence-based treatment approach. Georg Thieme Verlag KG Stuttgart · New York.

  18. Current concepts and controversies on adolescent idiopathic scoliosis: Part I

    PubMed Central

    Sud, Alok; Tsirikos, Athanasios I

    2013-01-01

    Adolescent idiopathic scoliosis is the most common spinal deformity encountered by General Orthopaedic Surgeons. Etiology remains unclear and current research focuses on genetic factors that may influence scoliosis development and risk of progression. Delayed diagnosis can result in severe deformities which affect the coronal and sagittal planes, as well as the rib cage, waistline symmetry, and shoulder balance. Patient's dissatisfaction in terms of physical appearance and mechanical back pain, as well as the risk for curve deterioration are usually the reasons for treatment. Conservative management involves mainly bracing with the aim to stop or slow down scoliosis progression during growth and if possible prevent the need for surgical treatment. This is mainly indicated in young compliant patients with a large amount of remaining growth and progressive curvatures. Scoliosis correction is indicated for severe or progressive curves which produce significant cosmetic deformity, muscular pain, and patient discontent. Posterior spinal arthrodesis with Harrington instrumentation and bone grafting was the first attempt to correct the coronal deformity and replace in situ fusion. This was associated with high pseudarthrosis rates, need for postoperative immobilization, and flattening of sagittal spinal contour. Segmental correction techniques were introduced along with the Luque rods, Harri-Luque, and Wisconsin systems. Correction in both coronal and sagittal planes was not satisfactory and high rates of nonunion persisted until Cotrel and Dubousset introduced the concept of global spinal derotation. Development of pedicle screws provided a powerful tool to correct three-dimensional vertebral deformity and opened a new era in the treatment of scoliosis. PMID:23682172

  19. Physiology of ileal pouch-anal anastomosis. Current concepts.

    PubMed

    Goes, R; Beart, R W

    1995-09-01

    Increasing experience with ileal pouch-anal anastomosis (IPAA) associated with increasing knowledge about anorectal physiology has lead to a large number of publications. The purpose of this review is to evaluate the current understanding of fecal continence as revealed by the evolution of the ileoanal procedure. Review of the literature covering the most important physiologic parameters involved in fecal continence was undertaken. Rectoanal inhibitory reflex is probably absent after IPAA but is preserved when distal anorectal mucosa is spared. Anal resting pressure decreases but is less affected when the internal anal sphincter is less traumatized. Squeeze pressure is not importantly affected, and the importance of reservoir function as a determinant of stool frequency is emphasized. IPAA does not affect the coordination between pouch and anal canal motility in the majority of cases. Normal continence is preserved, even during the night, by preserving a gradient of pressure between the pouch and anal canal. Physiologic concepts are well established, but controversies about the continence mechanism related to IPAA remain. The IPAA procedure has allowed discrimination of details about the function of multiple structures involved in fecal continence.

  20. Current concepts of mechanical and neural factors in ocular motility

    PubMed Central

    Demer, Joseph L.

    2007-01-01

    Purpose of review The oculomotor periphery was classically regarded as a simple mechanism executing complex behaviors specified explicitly by neural commands. A competing view has emerged that many important aspects of ocular motility are properties of the extraocular muscles and their associated connective tissue pulleys. This review considers current concepts regarding aspects of ocular motility that are mechanically determined versus those that are specified explicitly as innervation. Recent findings While it was established several years ago that the rectus extraocular muscles have connective tissue pulleys, recent functional imaging and histology has suggested that the rectus pulley array constitutes an inner mechanism, analogous to a gimbal, that is rotated torsionally around the orbital axis by an outer mechanism driven by the oblique extraocular muscles. This arrangement may account mechanically for several commutative aspects of ocular motor control, including Listing’s Law, yet permits implementation of non-commutative motility. Recent human behavioral studies, as well as neurophysiology in monkeys, are consistent with implementation of Listing’s Law in the oculomotor periphery, rather than centrally. Summary Varied evidence now strongly supports the conclusion that Listing’s Law and other important ocular kinematics are mechanically determined. This finding implies more limited possibilities for neural adaptation to some ocular motor pathologies, but indicates possibilities for surgical treatments. PMID:16415671

  1. FROM CONCEPT TO EQUIVALENCY: THE 503 REGULATIONS AND THE PATHOGEN EQUIVALENCY COMMITTEE (PAPER)

    EPA Science Inventory

    Since its creation in 1985, the Pathogen Equivalency Committee (PEC) has been reviewing innovative and alternative sludge disinfection technologies with regards to their abilities to protect human health and the environment. The PEC is charged to make recommendations on whether t...

  2. FROM CONCEPT TO EQUIVALENCY: THE 503 REGULATIONS AND THE PATHOGEN EQUIVALENCY COMMITTEE

    EPA Science Inventory

    Since its creation in 1985, the Pathogen Equivalency Committee (PEC) has been reviewing innovative and alternative sludge disinfection technologies with regards to their abilities to protect human health and the environment. The PEC is charged to make recommendations on whether t...

  3. FROM CONCEPT TO EQUIVALENCY: THE 503 REGULATIONS AND THE PATHOGEN EQUIVALENCY COMMITTEE

    EPA Science Inventory

    Since its creation in 1985, the Pathogen Equivalency Committee (PEC) has been reviewing innovative and alternative sludge disinfection technologies with regards to their abilities to protect human health and the environment. The PEC is charged to make recommendations on whether t...

  4. FROM CONCEPT TO EQUIVALENCY: THE 503 REGULATIONS AND THE PATHOGEN EQUIVALENCY COMMITTEE (PAPER)

    EPA Science Inventory

    Since its creation in 1985, the Pathogen Equivalency Committee (PEC) has been reviewing innovative and alternative sludge disinfection technologies with regards to their abilities to protect human health and the environment. The PEC is charged to make recommendations on whether t...

  5. Human error in hospitals and industrial accidents: current concepts.

    PubMed

    Spencer, F C

    2000-10-01

    Most data concerning errors and accidents are from industrial accidents and airline injuries. General Electric, Alcoa, and Motorola, among others, all have reported complex programs that resulted in a marked reduction in frequency of worker injuries. In the field of medicine, however, with the outstanding exception of anesthesiology, there is a paucity of information, most reports referring to the 1984 Harvard-New York State Study, more than 16 years ago. This scarcity of information indicates the complexity of the problem. It seems very unlikely that simple exhortation or additional regulations will help because the problem lies principally in the multiple human-machine interfaces that constitute modern medical care. The absence of success stories also indicates that the best methods have to be learned by experience. A liaison with industry should be helpful, although the varieties of human illness are far different from a standardized manufacturing process. Concurrent with the studies of industrial and nuclear accidents, cognitive psychologists have intensively studied how the brain stores and retrieves information. Several concepts have emerged. First, errors are not character defects to be treated by the classic approach of discipline and education, but are byproducts of normal thinking that occur frequently. Second, major accidents are rarely causedby a single error; instead, they are often a combination of chronic system errors, termed latent errors. Identifying and correcting these latent errors should be the principal focus for corrective planning rather than searching for an individual culprit. This nonpunitive concept of errors is a key basis for an effective reporting system, brilliantly demonstrated in aviation with the ASRS system developed more than 25 years ago. The ASRS currently receives more than 30,000 reports annually and is credited with the remarkable increase in safety of airplane travel. Adverse drug events constitute about 25% of hospital

  6. COMMITTEES COMMITTEES

    NASA Astrophysics Data System (ADS)

    2010-11-01

    ORGANISING COMMITTEE Chairman: Alexander G Petrov Director, Institute of Solid State Physics, Bulgarian Academy of Sciences, Sofia, Bulgaria Chairman Emeritus: Nikolay Kirov Institute of Solid State Physics, Bulgarian Academy of Sciences, Sofia, Bulgaria Local Organising Committee: Chairman: Alexander G Petrov Members: Diana Nesheva, Doriana Dimova-Malinovska, Eleonora Popova, Lyubomila Dedinska, Christo Popov, Vasil Lovchinov, Marina Primatarowa, Emilia Vlaikova, Irina Velkova, Hassan Chamati PROGRAMME COMMITTEE Chairman: A G Petrov Members: D Alexandrov (Thunder Bay), V Celebonovic (Belgrade), D Dimova-Malinovska (Sofia), B Dulmet (Besancon), A Grechnikov (Moscow), M Gunes (Mugla), C Main (Dundee), D Nesheva (Sofia), M C Petty (Durham), M Popescu (Bucharest), S Reynolds (Dundee), K Shimakawa (Gifu), J Singh (Darwin), N Starbov (Sofia), M Tomilin (St Petersburg), Ph Vanderbemden (Liege), A Vaseashta (Washington) LOCAL SCIENTIFIC COUNCIL Chairman: A G Petrov Members: Bulgarian Academy of Sciences N Sabotinov (President) I Nedkov (Scientific Secretary, Physics) Institute of Solid State Physics N Kirov, D Nesheva, V Lovchinov, St Andreev, M Primatarowa Institute of Electronics R Enikov (Director) Central Lab. of Solar Energy and New Energy Sources D Dimova-Malinovska Institute of Optical Materials and Technologies V Saynov, N Starbov Central Lab. of Applied Physics R Kakanakov (Director) Sofia University - Faculty of Physics A Andreeva, S Russev (Heads of Departments)

  7. Current concepts in the management of diabetic nephropathy.

    PubMed

    Waanders, F; Visser, F W; Gans, R O B

    2013-11-01

    Although much progress has been made in slowing the progression of diabetic nephropathy, renal dysfunction and development of end-stage renal disease (ESRD) remain major concerns in diabetes. In addition, diabetic patients with microalbuminuria have an increased cardiovascular mortality. Therefore, new treatment modalities or strategies are needed to prevent or slow the progression of diabetic nephropathy and prevent cardiovascular disease in diabetes. In this review we describe current concepts in pathophysiology, treatment goals and we discuss future developments in the treatment of diabetic nephropathy. Common risk factors for diabetic nephropathy and its progression are longer duration, poor glycaemic control, hypertension and the presence of albuminuria. Available treatment options, especially renin-angiotensin aldosterone system (RAAS) blockade, but also better blood pressure and blood glucose control, decrease the incidence of cardiovascular disease and renal disease in diabetes. It is important that treatment goals are tailored to the individual patient with individual treatment goals of glycaemic control and blood pressure, depending on age, type of diabetes and diabetes duration. Aggressive treatment of glucose control and blood pressure might not always be best practice for every patient. Since the proportion of ESRD due to diabetic nephropathy remains high, optimisation of RAAS blockade is advocated and can be achieved by adequate sodium restriction and/or diuretic treatment. Moreover, aldosterone blockade might be a valuable strategy, which has potency to slow the progression of diabetic renal disease. Other possible future interventions are under investigation, but large clinical trials have to be awaited to confirm the safety and efficacy of these drugs.

  8. 76 FR 13597 - Request for an Extension of a Currently Approved Information Collection; County Committee Elections

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-03-14

    ... Committee Elections AGENCY: Farm Service Agency, USDA. ACTION: Notice; request for comments. SUMMARY: In... associated with the FSA County Committee Elections. The collection of information from FSA farmers and... Independence Avenue, Washington, DC 20250. E-mail: Send comments to: Kenneth.nagel@wdc.usda.gov . Fax:...

  9. Current concepts in the biopsy of musculoskeletal tumors.

    PubMed

    Traina, Francesco; Errani, Costantino; Toscano, Angelo; Pungetti, Camilla; Fabbri, Daniele; Mazzotti, Antonio; Donati, Davide; Faldini, Cesare

    2015-01-07

    A musculoskeletal tumor biopsy can involve fine needle aspiration, core needle biopsy, or incisional biopsy. Controversy regarding the diagnostic yield of these biopsy techniques continues. The purpose of this article is to summarize the current concepts in the biopsy of musculoskeletal tumors. We performed a literature review of clinical articles reporting on the biopsy of bone and soft-tissue primary tumors. Clinical articles were excluded on the basis on abstract content if they represented case reports, review or opinion articles, or technique descriptions. Eighteen of the thirty-nine articles that remained were excluded because the results did not indicate the diagnostic accuracy of the various biopsy techniques. Thus, twenty-one articles with diagnostic data on the biopsy of bone and soft-tissue tumors were included in this review. Core needle biopsy appeared to be more accurate than fine needle aspiration, and incisional biopsy appeared to be more accurate than both of these techniques, but the differences did not reach significance. Incisional biopsy was more expensive than the percutaneous biopsy methods. In deep musculoskeletal tumors, incorporation of ultrasonography or computed tomography for guidance is easy and safe and can be useful for increasing the accuracy of the biopsy. Advantages of a percutaneous technique compared with an incisional one are the low risk of contamination and the minimally invasive nature. Certain anatomic locations and histologic types were associated with diagnostic difficulty. Vertebral tumors had the lowest diagnostic accuracy regardless of the biopsy technique. Myxoid, infection, and round cell histologies were associated with the lowest diagnostic accuracy. The current literature has not clarified the optimal biopsy technique for the diagnosis of bone and soft-tissue tumors. However, core needle biopsy is usually preferable to incisional biopsy because of the low risk of contamination and the low cost. In addition, the

  10. COMMITTEES: Committees

    NASA Astrophysics Data System (ADS)

    2010-01-01

    TAUP STEERING COMMITTEE F T Avignone, University of South Carolina B C Barish, CALTECH E Bellotti, University of Milano, INFN J Bernabeu, University of Valencia A Bottino (Chair), University of Torino, INFN N Fornengo, University of Torino, INFN T Kajita, ICRR University of Tokyo C W Kim, Johns Hopkins University, KIAS V Matveev, INR Moscow J Morales, University of Zaragoza G Raffelt, MPI Munchen D Sinclair, University of Carleton M Spiro, IN2P3 TAUP 2009 INTERNATIONAL ADVISORY COMMITTEE J J Aubert, CNRS Marseille M Baldo-Ceolin, University of Padova, INFN G Bellini, University of Milano, INFN L Bergstrom, University of Stockholm R Bernabei, University of Roma Tor Vergata, INFN A Bettini, University of Padova, INFN, LSC S Bilenky, JINR Dubna D O Caldwell, UCSB J Cronin, University of Chicago A Dar, Technion Haifa G Domogatsky, INR Moscow J Ellis, CERN E Fernandez, IFAE Barcelona E Fiorini, University of Milano, INFN T Gaisser, University of Delaware G Gelmini, UCLA G Gerbier, CEA Saclay A Giazotto, INFN Pisa F Halzen, University of Wisconsin W Haxton, University of Washington T Kirsten MPI Heidelberg L Maiani, University of Roma La Sapienza, INFN A McDonald, Queen's University K Nakamura, KEK R Petronzio, INFN, University of Roma Tor Vergata L Resvanis, University of Athens F Ronga INFN, LNF C Rubbia INFN, LNGS A Smirnov, ICTP Trieste C Spiering, DESY N Spooner, University of Sheffield A Suzuki, KEK S Ting MIT, CERN M S Turner, FNAL, University of Chicago J W F Valle, IFIC Valencia D Vignaud, APC Paris G Zatsepin, INR Moscow TAUP 2009 ORGANIZING COMMITTEE R Aloisio, LNGS R Antolini, LNGS F Arneodo, LNGS Z Berezhiani, University of L'Aquila, INFN V Berezinsky, LNGS R Cerulli, LNGS E Coccia [Chair], LNGS/INFN, U of Roma Tor Vergata N D'Ambrosio, LNGS N Fornengo, University of Torino, INFN M Laubenstein, LNGS O Palamara, LNGS L Pandola [Scientific Secretary], LNGS

  11. Anthropogenic SO{sub 2}/NO{sub x} committee--current status

    SciTech Connect

    Benkovitz, C.M.

    1993-04-01

    Current activities of the Anthropogenic SO{sub 2}/NO{sub x} Committee center around the compilation of Version 1 of the GEIA inventories. These inventories will be based on the GEIA-specified 1{degrees} by 1{degrees} grid (lower left corner at 180{degrees}W/90{degrees}S, west to east and south to north), reflect 1985 emissions and consist of two data sets: Version 1A inventories with annual emissions at one level and Version 1B inventories with seasonal emissions, two vertical levels (defined at 100 m) and sectoral split information. The basic information used for both versions of the GEIA inventories will be identical; i.e., emissions totals across both inventories will be the same. Work is being carried out in two complementary working groups; Carmen Benkovitz, Brookhaven National Laboratory, Upton, NY, USA heads the work on the annual inventory, Eva Voldner, Atmospheric Environment Services, Canada and Trevor Scholtz, ORTECH International, Canada, head the work on the seasonal inventory.

  12. Rethinking the Current American Joint Committee on Cancer TNM Staging System for Medullary Thyroid Cancer.

    PubMed

    Adam, Mohamed Abdelgadir; Thomas, Samantha; Roman, Sanziana A; Hyslop, Terry; Sosa, Julie A

    2017-06-21

    Controversy exists around the American Joint Committee on Cancer (AJCC) TNM staging system for medullary thyroid cancer (MTC). Because of the rarity of the disease and limited available data, the staging system for MTC has been largely extrapolated from staging for differentiated thyroid cancer. To evaluate how well the current (seventh and eighth editions) AJCC TNM staging system correlates with survival for patients with MTC and to suggest a possible revision. This population-based retrospective cohort analysis used the National Cancer Database to select patients aged 18 years or older diagnosed with MTC in the United States between 1998 and 2012. Patient demographic and tumor characteristics were assessed, and pathologic tumor stages were provided as T, N, and M categories. Recursive partitioning with bootstrapping was used to divide patients by TNM stages into groups with similar survival. The newly identified groupings were validated in a Surveillance, Epidemiology, and End Results (SEER) cohort. Data analysis was conducted between July 17, 2016, and November 11, 2016. Overall survival and disease-specific survival. Of the 3315 patients with MTC included in the analysis, 1941 (58.6%) were women. The median (interquartile range) age was 54 (42-65) years, and 2839 (85.6%) self-reported their race/ethnicity as white. The current AJCC TNM staging system classified 941 of these patients (28.4%) as stage I, 907 (27.4%) as stage II, 424 (12.9%) as stage III, and 1043 (31.5%) as stage IV. Recursive partitioning analysis yielded 4 TNM groups: stage I (T1N0-1aM0, T2N0M0), stage II (T1N1bM0, T2N1a-bM0, and T3N0M0), stage III (T3N1a-bM0, T4N0-1bM0), and stage IV (T1-4N0-1bM1). Based on these proposed TNM groupings, 1797 of the 3315 patients (54.2%) were classified as stage I, 684 (20.6%) as stage II, 669 (20.2%) as stage III, and 165 (5.0%) as stage IV. Under the proposed TNM groupings, survival differences across TNM groups were more distinct than under the current AJCC

  13. Medicalization: Current Concept and Future Directions in a Bionic Society

    PubMed Central

    Maturo, Antonio

    2012-01-01

    The article illustrates the main features of the concept of medicalization, starting from its theoretical roots. Although it is the process of extending the medical gaze on human conditions, it appears that medicalization cannot be strictly connected to medical imperialism anymore. Other “engines” of medicalization are influential: consumers, biotechnology and managed care. The growth of research and theoretical reflections on medicalization has led to the proposal of other parallel concepts like pharmaceuticalization, genetization and biomedicalization. These new theoretical tools could be useful in the analysis of human enhancement. Human enhancement can be considered as the use of biomedical technology to improve performance on a human being who is not in need of a cure: a practice that is increasingly spreading in what might be defined as a “bionic society”. PMID:22654387

  14. Unifying concept of serotonin transporter-associated currents.

    PubMed

    Schicker, Klaus; Uzelac, Zeljko; Gesmonde, Joan; Bulling, Simon; Stockner, Thomas; Freissmuth, Michael; Boehm, Stefan; Rudnick, Gary; Sitte, Harald H; Sandtner, Walter

    2012-01-02

    Serotonin (5-HT) uptake by the human serotonin transporter (hSERT) is driven by ion gradients. The stoichiometry of transported 5-HT and ions is predicted to result in electroneutral charge movement. However, hSERT mediates a current when challenged with 5-HT. This discrepancy can be accounted for by an uncoupled ion flux. Here, we investigated the mechanistic basis of the uncoupled currents and its relation to the conformational cycle of hSERT. Our observations support the conclusion that the conducting state underlying the uncoupled ion flux is in equilibrium with an inward facing state of the transporter with K+ bound. We identified conditions associated with accumulation of the transporter in inward facing conformations. Manipulations that increased the abundance of inward facing states resulted in enhanced steady-state currents. We present a comprehensive kinetic model of the transport cycle, which recapitulates salient features of the recorded currents. This study provides a framework for exploring transporter-associated currents.

  15. Oral Field Cancerization: An Update on Current Concepts

    PubMed Central

    Mohan, Meenakshi; Jagannathan, Nithya

    2014-01-01

    There always exists a field with genetically altered cells with a high risk of developing premalignant and malignant lesions. It may often happen that an individual stem cell is genetically altered and can cause the formation of a clone or a patch which is likely to turn into a tumor. This explains the higher recurrence rates following tumor resections. It is essential to identify and to treat this field in order to have greater chances to prevent cancer and achieve a better outcome. This article reports concepts, theories and markers for the assessment of field cancerization. PMID:25992232

  16. [Understanding a new conception of addiction in current clinical practices].

    PubMed

    Matsumoto, Toshihiko

    2012-02-01

    This paper described the historical process that the conception of "addiction" and "dependence" have been formed and changed. Before, the "addiction" was a prejudiced word used when people contempt an individual with compulsive drinking or taking psychoactive drugs, and this word implied moralistic and ethical faults of the individual. After that, this word describing an individual without control of drinking was taken place by the "dependence." This is the neutral and medical conception, defined by presence of tolerance and withdrawal symptoms, although it was based on the "alcoholism." which originated in the citizen movement in 1930s in U.S. Recently some professionals have preferred to use the "addiction" when describing an individual losing control of deviated, impulsive, and repetitive behavior including pathological gambling and compulsive buying. These behaviors have been discriminated form substance dependence, while clinically applied to analogical treatment to substance dependence. However, the DSM-5 draft which the American Psychiatric Association has published as a draft of new diagnostic criteria for mental disorders has classified both of substance dependence and addictive behavior into the same category, and has removed the word "dependence" in the description. In this paper, we looked back on historical conflicts between the two words of "dependence" and "addiction," and discussed the clinical meanings and problems of these words.

  17. Unifying Concept of Serotonin Transporter-associated Currents*

    PubMed Central

    Schicker, Klaus; Uzelac, Zeljko; Gesmonde, Joan; Bulling, Simon; Stockner, Thomas; Freissmuth, Michael; Boehm, Stefan; Rudnick, Gary; Sitte, Harald H.; Sandtner, Walter

    2012-01-01

    Serotonin (5-HT) uptake by the human serotonin transporter (hSERT) is driven by ion gradients. The stoichiometry of transported 5-HT and ions is predicted to result in electroneutral charge movement. However, hSERT mediates a current when challenged with 5-HT. This discrepancy can be accounted for by an uncoupled ion flux. Here, we investigated the mechanistic basis of the uncoupled currents and its relation to the conformational cycle of hSERT. Our observations support the conclusion that the conducting state underlying the uncoupled ion flux is in equilibrium with an inward facing state of the transporter with K+ bound. We identified conditions associated with accumulation of the transporter in inward facing conformations. Manipulations that increased the abundance of inward facing states resulted in enhanced steady-state currents. We present a comprehensive kinetic model of the transport cycle, which recapitulates salient features of the recorded currents. This study provides a framework for exploring transporter-associated currents. PMID:22072712

  18. Spin currents, spin torques, and the concept of spin superfluidity

    NASA Astrophysics Data System (ADS)

    Rückriegel, Andreas; Kopietz, Peter

    2017-03-01

    In magnets with noncollinear spin configuration the expectation value of the conventionally defined spin current operator contains a contribution which renormalizes an external magnetic field and hence affects only the precessional motion of the spin polarization. This term, which has been named angular spin current by Sun and Xie [Phys. Rev. B 72, 245305 (2005)], 10.1103/PhysRevB.72.245305, does not describe the translational motion of magnetic moments. We give a prescription for how to separate these two types of spin transport and show that the translational movement of the spin is always polarized along the direction of the local magnetization. We also show that at vanishing temperature the classical magnetic order parameter in magnetic insulators cannot carry a translational spin current and elucidate how this affects the interpretation of spin supercurrents.

  19. Presurgical hand antisepsis: concepts and current habits of veterinary surgeons.

    PubMed

    Verwilghen, Denis; Grulke, Sigrid; Kampf, Günter

    2011-07-01

    To assess current habits for surgical hand preparation among veterinary surgical specialists and to compare data with current guidelines for hand asepsis techniques. Survey of veterinary surgical specialists. Diplomates of the American (ACVS) and European Colleges of Veterinary Surgeons (ECVS). An internet-based survey of hand preparation methods before surgical procedures was conducted of 1300 listed ACVS and ECVS Diplomates. A 42.6% response rate was obtained. Approximately, 80% of respondents use disinfecting soaps as a primary method for hand antisepsis. Of those, 81% use chlorhexidine-based scrubs and 7% use a neutral soap followed by a hydroalcoholic solution. Contrary to current recommendations of the World Health Organization and scientific evidence supporting use of hydro-alcoholic rubs for presurgical hand preparation, veterinary surgical specialists still use surgical scrub solutions containing disinfecting soaps. © Copyright 2011 by The American College of Veterinary Surgeons.

  20. Topical negative pressure therapy: current concepts and practice.

    PubMed

    Malahias, M; Hindocha, S; Saedi, F; McArthur, P

    2012-10-01

    Research into topical negative pressure therapy (TNPT) started in 1989 with Dr Louis Argenta and Prof Michael Morykwas of Wake Forest University School of Medicine in North Carolina, USA. In 1997, Morykwas and Argenta concluded that TNPT both enhanced granulation tissue formation and helped bacterial clearance, through the actions of negative pressure Armstrong and Lavery confirmed this in 2005, concluding that TNPT therapy was promoting the development of granulation tissue. Numerous other studies have proved that TNPT is beneficial for a myriad of other wounds including: sternotomy wounds, extensive de-gloving injuries, various soft tissue injuries prior to surgical closure, skin grafting, pressure sores, leg ulcers, sacral pressure ulcers, acute traumatic soft tissue defects, and soft tissue defects following rigid stabilisation of lower extremity fractures. This review aims to summarise the clinical and scientific concepts of TNPT and its future applications.

  1. Current concepts in the management of hidradenitis suppurativa in children.

    PubMed

    Danby, F William

    2015-08-01

    This review is intended to provide the background aetiopathogenetic framework upon which management of this disorder can be based, particularly with relation to new concepts of the pathogenesis of the disorder. The emphasis is on the prevention of the disorder's full expression by addressing the metabolic changes that drive the underlying structural damage and the immune system's subsequent reaction to this damage. The mechanism by which dietary factors impact on this disease are elucidated, the anatomic defect suspected to be responsible for the disorder is introduced, and an updated flow sheet describing and linking the clinicopathological changes recently described are provided. Recent work in the understanding of the induction and evolution of the lesions provides a background upon which the preventive regimen and both the medical and surgical approaches can be effectively based.

  2. History and current concepts in the analysis of facial attractiveness.

    PubMed

    Bashour, Mounir

    2006-09-01

    Facial attractiveness research has yielded many discoveries in the past 30 years, and facial cosmetic, plastic, and reconstructive surgeons should have a thorough understanding of these findings. Many of the recent studies were conducted by social, developmental, cognitive, and evolutionary psychologists, and although the findings have been published in the psychology literature, they have not been presented in a comprehensive manner appropriate to surgeons. The author reviews the findings of facial attractiveness research from antiquity to the present day and highlights and analyzes important concepts necessary for a thorough understanding of facial attractiveness. Four important cues emerge as being the most important determinants of attractiveness: averageness (prototypicality), sexual dimorphism, youthfulness, and symmetry. A surgeon planning facial cosmetic, plastic, or reconstructive surgery can potentially gain both profound insight and better quality surgical results by appreciating these findings.

  3. Legg-Calvé-Perthes disease. Current concepts and controversies.

    PubMed

    Thompson, G H; Salter, R B

    1987-10-01

    Legg-Calvé-Perthes disease is a common, controversial pediatric hip disorder. It is currently accepted that the disorder represents idiopathic avascular necrosis (osteonecrosis) of the capital femoral epiphysis. Treatment by conservative or surgical containment is recommended primarily for older children with extensive femoral head involvement. The results of containment treatment indicate improved results over the natural history of the disease process.

  4. LLNL current meter array--concept and system description

    SciTech Connect

    Mantrom, D.D.

    1994-11-15

    A measurement capability using a horizontal array of 10 S4 current meters mounted on a stiff floating structure with 35 m aperture has been developed to support interpretation of radar imaging of surface effects associated with internal waves. This system has been fielded three times and most recently, has collected data alongside the sea-surface footprint of a land-fixed radar imaging ship-generated internal waves. The underlying need for this measurement capability is described. The specifications resulting from this need are presented and the engineering design and deployment procedures of the platform and systems that resulted are described The current meter data are multiplexed along with meteorological and system status data on board the floating platform and are telemetered to a shore station and on to a data acquisition system. The raw data are recorded, and are then processed to form space-time images of current and strain rate (a spatial derivative of the current field). Examples of raw and processed data associated with ship-generated internal waves are presented.

  5. Anemia associated with chronic heart failure: current concepts

    PubMed Central

    Shah, Ravish; Agarwal, Anil K

    2013-01-01

    Anemia is a frequent comorbidity of heart failure and is associated with poor outcomes. Anemia in heart failure is considered to develop due to a complex interaction of iron deficiency, kidney disease, and cytokine production, although micronutrient insufficiency and blood loss may contribute. Currently, treatment of anemia of heart failure lacks clear targets and specific therapy is not defined. Intravenous iron use has been shown to benefit anemic as well as nonanemic patients with heart failure. Treatment with erythropoietin-stimulating agents has been considered alone or in combination with iron, but robust evidence to dictate clear guidelines is not currently available. Available and emerging new agents in the treatment of anemia of heart failure will need to be tested in randomized, controlled studies. PMID:23403618

  6. Anemia associated with chronic heart failure: current concepts.

    PubMed

    Shah, Ravish; Agarwal, Anil K

    2013-01-01

    Anemia is a frequent comorbidity of heart failure and is associated with poor outcomes. Anemia in heart failure is considered to develop due to a complex interaction of iron deficiency, kidney disease, and cytokine production, although micronutrient insufficiency and blood loss may contribute. Currently, treatment of anemia of heart failure lacks clear targets and specific therapy is not defined. Intravenous iron use has been shown to benefit anemic as well as nonanemic patients with heart failure. Treatment with erythropoietin-stimulating agents has been considered alone or in combination with iron, but robust evidence to dictate clear guidelines is not currently available. Available and emerging new agents in the treatment of anemia of heart failure will need to be tested in randomized, controlled studies.

  7. Revisiting reflexology: Concept, evidence, current practice, and practitioner training

    PubMed Central

    Embong, Nurul Haswani; Soh, Yee Chang; Ming, Long Chiau; Wong, Tin Wui

    2015-01-01

    Reflexology is basically a study of how one part of the human body relates to another part of the body. Reflexology practitioners rely on the reflexes map of the feet and hands to all the internal organs and other human body parts. They believe that by applying the appropriate pressure and massage certain spots on the feet and hands, all other body parts could be energized and rejuvenated. This review aimed to revisit the concept of reflexology and examine its effectiveness, practices, and the training for reflexology practitioners. PubMed, SCOPUS, Google Scholar, and SpringerLink databases were utilized to search the following medical subject headings or keywords: foot massage, reflexology, foot reflexotherapy, reflexological treatment, and zone therapy. The articles published for the last 10 years were included. Previous systematic reviews failed to show concrete evidence for any specific effect of reflexology in any conditions. Due to its non-invasive, non-pharmacological complementary nature, reflexology is widely accepted and anecdotal evidence of positive effect reflexology in a variety of health conditions are available. Adequate training for practitioners is necessary to ensure the consistency of service provided. PMID:26587391

  8. Current concepts in transarterial chemoembolization of hepatocellular carcinoma.

    PubMed

    Huppert, Peter

    2011-12-01

    Transarterial chemoembolization (TACE) has the potential to improve survival in patients with intermediate stage hepatocellular carcinoma (HCC). Careful selection of patients is mandatory to gain survival benefit and safe quality of life. Basic principles of TACE in HCC include selective treatment via intrahepatic and extrahepatic arteries, proper management of side effects and continuation of treatment guided by imaging. After conventional TACE, based on delivery of cytotoxic drugs emulsified in iodized oil and embolization of various types of particles, has been used for more than 20 years, the new concept of drug-eluting microspheres has been introduced. This technology effectively combines enhanced local drug delivery and ischemic embolization effects. Clinical studies showed intensified local necroses and reduced systemic toxic side effects compared to conventional TACE. Embolization of HCC with sub-100 μm particles penetrating deeply into the tumor vascular bed is another promising new option. Very effective devascularization of HCC nodules has been shown after 40 μm bland embolizations, however, potential risks like passage of particles into hepatic veins and systemic circulation have to be considered. Today the indication for TACE in intermediate stage HCC patients is widely accepted; however, there is no clear methodical standard so far. Further studies are necessary to define how to adapt various available methods to individual HCC and patients characteristics.

  9. Current concepts in simulation-based trauma education.

    PubMed

    Cherry, Robert A; Ali, Jameel

    2008-11-01

    The use of simulation-based technology in trauma education has focused on providing a safe and effective alternative to the more traditional methods that are used to teach technical skills and critical concepts in trauma resuscitation. Trauma team training using simulation-based technology is also being used to develop skills in leadership, team-information sharing, communication, and decision-making. The integration of simulators into medical student curriculum, residency training, and continuing medical education has been strongly recommended by the American College of Surgeons as an innovative means of enhancing patient safety, reducing medical errors, and performing a systematic evaluation of various competencies. Advanced human patient simulators are increasingly being used in trauma as an evaluation tool to assess clinical performance and to teach and reinforce essential knowledge, skills, and abilities. A number of specialty simulators in trauma and critical care have also been designed to meet these educational objectives. Ongoing educational research is still needed to validate long-term retention of knowledge and skills, provide reliable methods to evaluate teaching effectiveness and performance, and to demonstrate improvement in patient safety and overall quality of care.

  10. Revisiting reflexology: Concept, evidence, current practice, and practitioner training.

    PubMed

    Embong, Nurul Haswani; Soh, Yee Chang; Ming, Long Chiau; Wong, Tin Wui

    2015-10-01

    Reflexology is basically a study of how one part of the human body relates to another part of the body. Reflexology practitioners rely on the reflexes map of the feet and hands to all the internal organs and other human body parts. They believe that by applying the appropriate pressure and massage certain spots on the feet and hands, all other body parts could be energized and rejuvenated. This review aimed to revisit the concept of reflexology and examine its effectiveness, practices, and the training for reflexology practitioners. PubMed, SCOPUS, Google Scholar, and SpringerLink databases were utilized to search the following medical subject headings or keywords: foot massage, reflexology, foot reflexotherapy, reflexological treatment, and zone therapy. The articles published for the last 10 years were included. Previous systematic reviews failed to show concrete evidence for any specific effect of reflexology in any conditions. Due to its non-invasive, non-pharmacological complementary nature, reflexology is widely accepted and anecdotal evidence of positive effect reflexology in a variety of health conditions are available. Adequate training for practitioners is necessary to ensure the consistency of service provided.

  11. Reverse polarity shoulder replacement: Current concepts and review of literature

    PubMed Central

    Lee, Ling Hong; Desai, Aravind

    2014-01-01

    Shoulder replacement in cuff tear arthropathy (CTA) is an unsolved challenge. CTA poses a soft tissue deficiency in an arthritic glenohumeral joint which the anatomical total shoulder replacement and hemiarthroplasty cannot reliably provide stability, range of movement, function or satisfactory long term outcome. In the past two decades since the introduction of the reverse shoulder replacement, the prosthesis has evolved and has shown promising results. It is a partially constraint joint by virtue of its design features. The reversal of the concavity and convexity of the joint to the proximal humerus and the glenoid, respectively, also shifts and improves its center of rotation onto the osseous surface of the glenoid with less exposure to shear stress. It is a successful pain relieving procedure, offering good outcome in patients with irreparable massive rotator cuff tear with or without osteoarthritis. Consequently, this has led to wider use and expansion of its indication to include more complex elective and trauma cases. Whereas originally used in the more elderly patients, there is increasingly more demand in the younger patients. It is important to have good quality long term data to support these increasing indications. Therefore, we review the literature on the concepts of reverse shoulder replacement and the contemporary evidence. PMID:25035828

  12. [A review of current concepts in evidence-based radiology].

    PubMed

    Roldán-Valadez, Ernesto; Lee, Angel; Jiménez-Corona, Aída; Vega-González, Iván; Martínez-López, Manuel; Vázquez-LaMadrid, Jorge

    2007-01-01

    It has been noted that "Good doctors use both individual clinical expertise and the best available external evidence, and neither alone is enough. " Evidence-based medicine (EBM) is defined as the process of systematically finding, critically appraising, and using contemporary research published in the medical literature as a basis to make decisions regarding individual patient care and health care policy. In radiology, including its diagnostic and interventional aspects, the principles and practice of EBM have not been thoroughly studied. In this brief review article, we describe key aspects of evidence-based radiology (EBR), concepts and steps followed in EBM and meta-analysis. The skills required to practice EBR are identified, and the roles of EBR in radiologic practice, education, and research are discussed. The application of EBM principles to diagnostic imaging facilitates the interpretation of imaging studies and produces a sound and comprehensive radiologic evaluation. This review could be useful for radiologists and clinicians at any stage of their training or career. It encourages the practice of EBM and EBR especially in developing countries.

  13. Flea control in cats: new concepts and the current armoury.

    PubMed

    Siak, Meng; Burrows, Mandy

    2013-01-01

    Flea allergic dermatitis is one of the most common skin diseases of cats presented for veterinary attention. It is therefore important for the practitioner to be able to design an appropriate flea management plan for their patients. There is no 'one size fits all' flea control programme for cats. Successful flea management requires an understanding of flea biology and knowledge of the mode of action of commercial flea products, of which there is a wide range available. Management of owner expectations can often present a challenge. Cat owners generally attribute a persistence of fleas after the administration of routine flea control to be a reflection of product failure. Owners may also be sceptical that fleas are responsible for the clinical signs of overgrooming in their cat and perceive a lack of response to flea adulticide treatment to be evidence of this fact. This article reviews an extensive body of published literature to update some concepts in flea control and discuss how judicious use of traditional and newer flea products can contribute to an integrated flea control strategy for cats.

  14. Concussions in the National Football League: A Current Concepts Review.

    PubMed

    Yengo-Kahn, Aaron M; Johnson, Daniel J; Zuckerman, Scott L; Solomon, Gary S

    2016-03-01

    Significant attention has been directed toward the immediate and long-term effects of sport-related concussions on athletes participating in contact sports, particularly football. The highest level of football, the National Football League (NFL), has received significant attention and criticism regarding player management and safety after mild traumatic brain injury (mTBI). Several review articles have reported data related to concussion in the NFL, but a succinct review and synthesis of data regarding NFL concussions is currently lacking. To (1) review systematically the published data regarding concussion in the NFL and assess limitations of the studies, (2) elucidate areas where further research is needed, and (3) identify methods to improve future investigations of concussion in the NFL. Systematic review of literature. English-language titles and abstracts published between 1900 and September 2014 were searched systematically across electronic databases, and a review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Peer-reviewed journal articles were included if they contained NFL concussion data with or without additional associated long-term effects. Reviews, editorials, letters to the editor, and comments were not included. Of the 344 records screened for review, 88 articles were assessed for eligibility. There were 31 studies that met the inclusion criteria and formed the basis of the evidence synthesis. Included in the current review were 8 case-control studies (Oxford Centre for Evidence-Based Medicine evidence level 3b), 6 descriptive epidemiological studies (level 4), 6 cross-sectional studies (level 4), 6 cohort studies (level 2b), and 5 case series (level 4). The study of concussions in the NFL has been limited by lack of recent empirical data, reliance on self-reported concussion history, and ascertainment bias of brains donated for autopsy studies. The scientific community

  15. Current Concepts and Future Directions in Differentiated Thyroid Cancer

    PubMed Central

    McLeod, Donald SA

    2010-01-01

    This paper provides an overview on the biology, monitoring and management of differentiated thyroid cancer (DTC), with particular attention to issues of relevance to clinical chemistry. The incidence of DTC appears to be increasing and management strategies are evolving as we learn more about its natural history and response to therapy. Clinical chemistry techniques play a central role in these protocols. Technical limitations inherent in current monitoring tools can hamper follow-up, although progress is being made. The molecular basis of DTC is being delineated with the potential to develop new strategies for diagnosis, monitoring and management of this condition. PMID:20179793

  16. Bronchiectasis in Children: Current Concepts in Immunology and Microbiology

    PubMed Central

    Pizzutto, Susan J.; Hare, Kim M.; Upham, John W.

    2017-01-01

    Bronchiectasis is a complex chronic respiratory condition traditionally characterized by chronic infection, airway inflammation, and progressive decline in lung function. Early diagnosis and intensive treatment protocols can stabilize or even improve the clinical prognosis of children with bronchiectasis. However, understanding the host immunologic mechanisms that contribute to recurrent infection and prolonged inflammation has been identified as an important area of research that would contribute substantially to effective prevention strategies for children at risk of bronchiectasis. This review will focus on the current understanding of the role of the host immune response and important pathogens in the pathogenesis of bronchiectasis (not associated with cystic fibrosis) in children. PMID:28611970

  17. Current concepts in acute respiratory support for neonates and children.

    PubMed

    Arca, Marjorie J; Uhing, Michael; Wakeham, Martin

    2015-02-01

    Current trends in mechanical respiratory support are evolving toward gentle approaches to avoid short- and long-term problems that are historically associated with mechanical ventilation. These ventilator-associated issues include the need for long-term sedation, muscle deconditioning, ventilator-associated lung injury (VALI), and ventilator-associated pneumonia (VAP). This article will describe recent trends of ventilatory support in neonates and children: (1) utilization of volume ventilation in infants, (2) synchrony and improving patient-ventilator interaction specifically using neurally adjusted ventilatory assist (NAVA), and (3) use of noninvasive ventilation techniques. When applicable, their uses in the surgical newborn and pediatric patients are described.

  18. [Current concepts in diagnostics and therapy of diabetes mellitus].

    PubMed

    Adolf, C; Freibothe, I; Seißler, J; Lechner, A

    2015-04-01

    In Germany approximately 7.2% of the population currently suffer from diabetes mellitus. A further increase in the prevalence is expected in the coming years. Many therapy options, sometimes even without a risk of hypoglycemia, are now available. The foundations of a sufficient therapy of type 2 diabetes are, however, still lifestyle measures, such as weight reduction, optimized nutrition and increased physical activity. Optimization of cardiac and cerebrovascular risk factors is also an essential component of management of diabetes in order to reduce or even avoid secondary complications.

  19. Current concepts in management of slipped capital femoral epiphysis.

    PubMed

    Bittersohl, Bernd; Hosalkar, Harish S; Zilkens, Christoph; Krauspe, Rüdiger

    2015-01-01

    Slipped capital femoral epiphysis (SCFE) is a common hip condition that can be disabling. In this review, we provide an orientation on current trends in the clinical management of SCFE including conventional procedures and specialised surgical developments. Different methods of fixation of the epiphysis, risks of complications, and the rationale of addressing deformity, primarily or secondarily, are presented. Although improved understanding of the anatomy, vascularity and implications of residual deformity have changed management strategies, the best modality of treatment that would restore complete vascularity to the femoral head and prevent any residual deformity, impingement and early osteoarthritis remains elusive.

  20. Current concepts, classification, and results in short stem hip arthroplasty.

    PubMed

    Falez, Francesco; Casella, Filippo; Papalia, Matteo

    2015-03-01

    Various short hip stems have been introduced with differing implant concepts of femoral fixation and implant length. There is a lack of proper classification for short hip stems, with a clear and accepted definition for implant length and extent of bone preservation in the metaphyseal and diaphyseal femur. This study analyzed the length of short hip stems. Stems were divided into collum, partial collum, and trochanter-sparing implants. An additional category was added, trochanter harming, which was defined as interruption of the circumferential integrity of the femoral neck. For all of the femoral components described, the designs were compared, excluding stems with insufficient clinical data. The 15 finally selected stems were classified as collum (1 stem), partial collum (7 stems), trochanter sparing (4 stems), and trochanter harming (3 stems). Mid-term results (>5 years of follow-up) were available for only 3 designs in the partial collum group. Taking into account the results of short-term studies (<5 years of follow-up), the femoral revision rate per 100 observed component years was <1 for most total hip arthroplasties. However, the studies varied greatly regarding level of significance, and short hip stems without published results are available commercially. Short hip stems cannot be circumscribed by a simple length limit. For some designs, clinical data collected from large patient cohorts showed a survivorship comparable to traditional stems. In cases that must be revised, this often can be performed with a conventional primary stem, fulfilling the promise to preserve bone for potential future revisions in younger patients. Copyright 2015, SLACK Incorporated.

  1. The Path to Fusion Energy for Concepts Currently at the Concept Exploration Level

    SciTech Connect

    Hooper, E B

    2003-01-09

    Concept Exploration (CE) experiments within the Innovative Confinement Concept Program have a unique role which impacts their contributions to the development of fusion energy. As stated in the FESAC ''Report on Alternate Concepts:'' These [CE] programs are aimed at innovation and basic understanding of relevant scientific phenomena. The emphasis on innovation motivates their application to the search for a better fusion reactor configuration. In addition, because of their unique character the CE experiments offer excellent opportunities to couple fusion-plasma physics to other sciences. A recent example of coupling is the fusion self-organized plasmas to reconnection physics and extra-terrestrial plasmas. Perhaps of even greater importance is the education of the future scientists needed for developing fusion energy. The CE experiments, both at universities and national labs, are of a size students can ''get their hands around;'' young scientists and engineers will be attracted by this intellectual challenge combined with the vision of low-pollution energy for mankind represented by a burning-plasma experiment. A CE concept showing promise for fusion energy is expected to advance to the Proof-of-Principal stage. Experience has shown that this progression may occur in several ways: NSTX followed from success in START, a CE-level experiment in England; NCSX built on a broad base of theory and a strong international stellarator data base, without a CE experiment to test quasi-axisymmetry; and MST is following an upgrade path from the CE experiment of the same name. The lesson to be learned is a highly positive one, namely that the portfolio approach--with its five stages of development--is being applied in a flexible and pragmatic manner without artificial constraints from strategic planning. This lesson also makes it clear that as we move towards the development of fusion energy we need to determine the best way forward for each promising configuration, taking

  2. Binary concepts and standardization in counter-current separation technology.

    PubMed

    Friesen, J B; Pauli, G F

    2009-05-08

    Counter-current separation (CS) technology is currently faced with the challenge of being fit for the purpose of omics analysis, which involves highly complex samples and digitized research environments. Resembling a network of binary decisions, CS requires standardization of operation parameters in order to be efficient. While recent CS engineering solutions uniformly involve centrifugal force designs to overcome the limitation of the earth's 1xg force, factors of instrument design, operation, and graphical representation of the outcome are equally important targets for standardization. For example, chromatograms that emphasize the unique K-based nature of CS, such as reciprocal symmetry (ReS) plots, foster the fundamental understanding of CS operation. Because significant differences exist in underlying mechanism (e.g., stationary phase volume), outcome (e.g., construction of chromatograms), and scale (e.g., factors affecting overall method sensitivity) of solid-liquid vs. liquid-liquid chromatography technologies, standardization will enable the systematic exploration of the differential properties of the two LC technologies, and will be key to making CS fit for the digital omics age.

  3. Arthritis of the thumb and digits: current concepts.

    PubMed

    Bernstein, Richard A

    2015-01-01

    Osteoarthritis of the hand continues to be a problem in an aging population and affects the proximal and distal interphalangeal, metacarpophalangeal, and carpometacarpal joints in the hands. Heberden nodes develop in the distal interphalangeal joints and typically present as a deformed and enlarged joint and can cause pain. Surgery rarely is necessary because functional difficulties are uncommon; however, there may be problems if the metacarpophalangeal and proximal interphalangeal joints are involved because cartilage destruction generates pain and causes weakness and motion loss. Implant arthroplasty typically can improve pain but does not reliably improve range of motion, and complication and revision rates are substantial. Arthrodesis continues as a treatment for digital osteoarthritis, but the surgeon must balance the risks of complications with the benefits of improved patient outcomes. The opposable thumb, which is critical for hand dexterity and strength, can be severely disabled by basal joint arthritis. The complex architecture of the basal joint continues to be defined by its relationship to the surrounding bony and ligamentous anatomy and its effect on the trapeziometacarpal joint. Nonsurgical treatment may be beneficial, but surgical options, including arthroscopy, osteotomy, and arthroplasty, should be considered if nonsurgical management fails. Prosthetic arthroplasty has a historically poor record; therefore, trapeziectomy remains the hallmark of current reconstructive techniques. Ligament reconstruction and tendon interposition arthroplasty are the most commonly performed surgical procedures, but hematoma distraction arthroplasty and various methods of suspensionplasty also are currently used.

  4. Current concepts in the management of periocular infantile (capillary) hemangioma.

    PubMed

    Ni, Nina; Guo, Suqin; Langer, Paul

    2011-09-01

    To review and evaluate the medical literature on new treatments for periocular infantile (capillary) hemangioma. Recent studies have shown a promising new therapy for infantile hemangioma using nonselective β-blockers, including oral propranolol and topical timolol. Conventional treatments for infantile hemangioma include the use of corticosteroids, laser, surgery, and immunomodulator therapy. Recently, systemic and topical β-blockers have been used to successfully treat infantile hemangioma. The drugs' mechanism of action remains uncertain, but plausible theories include vasoconstriction, modulation of pro-survival signal transduction pathways, and endothelial cell apoptosis. Whereas no life-threatening adverse events from β-blocker treatment have been described, there have been reports of bradycardia, hypotension, bronchospasm, hypoglycemia, and electrolyte disturbances resulting from systemic use of propranolol to treat infantile hemangioma. Sleep and gastrointestinal disturbances have also been frequently reported. Topical timolol application for localized, superficial tumors may confer similar efficacy as oral propranolol while reducing systemic effects. Despite the recent explosion of interest surrounding this novel treatment, current treatment and protocol-monitoring recommendations are based largely on the experience of individual centers. Several randomized controlled studies are currently underway, the results of which will guide future standard-of-care treatment for infantile hemangioma.

  5. Current concepts in the treatment of sports concussions.

    PubMed

    Putukian, Margot; Kutcher, Jeffrey

    2014-10-01

    The management of patients with sports-related concussion (SRC) is comprehensive and includes preseason planning, education, initial evaluation, postinjury assessment, disposition, return-to-play decisions, and consideration of long-term brain health. Several recent publications have addressed sports concussion management using the best available evidence, and we review them here. The diagnosis and management of sports concussion have evolved over the past several decades, and with a greater understanding of the importance of both short- and long-term sequelae, there has been a clear trend toward recognizing and treating these brain injuries more cautiously and developing a proactive approach to management and return-to-play decision making. Although each of these used different methodologies in their review of the literature, their conclusions are fairly consistent, providing basic guidelines for contemporary approaches to management of SRC. Although many questions remain unanswered, there are several areas of agreement including the importance of education, preseason assessment, the benefit and utility of a standardized multimodal assessment on the sidelines, individualized treatment and return-to-play protocols, and the benefit of a multidisciplinary team in managing complicated injuries. This paper reviews these current sports concussion guidelines and the best available evidence that guides current management of SRC.

  6. Chapter 8: Current techniques and concepts in peripheral nerve repair.

    PubMed

    Siemionow, Maria; Brzezicki, Grzegorz

    2009-01-01

    Despite the progress in understanding the pathophysiology of peripheral nervous system injury and regeneration, as well as advancements in microsurgical techniques, peripheral nerve injuries are still a major challenge for reconstructive surgeons. Thorough knowledge of anatomy, pathophysiology, and surgical reconstruction is a prerequisite of proper peripheral nerve injury management. This chapter reviews the currently available surgical treatment options for different types of nerve injuries in clinical conditions. In overview of direct nerve repair, various end-to-end coaptation techniques and the role of end-to-side repair for proximal nerve injuries is described. When primary repair cannot be performed without undue tension, nerve grafting or tubulization techniques are required. Current gold standard for bridging nerve gaps is nerve autografting. However, disadvantages of this approach, such as donor site morbidity and limited length of available graft material encouraged the search for alternative means of nerve gap reconstruction. Nerve allografting was introduced for repair of extensive nerve injuries. Tubulization techniques with natural or artificial conduits are applicable as an alternative for bridging short nerve defects without the morbidities associated with harvesting of autologous nerve grafts. Achieving better outcomes depends both on the advancements in microsurgical techniques and introduction of molecular biology discoveries into clinical practice. The field of peripheral nerve research is dynamically developing and concentrates on more sophisticated approaches tested at the basic science level. Future directions in peripheral nerve reconstruction including, tolerance induction and minimal immunosuppression for nerve allografting, cell based supportive therapies and bioengineering of nerve conduits are also reviewed in this chapter.

  7. Treatment for Degenerative Lumbar Spondylolisthesis: Current Concepts and New Evidence.

    PubMed

    Samuel, Andre M; Moore, Harold G; Cunningham, Matthew E

    2017-10-09

    Current guidelines for the optimal treatment degenerative spondylolisthesis are weak and based on limited high-quality evidence. There is some moderate evidence that decompression alone may be a feasible treatment with lower surgical morbidity and similar outcomes to fusion when performed in a select population with a low-grade slip. Similarly, addition of interbody fusion may be best suited to a subset of patients with high-grade degenerative spondylolisthesis, although this remains controversial. Minimally invasive techniques are increasingly being utilized for both decompression and fusion surgeries with more and more studies showing similar outcomes and lower postoperative morbidity for patients. This will likely be an area of continued intense research. Finally, the role of spondylolisthesis reduction will likely be determined as further investigation into optimal sagittal balance and spinopelvic parameters is conducted. Future identification of ideal thresholds for sagittal vertical axis and slip angle that will prevent progression and reoperation will play an important role in surgical treatment planning. Current evidence supports surgical treatment of degenerative spondylolisthesis. While posterolateral spinal fusion remains the treatment of choice, the use of interbodies and decompressions without fusion may be efficacious in certain populations. However, additional high-quality evidence is needed, especially in newer areas of practice such as minimally invasive techniques and sagittal balance correction.

  8. Current concepts in the treatment of cartilage damage. A review.

    PubMed

    Musumeci, Giuseppe; Loreto, Carla; Castorina, Sergio; Imbesi, Rosa; Leonardi, Rosalia; Castrogiovanni, Paola

    2013-01-01

    A literature review of tile treatment of cartilage defects was conducted, examining the current literature on the well-known treatments. In particular, advantages and drawbacks of each of the discussed treatments were evaluated considering outcomes available in literature. The literature search was conducted on PubMed and Scopus using appropriate keywords in relation to cartilage defects. Main research articles were selected for review. Cartilage damage affects thousands of persons each year; they are treated with implants and surgery. A major problem in the treatment of cartilage defects is the inability of cartilage to repair, which reduces the effectiveness of the treatment. In addition, cyclic loading of joints further degrades cartilage even after treatment. In relation to the conditions of cartilage lesions and the features of patients, a specific treatment is required in each case. Current treatments are often unpredictable in results but result in long term improvements for many patients, especially young patients. The well established treatments such as osteochondral implants, bone marrow stimulation techniques, chondrogenic cell implantations have advantages and drawbacks, so that the search has not been interrupted for new strategies, such as scaffold materials. In this review we describe benefits and disadvantages of the established methods of cartilage regeneration that seem to have a better long-term effectiveness.

  9. [Anaplastic glioma. Neuropathology, molecular diagnostics and current study concepts].

    PubMed

    Wick, W; Weller, M

    2010-08-01

    According to the current WHO classification anaplastic gliomas comprise pure astrocytomas and oligodendrogliomas and mixed tumors. This review summarizes findings, discusses problems and defines new questions from the phase III trials on anaplastic gliomas. The molecular subgroup analyses of the NOA-04 trial identified three molecular parameters, which predict longer progression-free and overall survival independent from the mode of therapy, radiotherapy or alkylating chemotherapy-. These are 1p/19q codeletion, methylation of the promoter of the O(6)-methylguanyl methyltransferase (MGMT) gene and hot-spot mutations in the isocitrate dehydrogenase 1 (IDH1) gene. The prognostic relevance of these markers is not lower than that of histopathological subclassification but determination is potentially more robust. Therefore, marker profiles should be included into the next WHO brain tumor classification. The current standard of care for first-line treatment in anaplastic gliomas is radiotherapy or chemotherapy. The next steps, e.g. within the international CATNON trial, are to define the role and optimal sequencing of combined modality treatment focusing on radiotherapy and temozolomide. Inclusion in this trial is already based on the WHO grade and the 1p/19q status and not on the histopathological subtype. Furthermore, anaplastic gliomas are an important group of brain tumors for developing future molecular targeted therapies and should therefore be in the main focus of academic and industrial drug development, which aims at improved efficacy and avoiding long-term side-effects.

  10. Current pathophysiological concepts and management of pulmonary hypertension.

    PubMed

    Lourenço, André P; Fontoura, Dulce; Henriques-Coelho, Tiago; Leite-Moreira, Adelino F

    2012-03-22

    Pulmonary hypertension (PH), increasingly recognized as a major health burden, remains underdiagnosed due mainly to the unspecific symptoms. Pulmonary arterial hypertension (PAH) has been extensively investigated. Pathophysiological knowledge derives mostly from experimental models. Paradoxically, common non-PAH PH forms remain largely unexplored. Drugs targeting lung vascular tonus became available during the last two decades, notwithstanding the disease progresses in many patients. The aim of this review is to summarize recent advances in epidemiology, pathophysiology and management with particular focus on associated myocardial and systemic compromise and experimental therapeutic possibilities. PAH, currently viewed as a panvasculopathy, is due to a crosstalk between endothelial and smooth muscle cells, inflammatory activation and altered subcellular pathways. Cardiac cachexia and right ventricular compromise are fundamental determinants of PH prognosis. Combined vasodilator therapy is already mainstay for refractory cases, but drugs directed at these new pathophysiological pathways may constitute a significant advance. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  11. Current Concepts of Immunology and Diagnosis in Amniotic Fluid Embolism

    PubMed Central

    Benson, Michael D.

    2012-01-01

    Amniotic fluid embolism (AFE) is one of the leading causes of maternal mortality and morbidity in developed countries. Current thinking about pathophysiology has shifted away from embolism toward a maternal immune response to the fetus. Two immunologic mechanisms have been studied to date. Anaphylaxis appears to be doubtful while the available evidence supports a role for complement activation. With the mechanism remaining to be elucidated, AFE remains a clinical diagnosis. It is diagnosed based on one or more of four key signs/symptoms: cardiovascular collapse, respiratory distress, coagulopathy, and/or coma/seizures. The only laboratory test that reliably supports the diagnosis is the finding of fetal material in the maternal pulmonary circulation at autopsy. Perhaps the most compelling mystery surrounding AFE is not why one in 20,000 parturients are afflicted, but rather how the vast majority of women can tolerate the foreign antigenic presence of their fetus both within their uterus and circulation? PMID:21969840

  12. Current Concepts in Treatment of Patellofemoral Osteochondritis Dissecans

    PubMed Central

    Paine, Russ; Chicas, Eric; Gardner, Emily; Bailey, Lane; McDermott, James

    2016-01-01

    Identification, protection, and management of patellofemoral articular cartilage lesions continue to remain on the forefront of sports medicine rehabilitation. Due to high-level compression forces that are applied through the patellofemoral (PF) joint, managing articular cartilage lesions is challenging for sports medicine specialists. Articular cartilage damage may exist in a wide spectrum of injuries ranging from small, single areas of focal damage to wide spread osteoarthritis involving large chondral regions. Management of these conditions has evolved over the last two centuries, most recently using biogenetic materials and cartilage replacement modalities. The purpose of this clinical commentary is to discuss PF articular cartilage injuries, etiological variables, and investigate the evolution in management of articular cartilage lesions. Rehabilitation of these lesions will also be discussed with a focus on current trends and return to function criteria. Level of Evidence 5 PMID:27904793

  13. Current concepts in the management of complex elbow trauma.

    PubMed

    Morrey, B F

    2009-06-01

    Complex instability of the elbow, also known as fracture dislocation of the elbow, is one of the most challenging injuries of the musculoskeletal system. A clear understanding of the biomechanics of the joint with special focus on the relative contributions of the articular components and the ligamentous constraints is critical to the proper management of these injuries. The accurate recognition and implications of associated injuries offers a rationale for approaching these difficult problems by appropriately addressing the elements of the trauma. Further, doing so in a timely fashion enhances the outcome. Currently, even the most devastating of injuries are felt to have a more favourable prognosis than was present in the past if the principles contained herein are followed.

  14. Current Concepts on the Physiopathological Relevance of Dopaminergic Receptors

    PubMed Central

    Ledonne, Ada; Mercuri, Nicola B.

    2017-01-01

    Dopamine (DA) is a key neurotransmitter modulating essential functions of the central nervous system (CNS), like voluntary movement, reward, several cognitive functions and goal-oriented behaviors. The factual relevance of DAergic transmission can be well appreciated by considering that its dysfunction is recognized as a core alteration in several devastating neurological and psychiatric disorders, including Parkinson’s disease (PD) and associated movement disorders, as well as, schizophrenia, bipolar disorder, attention deficit hyperactivity disorder (ADHD) and addiction. Here we present an overview of the current knowledge on the involvement of DAergic receptors in the regulation of key physiological brain activities, and the consequences of their dysfunctions in brain disorders such as PD, schizophrenia and addiction. PMID:28228718

  15. Current Concepts on Diagnosis and Treatment of Mastocytosis

    PubMed Central

    Magliacane, D.; Parente, R.; Triggiani, M.

    2014-01-01

    Mastocytosis is a heterogeneous group of disorders characterized by a clonal proliferation and accumulation of mast cells in one or more organ, primarily in the skin and bone marrow. The clinical spectrum of the disease varies from relatively benign forms with isolated skin lesions to very aggressive variants with extensive systemic involvement and poor prognosis. The growth and proliferation of clonal mast cells is caused by an activating mutation of the tyrosine kinase receptor Kit for Stem Cell Factor, the main growth factor for mast cells. Clinical symptoms are related to mast-cell mediator release, to the tissue mast cell infiltration or both. The degree of infiltration and cell activation determines the highly variable clinical and morphological features. Current treatment of mastocytosis includes symptomatic, antimediator drugs and cytoreductive targeted therapies. PMID:24778999

  16. [Pathophysiology of hypertension : What are our current concepts?].

    PubMed

    Jordan, J

    2015-03-01

    In the year 2015, many questions regarding the pathophysiology of essential arterial hypertension remain unresolved. Substantial scientific progress has been made in various medical areas aided by novel molecular"omics" techniques. The findings could then be implemented in diagnostic and therapeutic procedures. In the field of hypertension research such methods have been applied in very large cohorts but have contributed less to pathophysiological understanding and clinical management than expected. The findings on the pathophysiological importance of baroreflex mechanisms, natriuretic peptides and osmotically inactive sodium storage discussed in this article all have something in common: all are based on small, carefully conducted human physiological investigations and often challenge current textbook knowledge. Nevertheless, these findings have opened up new research fields and are likely to affect clinical care.

  17. Current Concepts in the Management of the Rheumatoid Hand

    PubMed Central

    Chung, Kevin C; Pushman, Allison G

    2011-01-01

    Hand surgeons are an integral part of the management team for patients with rheumatoid arthritis. There is now a greater understanding of the national utilization of rheumatoid hand surgery, which highlights the differences between hand surgeons and rheumatologists regarding the treatment of the rheumatoid hand. Advances in medical treatments have also decreased the prevalence of hand deformities caused by this disease. Hand surgeons today have less exposure to treating rheumatoid hand, but despite more effective medical options, surgery may still offer patients hope for improvement of hand function and appearance. This article will summarize the current state of rheumatoid hand surgery and discuss the surgical treatment strategies for optimizing outcomes for patients suffering from rheumatoid arthritis. PMID:21463736

  18. Current concepts in diagnosis and treatment of chronic lymphocytic leukemia

    PubMed Central

    Roliński, Jacek

    2015-01-01

    Chronic lymphocytic leukemia (CLL) is the most commonly diagnosed type of leukemia in Western Europe and North America, and represents about 30% of all leukemias in adults. Chronic lymphocytic leukemia is a disease of the elderly, who are often in poorer general health and burdened with multiple comorbidities. These factors affect the decision making when choosing an appropriate method of treatment. In recent years there has been significant progress in the treatment of chronic lymphocytic leukemia, first due to the introduction of immunochemotherapy with monoclonal antibodies and latterly small molecules, like tyrosine kinase inhibitors targeting B-cell receptor signaling. This article discusses the current diagnostic principles, the most important prognostic factors and therapeutic options, available in first-line treatment and in refractory/resistant disease, including high-risk CLL, both for patients with good and those with poor performance status. It also presents important novel molecules which have been evaluated in clinical trials. PMID:26793019

  19. Epidemic keratoconjunctivitis: A review of current concepts in management

    PubMed Central

    Pihos, Andria M.

    2012-01-01

    Epidemic keratoconjunctivitis (EKC) is an ocular surface infection caused by adenovirus. To date, there are no approved topical antiadenoviral therapeutics to treat EKC. Recent research reveals that treatment with topical corticosteroids for symptomatic relief of EKC enhances adenovirus replication and delays cell shedding from the ocular surface which delays adenovirus elimination. The current management of EKC largely revolves around accurate diagnosis of the condition and implementation of disinfection protocol to prevent its spread. Development of an effective antiviral treatment that addresses inflammation and does not prolong viral shedding would provide significant benefit. The literature reports on a variety of therapeutics that could potentially satisfy this deficiency. Topical ganciclovir and povidone-iodine combination drops have shown the most recent potential, but both therapeutics need to be investigated in larger scale studies. Until an antiadenoviral option is produced, the treatment of EKC should maintain a judicious case by case approach aiming to contain its dissemination and prevent visual consequences.

  20. Current Concepts in Treatment of Patellofemoral Osteochondritis Dissecans.

    PubMed

    Juneau, Chris; Paine, Russ; Chicas, Eric; Gardner, Emily; Bailey, Lane; McDermott, James

    2016-12-01

    Identification, protection, and management of patellofemoral articular cartilage lesions continue to remain on the forefront of sports medicine rehabilitation. Due to high-level compression forces that are applied through the patellofemoral (PF) joint, managing articular cartilage lesions is challenging for sports medicine specialists. Articular cartilage damage may exist in a wide spectrum of injuries ranging from small, single areas of focal damage to wide spread osteoarthritis involving large chondral regions. Management of these conditions has evolved over the last two centuries, most recently using biogenetic materials and cartilage replacement modalities. The purpose of this clinical commentary is to discuss PF articular cartilage injuries, etiological variables, and investigate the evolution in management of articular cartilage lesions. Rehabilitation of these lesions will also be discussed with a focus on current trends and return to function criteria.

  1. [Asperger syndrome: evolution of the concept and current clinical data].

    PubMed

    Aussilloux, C; Baghdadli, A

    2008-05-01

    Although Asperger syndrome is described by international classifications as a category of pervasive developmental disorder (PDD), its validity as a specific entity distinct from autistic disorders remains controversial. The syndrome, first described by Hans Asperger, could not be distinguished from high functioning autism (onset, symptoms, outcome...). However, international classifications propose a distinction between the two syndromes based on a delayed onset, the absence of speech delay, the presence of motor disorders and a better outcome in Asperger syndrome. This categorical differentiation is not confirmed by current studies and in the absence of biological markers, no clinical, neuropsychological or epidemiological criteria makes it possible to distinguish high functioning autism from Asperger syndrome. From a clinical perspective, it is nevertheless of interest to isolate Asperger syndrome from other autistic disorders to propose specific assessment and therapy.

  2. Current concepts of immunology and diagnosis in amniotic fluid embolism.

    PubMed

    Benson, Michael D

    2012-01-01

    Amniotic fluid embolism (AFE) is one of the leading causes of maternal mortality and morbidity in developed countries. Current thinking about pathophysiology has shifted away from embolism toward a maternal immune response to the fetus. Two immunologic mechanisms have been studied to date. Anaphylaxis appears to be doubtful while the available evidence supports a role for complement activation. With the mechanism remaining to be elucidated, AFE remains a clinical diagnosis. It is diagnosed based on one or more of four key signs/symptoms: cardiovascular collapse, respiratory distress, coagulopathy, and/or coma/seizures. The only laboratory test that reliably supports the diagnosis is the finding of fetal material in the maternal pulmonary circulation at autopsy. Perhaps the most compelling mystery surrounding AFE is not why one in 20,000 parturients are afflicted, but rather how the vast majority of women can tolerate the foreign antigenic presence of their fetus both within their uterus and circulation?

  3. Acute Compartment Syndrome of the Limbs: Current Concepts and Management

    PubMed Central

    Mabvuure, Nigel Tapiwa; Malahias, Marco; Hindocha, Sandip; Khan, Wasim; Juma, Ali

    2012-01-01

    Acute compartment syndrome (ACS) of the limb refers to a constellation of symptoms, which occur following a rise in the pressure inside a limb muscle compartment. A failure or delay in recognising ACS almost invariably results in adverse outcomes for patients. Unrecognised ACS can leave patients with nonviable limbs requiring amputation and can also be life–threatening. Several clinical features indicate ACS. Where diagnosis is unclear there are several techniques for measuring intracompartmental pressure described in this review. As early diagnosis and fasciotomy are known to be the best determinants of good outcomes, it is important that surgeons are aware of the features that make this diagnosis likely. This clinical review discusses current knowledge on the relevant clinical anatomy, aetiology, pathophysiology, risk factors, clinical features, diagnostic procedures and management of an acute presentation of compartment syndrome. PMID:23248724

  4. Current concepts of active vasodilation in human skin

    PubMed Central

    Wong, Brett J.; Hollowed, Casey G.

    2017-01-01

    ABSTRACT In humans, an increase in internal core temperature elicits large increases in skin blood flow and sweating. The increase in skin blood flow serves to transfer heat via convection from the body core to the skin surface while sweating results in evaporative cooling of the skin. Cutaneous vasodilation and sudomotor activity are controlled by a sympathetic cholinergic active vasodilator system that is hypothesized to operate through a co-transmission mechanism. To date, mechanisms of cutaneous active vasodilation remain equivocal despite many years of research by several productive laboratory groups. The purpose of this review is to highlight recent advancements in the field of cutaneous active vasodilation framed in the context of some of the historical findings that laid the groundwork for our current understanding of cutaneous active vasodilation. PMID:28349094

  5. Sebum, inflammasomes and the skin: current concepts and future perspective.

    PubMed

    Oyewole, Anne O; Birch-Machin, Mark A

    2015-09-01

    Increasing evidence has identified ultraviolet radiation (UVR) as the skins most potent mutagen as over exposure results in sunburn, inflammation and DNA damage, thus contributing to a photo-ageing phenotype and possibly skin carcinogenesis. The lipid-rich sebum secreted onto the surface of the skin plays an important physiological role in protecting the skin against external challenges. When skin is photosensitised by UVR, the lipid constituents of sebum are easily oxidised, generating several lipid photo-oxidative products (e.g. squalene peroxides). These photo-oxidative products have been shown to exert diverse toxicological, biological and immunological effects in the skin and have therefore been implicated in several detrimental skin alterations including premature skin ageing. The involvement of lipid peroxidation products in UVR-induced inflammatory responses has been inadequately studied and highly controversial. Furthermore, it is unclear to what extent these oxidative products contribute to the underlying mechanisms of skin photo-ageing. Therefore, this viewpoint essay will discuss the current knowledge on the effect of UVR exposure on skin surface lipids and how these may mediate UVR-induced inflammatory responses which may be key contributors to photo-damage in skin. This essay will also examine the potential role of inflammasomes (innate immune complexes) in the inflammatory response associated with UVR-induced lipid peroxidation. Limited evidence is available on the interactions between sebaceous lipids, downstream mediators and concomitant immune response in sun-exposed skin and clearer elucidation may lead to novel biomarkers of photo-ageing and the incorporation of new molecules into current skin therapies which better target oxidised lipids and or downstream mediators/pathways. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  6. Vitamin D and assisted reproduction technologies: current concepts.

    PubMed

    Vanni, Valeria S; Vigano', Paola; Somigliana, Edgardo; Papaleo, Enrico; Paffoni, Alessio; Pagliardini, Luca; Candiani, Massimo

    2014-05-31

    Accumulating evidence from animal and human studies suggests that vitamin D is involved in many functions of the human reproductive system in both genders, but no comprehensive analysis of the potential relationship between vitamin D status and Assisted Reproduction Technologies (ART) outcomes is currently available. On this basis, the purpose of this systematic review and meta-analysis was to perform an in-depth evaluation of clinical studies assessing whether vitamin D status of patients undergoing ART could be related to cycle outcome variables. This issue is of interest considering that vitamin D deficiency is easily amenable to correction and oral vitamin D supplementation is cheap and without significant side effects. Surprisingly, no studies are currently available assessing vitamin D status among male partners of couples undergoing ART, while seven studies on vitamin D status of women undergoing controlled ovarian hyperstimulation (COH) for ART were found and included in the review. Results show that vitamin D deficiency is highly prevalent among women undergoing COH, ranging from 21% to 31% across studies conducted in Western countries and reaching 75-99% in Iranian studies. Data on vitamin D deficiency (25-hydroxyvitamin D serum levels <20 ng/ml) in relation to ART outcomes could be extracted from three studies and included in the meta-analysis, yielding a common risk ratio (RR) of 0.89 (95% CI 0.53-1.49) and showing a lower but not statistically significant likelihood of clinical pregnancy for vitamin-D-deficient women compared with vitamin-D-sufficient patients. In conclusion, there is insufficient evidence to support the routine assessment of vitamin D status to predict the clinical pregnancy rate in couples undergoing ART. The partly conflicting results of the available studies, potentially explaining the lack of statistical significance for a negative influence of vitamin D deficiency on clinical pregnancy rate, are likely secondary to confounders

  7. Current concepts and controversies on adolescent idiopathic scoliosis: Part II

    PubMed Central

    Sud, Alok; Tsirikos, Athanasios I

    2013-01-01

    A new era in the surgical treatment of adolescent idiopathic scoliosis (AIS) opened with the introduction of pedicle screw instrumentation, which provides 3-column vertebral fixation and allows major deformity correction on the coronal, sagittal, and axial planes. A steep learning curve can be expected for spinal surgeons to become familiar with pedicle screw placement and correction techniques. Potential complications including injury to adjacent neural, vascular, and visceral structures can occur due to screw misplacement or pull-out during correction maneuvers. These major complications are better recognized as pedicle screw techniques become more popular and may result in serious morbidity and mortality. Extensive laboratory and clinical training is mandatory before pedicle screw techniques in scoliosis surgery are put to practice. Wider application, especially in developing countries, is limited by the high cost of implants. Refined correction techniques are currently developed and these utilize a lesser number of pedicle anchors which are strategically positioned to allow optimum deformity correction while reducing the neurological risk, surgical time, and blood loss, as well as instrumentation cost. Such techniques can be particularly attractive at a time when cost has major implications on provision of health care as they can make scoliosis treatment available to a wider population of patients. Pedicle screw techniques are currently considered the gold standard for scoliosis correction due to their documented superior biomechanical properties and ability to produce improved clinical outcomes as reflected by health-related quality-of-life questionnaires. Ongoing research promises further advances with the future of AIS treatment incorporating genetic counseling and possibly fusionless techniques. PMID:23798750

  8. Ranula: Current Concept of Pathophysiologic Basis and Surgical Management Options.

    PubMed

    Kokong, Daniel; Iduh, Augustine; Chukwu, Ikechukwu; Mugu, Joyce; Nuhu, Samuel; Augustine, Sule

    2017-06-01

    There is no consensus opinion on a definitive surgical management option for ranulas to curtail recurrence, largely from the existing gap in knowledge on the pathophysiologic basis. To highlight the current scientific basis of ranula development that informed the preferred surgical approach. Retrospective cohort study. Public Tertiary Academic Health Institution. A 7-year 7-month study of ranulas surgically managed at our tertiary health institution was undertaken-June 1, 2008-December 31, 2015-from case files retrieved utilising the ICD-10 version 10 standard codes. Twelve cases, representing 0.4 and 1.2% of all institutional and ENT operations, respectively, were managed for ranulas with a M:F = 1:1. The ages ranged from 5/12 to 39 years, mean = 18.5 years, and the disease was prevalent in the third decade of life. Main presentation in the under-fives was related to airway and feeding compromise, while in adults, cosmetic facial appearance. Ranulas in adults were plunging (n = 8, 58.3%), left-sided save one with M:F = 2:1. All were unilateral with R:L = 1:2. Treatment included aspiration (n = 2, 16.7%) with 100% recurrence, intra-/extraoral excision of ranula only (n = 4, 33.3%) with recurrence rate of 50% (n = 2, 16.7%), while marsupialisation in children (n = 1, 8.3%) had no recurrence. Similarly, transcervical approach (n = 5, 41.7%) with excision of both the ranula/sublingual salivary gland recorded zero recurrence. Recurrence was the main complication (n = 4, 33.3%). With the current knowledge on the pathophysiologic basis, extirpation of both the sublingual salivary gland and the ranula by a specialist surgeon is key for a successful outcome.

  9. Bovine digital dermatitis: Current concepts from laboratory to farm.

    PubMed

    Evans, N J; Murray, R D; Carter, S D

    2016-05-01

    Bovine digital dermatitis (DD) is a severe infectious disease causing lameness in dairy cattle worldwide and is an important ruminant welfare problem that has considerable economic issues. Bovine DD is endemic in many regions worldwide and it is important to understand this major disease so that effective control strategies can be identified. There is substantial evidence that specific treponeme phylotypes play an important causative role in bovine DD. This review considers current research, including DD Treponema spp. investigations, associated DD pathobiology, and current and potential treatment and control options. Epidemiological data, alongside new microbiological data, help delineate important transmission routes and reservoirs of infection that allow effective interventions to be identified. Better on-farm housing hygiene, pasture access, routine footbathing and claw trimming with disinfected equipment need to be implemented to significantly reduce the incidence of DD. There is a paucity of peer reviewed research into both commonly used and novel treatments. In vitro antimicrobial susceptibility studies of DD treponemes and effective treatment of human treponematoses clearly indicate that antibiotics frequently selected for DD treatments are not the most efficacious. Whilst there are understandable concerns over milk withdrawal times in dairy cattle, more needs to be done to identify, license and implement more appropriate antibiotic treatments, since continued overuse of less efficacious antibiotics, applied incorrectly, will lead to increased disease recurrence and transmission. More research is needed into methods of preventing DD that circumvent the use of antibiotics, including vaccination and transmission blocking studies, to reduce or hopefully eradicate DD in the future. Copyright © 2016 Elsevier Ltd. All rights reserved.

  10. Vestibular compensation and vestibular rehabilitation. Current concepts and new trends.

    PubMed

    Deveze, A; Bernard-Demanze, L; Xavier, F; Lavieille, J-P; Elziere, M

    2014-01-01

    The aim of this review is to present the current knowledge of the mechanisms underlying the vestibular compensation and demonstrating how the vestibular rehabilitation is conducted to help the recovery of balance function. Vestibular rehabilitation is based on improving the natural phenomenon called vestibular compensation that occurs after acute vestibular disturbance or chronic and gradual misbalance. Central compensation implies three main mechanisms namely adaptation, substitution and habituation. The compensation, aided by the rehabilitation aimed to compensate and/or to correct the underused or misused of the visual, proprioceptive and vestibular inputs involved in the postural control. As the strategy of equilibration is not corrected, the patient is incompletely cured and remains with inappropriate balance control with its significance on the risk of fall and impact on quality of life. The vestibular rehabilitation helps to correct inappropriate strategy of equilibrium or to accelerate a good but slow compensation phenomenon. Nowadays, new tools are more and more employed for the diagnosis of vestibular deficit (that may include various sources of impairment), the assessment of postural deficit, the control of the appropriate strategy as well to facilitate the efficiency of the rehabilitation especially in elderly people.

  11. Current concepts for oil decontamination of crush injuries: a review

    PubMed Central

    2014-01-01

    This anecdotal, non-systematic review serves to explore the principles and methods of effective oil decontamination from cutaneous wounds, particularly crush injuries. The current expansion of the petroleum industry is necessary to meet increasing world demands for oil. Most stages of oil refining and applications involve significant injury risks, particularly for crush injuries that become contaminated with petroleum compounds. A literature review regarding a standard of care for effective cutaneous oil decontamination is lacking. Based on case reports, animal models, and in vitro studies identified in our expert opinion review, standard water and soap cleansing may not be an appropriate approach. Instead, the principle of ‘like dissolves like’ guides the use of lipophilic, petroleum-derived solvents to attract and subsequently dissolve the petroleum contaminant from the skin injury. Limitations include paucity of and dated literature sources regarding the topic as well as no models specifically addressing crush injuries. Our literature review found that oil decontamination of cutaneous injuries may be best accomplished with oil-based cleansers. Certainly, this topic has significant importance for the potentially carcinogenic petroleum compounds that pervade virtually every aspect of modern human life. PMID:24855490

  12. Current and future concepts in helmet and sports injury prevention.

    PubMed

    Hoshizaki, T Blaine; Post, Andrew; Oeur, R Anna; Brien, Susan E

    2014-10-01

    Since the introduction of head protection, a decrease in sports-related traumatic brain injuries has been reported. The incidence of concussive injury, however, has remained the same or on the rise. These trends suggest that current helmets and helmet standards are not effective in protecting against concussive injuries. This article presents a literature review that describes the discrepancy between how helmets are designed and tested and how concussions occur. Most helmet standards typically use a linear drop system and measure criterion such as head Injury criteria, Gadd Severity Index, and peak linear acceleration based on research involving severe traumatic brain injuries. Concussions in sports occur in a number of different ways that can be categorized into collision, falls, punches, and projectiles. Concussive injuries are linked to strains induced by rotational acceleration. Because helmet standards use a linear drop system simulating fall-type injury events, the majority of injury mechanisms are neglected. In response to the need for protection against concussion, helmet manufacturers have begun to innovate and design helmets using other injury criteria such as rotational acceleration and brain tissue distortion measures via finite-element analysis. In addition to these initiatives, research has been conducted to develop impact protocols that more closely reflect how concussions occur in sports. Future research involves a better understanding of how sports-related concussions occur and identifying variables that best describe them. These variables can be used to guide helmet innovation and helmet standards to improve the quality of helmet protection for concussive injury.

  13. Current concepts of oxygen management in retinopathy of prematurity.

    PubMed

    Owen, Leah A; Hartnett, M Elizabeth

    2014-01-01

    Retinopathy of prematurity (ROP) is a potentially blinding disorder in premature infants. The underlying pathophysiology is incompletely understood, limiting the prevention and treatment of this devastating condition. Current therapies are directed toward management of aberrant neovascularization thought to result from retinal ischemia in the developing preterm retina. The molecular mediators important for development of retinal ischemia and subsequent neovascular pathology are not fully understood. However, oxygen has been shown to be a key mediator of disease and the oxygen environment for preterm infants has been extensively studied. Despite this, the optimal oxygen environment for preterm infants remains unclear and recent works seeking to clarify this relationship demonstrate somewhat disparate findings. These data further substantiate that ROP is a complex disease with multifactorial etiology including genetic and environmental factors. Therefore, while environmental factors such as oxygen are important to our understanding of the disease process and care of preterm infants, identification of the molecular mediators downstream of oxygen which are necessary for development of ROP pathology will be critical to improve prevention, diagnosis and treatment strategies.

  14. Precision medicine in pheochromocytoma and paraganglioma: current and future concepts.

    PubMed

    Björklund, P; Pacak, K; Crona, J

    2016-12-01

    Pheochromocytoma and paraganglioma (PPGL) are rare diseases but are also amongst the most characterized tumour types. Hence, patients with PPGL have greatly benefited from precision medicine for more than two decades. According to current molecular biology and genetics-based taxonomy, PPGL can be divided into three different clusters characterized by: Krebs cycle reprogramming with oncometabolite accumulation or depletion (group 1a); activation of the (pseudo)hypoxia signalling pathway with increased tumour cell proliferation, invasiveness and migration (group 1b); and aberrant kinase signalling causing a pro-mitogenic and anti-apoptotic state (group 2). Categorization into these clusters is highly dependent on mutation subtypes. At least 12 different syndromes with distinct genetic causes, phenotypes and outcomes have been described. Genetic screening tests have a documented benefit, as different PPGL syndromes require specific approaches for optimal diagnosis and localization of various syndrome-related tumours. Genotype-tailored treatment options, follow-up and preventive care are being investigated. Future new developments in precision medicine for PPGL will mainly focus on further identification of driver mechanisms behind both disease initiation and malignant progression. Identification of novel druggable targets and prospective validation of treatment options are eagerly awaited. To achieve these goals, we predict that collaborative large-scale studies will be needed: Pheochromocytoma may provide an example for developing precision medicine in orphan diseases that could ultimately aid in similar efforts for other rare conditions. © 2016 The Association for the Publication of the Journal of Internal Medicine.

  15. Current concepts for oil decontamination of crush injuries: a review.

    PubMed

    Karimkhani, Chante; Amir, Mahsa; Dellavalle, Robert P; Ipaktchi, Kyros

    2014-01-01

    This anecdotal, non-systematic review serves to explore the principles and methods of effective oil decontamination from cutaneous wounds, particularly crush injuries. The current expansion of the petroleum industry is necessary to meet increasing world demands for oil. Most stages of oil refining and applications involve significant injury risks, particularly for crush injuries that become contaminated with petroleum compounds. A literature review regarding a standard of care for effective cutaneous oil decontamination is lacking. Based on case reports, animal models, and in vitro studies identified in our expert opinion review, standard water and soap cleansing may not be an appropriate approach. Instead, the principle of 'like dissolves like' guides the use of lipophilic, petroleum-derived solvents to attract and subsequently dissolve the petroleum contaminant from the skin injury. Limitations include paucity of and dated literature sources regarding the topic as well as no models specifically addressing crush injuries. Our literature review found that oil decontamination of cutaneous injuries may be best accomplished with oil-based cleansers. Certainly, this topic has significant importance for the potentially carcinogenic petroleum compounds that pervade virtually every aspect of modern human life.

  16. Current concepts in the management of acute pancreatitis

    PubMed Central

    Srinivasan, Gautham; Venkatakrishnan, L.; Sambandam, Swaminathan; Singh, Gursharan; Kaur, Maninder; Janarthan, Krishnaveni; John, B. Joseph

    2016-01-01

    Guidelines for the management of acute pancreatitis (AP) are based on the Western experience, which may be difficult to extrapolate in India due to socioeconomic constraints. Hence, modifications based on the available resources and referral patterns should be introduced so as to ensure appropriate care. We reviewed the current literature on the management of AP available in English on Medline and proposed guidelines locally applicable. Patients of AP presenting with systemic inflammatory response syndrome are at risk of moderate-severe pancreatitis and hence, should be referred to a tertiary center early. The vast majority of patients with AP have mild disease and can be managed at smaller centers. Early aggressive fluid resuscitation with controlled fluid expansion, early enteral nutrition, and culture-directed antibiotics improve outcomes in AP. Infected pancreatic necrosis should be managed in a tertiary care hospital within a multidisciplinary setup. The “step up” approach involving antibiotics, percutaneous drainage, and minimally invasive necrosectomy instituted sequentially based on clinical response has improved the outcomes in this subgroup of patients. PMID:28348985

  17. Diffusion-weighted MR imaging in musculoskeletal diseases: current concepts.

    PubMed

    Dallaudière, B; Lecouvet, F; Vande Berg, B; Omoumi, P; Perlepe, V; Cerny, M; Malghem, J; Larbi, A

    2015-04-01

    MR imaging is currently regarded as a pivotal technique for the assessment of a variety of musculoskeletal conditions. Diffusion-weighted MR imaging (DWI) is a relatively recent sequence that provides information on the degree of cellularity of lesions. Apparent diffusion coefficient (ADC) value provides information on the movement of water molecules outside the cells. The literature contains many studies that have evaluated the role of DWI in musculoskeletal diseases. However, to date they yielded conflicting results on the use and the diagnostic capabilities of DWI in the area of musculoskeletal diseases. However, many of them have showed that DWI is a useful technique for the evaluation of the extent of the disease in a subset of musculoskeletal cancers. In terms of tissue characterization, DWI may be an adjunct to the more conventional MR imaging techniques but should be interpreted along with the signal of the lesion as observed on conventional sequences, especially in musculoskeletal cancers. Regarding the monitoring of response to therapy in cancer or inflammatory disease, the use of ADC value may represent a more reliable additional tool but must be compared to the initial ADC value of the lesions along with the knowledge of the actual therapy.

  18. Current concepts in the management of prosthetic joint infection.

    PubMed

    Aboltins, C; Daffy, J; Choong, P; Stanley, P

    2014-09-01

    Prosthetic joint infection (PJI) is a serious complication of arthroplasty that is associated with significant mortality, morbidity and costs. PJI is difficult to cure because causative bacteria form and persist in biofilm adherent to the prosthesis surface. PJI can be classified into early, delayed or late according to the time of onset after insertion of the prosthesis, and this classification can help determine pathogenesis and appropriate management. Traditional treatment has been with prolonged intravenous antibiotics and prosthesis exchange, which has been successful in treating infection but is technically difficult and has high rates of associated morbidity. On the basis of in vitro and animal studies, interest has turned to the use of antimicrobials that are particularly active against biofilm-associated bacteria. Recent clinical evidence shows success in more than 77% of early PJI with surgical debridement, retention of prosthesis and the use of rifampicin-based combinations for staphylococcal PJI. Fluoroquinolones are preferred for Gram-negative PJI. Optimal antimicrobial treatment duration and the management of polymicrobial, enterococcal, fungal and culture-negative infections are still yet to be defined but will become more clear as the results of current research comes to hand. © 2014 The Authors; Internal Medicine Journal © 2014 Royal Australasian College of Physicians.

  19. Neural Synchrony in Cortical Networks: History, Concept and Current Status

    PubMed Central

    Uhlhaas, Peter J.; Pipa, Gordon; Lima, Bruss; Melloni, Lucia; Neuenschwander, Sergio; Nikolić, Danko; Singer, Wolf

    2009-01-01

    Following the discovery of context-dependent synchronization of oscillatory neuronal responses in the visual system, the role of neural synchrony in cortical networks has been expanded to provide a general mechanism for the coordination of distributed neural activity patterns. In the current paper, we present an update of the status of this hypothesis through summarizing recent results from our laboratory that suggest important new insights regarding the mechanisms, function and relevance of this phenomenon. In the first part, we present recent results derived from animal experiments and mathematical simulations that provide novel explanations and mechanisms for zero and nero-zero phase lag synchronization. In the second part, we shall discuss the role of neural synchrony for expectancy during perceptual organization and its role in conscious experience. This will be followed by evidence that indicates that in addition to supporting conscious cognition, neural synchrony is abnormal in major brain disorders, such as schizophrenia and autism spectrum disorders. We conclude this paper with suggestions for further research as well as with critical issues that need to be addressed in future studies. PMID:19668703

  20. Current concepts on osteonecrosis of the femoral head

    PubMed Central

    Moya-Angeler, Joaquin; Gianakos, Arianna L; Villa, Jordan C; Ni, Amelia; Lane, Joseph M

    2015-01-01

    It is estimated that 20000 to 30000 new patients are diagnosed with osteonecrosis annually accounting for approximately 10% of the 250000 total hip arthroplasties done annually in the United States. The lack of level 1 evidence in the literature makes it difficult to identify optimal treatment protocols to manage patients with pre-collapse avascular necrosis of the femoral head, and early intervention prior to collapse is critical to successful outcomes in joint preserving procedures. There have been a variety of traumatic and atraumatic factors that have been identified as risk factors for osteonecrosis, but the etiology and pathogenesis still remains unclear. Current osteonecrosis diagnosis is dependent upon plain anteroposterior and frog-leg lateral radiographs of the hip, followed by magnetic resonance imaging (MRI). Generally, the first radiographic changes seen by radiograph will be cystic and sclerotic changes in the femoral head. Although the diagnosis may be made by radiograph, plain radiographs are generally insufficient for early diagnosis, therefore MRI is considered the most accurate benchmark. Treatment options include pharmacologic agents such as bisphosphonates and statins, biophysical treatments, as well as joint-preserving and joint-replacing surgeries. the surgical treatment of osteonecrosis of the femoral head can be divided into two major branches: femoral head sparing procedures (FHSP) and femoral head replacement procedures (FHRP). In general, FHSP are indicated at pre-collapse stages with minimal symptoms whereas FHRP are preferred at post-collapse symptomatic stages. It is difficult to know whether any treatment modality changes the natural history of core decompression since the true natural history of core decompression has not been delineated. PMID:26396935

  1. Cutaneous wound healing: Current concepts and advances in wound care

    PubMed Central

    Klein, Kenneth C; Guha, Somes Chandra

    2014-01-01

    A non-healing wound is defined as showing no measurable signs of healing for at least 30 consecutive treatments with standard wound care.[1] It is a snapshot of a patient's total health as well as the ongoing battle between noxious factors and the restoration of optimal macro and micro circulation, oxygenation and nutrition. In practice, standard therapies for non-healing cutaneous wounds include application of appropriate dressings, periodic debridement and eliminating causative factors.[2] The vast majority of wounds would heal by such approach with variable degrees of residual morbidity, disability and even mortality. Globally, beyond the above therapies, newer tools of healing are selectively accessible to caregivers, for various logistical or financial reasons. Our review will focus on the use of hyperbaric oxygen therapy (HBOT), as used at our institution (CAMC), and some other modalities that are relatively accessible to patients. HBOT is a relatively safe and technologically simpler way to deliver care worldwide. However, the expense for including HBOT as standard of care for recognized indications per UHMS(Undersea and Hyperbaric Medical Society) may vary widely from country to country and payment system.[3] In the USA, CMS (Centers for Medicare and Medicaid Services) approved indications for HBOT vary from that of the UHMS for logistical reasons.[1] We shall also briefly look into other newer therapies per current clinical usage and general acceptance by the medical community. Admittedly, there would be other novel tools with variable success in wound healing worldwide, but it would be difficult to include all in this treatise. PMID:25593414

  2. CURRENT CONCEPTS IN THE TREATMENT OF GROSS PATELLOFEMORAL INSTABILITY

    PubMed Central

    Buchanan, Grant; Czarkowski, Brian; Giangarra, Charles E.

    2016-01-01

    Patellofemoral instability is a painful and commonly recurring condition, which often must be managed surgically. Diagnosis can be aided by the use of a variety of physical exam signs, such as the Q angle, Beighton hypermobility score, glide test, J sign, patellar tilt test, and apprehension test. Imaging modalities including x-ray, CT, and MRI guide both diagnosis and management by revealing trochlear dysplasia, bony malalignment, and ligamentous injury that contribute to instability. Following an initial patellar dislocation, nonoperative management with bracing and physical therapy is an acceptable option, despite limited evidence that operative management may improve functional outcome and reduce recurrent dislocations. For recurrent dislocations, operative management is indicated, and the appropriate procedure depends on the patient's anatomy and the cause of instability. Reconstruction of the medial patellofemoral ligament (MPFL) restores the primary soft tissue restraint to lateral patellar dislocations, and can be performed using a variety of techniques. In patients whose instability is related to bony malalignment, a tibial tubercle osteotomy is commonly performed to realign the extensor mechanism and establish proper patellar tracking. In patients with trochlear dysplasia, a trochleoplasty may be performed to create a sufficient groove for the patella to traverse. Often these procedures must be combined to address all causes of instability. The reported outcomes following all three of these procedures are generally very good, with the majority of patients experiencing functional improvements and a low rate of recurrent instability, although more large randomized controlled trials are needed to determine which techniques are most effective. The purpose of this clinical commentary is to provide an overview of the current methods employed by orthopedic surgeons to diagnose and manage patellar instability. Level of Evidence 5 PMID:27904790

  3. Current concepts on osteonecrosis of the femoral head.

    PubMed

    Moya-Angeler, Joaquin; Gianakos, Arianna L; Villa, Jordan C; Ni, Amelia; Lane, Joseph M

    2015-09-18

    It is estimated that 20000 to 30000 new patients are diagnosed with osteonecrosis annually accounting for approximately 10% of the 250000 total hip arthroplasties done annually in the United States. The lack of level 1 evidence in the literature makes it difficult to identify optimal treatment protocols to manage patients with pre-collapse avascular necrosis of the femoral head, and early intervention prior to collapse is critical to successful outcomes in joint preserving procedures. There have been a variety of traumatic and atraumatic factors that have been identified as risk factors for osteonecrosis, but the etiology and pathogenesis still remains unclear. Current osteonecrosis diagnosis is dependent upon plain anteroposterior and frog-leg lateral radiographs of the hip, followed by magnetic resonance imaging (MRI). Generally, the first radiographic changes seen by radiograph will be cystic and sclerotic changes in the femoral head. Although the diagnosis may be made by radiograph, plain radiographs are generally insufficient for early diagnosis, therefore MRI is considered the most accurate benchmark. Treatment options include pharmacologic agents such as bisphosphonates and statins, biophysical treatments, as well as joint-preserving and joint-replacing surgeries. the surgical treatment of osteonecrosis of the femoral head can be divided into two major branches: femoral head sparing procedures (FHSP) and femoral head replacement procedures (FHRP). In general, FHSP are indicated at pre-collapse stages with minimal symptoms whereas FHRP are preferred at post-collapse symptomatic stages. It is difficult to know whether any treatment modality changes the natural history of core decompression since the true natural history of core decompression has not been delineated.

  4. CURRENT CONCEPTS IN THE TREATMENT OF GROSS PATELLOFEMORAL INSTABILITY.

    PubMed

    Buchanan, Grant; Torres, LeeAnne; Czarkowski, Brian; Giangarra, Charles E

    2016-12-01

    Patellofemoral instability is a painful and commonly recurring condition, which often must be managed surgically. Diagnosis can be aided by the use of a variety of physical exam signs, such as the Q angle, Beighton hypermobility score, glide test, J sign, patellar tilt test, and apprehension test. Imaging modalities including x-ray, CT, and MRI guide both diagnosis and management by revealing trochlear dysplasia, bony malalignment, and ligamentous injury that contribute to instability. Following an initial patellar dislocation, nonoperative management with bracing and physical therapy is an acceptable option, despite limited evidence that operative management may improve functional outcome and reduce recurrent dislocations. For recurrent dislocations, operative management is indicated, and the appropriate procedure depends on the patient's anatomy and the cause of instability. Reconstruction of the medial patellofemoral ligament (MPFL) restores the primary soft tissue restraint to lateral patellar dislocations, and can be performed using a variety of techniques. In patients whose instability is related to bony malalignment, a tibial tubercle osteotomy is commonly performed to realign the extensor mechanism and establish proper patellar tracking. In patients with trochlear dysplasia, a trochleoplasty may be performed to create a sufficient groove for the patella to traverse. Often these procedures must be combined to address all causes of instability. The reported outcomes following all three of these procedures are generally very good, with the majority of patients experiencing functional improvements and a low rate of recurrent instability, although more large randomized controlled trials are needed to determine which techniques are most effective. The purpose of this clinical commentary is to provide an overview of the current methods employed by orthopedic surgeons to diagnose and manage patellar instability. 5.

  5. Current concepts in the treatment of cartilage lesions with special regard to the knee joint.

    PubMed

    Widuchowski, Wojciech; Tomaszewski, Wiesław; Widuchowski, Jerzy; Czamara, Andrzej

    2011-01-01

    The last twenty years have been marked by a rapid development of articular cartilage treatment and regeneration techniques. We present current concepts in the treatment of cartilage lesions and injuries, including gene therapy and tissue engineering.

  6. A return stroke model based purely on the current dissipation concept

    NASA Astrophysics Data System (ADS)

    Cooray, Vernon

    2015-12-01

    A return stroke model based purely on the current dissipation concept is introduced. With three model parameters the model is capable of generating electric and magnetic fields that are in reasonable agreement with experimentally observed electromagnetic fields.

  7. Diagnosis and treatment of osteochondral lesions of the ankle: current concepts.

    PubMed

    Prado, Marcelo Pires; Kennedy, John G; Raduan, Fernando; Nery, Caio

    2016-01-01

    We conducted a wide-ranging review of the literature regarding osteochondral lesions of the ankle, with the aim of presenting the current concepts, treatment options, trends and future perspectives relating to this topic.

  8. Current situation of International Organization for Standardization/Technical Committee 249 international standards of traditional Chinese medicine.

    PubMed

    Liu, Yu-Qi; Wang, Yue-Xi; Shi, Nan-Nan; Han, Xue-Jie; Lu, Ai-Ping

    2017-05-01

    To review the current situation and progress of traditional Chinese medicine (TCM) international standards, standard projects and proposals in International Organization for Standardization (ISO)/ technical committee (TC) 249. ISO/TC 249 standards and standard projects on the ISO website were searched and new standard proposals information were collected from ISO/TC 249 National Mirror Committee in China. Then all the available data were summarized in 5 closely related items, including proposed time, proposed country, assigned working group (WG), current stage and classifification. In ISO/TC 249, there were 2 international standards, 18 standard projects and 24 new standard proposals proposed in 2014. These 44 standard subjects increased year by year since 2011. Twenty-nine of them were proposed by China, 15 were assigned to WG 4, 36 were in preliminary and preparatory stage and 8 were categorized into 4 fifields, 7 groups and sub-groups based on International Classifification Standards. A rapid and steady development of international standardization in TCM can be observed in ISO/TC 249.

  9. Current concepts of Harm-Benefit Analysis of Animal Experiments - Report from the AALAS-FELASA Working Group on Harm-Benefit Analysis - Part 1.

    PubMed

    Brønstad, Aurora; Newcomer, Christian E; Decelle, Thierry; Everitt, Jeffrey I; Guillen, Javier; Laber, Kathy

    2016-06-01

    International regulations and guidelines strongly suggest that the use of animal models in scientific research should be initiated only after the authority responsible for the review of animal studies has concluded a well-thought-out harm-benefit analysis (HBA) and deemed the project to be appropriate. Although the process for conducting HBAs may not be new, the relevant factors and algorithms used in conducting them during the review process are deemed to be poorly defined or lacking by committees in many institutions. This paper presents the current concept of HBAs based on a literature review. References on cost or risk benefit from clinical trials and other industries are also included. Several approaches to HBA have been discovered including algorithms, graphic presentations and generic processes. The aim of this study is to better aid and harmonize understanding of the concepts of 'harm', 'benefit' and 'harm-benefit analysis'.

  10. Current quality assurance concepts and considerations for quality control of in-clinic biochemistry testing.

    PubMed

    Lester, Sally; Harr, K E; Rishniw, Mark; Pion, Paul

    2013-01-15

    Quality assurance is an implied concept inherent in every consumer's purchase of a product or service. In laboratory testing, quality assurance encompasses preanalytic (sampling, transport, and handling prior to testing), analytic (measurement), and postanalytic (reporting and interpretation) factors. Quality-assurance programs require that procedures are in place to detect errors in all 3 components and that the procedures are characterized by both documentation and correction of errors. There are regulatory bodies that provide mandatory standards for and regulation of human medical laboratories. No such regulations exist for veterinary laboratory testing. The American Society for Veterinary Clinical Pathology (ASVCP) Quality Assurance and Laboratory Standards Committee was formed in 1996 in response to concerns of ASVCP members about quality assurance and quality control in laboratories performing veterinary testing. Guidelines for veterinary laboratory testing have been developed by the ASVCP. The purpose of this report was to provide an overview of selected quality-assurance concepts and to provide recommendations for quality control for in-clinic biochemistry testing in general veterinary practice.

  11. The Role of Current Techniques and Concepts in Peripheral Nerve Repair

    PubMed Central

    Houschyar, K. S.; Momeni, A.; Pyles, M. N.; Cha, J. Y.; Maan, Z. N.; Duscher, D.; Jew, O. S.; Siemers, F.; van Schoonhoven, J.

    2016-01-01

    Patients with peripheral nerve injuries, especially severe injury, often face poor nerve regeneration and incomplete functional recovery, even after surgical nerve repair. This review summarizes treatment options of peripheral nerve injuries with current techniques and concepts and reviews developments in research and clinical application of these therapies. PMID:26904282

  12. Historical Aspects of the Concept of "Compulsory Education": Rethinking the Rhetoric of Debates in Current Reform

    ERIC Educational Resources Information Center

    Sato, Manabu

    2008-01-01

    Current Educational Reform in Japan is oddly captured with confused conceptions of "compulsory education." The Ministry of Education blankets such connotations of it, as a national budget system, mandated school curriculum, responsible partnership of school with community and accountabilities of local school board, in defense of vested…

  13. Student Participation in University Governance: The Role Conceptions and Sense of Efficacy of Student Representatives on Departmental Committees

    ERIC Educational Resources Information Center

    Lizzio, Alf; Wilson, Keithia

    2009-01-01

    The role and contribution of students to the governance of university departments is a relatively neglected area of inquiry. This study investigated the factors which student representatives perceived to help or hinder their effectiveness as student members of departmental committees. Twenty students from a range of disciplines were interviewed…

  14. Student Participation in University Governance: The Role Conceptions and Sense of Efficacy of Student Representatives on Departmental Committees

    ERIC Educational Resources Information Center

    Lizzio, Alf; Wilson, Keithia

    2009-01-01

    The role and contribution of students to the governance of university departments is a relatively neglected area of inquiry. This study investigated the factors which student representatives perceived to help or hinder their effectiveness as student members of departmental committees. Twenty students from a range of disciplines were interviewed…

  15. [Current classification and nomenclature of plant viruses (by materials of the International Committee on Virus Taxonomy). Part I].

    PubMed

    Kraev, V G

    2000-01-01

    The rules of classification and nomenclature of plant viruses are reviewed in connection with the reports of the International Committee on Viruses Taxonomy. The characteristics of the families and genera of plant viruses approved by the Committee in 1995 are presented.

  16. "The Project Cannot Be Approved in Its Current Form": Feminist Visual Research Meets the Human Research Ethics Committee

    ERIC Educational Resources Information Center

    Pitt, Penelope

    2014-01-01

    This article reflects on a university human research ethics committee's unease regarding a feminist visual pilot study within the field of education. The small exploratory study proposed to explore a migrant mother's production of her son's identity through her family photograph collection. The committee requested substantial…

  17. "The Project Cannot Be Approved in Its Current Form": Feminist Visual Research Meets the Human Research Ethics Committee

    ERIC Educational Resources Information Center

    Pitt, Penelope

    2014-01-01

    This article reflects on a university human research ethics committee's unease regarding a feminist visual pilot study within the field of education. The small exploratory study proposed to explore a migrant mother's production of her son's identity through her family photograph collection. The committee requested substantial…

  18. Snapping scapula syndrome: current concepts review in conservative and surgical treatment

    PubMed Central

    Merolla, Giovanni; Cerciello, Simone; Paladini, Paolo; Porcellini, Giuseppe

    2013-01-01

    Summary The snapping scapula, also called “washboard syndrome” is a controversial condition attributed to bony and soft tissue abnormalities. The syndrome was understimated for long time and often associated only with specific osseous abnormalities. The nodal point in the overview of the syndrome is that crepitus associated with symptomatic bursitis may be physiologic and is not uncommon a clinical presentation without any form of crepitus or craquement. In the current rewiew we analyzed the current concepts in the conservative and surgical management of snapping scapula syndrome, preceded by a description of scapular anatomy, pathophysiology of scapulothoracic articulation and clinical features of snapping scapula. PMID:23888290

  19. Leading-edge vortex research: Some nonplanar concepts and current challenges

    NASA Technical Reports Server (NTRS)

    Campbell, J. F.; Osborn, R. F.

    1986-01-01

    Some background information is provided for the Vortex Flow Aerodynamics Conference and that current slender wing airplanes do not use variable leading edge geometry to improve transonic drag polar is shown. Highlights of some of the initial studies combining wing camber, or flaps, with vortex flow are presented. Current vortex flap studies were reviewed to show that there is a large subsonic data base and that transonic and supersonic generic studies have begun. There is a need for validated flow field solvers to calculate vortex/shock interactions at transonic and supersonic speeds. Many important research opportunities exist for fundamental vortex flow investigations and for designing advanced fighter concepts.

  20. Occlusion in implant dentistry. A review of the literature of prosthetic determinants and current concepts.

    PubMed

    Gross, M D

    2008-06-01

    Today the clinician is faced with widely varying concepts regarding the number, location, distribution and inclination of implants required to support the functional and parafunctional demands of occlusal loading. Primary clinical dilemmas of planning for maximal or minimal numbers of implants, their axial inclination, lengths and required volume and quality of supporting bone remain largely unanswered by adequate clinical outcome research. Planning and executing optimal occlusion schemes is an integral part of implant supported restorations. In its wider sense this includes considerations of multiple inter-relating factors of ensuring adequate bone support, implant location number, length, distribution and inclination, splinting, vertical dimension aesthetics, static and dynamic occlusal schemes and more. Current concepts and research on occlusal loading and overloading are reviewed together with clinical outcome and biomechanical studies and their clinical relevance discussed. A comparison between teeth and implants regarding their proprioceptive properties and mechanisms of supporting functional and parafunctional loading is made and clinical applications made regarding current concepts in restoring the partially edentulous dentition. The relevance of occlusal traumatism and fatigue microdamage alone or in combination with periodontal or peri-implant inflammation is reviewed and applied to clinical considerations regarding splinting of adjacent implants and teeth, posterior support and eccentric guidance schemes. Occlusal restoration of the natural dentition has classically been divided into considerations of planning for sufficient posterior support, occlusal vertical dimension and eccentric guidance to provide comfort and aesthetics. Mutual protection and anterior disclusion have come to be considered as acceptable therapeutic modalities. These concepts have been transferred to the restoration of implant-supported restoration largely by default. However, in

  1. Nephrotic syndrome: a nursing care plan based on current pathophysiologic concepts.

    PubMed

    Johnson, D L

    1989-01-01

    The classic conception of the pathophysiology of the nephrotic syndrome (NS) is now being seriously questioned, on the basis of current research findings. New conceptions of the syndrome, with its proteinuria, hypoalbuminemia, and edema, are providing explanations for the discrepancies between the original theory and clinical data from individual patients, particularly related to edema formation. Many of the edema-preventing mechanisms are normal in patients with NS, but may fail when plasma osmotic pressure falls significantly. Plasma volumes, blood volumes, and blood pressures of patients with NS have been found to be generally normal or slightly increased, in contrast to the classic "hypovolemia" theory. Activation of the renin-angiotension-aldosterone system is variable and cannot fully explain the sodium and water retention. The decreased renal filtration rates and abnormal sodium retention/excretion rates are now best explained by an intrarenal defect, on the basis of multiple research approaches. These research conceptions of the pathophysiology of NS are significant for nurses because they can be used in patient assessment, interpretation of patient data, monitoring during treatment, collaboration about the plan of care, development of nursing care plans, and patient teaching. Several nursing diagnoses may be appropriate for patients with NS: alteration in fluid volume: excess; potential for infection; alteration in nutrition: less than body requirements, potential alteration in comfort; knowledge deficit; and potential disturbance in self-concept: body image.

  2. Weighting factors for radiation quality: how to unite the two current concepts.

    PubMed

    Kellerer, Albrecht M

    2004-01-01

    The quality factor, Q(L), used to be the universal weighting factor to account for radiation quality, until--in its 1991 Recommendations--the ICRP established a dichotomy between 'computable' and 'measurable' quantities. The new concept of the radiation weighting factor, w(R), was introduced for use with the 'computable' quantities, such as the effective dose, E. At the same time, the application of Q(L) was restricted to 'measurable' quantities, such as the operational quantities ambient dose equivalent or personal dose equivalent. The result has been a dual system of incoherent dosimetric quantities. The most conspicuous inconsistency resulted for neutrons, for which the new concept of wR had been primarily designed. While its definition requires an accounting for the gamma rays produced by neutron capture in the human body, this effect is not adequately reflected in the numerical values of wR, which are now suitable for mice, but are--at energies of the incident neutrons below 1 MeV--conspicuously too large for man. A recent Report 92 to ICRP has developed a proposal to correct the current imbalance and to define a linkage between the concepts Q(L) and wR. The proposal is here considered within a broader assessment of the rationale that led to the current dual system of dosimetric quantities.

  3. Current concepts in the management of inguinal hernia and hydrocele in pediatric patients in laparoscopic era.

    PubMed

    Esposito, Ciro; Escolino, Maria; Turrà, Francesco; Roberti, Agnese; Cerulo, Mariapina; Farina, Alessandra; Caiazzo, Simona; Cortese, Giuseppe; Servillo, Giuseppe; Settimi, Alessandro

    2016-08-01

    The surgical repair of inguinal hernia and hydrocele is one of the most common operations performed in pediatric surgery practice. This article reviews current concepts in the management of inguinal hernia and hydrocele based on the recent literature and the authors׳ experience. We describe the principles of clinical assessment and anesthetic management of children undergoing repair of inguinal hernia, underlining the differences between an inguinal approach and minimally invasive surgery (MIS). Other points discussed include the current management of particular aspects of these pathologies such as bilateral hernias; contralateral patency of the peritoneal processus vaginalis; hernias in premature infants; direct, femoral, and other rare hernias; and the management of incarcerated or recurrent hernias. In addition, the authors discuss the role of laparoscopy in the surgical treatment of an inguinal hernia and hydrocele, emphasizing that the current use of MIS in pediatric patients has completely changed the management of pediatric inguinal hernias. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. Chemotherapy for Good-Risk Nonseminomatous Germ Cell Tumors: Current Concepts and Controversies.

    PubMed

    In, Gino; Dorff, Tanya

    2015-08-01

    The rate of diagnosis of germ cell tumors has remained fairly constant. By the International Germ Cell Cancer Consensus Classification, roughly 60% of all metastatic germ cell tumors are classified as good risk. This group of patients has an excellent prognosis, with greater than 90% expectation of cure. Treatment standards have not changed much in recent years. This article focuses on key concepts in the development of the currently accepted first-line regimens and addresses some evolving areas of interest, if not controversy.

  5. Dhat syndrome: Evolution of concept, current understanding, and need of an integrated approach

    PubMed Central

    Kar, Sujita Kumar; Sarkar, Siddharth

    2015-01-01

    Dhat syndrome has often been construed as a culture-bound sexual neurosis of the Indian subcontinent. Symptoms similar to that of Dhat syndrome has been described in other cultures across different time periods. The present paper looks at the evolution of the concept of Dhat syndrome in India. The review also takes an overview of the current understanding of this syndrome in terms of nosological status as a distinct entity and its “culture-bound” status. The narrative finally attempts to discuss the integrated approach for the treatment of this disorder. PMID:26538854

  6. Parametric Weight Comparison of Current and Proposed Thermal Protection System (TPS) Concepts

    NASA Technical Reports Server (NTRS)

    Myers, David E.; Martin, Carl J.; Blosser, Max L.

    1999-01-01

    A parametric weight assessment of advanced metallic panel, ceramic blanket, and ceramic tile thermal protection systems (TPS) was conducted using an implicit, one-dimensional (1 -D) thermal finite element sizing code. This sizing code contained models to ac- count for coatings, fasteners, adhesives, and strain isolation pads. Atmospheric entry heating profiles for two vehicles, the Access to Space (ATS) rocket-powered single-stage-to-orbit (SSTO) vehicle and a proposed Reusable Launch Vehicle (RLV), were used to ensure that the trends were not unique to a particular trajectory. Eight TPS concepts were compared for a range of applied heat loads and substructural heat capacities to identify general trends. This study found the blanket TPS concepts have the lightest weights over the majority of their applicable ranges, and current technology ceramic tiles and metallic TPS concepts have similar weights. A proposed, state-of-the-art metallic system which uses a higher temperature alloy and efficient multilayer insulation was predicted to be significantly lighter than the ceramic tile systems and approaches blanket TPS weights for higher integrated heat loads.

  7. The current theoretical assumptions of the Bobath concept as determined by the members of BBTA.

    PubMed

    Raine, Sue

    2007-01-01

    The Bobath concept is a problem-solving approach to the assessment and treatment of individuals following a lesion of the central nervous system that offers therapists a framework for their clinical practice. The aim of this study was to facilitate a group of experts in determining the current theoretical assumptions underpinning the Bobath concept.A four-round Delphi study was used. The expert sample included all 15 members of the British Bobath Tutors Association. Initial statements were identified from the literature with respondents generating additional statements. Level of agreement was determined by using a five-point Likert scale. Level of consensus was set at 80%. Eighty-five statements were rated from the literature along with 115 generated by the group. Ninety-three statements were identified as representing the theoretical underpinning of the Bobath concept. The Bobath experts agreed that therapists need to be aware of the principles of motor learning such as active participation, opportunities for practice and meaningful goals. They emphasized that therapy is an interactive process between individual, therapist, and the environment and aims to promote efficiency of movement to the individual's maximum potential rather than normal movement. Treatment was identified by the experts as having "change of functional outcome" at its center.

  8. Cariology for the 21st Century: current caries management concepts for dental practice.

    PubMed

    Fontana, Margherita; Cabezas, Carlos Gonzalez; Fitzgerald, Mark

    2013-04-01

    The objective of this manuscript is to provide an overview of currently accepted, evidence-based and/or expert opinion recommendations for the prevention and management of dental caries in dental practice. Discussions are centered on current concepts for caries lesion detection (e.g., cavitated and non-cavitated lesions) and diagnosis (e.g., active vs. arrested lesions), including thresholds for non-surgical (e.g., fluorides, sealant) and surgical (i.e., restorative) interventions, risk assessment, and a review of caries management interventions for caries disease management. The goal is to prevent and manage the caries disease process using patient-centered, risk-based interventions supported by the best available evidence, taking into account the dentist's clinical expertise and the patient's treatment needs and preferences, in order to maintain or re-establish health and preserve tooth structure.

  9. Current concepts in the diagnosis and management of left ventricular assist device infections.

    PubMed

    Nienaber, Juhsien; Wilhelm, Mark P; Sohail, M Rizwan

    2013-02-01

    Left ventricular assist devices (LVAD) are increasingly being used both as a bridge to transplantation and for long-term myocardial surrogate destination therapy in patients with end-stage heart failure. Primarily owing to the presence of a driveline that connects the device to an external battery through an open skin incision, the rates of LVAD-related infections (LVADRIs) are high, ranging from 30 to 50%. LVADRIs can be broadly classified into driveline infection, pump pocket infection, bloodstream infection and endocarditis/pump or cannula infection. Diagnostic evaluation and management of these complicated infections can be quite challenging for clinicians involved in the care of these patients. Here, the authors summarize the current epidemiology, microbiology, diagnostic approach and management strategies for each type of LVADRI. The authors also review current concepts regarding antibiotic prophylaxis for LVAD implantation. Finally, the authors highlight the gaps in the knowledge of LVADRI and provide directions for future studies.

  10. The ‘structure-function’ relationship in glaucoma – past thinking and current concepts

    PubMed Central

    Malik, Rizwan; Swanson, William H.; Garway-Heath, David F

    2013-01-01

    An understanding of the relationship between functional and structural measures in primary open angle glaucoma (POAG) is necessary for both grading the severity of disease and for understanding the natural history of the condition. This article outlines the current evidence for the nature of this relationship, and highlights the current mathematical models linking structure and function. Large clinical trials demonstrate that both structural and functional change are apparent in advanced stages of disease, while, at an individual level, detectable structural abnormality may precede functional abnormality in some patients whilst the converse in true in other patients. Although the exact nature of the ‘structure-function’ relationship in POAG is still the topic of scientific debate and the subject of continuing research, this article aims to provide the clinician with an understanding of the past concepts and contemporary thinking in relation to the structure-function relationship in POAG. PMID:22339936

  11. [New aspects of polytrauma treatment - current facts and developments: report of the first annual conference of the Committee on Emergency Medicine, Intensive Care and Trauma Management (Sektion NIS)].

    PubMed

    Trentzsch, H; Wölfl, C; Matthes, G; Paffrath, T; Lefering, R; Flohé, S

    2013-11-01

    Taking care of severely injured patients is a complex and ambitious mission. The committee on emergency medicine, intensive care and trauma management of the German Society of Trauma Surgery (Sektion NIS) has accepted this challenge. On the occasion of the release of the annual report of the TraumaRegistry DGU®, the committee held its first annual congress in order to provide members and an intrigued audience with current trends and results from the latest research in national trauma care ranging from the animal facility to the S3 guidelines. Topics of focus were new realizations based on data from the TraumaRegistry DGU® and means of quality assurance in trauma care. This article gives a report on the meeting and summarizes the major results of the presented studies and the latest deployments in this field of trauma research.

  12. Orofacial pain and occlusion: is there a link? An overview of current concepts and the clinical implications.

    PubMed

    Racich, Michael J

    2005-02-01

    This paper addresses the current concepts in orofacial pain and occlusion and queries their possible relationship to each other. English-language peer-reviewed articles were identified using Medline (1990-2003), as well as a hand search. The key words occlusion, orofacial pain , and temporomandibular disorders (TMD) were used. Additional references from citations within the articles were obtained, and current textbooks were used as well. The textbooks provided contemporary concept overviews and further additional references.

  13. Implementation of an active instructional design for teaching the concepts of current, voltage and resistance

    NASA Astrophysics Data System (ADS)

    Orlaineta-Agüero, S.; Del Sol-Fernández, S.; Sánchez-Guzmán, D.; García-Salcedo, R.

    2017-01-01

    In the present work we show the implementation of a learning sequence based on an active learning methodology for teaching Physics, this proposal tends to promote a better learning in high school students with the use of a comic book and it combines the use of different low-cost experimental activities for teaching the electrical concepts of Current, Resistance and Voltage. We consider that this kind of strategy can be easily extrapolated to higher-education levels like Engineering-college/university level and other disciplines of Science. To evaluate this proposal, we used some conceptual questions from the Electric Circuits Concept Evaluation survey developed by Sokoloff and the results from this survey was analysed with the Normalized Conceptual Gain proposed by Hake and the Concentration Factor that was proposed by Bao and Redish, to identify the effectiveness of the methodology and the models that the students presented after and before the instruction, respectively. We found that this methodology was more effective than only the implementation of traditional lectures, we consider that these results cannot be generalized but gave us the opportunity to view many important approaches in Physics Education; finally, we will continue to apply the same experiment with more students, in the same and upper levels of education, to confirm and validate the effectiveness of this methodology proposal.

  14. Overview and Current Status of Analyses of Potential LEU Design Concepts for TREAT

    SciTech Connect

    Connaway, H. M.; Kontogeorgakos, D. C.; Papadias, D. D.; Wright, A. E.

    2015-10-01

    Neutronic and thermal-hydraulic analyses have been performed to evaluate the performance of different low-enriched uranium (LEU) fuel design concepts for the conversion of the Transient Reactor Test Facility (TREAT) from its current high-enriched uranium (HEU) fuel. TREAT is an experimental reactor developed to generate high neutron flux transients for the testing of nuclear fuels. The goal of this work was to identify an LEU design which can maintain the performance of the existing HEU core while continuing to operate safely. A wide variety of design options were considered, with a focus on minimizing peak fuel temperatures and optimizing the power coupling between the TREAT core and test samples. Designs were also evaluated to ensure that they provide sufficient reactivity and shutdown margin for each control rod bank. Analyses were performed using the core loading and experiment configuration of historic M8 Power Calibration experiments (M8CAL). The Monte Carlo code MCNP was utilized for steady-state analyses, and transient calculations were performed with the point kinetics code TREKIN. Thermal analyses were performed with the COMSOL multi-physics code. Using the results of this study, a new LEU Baseline design concept is being established, which will be evaluated in detail in a future report.

  15. Theory of mind and recognition of facial emotion in dementia: challenge to current concepts.

    PubMed

    Freedman, Morris; Binns, Malcolm A; Black, Sandra E; Murphy, Cara; Stuss, Donald T

    2013-01-01

    Current literature suggests that theory of mind (ToM) and recognition of facial emotion are impaired in behavioral variant frontotemporal dementia (bvFTD). In contrast, studies suggest that ToM is spared in Alzheimer disease (AD). However, there is controversy whether recognition of emotion in faces is impaired in AD. This study challenges the concepts that ToM is preserved in AD and that recognition of facial emotion is impaired in bvFTD. ToM, recognition of facial emotion, and identification of emotions associated with video vignettes were studied in bvFTD, AD, and normal controls. ToM was assessed using false-belief and visual perspective-taking tasks. Identification of facial emotion was tested using Ekman and Friesen's pictures of facial affect. After adjusting for relevant covariates, there were significant ToM deficits in bvFTD and AD compared with controls, whereas neither group was impaired in the identification of emotions associated with video vignettes. There was borderline impairment in recognizing angry faces in bvFTD. Patients with AD showed significant deficits on false belief and visual perspective taking, and bvFTD patients were impaired on second-order false belief. We report novel findings challenging the concepts that ToM is spared in AD and that recognition of facial emotion is impaired in bvFTD.

  16. Comprehensive management of pressure ulcers in spinal cord injury: Current concepts and future trends

    PubMed Central

    Kruger, Erwin A.; Pires, Marilyn; Ngann, Yvette; Sterling, Michelle; Rubayi, Salah

    2013-01-01

    Pressure ulcers in spinal cord injury represent a challenging problem for patients, their caregivers, and their physicians. They often lead to recurrent hospitalizations, multiple surgeries, and potentially devastating complications. They present a significant cost to the healthcare system, they require a multidisciplinary team approach to manage well, and outcomes directly depend on patients' education, prevention, and compliance with conservative and surgical protocols. With so many factors involved in the successful treatment of pressure ulcers, an update on their comprehensive management in spinal cord injury is warranted. Current concepts of local wound care, surgical options, as well as future trends from the latest wound healing research are reviewed to aid medical professionals in treating patients with this difficult problem. PMID:24090179

  17. Leishmaniases of the New World: current concepts and implications for future research.

    PubMed Central

    Grimaldi, G; Tesh, R B

    1993-01-01

    Recent epidemiologic studies indicate that leishmaniasis in the Americas is far more abundant and of greater public health importance than was previously recognized. The disease in the New World is caused by a number of different parasite species that are capable of producing a wide variety of clinical manifestations. The outcome of leishmanial infection in humans is largely dependent on the immune responsiveness of the host and the virulence of the infecting parasite strain. This article reviews current concepts of the clinical forms, immunology, pathology, laboratory diagnosis, and treatment of the disease as well as aspects of its epidemiology and control. Recommendations for future research on the disease and its control are made. PMID:8358705

  18. Stereotactic radiosurgery of glomus jugulare tumors: current concepts, recent advances and future perspectives.

    PubMed

    Sager, Omer; Dincoglan, Ferrat; Beyzadeoglu, Murat

    2015-01-01

    Stereotactic radiosurgery (SRS), a very highly focused form of therapeutic irradiation, has been widely recognized as a viable treatment option in the management of intracranial pathologies including benign tumors, malign tumors, vascular malformations and functional disorders. The applications of SRS are continuously expanding thanks to the ever-increasing advances and corresponding improvements in neuroimaging, radiation treatment techniques, equipment, treatment planning and delivery systems. In the context of glomus jugulare tumors (GJT), SRS is being more increasingly used both as the upfront management modality or as a complementary or salvage treatment option. As its safety and efficacy is being evident with compiling data from studies with longer follow-up durations, SRS appears to take the lead in the management of most patients with GJT. Herein, we address current concepts, recent advances and future perspectives in SRS of GJT in light of the literature.

  19. Current concepts in fluid resuscitation for prehospital care of combat casualties.

    PubMed

    Dubick, Michael A

    2011-01-01

    Historically, hemorrhage accounts for the primary cause of death on the battlefield in conventional warfare. In addition, hemorrhage was associated with 85% of potentially survivable deaths in the current conflicts, approximately two-thirds of which were from noncompressible injuries. Future combat casualty care strategies suggest the likelihood of long transport times or significant time delays in evacuation of casualties. In addition, there are logistical limitations to providing large volumes of resuscitation fluid far-forward, and current guidelines do not recommend infusing large volumes of fluid until bleeding is controlled. Since the medic has few options for treating noncompressible injuries short of infusing fluid to maintain a blood pressure, the concept of damage control resuscitation was developed to promote hemostatic resuscitation. Damage control resuscitation recommends limiting the amount of crystalloids or colloids infused and using plasma and other blood products in more optimal ratios for the treatment of severe hemorrhage to improve battlefield survival and to reduce or prevent early and late deleterious sequelae. Taken together, these efforts have important implications towards the development of optimal fluid resuscitation strategies for stabilization of the combat casualty.

  20. Microsurgical reconstruction of the head and neck region: Current concepts of maxillofacial surgery units worldwide.

    PubMed

    Kansy, Katinka; Mueller, Andreas Albert; Mücke, Thomas; Koersgen, Friederike; Wolff, Klaus Dietrich; Zeilhofer, Hans-Florian; Hölzle, Frank; Pradel, Winnie; Schneider, Matthias; Kolk, Andreas; Smeets, Ralf; Acero, Julio; Haers, Piet; Ghali, G E; Hoffmann, Jürgen

    2015-10-01

    Microvascular surgery following tumor resection has become an important field of oral maxillofacial surgery (OMFS). Following the surveys on current reconstructive practice in German-speaking countries and Europe, this paper presents the third phase of the project when the survey was conducted globally. The DOESAK questionnaire has been developed via a multicenter approach with maxillofacial surgeons from 19 different hospitals in Germany, Austria and Switzerland. It was distributed in three different phases to a growing number of maxillofacial units in German-speaking clinics, over Europe and then worldwide. Thirty-eight units from Germany, Austria and Switzerland, 65 remaining European OMFS-departments and 226 units worldwide responded to the survey. There is wide agreement on the most commonly used flaps, intraoperative rapid sections and a trend towards primary bony reconstruction. No uniform concepts can be identified concerning osteosynthesis of bone transplants, microsurgical techniques, administration of supportive medication and postoperative monitoring protocols. Microsurgical reconstruction is the gold standard for the majority of oncologic cases in Europe, but worldwide, only every second unit has access to this technique. The DOESAK questionnaire has proven to be a valid and well accepted tool for gathering information about current practice in reconstructive OMFS surgery. The questionnaire has been able to demonstrate similarities, differences and global inequalities. Copyright © 2015 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  1. Current Concepts for Anterior Cruciate Ligament Reconstruction: A Criterion–Based Rehabilitation Progression

    PubMed Central

    ADAMS, DOUGLAS; LOGERSTEDT, DAVID; HUNTER-GIORDANO, AIRELLE; AXE, MICHAEL J.; SNYDER-MACKLER, LYNN

    2013-01-01

    SYNOPSIS The management of patients after anterior cruciate ligament reconstruction should be evidence based. Since our original published guidelines in 1996, successful outcomes have been consistently achieved with the rehabilitation principles of early weight bearing, using a combination of weight-bearing and non–weight-bearing exercise focused on quadriceps and lower extremity strength, and meeting specific objective requirements for return to activity. As rehabilitative evidence and surgical technology and procedures have progressed, the original guidelines should be revisited to ensure that the most up-to-date evidence is guiding rehabilitative care. Emerging evidence on rehabilitative interventions and advancements in concomitant surgeries, including those addressing chondral and meniscal injuries, continues to grow and greatly affect the rehabilitative care of patients with anterior cruciate ligament reconstruction. The aim of this article is to update previously published rehabilitation guidelines, using the most recent research to reflect the most current evidence for management of patients after anterior cruciate ligament reconstruction. The focus will be on current concepts in rehabilitation interventions and modifications needed for concomitant surgery and pathology. PMID:22402434

  2. Risk assessment of ochratoxin: current views of the European Scientific Committee on Food, the JECFA and the Codex Committee on Food Additives and Contaminants.

    PubMed

    Walker, Ron

    2002-01-01

    The chlorinated isocoumarin compound, ochratoxin A (OTA), together with some related derivatives (ochratoxins B, C, alpha, beta) are produced by Penicillium verrucosum and by several spp. of Aspergillus, most notably A. ochraceus. P. verrucosum is the principal source of OTA contamination of stored foods in temperate climates while Aspergillus spp. predominate in warmer countries. The major dietary sources of OTA are cereals but significant levels of contamination may be found in grape juice and red wine, coffee, cocoa, nuts, spices and dried fruits. Because of the chemical stability of OTA and long half-life in mammalian tissues, contamination may also carry over into pork and pig blood products and into beer. OTA is potently nephrotoxic and carcinogenic, the potency varying markedly between species and sexes; it is also teratogenic and immunotoxic. There have been different approaches to the risk assessment of OTA in different jurisdictions, largely arising from whether or not the carcinogenicity of OTA is considered to arise through a thresholded or non-thresholded mechanism. Consequently the tolerable intakes have variously been estimated at 100 ng/kg bw/week (JECFA), 1.5 to 5.7 ng/kg bw/day (Canada) and not more than 5 ng/kg bw/day (European Commission). These differences are also reflected in risk management measures that have been implemented or proposed with different maximum contamination levels being applied to different commodities and to the same commodity in different countries. Prevention of contamination at source is considered to be the most effective public health measure. There is also a need to harmonise the risk assessment and management processes to a greater extent than currently exist if barriers to trade are to be avoided.

  3. Publication committee meeting

    NASA Astrophysics Data System (ADS)

    The Publications Committee has oversight responsibility for the entire AGU publications program. It is supported in this activity by the Journals Board, the Books Board, and the Translations Board. The 1982-1984 committee is chaired by Thomas Graedel. Serving with him are David Atlas, Grant Gross, Jurate Landwehr, Peter Molnar, George Reid, and Rob Van der Voo.At its November 3-4 meeting the new committee spent much of its time acquainting its elf with the scope of the program, the current problems, and the potential opportunities. In addition to setting the background against which the work of the next two years would take place, the committee

  4. Evolution of the Treatment Integrity Concept: Current Status and Future Directions

    ERIC Educational Resources Information Center

    Gresham, Frank M.

    2009-01-01

    The concept of treatment integrity cuts across a diversity of fields involved with providing treatments or interventions to individuals. In medical treatments, the concept of "treatment compliance" or "treatment adherence" is an important and problematic issue. In the field of nutrition, the concept of "dietary adherence" is important for…

  5. Evolution of the Treatment Integrity Concept: Current Status and Future Directions

    ERIC Educational Resources Information Center

    Gresham, Frank M.

    2009-01-01

    The concept of treatment integrity cuts across a diversity of fields involved with providing treatments or interventions to individuals. In medical treatments, the concept of "treatment compliance" or "treatment adherence" is an important and problematic issue. In the field of nutrition, the concept of "dietary adherence" is important for…

  6. Training cognition in ADHD: current findings, borrowed concepts, and future directions.

    PubMed

    Rutledge, Kyle J; van den Bos, Wouter; McClure, Samuel M; Schweitzer, Julie B

    2012-07-01

    With both its high prevalence and myriad of negative outcomes, Attention-Deficit/Hyperactivity Disorder (ADHD) demands a careful consideration of the efficacy of its treatment options. Although the benefits of medication have a robust empirical background, nonpharmaceutical interventions evoke particular interest, as they are often viewed more favorably by parents. This review pays special attention to the use of working memory and recent cognitive training attempts in ADHD, describing its cognitive, behavioral, and biological effects in relation to current neurological theory of the disorder. While these treatments have demonstrated positive effects on some measures, there are limitations, as studies have failed to demonstrate generalization to critical measures, such as teacher-rated classroom behaviors, and have provided limited but growing evidence of functionally significant improvements in behavior. There is also a clear lack of research on the effects of training on reward systems and self-control. These limitations may be addressed by broadening the scope and procedures of the training and incorporating research concepts from other fields of study. First, it is important to consider the developmental trajectories of brain regions in individuals with the disorder, as they may relate to the effectiveness of cognitive training. Notions from behavioral economics, including delay discounting and framing (i.e., context) manipulations that influence present orientation, also have applications in the study of cognitive training in ADHD. In considering these other domains, we may find new ways to conceptualize and enhance cognitive training in ADHD and, in turn, address current limitations of interventions that fall in this category.

  7. An Overview of the Mid-Infrared Spectro-Interferometer MATISSE: Science, Concept, and Current Status

    NASA Technical Reports Server (NTRS)

    Matter, A.; Lopez, B.; Antonelli, P.; Lehmitz, M.; Bettonvil, F.; Beckmann, U.; Lagarde, S.; Jaffe, W.; Petrov, R. G.; Berio, P.; hide

    2016-01-01

    MATISSE is the second-generation mid-infrared spectrograph and imager for the Very Large Telescope Interferometer (VLTI) at Paranal. This new interferometric instrument will allow significant advances by opening new avenues in various fundamental research fields: studying the planet-forming region of disks around young stellar objects, understanding the surface structures and mass loss phenomena affecting evolved stars, and probing the environments of black holes in active galactic nuclei. As a first breakthrough, MATISSE will enlarge the spectral domain of current optical interferometers by offering the L and M bands in addition to the N band. This will open a wide wavelength domain, ranging from 2.8 to 13 microns, exploring angular scales as small as 3 mas (L band) 10 mas (N band). As a second breakthrough, MATISSE will allow mid-infrared imaging - closure-phase aperture-synthesis imaging - with up to four Unit Telescopes (UT) or Auxiliary Telescopes (AT) of the VLTI. Moreover, MATISSE will offer a spectral resolution range from R approx. 30 to R approx. 5000. Here, we present one of the main science objectives, the study of protoplanetary disks, that has driven the instrument design and motivated several VLTI upgrades (GRA4MAT and NAOMI). We introduce the physical concept of MATISSE including a description of the signal on the detectors and an evaluation of the expected performances. We also discuss the current status of the MATISSE instrument, which is entering its testing phase, and the foreseen schedule for the next two years that will lead to the first light at Paranal.

  8. An overview of the mid-infrared spectro-interferometer MATISSE: science, concept, and current status

    NASA Astrophysics Data System (ADS)

    Matter, A.; Lopez, B.; Antonelli, P.; Lehmitz, M.; Bettonvil, F.; Beckmann, U.; Lagarde, S.; Jaffe, W.; Petrov, R.; Berio, P.; Millour, F.; Robbe-Dubois, S.; Glindemann, A.; Bristow, P.; Schoeller, M.; Lanz, T.; Henning, T.; Weigelt, G.; Heininger, M.; Morel, S.; Cruzalebes, P.; Meisenheimer, K.; Hofferbert, R.; Wolf, S.; Bresson, Y.; Agocs, T.; Allouche, F.; Augereau, J.-C.; Avila, G.; Bailet, C.; Behrend, J.; van Belle, G.; Berger, J.-P.; van Boekel, R.; Bourget, P.; Brast, R.; Clausse, J.-M.; Connot, C.; Conzelmann, R.; Csepany, G.; Danchi, W. C.; Delbo, M.; Dominik, C.; van Duin, A.; Elswijk, E.; Fantei, Y.; Finger, G.; Gabasch, A.; Gonté, F.; Graser, U.; Guitton, F.; Guniat, S.; De Haan, M.; Haguenauer, P.; Hanenburg, H.; Hofmann, K.-H.; Hogerheijde, M.; ter Horst, R.; Hron, J.; Hummel, C.; Isderda, J.; Ives, D.; Jakob, G.; Jasko, A.; Jolley, P.; Kiraly, S.; Kragt, J.; Kroener, T.; Kroes, G.; Kuindersma, S.; Labadie, L.; Laun, W.; Leinert, C.; Lizon, J.-L.; Lucuix, C.; Marcotto, A.; Martinache, F.; Martinot-Lagarde, G.; Mauclert, N.; Mehrgan, L.; Meilland, A.; Mellein, M.; Menardi, S.; Merand, A.; Neumann, U.; Nussbaum, E.; Ottogalli, S.; Palsa, R.; Panduro, J.; Pantin, E.; Percheron, I.; Phan Duc, T.; Pott, J.-U.; Pozna, E.; Roelfsema, R.; Rupprecht, G.; Schertl, D.; Schmidt, C.; Schuil, M.; Spang, A.; Stegmeier, J.; Tromp, N.; Vakili, F.; Vannier, M.; Wagner, K.; Venema, L.; Woillez, J.

    2016-08-01

    MATISSE is the second-generation mid-infrared spectrograph and imager for the Very Large Telescope Interferometer (VLTI) at Paranal. This new interferometric instrument will allow significant advances by opening new avenues in various fundamental research fields: studying the planet-forming region of disks around young stellar objects, understanding the surface structures and mass loss phenomena affecting evolved stars, and probing the environments of black holes in active galactic nuclei. As a first breakthrough, MATISSE will enlarge the spectral domain of current optical interferometers by offering the L and M bands in addition to the N band. This will open a wide wavelength domain, ranging from 2.8 to 13 μm, exploring angular scales as small as 3 mas (L band) / 10 mas (N band). As a second breakthrough, MATISSE will allow mid-infrared imaging - closure-phase aperture-synthesis imaging - with up to four Unit Telescopes (UT) or Auxiliary Telescopes (AT) of the VLTI. Moreover, MATISSE will offer a spectral resolution range from R ˜ 30 to R ˜ 5000. Here, we present one of the main science objectives, the study of protoplanetary disks, that has driven the instrument design and motivated several VLTI upgrades (GRA4MAT and NAOMI). We introduce the physical concept of MATISSE including a description of the signal on the detectors and an evaluation of the expected performances. We also discuss the current status of the MATISSE instrument, which is entering its testing phase, and the foreseen schedule for the next two years that will lead to the first light at Paranal.

  9. Current oncologic concepts and emerging techniques for imaging of head and neck squamous cell cancer

    PubMed Central

    Sadick, Maliha; Schoenberg, Stefan O.; Hoermann, Karl; Sadick, Haneen

    2012-01-01

    The incidence of head and neck squamous cell carcinoma (HNSCC) is increasing and currently they account for 5% of all malignancies worldwide. Inspite of ongoing developments in diagnostic imaging and new therapeutic options, HNSCC still represents a multidisciplinary challenge. One of the most important prognostic factors in HNSCC is the presence of lymph node metastases. Patients with confirmed nodal involvement have a considerable reduction of their 5-year overall survival rate. In the era of individually optimised surgery, chemotherapy and intensity modulated radiotherapy, the main role of pre- and posttherapeutic imaging remains cancer detection at an early stage and accurate follow-up. The combined effort of early diagnosis and close patient monitoring after surgery and/or radio-chemotherapy influences disease progression and outcome predicition in patients with HNSCC. This review article focuses on currrent oncologic concepts and emerging tools in imaging of head and neck squamous cell cancer. Besides the diagnostic spectrum of the individual imaging modalities, their limitations are also discussed. One main part of this article is dedicated to PET-CT which combines functional and morphological imaging. Furthermore latest developments in MRI are presented with regard to lymph node staging and response prediction. Last but not least, a clinical contribution in this review explains, which information the head and neck surgeon requires from the multimodality imaging and its impact on operation planning. PMID:23320060

  10. Old concepts, new molecules and current approaches applied to the bacterial nucleotide signalling field

    PubMed Central

    2016-01-01

    Signalling nucleotides are key molecules that help bacteria to rapidly coordinate cellular pathways and adapt to changes in their environment. During the past 10 years, the nucleotide signalling field has seen much excitement, as several new signalling nucleotides have been discovered in both eukaryotic and bacterial cells. The fields have since advanced quickly, aided by the development of important tools such as the synthesis of modified nucleotides, which, combined with sensitive mass spectrometry methods, allowed for the rapid identification of specific receptor proteins along with other novel genome-wide screening methods. In this review, we describe the principle concepts of nucleotide signalling networks and summarize the recent work that led to the discovery of the novel signalling nucleotides. We also highlight current approaches applied to the research in the field as well as resources and methodological advances aiding in a rapid identification of nucleotide-specific receptor proteins. This article is part of the themed issue ‘The new bacteriology’. PMID:27672152

  11. Acute respiratory distress syndrome following cardiovascular surgery: current concepts and novel therapeutic approaches

    PubMed Central

    Hoegl, Sandra; Zwissler, Bernhard; Eltzschig, Holger K.; Vohwinkel, Christine

    2015-01-01

    Purpose of review This review gives an update on current treatment options and novel concepts on the prevention and treatment of the acute respiratory distress syndrome (ARDS) in cardiovascular surgery patients. Recent findings The only proven beneficial therapeutic options in ARDS are those that help to prevent further ventilator-induced lung injury, such as prone position, use of lung-protective ventilation strategies, and extracorporeal membrane oxygenation. In the future also new approaches like mesenchymal cell therapy, activation of hypoxia-elicited transcription factors or targeting of purinergic signaling may be successful outside the experimental setting. Owing to the so far limited treatment options, it is of great importance to determine patients at risk for developing ARDS already perioperatively. In this context, serum biomarkers and lung injury prediction scores could be useful. Summary Preventing ARDS as a severe complication in the cardiovascular surgery setting may help to reduce morbidity and mortality. As cardiovascular surgery patients are of greater risk to develop ARDS, preventive interventions should be implemented early on. Especially, use of low tidal volumes, avoiding of fluid overload and restrictive blood transfusion regimes may help to prevent ARDS. PMID:26598954

  12. Current concepts and techniques for caries excavation and adhesion to residual dentin.

    PubMed

    de Almeida Neves, Aline; Coutinho, Eduardo; Cardoso, Marcio Vivan; Lambrechts, Paul; Van Meerbeek, Bart

    2011-02-01

    The advent of "Adhesive Dentistry" has simplified the guidelines for cavity preparation enormously. The design and extent of the current preparations are basically defined by the extent and shape of the caries lesion, potentially slightly extended by bevelling the cavity margins in order to meet the modern concept of minimally invasive dentistry. New caries excavation techniques have been introduced, such as the use of plastic and ceramic burs, improved caries-disclosing dyes, enzymatic caries-dissolving agents, caries-selective sono/air abrasion and laser ablation. They all aim to remove or help remove caries-infected tissue as selectively as possible, while being minimally invasive through maximum preservation of caries-affected tissue. Each technique entails a specific caries-removal endpoint and produces residual dentin substrates of different natures and thus different receptiveness for adhesive procedures. This paper reviews the newest developments in caries excavation techniques and their effect on the remaining dentin tissue with regard to its bonding receptiveness.

  13. Current Concepts and Occurrence of Epithelial Odontogenic Tumors: I. Ameloblastoma and Adenomatoid Odontogenic Tumor

    PubMed Central

    Kim, Yeon Sook

    2013-01-01

    Ameloblastomas and adenomatoid odontogenic tumors (AOTs) are common epithelial tumors of odontogenic origin. Ameloblastomas are clinico-pathologically classified into solid/multicystic, unicystic, desmoplastic, and peripheral types, and also divided into follicular, plexiform, acanthomatous, granular types, etc., based on their histological features. Craniopharyngiomas, derived from the remnants of Rathke's pouch or a misplaced enamel organ, are also comparable to the odontogenic tumors. The malignant transformation of ameloblastomas results in the formation of ameloblastic carcinomas and malignant ameloblastomas depending on cytological dysplasia and metastasis, respectively. AOTs are classified into follicular, extrafollicular, and peripheral types. Ameloblastomas are common, have an aggressive behavior and recurrent course, and are rarely metastatic, while AOTs are hamartomatous benign lesions derived from the complex system of the dental lamina or its remnants. With advances in the elucidation of molecular signaling mechanisms in cells, the cytodifferentiation of epithelial tumor cells in ameloblastomas and AOTs can be identified using different biomarkers. Therefore, it is suggested that comprehensive pathological observation including molecular genetic information can provide a more reliable differential diagnosis for the propagation and prognosis of ameloblastomas and AOTs. This study aimed to review the current concepts of ameloblastomas and AOTs and to discuss their clinico-pathological features relevant to tumorigenesis and prognosis. PMID:23837011

  14. Current and emerging basic science concepts in bone biology: implications in craniofacial surgery.

    PubMed

    Oppenheimer, Adam J; Mesa, John; Buchman, Steven R

    2012-01-01

    Ongoing research in bone biology has brought cutting-edge technologies into everyday use in craniofacial surgery. Nonetheless, when osseous defects of the craniomaxillofacial skeleton are encountered, autogenous bone grafting remains the criterion standard for reconstruction. Accordingly, the core principles of bone graft physiology continue to be of paramount importance. Bone grafts, however, are not a panacea; donor site morbidity and operative risk are among the limitations of autologous bone graft harvest. Bone graft survival is impaired when irradiation, contamination, and impaired vascularity are encountered. Although the dura can induce calvarial ossification in children younger than 2 years, the repair of critical-size defects in the pediatric population may be hindered by inadequate bone graft donor volume. The novel and emerging field of bone tissue engineering holds great promise as a limitless source of autogenous bone. Three core constituents of bone tissue engineering have been established: scaffolds, signals, and cells. Blood supply is the sine qua non of these components, which are used both individually and concertedly in regenerative craniofacial surgery. The discerning craniofacial surgeon must determine the proper use for these bone graft alternatives, while understanding their concomitant risks. This article presents a review of contemporary and emerging concepts in bone biology and their implications in craniofacial surgery. Current practices, areas of controversy, and near-term future applications are emphasized.

  15. The Draining Lymph Node in Rheumatoid Arthritis: Current Concepts and Research Perspectives

    PubMed Central

    Benaglio, Francesca; Binda, Elisa; Caporali, Roberto; Montecucco, Carlomaurizio

    2015-01-01

    Rheumatoid arthritis (RA) is a chronic autoimmune inflammatory disease of unknown aetiology, leading to progressive damage of bone and cartilage with functional impairment and disability. Whilst the synovial membrane represents the epicentre of the immune-inflammatory process, there is growing evidence indicating the potential involvement of additional anatomical compartments, such as the lung, bone marrow, and secondary lymphoid tissues. Draining lymph nodes represent the elective site for tissue immune-surveillance, for the generation of adaptive immune responses and a candidate compartment for the maintenance of peripheral tolerance. Despite the precise role of the juxta- and extra-articular lymph node stations in the pathogenesis of RA remaining poorly defined, several lines of research exploiting new technological approaches are now focusing on their assessment as a potential new source of pathobiologic information, biomarkers, and complementary therapeutic targets. In this review we present an updated overview of the main concepts driving lymph node research in RA, highlighting the most relevant findings, current hypothesis, and translational perspectives. PMID:25793195

  16. Economic Thresholds in Soybean-Integrated Pest Management: Old Concepts, Current Adoption, and Adequacy.

    PubMed

    Bueno, A F; Paula-Moraes, S V; Gazzoni, D L; Pomari, A F

    2013-10-01

    Increasing global demands for food underline the need for higher crop yields. The relatively low costs of the most commonly used insecticides in combination with increasing soybean market prices led growers and technical advisors to debate the adequacy of recommended economic thresholds (ETs). The adoption of ETs and pest sampling has diminished in Brazil, leading to excessive pesticide use on soybean. The reduced efficacy of natural biological control, faster pest resurgence, and environment contamination are among the side-effects of pesticide abuse. To address these problems and maximize agricultural production, pest control programs must be guided by a proper integrated pest management (IPM) approach, including the ET concept. Therefore, the most appropriate time to initiate insecticide spraying in soybean is indicated by the available ETs which are supported by experiments over the last 40 years in different edapho-climatic conditions and regions with distinct soybean cultivars. Published scientific data indicate that preventive insecticide use is an expensive and harmful use of chemicals that increases the negative impact of pesticides in agroecosystems. However, the established ETs are for a limited number of species (key pests), and they only address the use of chemicals. There is a lack of information regarding secondary pests and other control strategies in addition to insecticides. It is clear then that much progress is still needed to improve ETs for pest management decisions. Nevertheless, using the current ETs provides a basis for reducing the use of chemicals in agriculture without reducing yields and overall production, thereby improving sustainability.

  17. The basal ganglia in Parkinson's disease: current concepts and unexplained observations.

    PubMed

    Obeso, Jose A; Marin, Concepcio; Rodriguez-Oroz, C; Blesa, Javier; Benitez-Temiño, B; Mena-Segovia, Juan; Rodríguez, Manuel; Olanow, C Warren

    2008-12-01

    The pathophysiology of Parkinson's disease is reviewed in light of recent advances in the understanding of the functional organization of the basal ganglia (BG). Current emphasis is placed on the parallel interactions between corticostriatal and corticosubthalamic afferents on the one hand, and internal feedback circuits modulating BG output through the globus pallidus pars interna and substantia nigra pars reticulata on the other. In the normal BG network, the globus pallidus pars externa emerges as a main regulatory station of output activity. In the parkinsonian state, dopamine depletion shifts the BG toward inhibiting cortically generated movements by increasing the gain in the globus pallidus pars externa-subthalamic nucleus-globus pallidus pars interna network and reducing activity in "direct" cortico-putaminal-globus pallidus pars interna projections. Standard pharmacological treatments do not mimic the normal physiology of the dopaminergic system and, therefore, fail to restore a functional balance between corticostriatal afferents in the so-called direct and indirect pathways, leading to the development of motor complications. This review emphasizes the concept that the BG can no longer be understood as a "go-through" station in the control of movement, behavior, and emotions. The growing understanding of the complexity of the normal BG and the changes induced by DA depletion should guide the development of more efficacious therapies for Parkinson's disease.

  18. Transcranial Direct Current Stimulation Effects on Athletes’ Cognitive Performance: An Exploratory Proof of Concept Trial

    PubMed Central

    Borducchi, Davimar M. M.; Gomes, July Silveira; Akiba, Henrique; Cordeiro, Quirino; Borducchi, José Henrique M.; Valentin, Lívia Stocco Sanches; Borducchi, Gabrielle M.; Dias, Álvaro Machado

    2016-01-01

    Among the 2016 Olympic and Paralympic Games’ unforgettable moments, one could not overlook performances by Phelps and Bolt, which challenge old premises about the maximum extension of individual supremacism in ultracompetitive modalities and the doping scandals. Different media channels resonated these two trends, with an unseen rise on discussions about traits and practices that may set ultrahigh performance athletes apart from the more ordinary ones. Yet, some key issues remain undebated. This paper aims to add to this debate, with a proof of concept trial, which investigates whether transcranial direct current stimulation (tDCS) may serve as an aid for professional athletes. Ten professional athletes of three different modalities (judo, N = 4 athletes, swimming, N = 3 athletes, and rhythmic gymnastics, N = 3 athletes) received anodal stimulation (2 mA) for 20 min on the left dorsolateral prefrontal cortex for ten consecutive weekdays. We observed a positive effect of tDCS in their cognitive performance, including a significant improvement in alternated, sustained, and divided attention and in memory scores. We also observed a decrease in Beck Depression Inventory scores (4.50 points) in this non-clinical population. These preliminary results suggest that tDCS sessions may translate into competitive advantages for professional athletes and recommend the deepening of the discussion on its ethical use in sports, which is ultimately tied to the wider debate around the risks and opportunities that neuromodulation brings to the table. PMID:27965597

  19. Current concepts: tissue engineering and regenerative medicine applications in the ankle joint

    PubMed Central

    Correia, S. I.; Pereira, H.; Silva-Correia, J.; Van Dijk, C. N.; Espregueira-Mendes, J.; Oliveira, J. M.; Reis, R. L.

    2014-01-01

    Tissue engineering and regenerative medicine (TERM) has caused a revolution in present and future trends of medicine and surgery. In different tissues, advanced TERM approaches bring new therapeutic possibilities in general population as well as in young patients and high-level athletes, improving restoration of biological functions and rehabilitation. The mainstream components required to obtain a functional regeneration of tissues may include biodegradable scaffolds, drugs or growth factors and different cell types (either autologous or heterologous) that can be cultured in bioreactor systems (in vitro) prior to implantation into the patient. Particularly in the ankle, which is subject to many different injuries (e.g. acute, chronic, traumatic and degenerative), there is still no definitive and feasible answer to ‘conventional’ methods. This review aims to provide current concepts of TERM applications to ankle injuries under preclinical and/or clinical research applied to skin, tendon, bone and cartilage problems. A particular attention has been given to biomaterial design and scaffold processing with potential use in osteochondral ankle lesions. PMID:24352667

  20. Use of novel proteosome inhibitors as a therapeutic strategy in lymphomas current experience and emerging concepts.

    PubMed

    Abayomi, Emmanuel Akinola; Sissolak, Gerhard; Jacobs, Peter

    2007-08-01

    Precedent from preclinical experiments coupled with two pivotal phase 2 studies in myeloma has focused attention on a potential role for ubiquitin-proteasome pathway in modulating a number of events that occur commonly in the neoplastic process involving proteins in the regulation of cells cycling, growth and differentiation. This influence is vested in the proteasomes which are large complexes of proteolytic enzymes responsible for degradation of many of these intracellular messengers. Logically interest has centred on molecules having the capacity to influence, by degradation, such molecules and although a number of agents are in development bortezomib is the only one currently in clinical use. Velcade, formerly PS-341, is a novel dipeptide boronic acid capable of reversibly inhibiting the 26S proteasome through a range of activities. The latter are anti-proliferative and proapoptotic with the latter blocking nuclear transcription via NF-kappa B in addition to down regulating adhesion and inhibiting angiogenesis. Additional changes are mediated in protein folding within the endoplasmic reticulum and contribute to cell death. These concepts are given focus by considering their introduction into treatment of lymphoreticular malignancy.

  1. Current concepts: tissue engineering and regenerative medicine applications in the ankle joint.

    PubMed

    Correia, S I; Pereira, H; Silva-Correia, J; Van Dijk, C N; Espregueira-Mendes, J; Oliveira, J M; Reis, R L

    2014-03-06

    Tissue engineering and regenerative medicine (TERM) has caused a revolution in present and future trends of medicine and surgery. In different tissues, advanced TERM approaches bring new therapeutic possibilities in general population as well as in young patients and high-level athletes, improving restoration of biological functions and rehabilitation. The mainstream components required to obtain a functional regeneration of tissues may include biodegradable scaffolds, drugs or growth factors and different cell types (either autologous or heterologous) that can be cultured in bioreactor systems (in vitro) prior to implantation into the patient. Particularly in the ankle, which is subject to many different injuries (e.g. acute, chronic, traumatic and degenerative), there is still no definitive and feasible answer to 'conventional' methods. This review aims to provide current concepts of TERM applications to ankle injuries under preclinical and/or clinical research applied to skin, tendon, bone and cartilage problems. A particular attention has been given to biomaterial design and scaffold processing with potential use in osteochondral ankle lesions.

  2. 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.

  3. Current status of transcatheter mitral valve repair therapies - From surgical concepts towards future directions.

    PubMed

    Nielsen, Sten Lyager

    Transcatheter mitral valve (MV) intervention has emerged as an effective treatment option for symptomatic severe mitral regurgitation (MR) in patients considered to be inoperable or at high operative risk for surgical MV surgery. In primary mitral regurgitation, surgical repair is the standard of care. Transcatheter edge-to-edge MV repair with the MitraClip system has the largest clinical experience to date and offers a sustained clinical benefit in selected surgical high-risk patients. Surgery for secondary MR remains a challenge. Indications and the preferred surgical procedure remain controversial, mainly because of high recurrence rate of MR and the absence of evidence for survival benefit after surgery. Secondary MR is currently the most common indication for MitraClip use in Europe. Many registries show the safety of this procedure and improvements in patient symptoms and quality of life after 1 year, but most patients still have considerable residual MR. Other transcatheter MV repair devices are still in their early experiences. However, durability, safety, and possible damage of adjacent cardiac structures remain important concerns. Future directions for treatment of patients with secondary MR will depend on outcomes from the clinical trials in progress, whatever the use of transcatheter techniques is expected to expand substantially in the next years. This review aims to provide an overview of transcatheter MV interventions, emerging from surgical concepts, including leaflet repair, chordal replacement, and annuloplasty, and to discuss the challenges they face and future directions in achieving successful clinical application.

  4. Intestinal tissue engineering: current concepts and future vision of regenerative medicine in the gut.

    PubMed

    Bitar, K N; Raghavan, S

    2012-01-01

    Functional tissue engineering of the gastrointestinal (GI) tract is a complex process aiming to aid the regeneration of structural layers of smooth muscle, intrinsic enteric neuronal plexuses, specialized mucosa, and epithelial cells as well as interstitial cells. The final tissue-engineered construct is intended to mimic the native GI tract anatomically and physiologically. Physiological functionality of tissue-engineered constructs is of utmost importance while considering clinical translation. The construct comprises of cellular components as well as biomaterial scaffolding components. Together, these determine the immune response a tissue-engineered construct would elicit from a host upon implantation. Over the last decade, significant advances have been made to mitigate adverse host reactions. These include a quest for identifying autologous cell sources like embryonic and adult stem cells, bone marrow-derived cells, neural crest-derived cells, and muscle derived-stem cells. Scaffolding biomaterials have been fabricated with increasing biocompatibility and biodegradability. Manufacturing processes have advanced to allow for precise spatial architecture of scaffolds to mimic in vivo milieu closely and achieve neovascularization. This review will focus on the current concepts and the future vision of functional tissue engineering of the diverse neuromuscular structures of the GI tract from the esophagus to the internal anal sphincter. © 2011 Blackwell Publishing Ltd.

  5. Current concepts on the use of glucocorticosteroids and beta 2-adrenoreceptor agonists to treat childhood asthma

    PubMed Central

    Nino, Gustavo; Grunstein, Michael M.

    2010-01-01

    Purpose of Review This article reviews current concepts regarding the clinical and scientific rationale for the combined use of glucocorticosteroids (GC) and beta2-adrenoreceptor (β2AR) agonists in the treatment of childhood asthma. Recent findings Several studies have demonstrated that inhaled corticosteroids (ICS) and β2AR-agonists are the most effective medications for the management of asthma in children. Given substantial evidence of an increased clinical benefit when these agents are used together, new studies are being pursued to establish the efficacy and safety of this combinational therapy in infants and children. Ongoing research is also investigating the mechanisms of β2AR and GC signaling and their molecular interactions. This new knowledge will likely lead to novel therapeutic approaches to asthma control. Summary There is increasing evidence demonstrating that the combination of long-acting β2AR-agonists and ICS may be more effective than high dose ICS therapy alone in the management of children with uncontrolled asthma. In addition, the use of a single inhaler containing ICS and a quick-acting β2AR-agonist might be a convenient alternative to prevent and treat asthma exacerbations. Future investigations should be designed to more specifically evaluate the efficacy and safety of these therapies in the different asthmatic phenotypes of infants and children. PMID:20164771

  6. Tissue engineering for the management of chronic wounds: current concepts and future perspectives.

    PubMed

    Wong, Victor W; Gurtner, Geoffrey C

    2012-10-01

    Chronic wounds constitute a significant and growing biomedical burden. With the increasing growth of populations prone to dysfunctional wound healing, there is an urgent and unmet need for novel strategies to both prevent and treat these complications. Tissue engineering offers the potential to create functional skin, and the synergistic efforts of biomedical engineers, material scientists, and molecular and cell biologists have yielded promising therapies for non-healing wounds. However, traditional paradigms for wound healing focus largely on the role of inflammatory cells and fail to incorporate more recent research highlighting the importance of stem cells and matrix dynamics in skin repair. Approaches to chronic wound healing centred on inflammation alone are inadequate to guide the development of regenerative medicine-based technologies. As the molecular pathways and biologic defects underlying non-healing wounds are further elucidated, multifaceted bioengineering systems must advance in parallel to exploit this knowledge. In this viewpoint essay, we highlight the current concepts in tissue engineering for chronic wounds and speculate on areas for future research in this increasingly interdisciplinary field.

  7. Skin Wound Healing: An Update on the Current Knowledge and Concepts.

    PubMed

    Sorg, Heiko; Tilkorn, Daniel J; Hager, Stephan; Hauser, Jörg; Mirastschijski, Ursula

    2017-01-01

    The integrity of healthy skin plays a crucial role in maintaining physiological homeostasis of the human body. The skin is the largest organ system of the body. As such, it plays pivotal roles in the protection against mechanical forces and infections, fluid imbalance, and thermal dysregulation. At the same time, it allows for flexibility to enable joint function in some areas of the body and more rigid fixation to hinder shifting of the palm or foot sole. Many instances lead to inadequate wound healing which necessitates medical intervention. Chronic conditions such as diabetes mellitus or peripheral vascular disease can lead to impaired wound healing. Acute trauma such as degloving or large-scale thermal injuries are followed by a loss of skin organ function rendering the organism vulnerable to infections, thermal dysregulation, and fluid loss. For this update article, we have reviewed the actual literature on skin wound healing purposes focusing on the main phases of wound healing, i.e., inflammation, proliferation, epithelialization, angiogenesis, remodeling, and scarring. The reader will get briefed on new insights and up-to-date concepts in skin wound healing. The macrophage as a key player in the inflammatory phase will be highlighted. During the epithelialization process, we will present the different concepts of how the wound will get closed, e.g., leapfrogging, lamellipodial crawling, shuffling, and the stem cell niche. The neovascularization represents an essential component in wound healing due to its fundamental impact from the very beginning after skin injury until the end of the wound remodeling. Here, the distinct pattern of the neovascularization process and the special new functions of the pericyte will be underscored. At the end, this update will present 3 topics of high interest in skin wound healing issues, dealing with scarring, tissue engineering, and plasma application. Although wound healing mechanisms and specific cell functions in wound

  8. Plastic Solar Cells: A Multidisciplinary Field to Construct Chemical Concepts from Current Research

    ERIC Educational Resources Information Center

    Gomez, Rafael; Segura, Jose L.

    2007-01-01

    Examples of plastic solar-cell technology to illustrate core concepts in chemistry are presented. The principles of operations of a plastic solar cell could be used to introduce key concepts, which are fundamentally important to understand photosynthesis and the basic process that govern most novel optoelectronic devices.

  9. Concept Development in Learning Physics: The Case of Electric Current and Voltage Revisited

    ERIC Educational Resources Information Center

    Koponen, Ismo T.; Huttunen, Laura

    2013-01-01

    In learning conceptual knowledge in physics, a common problem is the development and differentiation of concepts in the learning process. An important part of this development process is the re-organisation or re-structuring process in which students' conceptual knowledge and concepts change. This study proposes a new view of concept…

  10. Teach for Fitness: A Manual for Teaching Fitness Concepts in K-12 Physical Education. Current Issues.

    ERIC Educational Resources Information Center

    Priest, Laurie

    This book is designed to aid and to encourage physical education teachers to incorporate the concepts of physical fitness into the physical education curriculum. The activities are written in an outline format using the following headings: (1) concept; (2) activity and/or knowledge level; (3) location (school or home); (4) time needed; (5)…

  11. Concept Development in Learning Physics: The Case of Electric Current and Voltage Revisited

    ERIC Educational Resources Information Center

    Koponen, Ismo T.; Huttunen, Laura

    2013-01-01

    In learning conceptual knowledge in physics, a common problem is the development and differentiation of concepts in the learning process. An important part of this development process is the re-organisation or re-structuring process in which students' conceptual knowledge and concepts change. This study proposes a new view of concept…

  12. Plastic Solar Cells: A Multidisciplinary Field to Construct Chemical Concepts from Current Research

    ERIC Educational Resources Information Center

    Gomez, Rafael; Segura, Jose L.

    2007-01-01

    Examples of plastic solar-cell technology to illustrate core concepts in chemistry are presented. The principles of operations of a plastic solar cell could be used to introduce key concepts, which are fundamentally important to understand photosynthesis and the basic process that govern most novel optoelectronic devices.

  13. The concept of sporadic cerebral small vessel disease: A road map on key definitions and current concepts.

    PubMed

    Charidimou, Andreas; Pantoni, Leonardo; Love, Seth

    2016-01-01

    Sporadic cerebral small vessel disease is considered to be among the most common known neuropathological processes and has an important role in stroke, cognitive impairment, and functional loss in elderly persons. The term is now commonly used to describe a range of neuroimaging, neuropathological, and associated clinical features, the pathogenesis of which is largely unclear but that are thought to arise from disease affecting the perforating cerebral arterioles, capillaries, and venules. Modern neuroimaging has revolutionized our understanding of the consequences of small vessels disease on the brain parenchyma, even though small arteries, arterioles, capillaries, and venules are difficult to be directly visualized with current techniques used in clinical practice. In this short review, we focus on histopathological and neuroimaging perspectives, basic definitions, and recent advances in the field.

  14. Chronic traumatic encephalopathy: clinical-biomarker correlations and current concepts in pathogenesis.

    PubMed

    Gandy, Sam; Ikonomovic, Milos D; Mitsis, Effie; Elder, Gregory; Ahlers, Stephen T; Barth, Jeffrey; Stone, James R; DeKosky, Steven T

    2014-09-17

    Chronic traumatic encephalopathy (CTE) is a recently revived term used to describe a neurodegenerative process that occurs as a long term complication of repetitive mild traumatic brain injury (TBI). Corsellis provided one of the classic descriptions of CTE in boxers under the name "dementia pugilistica" (DP). Much recent attention has been drawn to the apparent association of CTE with contact sports (football, soccer, hockey) and with frequent battlefield exposure to blast waves generated by improvised explosive devices (IEDs). Recently, a promising serum biomarker has been identified by measurement of serum levels of the neuronal microtubule associated protein tau. New positron emission tomography (PET) ligands (e.g., [18 F] T807) that identify brain tauopathy have been successfully deployed for the in vitro and in vivo detection of presumptive tauopathy in the brains of subjects with clinically probable CTE. Major academic and lay publications on DP/CTE were reviewed beginning with the 1928 paper describing the initial use of the term CTE by Martland. The major current concepts in the neurological, psychiatric, neuropsychological, neuroimaging, and body fluid biomarker science of DP/CTE have been summarized. Newer achievements, such as serum tau and [18 F] T807 tauopathy imaging, are also introduced and their significance has been explained. Recent advances in the science of DP/CTE hold promise for elucidating a long sought accurate determination of the true prevalence of CTE. This information holds potentially important public health implications for estimating the risk of contact sports in inflicting permanent and/or progressive brain damage on children, adolescents, and adults.

  15. A discussion of current issues and concepts in the practice of skull-photo/craniofacial superimposition.

    PubMed

    Gordon, G M; Steyn, M

    2016-05-01

    A recent review paper on cranio-facial superimposition (CFS) stated that "there have been specific conceptual variances" from the original methods used in the practice of skull-photo superimposition, leading to poor results as far as accuracy is concerned. It was argued that the deviations in the practice of the technique have resulted in the reduced accuracies (for both failure to include and failure to exclude) that are noted in several recent studies. This paper aims to present the results from recent research to highlight the advancement of skull-photo/cranio-facial superimposition, and to discuss some of the issues raised regarding deviations from original techniques. The evolving methodology of CFS is clarified in context with the advancement of technology, forensic science and specifically within the field of forensic anthropology. Developments in the skull-photo/cranio-facial superimposition techniques have largely focused on testing reliability and accuracy objectively. Techniques now being employed by forensic anthropologists must conform to rigorous scientific testing and methodologies. Skull-photo/cranio-facial superimposition is constantly undergoing accuracy and repeatability testing which is in line with the principles of the scientific method and additionally allows for advancement in the field. Much of the research has indicated that CFS is useful in exclusion which is consistent with the concept of Popperian falsifiability - a hypothesis and experimental design which is falsifiable. As the hypothesis is disproved or falsified, another evolves to replace it and explain the new observations. Current and future studies employing different methods to test the accuracy and reliability of skull-photo/cranio-facial superimposition will enable researchers to establish the contribution the technique can have for identification purposes.

  16. Invited Hand Article: Current Concepts in Treatment of Fracture-Dislocations of the Proximal Interphalangeal Joint

    PubMed Central

    Haase, Steven C.; Chung, Kevin C.

    2014-01-01

    Background Proximal interphalangeal joint fracture-dislocations are common injuries that require expedient and attentive treatment for the best outcomes. Management can range from protective splinting and early mobilization to complex operations. In this review, the current concepts surrounding the managment of these injuries are reviewed. Methods A literature review was performed of all recent articles pertaining to proximal interphalangeal joint fracture-dislocation, with specific focus on middle phalangeal base fractures. Where appropriate, older articles, or articles on closely related injury types were included for completeness. The methodology and outcomes of each study were analyzed. Results When small avulsion fractures are present, good results are routinely obtained with reduction and early mobilization of stable injuries. Strategies for management of the unstable dorsal fracture-dislocation have evolved over time. To provide early stability, a variety of techniques have evolved, including closed, percutaneous, external, and internal fixation methods. Although each of these techniques can be successful in skilled hands, none have been subjected to rigorous, prospective, comparative trials. Volar dislocations fare less well, with significant loss of motion in many studies. Pilon fractures represent the most complicated injuries, and return of normal motion is not expected. Conclusion The best outcomes can be achieved by (1) establishing enough stability to allow early motion, (2) restoring gliding joint motion rather than non-congruent motion, and (3) restoring the articular surface congruity when possible. Although the majority of literature on this topic consists of expert opinion and retrospective case series, the consensus appears to favor less invasive techniques whenever possible. PMID:25415092

  17. Current concepts and future approaches to the development of autologous/autogenous vaccines for veterinary use.

    PubMed

    Tollis, M

    2004-01-01

    Current classification of autologous/autogenous (A/A) vaccines is commonly based on the concept of strain/antigen specificity associated with targeted treatment of a restricted number of animals. However, fulfilling these two conditions is not sufficient for immune-veterinary immunebiologicals to be excluded from the provisions of Directive 2001/82/EC. Indeed, non-inactivated A/A vaccines are not automatically considered out of the scope of the community code relating to veterinary medicinal products, in particular to immune-biologicals. As a major consequence of the "regulatory" exclusion from the requirements of EU rules, A/A vaccines can be usually manufactured and distributed without having obtained a marketing authorization by the competent authority of a Member State. Furthermore, strain specificity enables veterinarians to consider the use of these vaccines in quite a large variety of epidemiological circumstances where no "conventional" vaccines are yet available or are considered efficacious. In addition, in contrast to "conventional" vaccines, which are considered exclusively as a preventive tool against infectious diseases, A/A vaccines can also be used to treat "continuing" infections. Although the limited scientific value of these products and the poor investigations of the effector mechanisms involved are widely recognized, their use is still claimed in conditions where disorders in the immune system are suspected. Today, a more appropriate definition of A/A vaccines is one that takes into account their historical tradition and practical use, such as stable- or herd-specific vaccines, custom ("..ized") vaccines, therapeutic vaccines, pharmavaccines, vaccines used for biological therapy, etc. Although acknowledging the "regulatory autonomy" of A/A vaccines versus "conventional" vaccines, here it will be presented as an overview of the necessary points to consider, to guarantee an acceptable standard in the development and control of this particular

  18. Coronary computed tomography angiography: overview of technical aspects, current concepts, and perspectives.

    PubMed

    Chartrand-Lefebvre, Carl; Cadrin-Chênevert, Alexandre; Bordeleau, Edith; Ugolini, Patricia; Ouellet, Robert; Sablayrolles, Jean-Louis; Prenovault, Julie

    2007-04-01

    Multidetector-row electrocardiogram (ECG)-gated cardiac computed tomography (CT) will probably be a major noninvasive imaging option in the near future. Recent developments indicate that this new technology is improving rapidly. This article presents an overview of the current concepts, perspectives, and technical capabilities in coronary CT angiography (CTA). We have reviewed the recent literature on the different applications of this technology; of particular note are the many studies that have demonstrated the high negative predictive value (NPV) of coronary CTA, when performed under optimal conditions, for significant stenoses in native coronary arteries. This new technology's level of performance allows it to be used to evaluate the presence of calcified plaques, coronary bypass graft patency, and the origin and course of congenital coronary anomalies. Despite a high NPV, the robustness of the technology is limited by arrhythmias, the requirement of low heart rates, and calcium-related artifacts. Some improvements are needed in the imaging of coronary stents, especially the smaller stents, and in the detection and characterization of noncalcified plaques. Further studies are needed to more precisely determine the role of CTA in various symptomatic and asymptomatic patient groups. Clinical testing of 64-slice scanners has recently begun. As the technology improves, so does the spatial and temporal resolution. To date, this is being achieved through the development of systems with an increased number of detectors and shorter gantry rotation time, as well as the development of systems equipped with 2 X-ray tubes and the eventual development of flat-panel technology. Thus further improvement of image quality is expected.

  19. Current concepts in the biopsy of musculoskeletal tumors: AAOS exhibit selection.

    PubMed

    Traina, Francesco; Errani, Costantino; Toscano, Angelo; Pungetti, Camilla; Fabbri, Daniele; Mazzotti, Antonio; Donati, Davide; Faldini, Cesare

    2015-01-21

    A musculoskeletal tumor biopsy can involve fine needle aspiration, core needle biopsy, or incisional biopsy. Controversy regarding the diagnostic yield of these biopsy techniques continues. The purpose of this article is to summarize the current concepts in the biopsy of musculoskeletal tumors. We performed a literature review of clinical articles reporting on the biopsy of bone and soft-tissue primary tumors. Clinical articles were excluded on the basis on abstract content if they represented case reports, review or opinion articles, or technique descriptions. Eighteen of the thirty-nine articles that remained were excluded because the results did not indicate the diagnostic accuracy of the various biopsy techniques. Thus, twenty-one articles with diagnostic data on the biopsy of bone and soft-tissue tumors were included in this review. Core needle biopsy appeared to be more accurate than fine needle aspiration, and incisional biopsy appeared to be more accurate than both of these techniques, but the differences did not reach significance. Incisional biopsy was more expensive than the percutaneous biopsy methods. In deep musculoskeletal tumors, incorporation of ultrasonography or computed tomography for guidance is easy and safe and can be useful for increasing the accuracy of the biopsy. Advantages of a percutaneous technique compared with an incisional one are the low risk of contamination and the minimally invasive nature. Certain anatomic locations and histologic types were associated with diagnostic difficulty. Vertebral tumors had the lowest diagnostic accuracy regardless of the biopsy technique. Myxoid, infection, and round cell histologies were associated with the lowest diagnostic accuracy. The current literature has not clarified the optimal biopsy technique for the diagnosis of bone and soft-tissue tumors. However, core needle biopsy is usually preferable to incisional biopsy because of the low risk of contamination and the low cost. In addition, the

  20. Current Concepts for Injury Prevention in Athletes After Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Hewett, Timothy E.; Di Stasi, Stephanie L.; Myer, Gregory D.

    2013-01-01

    Ligament reconstruction is the current standard of care for active patients with an anterior cruciate ligament (ACL) rupture. Although the majority of ACL reconstruction (ACLR) surgeries successfully restore the mechanical stability of the injured knee, postsurgical outcomes remain widely varied. Less than half of athletes who undergo ACLR return to sport within the first year after surgery, and it is estimated that approximately 1 in 4 to 1 in 5 young, active athletes who undergo ACLR will go on to a second knee injury. The outcomes after a second knee injury and surgery are significantly less favorable than outcomes after primary injuries. As advances in graft reconstruction and fixation techniques have improved to consistently restore passive joint stability to the preinjury level, successful return to sport after ACLR appears to be predicated on numerous postsurgical factors. Importantly, a secondary ACL injury is most strongly related to modifiable postsurgical risk factors. Biomechanical abnormalities and movement asymmetries, which are more prevalent in this cohort than previously hypothesized, can persist despite high levels of functional performance, and also represent biomechanical and neuromuscular control deficits and imbalances that are strongly associated with secondary injury incidence. Decreased neuromuscular control and high-risk movement biomechanics, which appear to be heavily influenced by abnormal trunk and lower extremity movement patterns, not only predict first knee injury risk but also reinjury risk. These seminal findings indicate that abnormal movement biomechanics and neuromuscular control profiles are likely both residual to, and exacerbated by, the initial injury. Evidence-based medicine (EBM) strategies should be used to develop effective, efficacious interventions targeted to these impairments to optimize the safe return to high-risk activity. In this Current Concepts article, the authors present the latest evidence related to risk

  1. Large-scale biomedical concept recognition: an evaluation of current automatic annotators and their parameters

    PubMed Central

    2014-01-01

    Background Ontological concepts are useful for many different biomedical tasks. Concepts are difficult to recognize in text due to a disconnect between what is captured in an ontology and how the concepts are expressed in text. There are many recognizers for specific ontologies, but a general approach for concept recognition is an open problem. Results Three dictionary-based systems (MetaMap, NCBO Annotator, and ConceptMapper) are evaluated on eight biomedical ontologies in the Colorado Richly Annotated Full-Text (CRAFT) Corpus. Over 1,000 parameter combinations are examined, and best-performing parameters for each system-ontology pair are presented. Conclusions Baselines for concept recognition by three systems on eight biomedical ontologies are established (F-measures range from 0.14–0.83). Out of the three systems we tested, ConceptMapper is generally the best-performing system; it produces the highest F-measure of seven out of eight ontologies. Default parameters are not ideal for most systems on most ontologies; by changing parameters F-measure can be increased by up to 0.4. Not only are best performing parameters presented, but suggestions for choosing the best parameters based on ontology characteristics are presented. PMID:24571547

  2. Current status of pregnancy-related maternal mortality in Japan: a report from the Maternal Death Exploratory Committee in Japan.

    PubMed

    Hasegawa, Junichi; Sekizawa, Akihiko; Tanaka, Hiroaki; Katsuragi, Shinji; Osato, Kazuhiro; Murakoshi, Takeshi; Nakata, Masahiko; Nakamura, Masamitsu; Yoshimatsu, Jun; Sadahiro, Tomohito; Kanayama, Naohiro; Ishiwata, Isamu; Kinoshita, Katsuyuki; Ikeda, Tomoaki

    2016-03-21

    To clarify the problems related to maternal deaths in Japan, including the diseases themselves, causes, treatments and the hospital or regional systems. Descriptive study. Maternal death registration system established by the Japan Association of Obstetricians and Gynecologists (JAOG). Women who died during pregnancy or within a year after delivery, from 2010 to 2014, throughout Japan (N=213). The preventability and problems in each maternal death. Maternal deaths were frequently caused by obstetric haemorrhage (23%), brain disease (16%), amniotic fluid embolism (12%), cardiovascular disease (8%) and pulmonary disease (8%). The Committee considered that it was impossible to prevent death in 51% of the cases, whereas they considered prevention in 26%, 15% and 7% of the cases to be slightly, moderately and highly possible, respectively. It was difficult to prevent maternal deaths due to amniotic fluid embolism and brain disease. In contrast, half of the deaths due to obstetric haemorrhage were considered preventable, because the peak duration between the initial symptoms and initial cardiopulmonary arrest was 1-3 h. A range of measures, including individual education and the construction of good relationships among regional hospitals, should be established in the near future, to improve primary care for patients with maternal haemorrhage and to save the lives of mothers in Japan. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  3. Satellite missions, global environment, and the concept of a global satellite observation information network. The role of the committee on Earth observation satellites (CEOS)

    NASA Astrophysics Data System (ADS)

    Smith, D. Brent; Williams, David F.; Fujita, Akihiro

    The paper traces the development of the Committee on Earth Observation Satellites (CEOS) since its November 1990 Plenary: its restructuring to include major intergovernmental user and international scientific organizational affiliates; its focus on data sharing issues and completion of a CEOS resolution guaranteeing global change researchers access to satellite data at the cost of filling a user request; unfolding of a CEOS-associated initiative of the UK Prime Minister reporting to UNCED delegations on the relevance of satellite missions to the study of the global environment; development of a "Dossier" providing detailed information on all CEOS agency satellite missions, including sensor specifications, ground systems, standard data products, and other information relevant to users; creation of a permanent CEOS Secretariat; and efforts currently underway to assess the feasibility of a global satellite observation information network. Of particular relevance to developing countries, the paper will discuss CEOS efforts to assure broad user access and to foster acceptance of applications in such important areas as disaster monitoring and mitigation, land cover change, weather forecasting, and long-term climate modeling.

  4. Implementation workshop of WHO guidelines on evaluation of malaria vaccines: Current regulatory concepts and issues related to vaccine quality, Pretoria, South Africa 07 Nov 2014.

    PubMed

    Ho, Mei Mei; Baca-Estrada, Maria; Conrad, Christoph; Karikari-Boateng, Eric; Kang, Hye-Na

    2015-08-26

    The current World Health Organization (WHO) guidelines on the quality, safety and efficacy of recombinant malaria vaccines targeting the pre-erythrocytic and blood stages of Plasmodium falciparum were adopted by the WHO Expert Committee on Biological Standardization in 2012 to provide guidance on the quality, nonclinical and clinical aspects of recombinant malaria vaccines. A WHO workshop was organised to facilitate implementation into African (national/regional) regulatory practices, of the regulatory evaluation principles outlined in the guidelines regarding quality aspects. The workshop was used also to share knowledge and experience on regulatory topics of chemistry, manufacturing and control with a focus on vaccines through presentations and an interactive discussion using a case study approach. The basic principles and concepts of vaccine quality including consistency of production, quality control and manufacturing process were presented and discussed in the meeting. By reviewing and practicing a case study, better understanding on the relationship between consistency of production and batch release tests of an adjuvanted pre-erythrocytic recombinant malaria vaccine was reached. The case study exercise was considered very useful to understand regulatory evaluation principles of vaccines and a suggestion was made to WHO to provide such practices also through its Global Learning Opportunities for Vaccine Quality programme.

  5. A Study of Second-Year Engineering Students' Alternative Conceptions about Electric Potential, Current Intensity and Ohm's Law

    ERIC Educational Resources Information Center

    Periago, M. Cristina; Bohigas, Xavier

    2005-01-01

    The aim of this research was to evaluate and analyse second-year industrial engineering and chemical engineering students prior knowledge of conceptual aspects of "circuit theory". Specifically, we focused on the basic concepts of electric potential and current intensity and on the fundamental relationship between them as expressed by Ohm's law.…

  6. A Study of Second-Year Engineering Students' Alternative Conceptions about Electric Potential, Current Intensity and Ohm's Law

    ERIC Educational Resources Information Center

    Periago, M. Cristina; Bohigas, Xavier

    2005-01-01

    The aim of this research was to evaluate and analyse second-year industrial engineering and chemical engineering students prior knowledge of conceptual aspects of "circuit theory". Specifically, we focused on the basic concepts of electric potential and current intensity and on the fundamental relationship between them as expressed by Ohm's law.…

  7. Magnetic Field Due to a Finite Length Current-Carrying Wire Using the Concept of Displacement Current

    ERIC Educational Resources Information Center

    Buschauer, Robert

    2014-01-01

    In undergraduate E&M courses the magnetic field due to a finite length, current-carrying wire can be calculated using the Biot-Savart law. However, to the author's knowledge, no textbook presents the calculation of this field using the Ampere-Maxwell law: ?B [multiplied by] dl = µ[subscript 0] (I + e[subscript 0] dF/dt) [multiplied by] 1

  8. Magnetic Field Due to a Finite Length Current-Carrying Wire Using the Concept of Displacement Current

    ERIC Educational Resources Information Center

    Buschauer, Robert

    2014-01-01

    In undergraduate E&M courses the magnetic field due to a finite length, current-carrying wire can be calculated using the Biot-Savart law. However, to the author's knowledge, no textbook presents the calculation of this field using the Ampere-Maxwell law: ?B [multiplied by] dl = µ[subscript 0] (I + e[subscript 0] dF/dt) [multiplied by] 1

  9. Conference Committees: Conference Committees

    NASA Astrophysics Data System (ADS)

    2009-09-01

    International Programm Committee (IPC) Harald Ade NCSU Sadao Aoki University Tsukuba David Attwood Lawrence Berkeley National Laboratory/CXRO Christian David Paul Scherrer Institut Peter Fischer Lawrence Berkeley National Laboratory Adam Hitchcock McMaster University Chris Jacobsen SUNY, Stony Brook Denis Joyeux Lab Charles Fabry de l'Institut d'Optique Yasushi Kagoshima University of Hyogo Hiroshi Kihara Kansai Medical University Janos Kirz SUNY Stony Brook Maya Kiskinova ELETTRA Ian McNulty Argonne National Lab/APS Alan Michette Kings College London Graeme Morrison Kings College London Keith Nugent University of Melbourne Zhu Peiping BSRF Institute of High Energy Physics Francois Polack Soleil Christoph Quitmann Paul Scherrer Institut Günther Schmahl University Göttingen Gerd Schneider Bessy Hyun-Joon Shin Pohang Accelerator Lab Jean Susini ESRF Mau-Tsu Tang NSRRC Tony Warwick Lawrence Berkeley Lab/ALS Local Organizing Committee Christoph Quitmann Chair, Scientific Program Charlotte Heer Secretary Christian David Scientific Program Frithjof Nolting Scientific Program Franz Pfeiffer Scientific Program Marco Stampanoni Scientific Program Robert Rudolph Sponsoring, Financials Alfred Waser Industry Exhibition Robert Keller Public Relation Markus Knecht Computing and WWW Annick Cavedon Proceedings and Excursions and Accompanying Persons Program Margrit Eichler Excursions and Accompanying Persons Program Kathy Eikenberry Excursions and Accompanying Persons Program Marlies Locher Excursions and Accompanying Persons Program

  10. Late-onset hypogonadism: current concepts and controversies of pathogenesis, diagnosis and treatment.

    PubMed

    Huhtaniemi, Ilpo

    2014-01-01

    long-term risks, is not yet available. In this review, we will summarize the current concepts and controversies in the pathogenesis, diagnosis and treatment of LOH.

  11. The risk-benefit task of research ethics committees: An evaluation of current approaches and the need to incorporate decision studies methods

    PubMed Central

    2012-01-01

    Background Research ethics committees (RECs) are tasked to assess the risks and the benefits of a trial. Currently, two procedure-level approaches are predominant, the Net Risk Test and the Component Analysis. Discussion By looking at decision studies, we see that both procedure-level approaches conflate the various risk-benefit tasks, i.e., risk-benefit assessment, risk-benefit evaluation, risk treatment, and decision making. This conflation makes the RECs’ risk-benefit task confusing, if not impossible. We further realize that RECs are not meant to do all the risk-benefit tasks; instead, RECs are meant to evaluate risks and benefits, appraise risk treatment suggestions, and make the final decision. Conclusion As such, research ethics would benefit from looking beyond the procedure-level approaches and allowing disciplines like decision studies to be involved in the discourse on RECs’ risk-benefit task. PMID:22520714

  12. [Weizsäcker's concept of time from the current viewpoint].

    PubMed

    Kiefer, Claus

    2014-01-01

    Carl Friedrich von Weizsäcker's concept of time is deeply based on the asymmetry between past and future, which he considers as a fundamental aspect of Nature. I review these ideas and their philosophical back ground and confront them with a presentation of the concept of time in modern physics. I argue that the observed irreversibility of our world can be understood from fundamental laws which are invariant under time reversal. I conclude with an outlook on the expected theory of quantum gravity.

  13. Public affairs committee actions

    NASA Astrophysics Data System (ADS)

    The AGU Public Affairs Committee will create an ad hoc committee to consider possible AGU position statements concerning the effects of nuclear war.The action was taken at the May 31, 1983, meeting of the Committee at the AGU Spring Meeting in Baltimore. Present were Carroll Ann Hodges, Chairman, and members Thomas J. Ahrens, David Cauffman, Jared Cohon, Stamatios Krimigis, Robert Murphy, Raymond Roble, and George Shaw. Also attending were the current Congressional Fellow Arthur Weissman and SPR—Cosmic Rays Section Secretary Miriam Forman.

  14. Preschool Children's Conceptions about the Electric Current and the Functioning of Electric Appliances.

    ERIC Educational Resources Information Center

    Solomonidou, Christina; Kakana, Domna-Mika

    2000-01-01

    Examined 5- and 6-year-olds' ideas about the functioning of common electrical appliances and properties of electric current. Found that children represented current in a static way, thinking it was included in the appliance, and confounded electric current and water flow, believing external electricity was different from internal. They were…

  15. Preschool Children's Conceptions about the Electric Current and the Functioning of Electric Appliances.

    ERIC Educational Resources Information Center

    Solomonidou, Christina; Kakana, Domna-Mika

    2000-01-01

    Examined 5- and 6-year-olds' ideas about the functioning of common electrical appliances and properties of electric current. Found that children represented current in a static way, thinking it was included in the appliance, and confounded electric current and water flow, believing external electricity was different from internal. They were…

  16. 29 CFR 1960.37 - Committee organization.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... elect to utilize the committee concept, safety and health committees shall be formed at both the... resolved by the Secretary. (b) Committees shall have equal representation of management and nonmanagement employees, who shall be members of record. (1) Management members of both national level and...

  17. An overview of engineering concepts and current design algorithms for probabilistic structural analysis

    NASA Technical Reports Server (NTRS)

    Duffy, S. F.; Hu, J.; Hopkins, D. A.

    1995-01-01

    The article begins by examining the fundamentals of traditional deterministic design philosophy. The initial section outlines the concepts of failure criteria and limit state functions two traditional notions that are embedded in deterministic design philosophy. This is followed by a discussion regarding safety factors (a possible limit state function) and the common utilization of statistical concepts in deterministic engineering design approaches. Next the fundamental aspects of a probabilistic failure analysis are explored and it is shown that deterministic design concepts mentioned in the initial portion of the article are embedded in probabilistic design methods. For components fabricated from ceramic materials (and other similarly brittle materials) the probabilistic design approach yields the widely used Weibull analysis after suitable assumptions are incorporated. The authors point out that Weibull analysis provides the rare instance where closed form solutions are available for a probabilistic failure analysis. Since numerical methods are usually required to evaluate component reliabilities, a section on Monte Carlo methods is included to introduce the concept. The article concludes with a presentation of the technical aspects that support the numerical method known as fast probability integration (FPI). This includes a discussion of the Hasofer-Lind and Rackwitz-Fiessler approximations.

  18. Environmental Education in Ecuador: Conceptions and Currents in Quito's Private Elementary Schools

    ERIC Educational Resources Information Center

    Viteri, Fátima; Clarebout, Geraldine; Crauwels, Marion

    2013-01-01

    While key conceptions and the status of environmental education (EE) have been reported at various international, regional, national and local levels, those in play in the schools of Quito (Ecuador) are still relatively unknown. Of particular interest to this study are private schools: they are considerable in number in Ecuador and elsewhere, yet…

  19. The Attitudes of the High School Students of Hail, Saudi Arabia towards the Current Educational Concepts

    ERIC Educational Resources Information Center

    Khasawneh, Kholoud Ahmed Saleem

    2014-01-01

    This study aimed to identify the attitudes of public secondary school students in the State of Hail towards the modern educational concepts, and what are the differences between them. It has been used in the study descriptive analytical method. The study was conducted on a sample of 400 male and female students, chosen randomly according to the…

  20. Environmental Education in Ecuador: Conceptions and Currents in Quito's Private Elementary Schools

    ERIC Educational Resources Information Center

    Viteri, Fátima; Clarebout, Geraldine; Crauwels, Marion

    2013-01-01

    While key conceptions and the status of environmental education (EE) have been reported at various international, regional, national and local levels, those in play in the schools of Quito (Ecuador) are still relatively unknown. Of particular interest to this study are private schools: they are considerable in number in Ecuador and elsewhere, yet…

  1. Update on current concepts and meanings in laboratory medicine --Standardization, traceability and harmonization.

    PubMed

    Greenberg, Neil

    2014-05-15

    An increasingly important quality objective in laboratory medicine is ensuring the equivalence of test results among different measurement procedures, different laboratories and health care systems, over time. In recent years, interest in sharing a single patient's clinical laboratory data, regardless of where the measurements are performed, has moved out of the domain of the scientific community and spilled over into the domain of regulators, lawmakers and the general population in many parts of the world. For all parties involved in the dialog, establishing and maintaining a clear understanding of the essential concepts that are vital to achieving global equivalence among clinical laboratory measurements have therefore become a priority. Concepts that are critical to this discussion include standardization, traceability and harmonization. This report provides an updated discussion and practical definitions for these terms and others that are linked to metrological principles.

  2. [Medical aspects of current flight safety concept of air forces of the Russian Federation].

    PubMed

    Blaginin, A A; Lizogub, I N

    2012-12-01

    Issues of medical supply of aviation operations, that is part of general system of flight safety are analyzed in this article. One of the main issues is development of the system of vocational preparation of medical personnel, taking part in organization and carrying flights. This issue consists of several themes: formation of united system of education from primary to post graduate; formation of modern training facility; assurance of high potential in academic and teaching staff and providing of good basic training and high learning motivation of applicants, who wants to become a air medical officer. Fundamental principles of developed concept of medical supply of flight safety are presented. It is shown that the essential condition of good implementation of the given concept is informaltion support of all its structures.

  3. Concept of Employment for Current Seabasing Capabilities. Integrating Seabasing Capabilities Into Exercises and Experiments

    DTIC Science & Technology

    2010-06-29

    Over the Shore (JLOTS) causeway ferries enable limited at-sea- arrival and assembly, sustainment and reconstitution. Concept of Employment for... shore -based sustainment infrastructure and the time required emplacing it. o Heavy Lift Vertical Take-off and Landing (HLVTOL), including MH- 53E, CH...In January 2010, a massive earthquake measuring 7.3 on the Richter scale hit the impoverished Caribbean island of Haiti causing catastrophic

  4. Structural and Functional Concepts in Current Mouse Phenotyping and Archiving Facilities

    PubMed Central

    Kollmus, Heike; Post, Rainer; Brielmeier, Markus; Fernández, Julia; Fuchs, Helmut; McKerlie, Colin; Montoliu, Lluis; Otaegui, Pedro J; Rebelo, Manuel; Riedesel, Hermann; Ruberte, Jesús; Sedlacek, Radislav; de Angelis, Martin Hrabě; Schughart, Klaus

    2012-01-01

    Collecting and analyzing available information on the building plans, concepts, and workflow from existing animal facilities is an essential prerequisite for most centers that are planning and designing the construction of a new animal experimental research unit. Here, we have collected and analyzed such information in the context of the European project Infrafrontier, which aims to develop a common European infrastructure for high-throughput systemic phenotyping, archiving, and dissemination of mouse models. A team of experts visited 9 research facilities and 3 commercial breeders in Europe, Canada, the United States, and Singapore. During the visits, detailed data of each facility were collected and subsequently represented in standardized floor plans and descriptive tables. These data showed that because the local needs of scientists and their projects, property issues, and national and regional laws require very specific solutions, a common strategy for the construction of such facilities does not exist. However, several basic concepts were apparent that can be described by standardized floor plans showing the principle functional units and their interconnection. Here, we provide detailed information of how individual facilities addressed their specific needs by using different concepts of connecting the principle units. Our analysis likely will be valuable to research centers that are planning to design new mouse phenotyping and archiving facilities. PMID:23043807

  5. Structural and functional concepts in current mouse phenotyping and archiving facilities.

    PubMed

    Kollmus, Heike; Post, Rainer; Brielmeier, Markus; Fernández, Julia; Fuchs, Helmut; McKerlie, Colin; Montoliu, Lluis; Otaegui, Pedro J; Rebelo, Manuel; Riedesel, Hermann; Ruberte, Jesús; Sedlacek, Radislav; de Angelis, Martin Hrabě; Schughart, Klaus

    2012-07-01

    Collecting and analyzing available information on the building plans, concepts, and workflow from existing animal facilities is an essential prerequisite for most centers that are planning and designing the construction of a new animal experimental research unit. Here, we have collected and analyzed such information in the context of the European project Infrafrontier, which aims to develop a common European infrastructure for high-throughput systemic phenotyping, archiving, and dissemination of mouse models. A team of experts visited 9 research facilities and 3 commercial breeders in Europe, Canada, the United States, and Singapore. During the visits, detailed data of each facility were collected and subsequently represented in standardized floor plans and descriptive tables. These data showed that because the local needs of scientists and their projects, property issues, and national and regional laws require very specific solutions, a common strategy for the construction of such facilities does not exist. However, several basic concepts were apparent that can be described by standardized floor plans showing the principle functional units and their interconnection. Here, we provide detailed information of how individual facilities addressed their specific needs by using different concepts of connecting the principle units. Our analysis likely will be valuable to research centers that are planning to design new mouse phenotyping and archiving facilities.

  6. Current Evidence Regarding the Treatment of Pediatric Lumbar Spondylolisthesis: A Report From the Scoliosis Research Society Evidence Based Medicine Committee.

    PubMed

    Crawford, Charles H; Larson, A Noelle; Gates, Marilyn; Bess, R Shay; Guillaume, Tenner J; Kim, Han Jo; Oetgen, Matthew E; Ledonio, Charles G; Sanders, James; Burton, Douglas C

    2017-09-01

    Structured literature review. The Scoliosis Research Society requested an assessment of the current state of peer-reviewed evidence regarding pediatric lumbar spondylolisthesis to identify what is known and what research remains essential to further understanding. Pediatric lumbar spondylolisthesis is common, yet no formal synthesis of the published literature regarding treatment has been previously performed. A comprehensive literature search was performed. From 6600 initial citations with abstract, 663 articles underwent full-text review. The best available evidence regarding surgical and medical/interventional treatment was provided by 51 studies. None of the studies were graded Level I or II evidence. Eighteen of the studies were Level III, representing the current best available evidence. Thirty-three of the studies were Level IV. Although studies suggest a benign course for "low grade" (<50% slip) isthmic spondylolisthesis, extensive literature suggests that a substantial number of patients present for treatment with pain and activity limitations. Pain resolution and return to activity is common with both medical/interventional and operative treatment. The role of medical/interventional bracing is not well established. Uninstrumented posterolateral fusion has been reported to produce good clinical results, but concerns regarding nonunion exist. Risk of slip progression is a specific concern in the "high grade" or dysplastic type. Although medical/interventional observation has been reported to be reasonable in a small series of asymptomatic high-grade slip patients, surgical treatment is commonly recommended to prevent progression. There is Level III evidence that instrumentation and reduction lowers the risk of nonunion, and that circumferential fusion is superior to posterior-only or anterior-only fusion. There is Level III evidence that patients with a higher slip angle are more likely to fail medical/interventional treatment of high

  7. [Current concepts of lithogenetic mechanism in the gallbladder and the role of biliary sludge in this process].

    PubMed

    Tsimmerman, Ia S

    2010-01-01

    A review of current data on cholelithiasis is presented. The concept of staged development of the pathological process in the biliary system is considered starting from dysfunction of gallbladder and sphincter apparatus of extrahepatic biliary ducts via chronic acalculous cholecystitis to chronic calculous cholecystitis. Other issues discussed include biliary acid metabolism; varieties, composition and formation of calculi in the gallbladder; biliary sludge and its role in cholelithogenesis. Debatable questions of sludge nature and composition as well as certain terminological problems are considered.

  8. CCCT - NCORP Cancer Control Steering Committees

    Cancer.gov

    The National Community Oncology Research Program (NCORP) Steering Committees review concepts for clinical trials to control cancer symptoms and cancer treatment side effects, and concepts for studies of cancer care delivery.

  9. Systemic Sclerosis: Current Concepts in Pathogenesis and Therapeutic Aspects of Dermatological Manifestations

    PubMed Central

    Viswanath, Vishalakshi; Phiske, Meghana M; Gopalani, Vinay V

    2013-01-01

    Systemic sclerosis (SSc) is a chronic, multisystem connective tissue disease with protean clinical manifestations. Recent advances in understanding the pathogenic mechanisms have led to development of target-oriented and vasomodulatory drugs which play a pivotal role in treating various dermatological manifestations. An exhaustive literature search was done using Medline, Embase, and Cochrane library to review the recent concepts regarding pathogenesis and evidence-based treatment of salient dermatological manifestations. The concept of shared genetic risk factors for the development of autoimmune diseases is seen in SSc. It is divided into fibroproliferative and inflammatory groups based on genome-wide molecular profiling. Genetic, infectious, and environmental factors play a key role; vascular injury, fibrosis, and immune activation are the chief pathogenic factors. Vitamin D deficiency has been documented in SSc and correlates with the severity of skin involvement. Skin sclerosis, Raynaud's phenomenon (RP) with digital vasculopathies, pigmentation, calcinosis, and leg ulcers affect the patient's quality of life. Immunosuppressives, biologicals, and hematopoietic stem cell transplantation are efficacious in skin sclerosis. Endothelin A receptor antagonists, calcium-channel blockers, angiotensin receptor inhibitors, prostacyclin analogs, and phosphodiesterase type 5 (PDE-5) inhibitors are the mainstay in RP and digital vasculopathies. Pigmentation in SSc has been attributed to melanogenic potential of endothelin-1 (ET-1); the role of ET 1 antagonists and vitamin D analogs needs to be investigated. Sexual dysfunction in both male and female patients has been attributed to vasculopathy and fibrosis, wherein PDE-5 inhibitors are found to be useful. The future concepts of treating SSc may be based on the gene expression signature. PMID:23918994

  10. 76 FR 44017 - Risk Communication Advisory Committee; Notice of Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-07-22

    ... HUMAN SERVICES Food and Drug Administration Risk Communication Advisory Committee; Notice of Meeting... the public. Name of Committee: Risk Communication Advisory Committee. General Function of the... work, as discussed in previous meetings, by current and former members of the Risk...

  11. Anthropogenic SO{sub 2}/NO{sub x} committee summary of current status--annual inventory

    SciTech Connect

    Benkovitz, C.M.

    1992-06-01

    At the First GEIA Workshop on Global Emissions Inventories, held in Baltimore, MD on December 1--2, 1991, data on anthropogenic emissions of sulfur and nitrogen developed by Dignon (1992) were selected to form the basis for the GEIA SO{sub 2} and NO{sub x} annual inventories. The Dignon data include emissions from fuel combustion only and currently extend to 1980. The methodology used was detailed in Dignon and Hameed (1985) and consists of statistical regression models based on available emissions data from the U.S and some other member countries of the Organization of Economic Cooperation and Development (OECD), which includes Australia, Canada, Japan and western European countries. Control regulations are incorporated via the use of different statistical parameter The grid definition from these inventories was also adopted for the GEIA grid: origin at 180{degree}W, 90{degree}S, 1{degree} {times} 1{degree} resolution (i.e., 360 cells in the longitude direction, 180 cells in the latitude direction). To upgrade the basic GEIA inventories, data for the different geographic regions being solicited from researchers located within these areas. This paper contains the upgrades which have been accomplished to date.

  12. Summary and viewgraphs from the Q-121 US/Japan advanced current drive concepts workshop

    SciTech Connect

    Bonoli, P.; Porkolab, M. ); Chan, V.; Pinsker, R.; Politzer, P. ); Darrow, D. . Plasma Physics Lab.); Ehst, D. ); Fukuyama, Atsushi ); Imai, Tsuyoshi; Watari, Tetsuo ); Itoh, Satoshi; Naka

    1990-03-09

    With the emphasis placed on current drive by ITER, which requires steady state operation in its engineering phase, it is important to bring theory and experiment in agreement for each of the schemes that could be used in that design. Both neutral beam and lower hybrid (LH) schemes are in excellent shape in that regard. Since the projected efficiency of all schemes is marginal it is also important to continue our search for more efficient processes. This workshop featured experimental and theoretical work in each processes. This workshop featured experimental and theoretical work in each of these areas, that is, validation of theory and the search for better ideas. There were a number of notable results to report, the most striking again (as with last year) the long pulse operation of TRIAM-1M. A low current was sustained for over 1 hour with LH waves, using new hall-effect sensors in the equilibrium field circuit to maintain position control. In JT-60, by sharpening the wave spectrum the current drive efficiency was improved to 0.34 {times} 10{sup 20}m{sup -2}A/W and 1.5 MA of current was driven entirely by the lower hybrid system. Also in that machine, using two different LH frequencies, the H-mode was entered. Finally, by using the LH system for startup they saved 2.5 resistive volt-sec of flux, which if extrapolated to ITER would save 40 volt-sec there. For the first time, and experiment on ECH current drive showed reasonable agreement with theory. Those experiments are reported here by James (LLNL) on the D3-D machine. Substantially lower ECH current drive than expected theoretically was observed on WT-3, but if differed by being in a low absorption regime. Nonetheless, excellent physics results were achieved in the WT-3 experiments, notably in having careful measurements of the parallel velocity distributions.

  13. The complement system and its role in the pathogenesis of periodontitis: current concepts.

    PubMed

    Damgaard, C; Holmstrup, P; Van Dyke, T E; Nielsen, C H

    2015-06-01

    Periodontitis is a highly prevalent inflammatory disease in tooth supporting tissues, induced by bacteria growing in a biofilm on tooth surfaces. Components of the complement system are present in the periodontal tissue and the system is activated in periodontitis. Continuous complement activation and modulation by bacteria within the biofilm in periodontal pockets, however, may enhance local tissue destruction, providing the biofilm with both essential nutrients and space to grow. A more profound understanding of the mechanisms involved in complement-derived tissue degradation may facilitate the development of new treatment concepts for periodontitis. Further studies on the role of complement in periodontitis pathogenesis may also contribute to the understanding of why some individuals fail to resolve periodontitis. Here, we review evidence that links complement to the pathogenesis of periodontitis with an emphasis on interaction of complement with bacteria from periodontitis-associated biofilm. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  14. Current concepts: rotator cuff pathology in athletes--a source of pain or adaptive pathology?

    PubMed

    Kuhn, John E

    2013-01-01

    Magnetic resonance imaging (MRI) findings are common in patients and athletes with shoulder pain. Historically these anatomic derangements have been thought to be the source of the patient's symptoms, and approaches have been focused on restoring the anatomy. This manuscript will address three objectives: (1) suggest that the approach to rotator cuff disease should be based on the patient's history and physical examination, and not necessarily on the anatomic disorders apparent on imaging; (2) review the data that supports the contention that rotator cuff disease is not the source of pain in the symptomatic shoulder, and (3) describe the concept of adaptive pathology. The findings on the MRI in the thrower's painful shoulder may be adaptive, and these alterations may be required to allow performance at high levels in sport.

  15. Semiconductor-metal subwavelength grating VCSELs: new concept of emission mirror enabling vertical current injection

    NASA Astrophysics Data System (ADS)

    Czyszanowski, Tomasz; Gebski, Marcin; Dems, Maciej; Panajotov, Krassimir

    2017-02-01

    We propose semiconductor-metal subwavelength grating (SMSG) which can be implemented as VCSEL mirror. Such new type of SMSG plays a double role of the electric contact and mirror simultaneously. It facilitates high optical power reflectance, perfectly vertical current injection. Such construction eliminates the inbuilt current confinement and allows scaling of emitted power by simple variation of SMSG spatial dimensions. To give the credibility to proposed design we perform numerical analysis of VCSEL with SMSG using fully vectorial optical model. We discuss properties of the proposed design realized in arsenide-based material configuration.

  16. Early Total Care versus Damage Control: Current Concepts in the Orthopedic Care of Polytrauma Patients.

    PubMed

    Nicola, Ratto

    2013-01-01

    The management of the polytraumatized orthopedic patient remains a challenging issue. In recent years many efforts have been made to develop rescue techniques and to promote guidelines for the management of these patients. Currently controversies persist between two orthopedic approaches: the Early Total Care and the Damage Control Orthopedics. An overview of the current literature on the orthopedic management of polytrauma patient is provided. Subsequently, femoral shaft fractures, representing extremely common lesions, and pelvic ring injuries, that are associated with a high mortality rate, are analyzed in detail.

  17. Realization of the German Concept for Interim Storage of Spent Nuclear Fuel - Current Situation and Prospects

    SciTech Connect

    Thomauske, B. R.

    2003-02-25

    The German government has determined a phase out of nuclear power. With respect to the management of spent fuel it was decided to terminate transports to reprocessing plants by 2005 and to set up interim storage facilities on power plant sites. This paper gives an overview of the German concept for spent fuel management focused on the new on-site interim storage concept and the applied interim storage facilities. Since the end of the year 1998, the utilities have applied for permission of on-site interim storage in 13 storage facilities and 5 storage areas; one application for the interim storage facility Stade was withdrawn due to the planned final shut down of Stade nuclear power plant in autumn 2003. In 2001 and 2002, 3 on-site storage areas and 2 on-site storage facilities for spent fuel were licensed by the Federal Office for Radiation Protection (BfS). A main task in 2002 and 2003 has been the examination of the safety and security of the planned interim storage facilities and the verification of the licensing prerequisites. In the aftermath of September 11, 2001, BfS has also examined the attack with a big passenger airplane. Up to now, these aircraft crash analyses have been performed for three on-site interim storage facilities; the fundamental results will be presented. It is the objective of BfS to conclude the licensing procedures for the applied on-site interim storage facilities in 2003. With an assumed construction period for the storage buildings of about two years, the on-site interim storage facilities could then be available in the year 2005.

  18. 75 FR 9416 - Advisory Committee Information Hotline

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-03-02

    ... Respiratory Therapy Devices Panel 3014512624 Circulatory System Devices Panel 3014512625 Clinical Chemistry... Central Nervous System Drugs Advisory Committee 3014512543 Pharmaceutical Science & Clinical Pharmacology... current information available about any particular advisory committee meeting, this system will...

  19. Variable Uses of Alternative Conceptions: A Case Study in Current Electricity.

    ERIC Educational Resources Information Center

    Heller, Patricia; Finley, Fred

    In order to investigate the nature of students' prior knowledge of current electricity and how they applied their knowledge to different problems, 5 middle school science teachers and 11 elementary school teachers were given a written test that required them to: (1) predict what happens to the brightness of a bulb if a change is made to the…

  20. On Pliability and Progress: Challenging Current Conceptions of Eighteenth-Century French Educational Thought

    ERIC Educational Resources Information Center

    Gilead, Tal

    2009-01-01

    Examining the educational writings of three of the eighteenth-century's most innovative thinkers, the Abbe de Saint-Pierre, Morelly and Helvetius, this article challenges the currently accepted view that it was a belief in human pliability which gave rise to the contemporary groundbreaking faith in the power of education to improve society. The…

  1. Variable Uses of Alternative Conceptions: A Case Study in Current Electricity.

    ERIC Educational Resources Information Center

    Heller, Patricia; Finley, Fred

    In order to investigate the nature of students' prior knowledge of current electricity and how they applied their knowledge to different problems, 5 middle school science teachers and 11 elementary school teachers were given a written test that required them to: (1) predict what happens to the brightness of a bulb if a change is made to the…

  2. Extended Deterrence and Allied Assurance: Key Concepts and Current Challenges for U.S. Policy

    DTIC Science & Technology

    2013-09-01

    Deterrence and Assurance Strategies 135 NATO/ Europe 136 Extended Deterrence 136 Assurance 139 Key Issues for NATO Extended Deterrence and...regional stability and strongly influence the national security strategies of both allies and adversaries. From the Asia-Pacific to Europe , however...to defending free access to international waters , outer space, and cyber space. Current Issues, Challenges, and Regional Considerations These

  3. On Pliability and Progress: Challenging Current Conceptions of Eighteenth-Century French Educational Thought

    ERIC Educational Resources Information Center

    Gilead, Tal

    2009-01-01

    Examining the educational writings of three of the eighteenth-century's most innovative thinkers, the Abbe de Saint-Pierre, Morelly and Helvetius, this article challenges the currently accepted view that it was a belief in human pliability which gave rise to the contemporary groundbreaking faith in the power of education to improve society. The…

  4. 75 FR 61819 - First Meeting: RTCA Special Committee 224: Airport Security Access Control Systems

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-10-06

    ... Federal Aviation Administration First Meeting: RTCA Special Committee 224: Airport Security Access Control Systems AGENCY: Federal Aviation Administration (FAA), DOT. ACTION: Notice of RTCA Special Committee 224... Overview RTCA Functional Overview Previous Committee History Current Committee Scope, Terms of Reference...

  5. Developing a two-tiered instrument with confidence levels for assessing students' conceptions of Direct Current circuits

    NASA Astrophysics Data System (ADS)

    Sabah, Saed Ahmad

    The purpose of this study is to develop and validate a two-tier revised instrument (DIRECT-TTC) for measuring students understanding of Direct Current (DC) circuits and identifying their alternative conceptions. Another main purpose of this study is to investigate the relationship between students' understanding of DC circuits and their confidence in their answers. The revised instrument consists of 15 two-tier items with a confidence scale. Both the Rasch analysis and students' interviews were used in validating the instrument and obtaining evidences for the validity of inferences. Through a two-stage quantitative and qualitative validation process using both conventional statistics and Rasch modeling, the results indicate that the instrument is both valid and reliable. The results show a statistically significant association between students' answers to the first- tier questions and explanations, r = .65 (p< .01, N = 214). The second-tier questions provided substantial information about students' conceptions of DC circuits beyond that provided by the first-tier questions. This research shows that the more able students with regard to the construct of understanding DC circuits are more likely to be confident in their answers, r = +.39 (p< .01). Several Rasch calibrations and correlation analyses indicate that the more difficult items are associated with less confidence in the correct answers. On the other hand, the results show no statistically significant relationship between item difficulty and students' confidence specifically in their incorrect answers. The difficult items with high confidence on incorrect answers exhibit the stronger alternative conceptions of DC circuits. The alternative conceptions of voltage and resistance are among the very strong alternative conceptions of DC circuits. Implications for researchers and teachers as well as recommendations for future research are presented.

  6. Thymic epithelial neoplasms: a review of current concepts using an evidence-based pathology approach.

    PubMed

    Marchevsky, Alberto M; McKenna, Robert J; Gupta, Ruta

    2008-06-01

    Evidence-based pathology promotes the critical evaluation of current clinical information and the development of evidence-based diagnostic and prognostic guidelines. No randomized clinical trials of patients who have thymomas or thymic carcinomas are available to evaluate the validity of the current World Health Organization (WHO) histologic classification or the widely used Masaoka staging system. A meta-analysis of over 2000 thymoma patients estimated that only three WHO histologic types of thymomas are associated with significant survival differences. Prospective randomized clinical trials and an international registry of patients who have Thymic epithelial neoplasms are needed to stratify patients who may benefit from neoadjuvant chemotherapy, postoperative radiation therapy, and other nonsurgical modalities.

  7. Contribution of genosystematics to current concepts of phylogeny and classification of bryophytes.

    PubMed

    Troitsky, A V; Ignatov, M S; Bobrova, V K; Milyutina, I A

    2007-12-01

    This paper is a survey of the current state of molecular studies on bryophyte phylogeny. Molecular data have greatly contributed to developing a phylogeny and classification of bryophytes. The previous traditional systems of classification based on morphological data are being significantly revised. New data of the authors are presented on phylogeny of Hypnales pleurocarpous mosses inferred from nucleotide sequence data of the nuclear DNA internal transcribed spacers ITS1-2 and the trnL-F region of the chloroplast genome.

  8. Current concepts in the management of recurrent anterior gleno-humeral joint instability with bone loss

    PubMed Central

    Ramhamadany, Eamon; Modi, Chetan S

    2016-01-01

    The management of recurrent anterior gleno-humeral joint instability is challenging in the presence of bone loss. It is often seen in young athletic patients and dislocations related to epileptic seizures and may involve glenoid bone deficiency, humeral bone deficiency or combined bipolar lesions. It is critical to accurately identify and assess the amount and position of bone loss in order to select the most appropriate treatment and reduce the risk of recurrent instability after surgery. The current literature suggests that coracoid and iliac crest bone block transfers are reliable for treating glenoid defects. The treatment of humeral defects is more controversial, however, although good early results have been reported after arthroscopic Remplissage for small defects. Larger humeral defects may require complex reconstruction or partial resurfacing. There is currently very limited evidence to support treatment strategies when dealing with bipolar lesions. The aim of this review is to summarise the current evidence regarding the best imaging modalities and treatment strategies in managing this complex problem relating particularly to contact athletes and dislocations related to epileptic seizures. PMID:27335809

  9. REHABILITATION AFTER ARTHROSCOPIC ROTATOR CUFF REPAIR: CURRENT CONCEPTS REVIEW AND EVIDENCE-BASED GUIDELINES

    PubMed Central

    Westgard, Paul; Chandler, Zachary; Gaskill, Trevor R.; Kokmeyer, Dirk; Millett, Peter J.

    2012-01-01

    Purpose: To provide an overview of the characteristics and timing of rotator cuff healing and provide an update on treatments used in rehabilitation of rotator cuff repairs. The authors' protocol of choice, used within a large sports medicine rehabilitation center, is presented and the rationale behind its implementation is discussed. Background: If initial nonsurgical treatment of a rotator cuff tear fails, surgical repair is often the next line of treatment. It is evident that a successful outcome after surgical rotator cuff repair is as much dependent on surgical technique as it is on rehabilitation. To this end, rehabilitation protocols have proven challenging to both the orthopaedic surgeon and the involved physical therapist. Instead of being based on scientific rationale, traditionally most rehabilitation protocols are solely based on clinical experience and expert opinion. Methods: A review of currently available literature on rehabilitation after arthroscopic rotator cuff tear repair on PUBMED / MEDLINE and EMBASE databases was performed to illustrate the available evidence behind various postoperative treatment modalities. Results: There is little high-level scientific evidence available to support or contest current postoperative rotator cuff rehabilitation protocols. Most existing protocols are based on clinical experience with modest incorporation of scientific data. Conclusion: Little scientific evidence is available to guide the timing of postsurgical rotator cuff rehabilitation. To this end, expert opinion and clinical experience remains a large facet of rehabilitation protocols. This review describes a rotator cuff rehabilitation protocol that incorporates currently available scientific literature guiding rehabilitation. PMID:22530194

  10. Concept and model of eddy current damper for vibration suppression of a beam

    NASA Astrophysics Data System (ADS)

    Sodano, Henry A.; Bae, Jae-Sung; Inman, Daniel J.; Keith Belvin, W.

    2005-12-01

    Electromagnetic forces are generated by the movement of a conductor through a stationary magnetic field or a time varying magnetic field through a stationary conductor and can be used to suppress the vibrations of a flexible structure. In the present study, a new electromagnetic damping mechanism is introduced. This mechanism is different from previously developed electromagnetic braking systems and eddy current dampers because the system investigated in the subsequent manuscript uses the radial magnetic flux to generate the electromagnetic damping force rather than the flux perpendicular to the magnet's face as done in other studies. One important advantage of the proposed mechanism is that it is simple and easy to apply. Additionally, a single magnet can be used to damp the transverse vibrations that are present in many structures. Furthermore, it does not require any electronic devices or external power supplies, therefore functioning as a non-contacting passive damper. A theoretical model of the system is derived using electromagnetic theory enabling us to estimate the electromagnetic damping force induced on the structure. The proposed eddy current damper was constructed and experiments were performed to verify the precision of the theoretical model. It is found that the proposed eddy current damping mechanism could increase the damping ratio by up to 150 times and provide sufficient damping force to quickly suppress the beam's vibration.

  11. [Regeneration of endocrine gastroenteropancreatic system in experimental and clinical pathology: concept development and current problems].

    PubMed

    Ivanova, V F

    2013-01-01

    Literature review contains the literature data and the results of author's own investigations describing the coming into being and the development of the concepts on the regeneration of endocrine gastroenteropancreatic (GEP) system under the conditions of norm, experimental and clinical pathology. Data analysis permitted to reveal the similarities and differences in the course of this process in various organs of the digestive system. Endocrine GEP system renewal occurs at different levels of its organization. At the tissue level, the endocrine cells renewal occurs via the transformation of exocrine cells into the endocrine ones and as a result of differentiation from stem cells via the "agranular" cell stage which are precursors of the endocrine cells. This pathway of regeneration is the major one after the damage. Regeneration at cellular level occurs through mitotic division of the differentiated endocrine cells (early stage of regeneration) and as a result of the formation granules with different hormonal profile in D-cells. At the intracellular level, the regeneration is realized through the intracellular structure restoration after their damage induced by the increase of cell functional activity accompanied by degranulation and dystrophic changes development

  12. Value of Information in Asia: Concepts, Current Use, and Future Directions.

    PubMed

    Dilokthornsakul, Piyameth; McQueen, R Brett; Chaiyakunapruk, Nathorn; Spackman, Eldon; Watanabe, Jonathan H; Campbell, Jonathan D

    2016-05-01

    Health technology assessment is a form of health policy research that provides policymakers with information relevant to decisions about policy alternatives. Findings from cost-effectiveness analysis (CEA) are one of the important aspects of health technology assessment. Nevertheless, the more advanced method of value of information (VOI), which is recommended by the International Society for Pharmacoeconomics and Outcomes Research and Society for Medical Decision Making Modeling Good Research Practices Task Force, has rarely been applied in CEA studies in Asia. The lack of VOI in Asian CEA studies may be due to limited understanding of VOI methods and what VOI can and cannot help policy decision makers accomplish. This concept article offers audiences a practical primer in understanding the calculation, presentation, and policy implications of VOI. In addition, it provides a rapid survey of health technology assessment guidelines and literature related to VOI in Asia and discusses the future directions of VOI use in Asia and its potential barriers. This article will enable health economists, outcomes researchers, and policymakers in Asia to better understand the importance of VOI analysis and its implications, leading to the appropriate use of VOI in Asia.

  13. Current concepts and future directions in the diagnosis and management of lymphatic vascular disease.

    PubMed

    Rockson, Stanley G

    2010-06-01

    Despite the central, complex role for the lymphatic system in the maintenance of human health, the biology of this important and complex vasculature has been relatively under-investigated. However, the last decade has witnessed a substantial growth in the elucidation of lymphatic structural biology and the function of this system in health and in disease. These newly gained insights can be used to formulate our evolving concepts about the diagnostic and therapeutic approaches to patients with lymphatic vascular disorders. In lymphedema, there is a spectrum of disease that extends from primary (heritable) to secondary (acquired) causes. Once detected, the presence of lymphatic edema mandates very specific modalities of intervention, predominated by physiotherapeutic techniques. In addition, a physiological basis for adjunctive, intermittent pneumatic compression has been established, and these modalities may be indicated in selected patient populations. The acknowledgement of a unique biology in lymphatic edemas is, increasingly, guiding research efforts within this field. Increasing investigative attention is being directed toward animal models of lymphatic vascular disease. As insight into the complex biology of the lymphatic vasculature continues to expand through focused biomedical investigation, the translation of these mechanistic insights into targeted, rationally conceived therapeutics will become increasingly feasible.

  14. Walled-off pancreatic necrosis and other current concepts in the radiological assessment of acute pancreatitis*

    PubMed Central

    Cunha, Elen Freitas de Cerqueira; Rocha, Manoel de Souza; Pereira, Fábio Payão; Blasbalg, Roberto; Baroni, Ronaldo Hueb

    2014-01-01

    Acute pancreatitis is an inflammatory condition caused by intracellular activation and extravasation of inappropriate proteolytic enzymes determining destruction of pancreatic parenchyma and peripancreatic tissues. This is a fairly common clinical condition with two main presentations, namely, endematous pancreatitis - a less severe presentation -, and necrotizing pancreatitis - the most severe presentation that affects a significant part of patients. The radiological evaluation, particularly by computed tomography, plays a fundamental role in the definition of the management of severe cases, especially regarding the characterization of local complications with implications in the prognosis and in the definition of the therapeutic approach. New concepts include the subdivision of necrotizing pancreatitis into the following presentations: pancreatic parenchymal necrosis with concomitant peripancreatic tissue necrosis, and necrosis restricted to peripancreatic tissues. Moreover, there was a systematization of the terms acute peripancreatic fluid collection, pseudocyst, post-necrotic pancreatic/peripancreatic fluid collections and walled-off pancreatic necrosis. The knowledge about such terms is extremely relevant to standardize the terminology utilized by specialists involved in the diagnosis and treatment of these patients. PMID:25741074

  15. Walled-off pancreatic necrosis and other current concepts in the radiological assessment of acute pancreatitis.

    PubMed

    Cunha, Elen Freitas de Cerqueira; Rocha, Manoel de Souza; Pereira, Fábio Payão; Blasbalg, Roberto; Baroni, Ronaldo Hueb

    2014-01-01

    Acute pancreatitis is an inflammatory condition caused by intracellular activation and extravasation of inappropriate proteolytic enzymes determining destruction of pancreatic parenchyma and peripancreatic tissues. This is a fairly common clinical condition with two main presentations, namely, endematous pancreatitis - a less severe presentation -, and necrotizing pancreatitis - the most severe presentation that affects a significant part of patients. The radiological evaluation, particularly by computed tomography, plays a fundamental role in the definition of the management of severe cases, especially regarding the characterization of local complications with implications in the prognosis and in the definition of the therapeutic approach. New concepts include the subdivision of necrotizing pancreatitis into the following presentations: pancreatic parenchymal necrosis with concomitant peripancreatic tissue necrosis, and necrosis restricted to peripancreatic tissues. Moreover, there was a systematization of the terms acute peripancreatic fluid collection, pseudocyst, post-necrotic pancreatic/peripancreatic fluid collections and walled-off pancreatic necrosis. The knowledge about such terms is extremely relevant to standardize the terminology utilized by specialists involved in the diagnosis and treatment of these patients.

  16. Trends, current developments, and concepts in distance learning and E-learning.

    PubMed

    Asselmeyer, H

    2004-04-01

    A glance at the history of distance learning shows that there is a long tradition of using contemporary technical resources for learning and teaching purposes. For some, the holy grail of distance learning is the concept of the industrialization (mass production) of teaching and learning. Although reality has time and again caught up with technological promise, the scope for using new information and communication technologies in teaching has frequently been disregarded. In the future, learning will entail handling organized knowledge resources in demand-specific, organized communities formed for finding solutions to distinct problems and generating new knowledge about learning processes within the problem solving process. The development of the potential of "e-learning" (and actually, it bears contemplating whether this term puts too much emphasis on conventional learning organized in temporally-limited courses or similar, to the detriment of intelligent management of knowledge in its own working context) will depend upon the extent to which organizations succeed in promoting the development of a learning and working culture, for example, by incentive systems, team promotion, and free access to knowledge resources. The Masters degree in Organization Studies is presented against this background as an example of teaching using a combination of resources, leading to undreamed of learning success.

  17. Synergetic sustainability enhancement via current biofuel infrastructure: waste-to-energy concept for biodiesel production.

    PubMed

    Kwon, Eilhann; Yi, Haakrho; Jeon, Young Jae

    2013-03-19

    The concept of waste-to-energy (WtE) with regards to the utilization of byproducts from the bioethanol industry (e.g., distiller's dried grain with solubles: DDGS) was employed to enhance the renewability of biodiesel, which would be an initiative stage of a biorefinery due to the conjunction between bioethanol and biodiesel. For example, DDGS is a strong candidate for use as a biodiesel feedstock due to the tremendous amount that is regularly generated. On the basis of an estimation of possible lipid recovery from DDGS, ∼30% of the biodiesel feedstock demand in 2010 could be supported by the total DDGS generation in the same year. Considering the future expansion of the bioethanol industry up to 2020, the possible lipid recovery from DDGS would provide more than 6 times the biodiesel feedstock demand in 2010. In order to enhance the renewability of biodiesel, the transformation of lipid extracted from DDGS into fatty acid ethyl ester (FAEE) via a noncatalytic transesterification reaction under ambient pressure was investigated in this work. The newly introduced method reported here enables the combination of the esterification of free fatty acids (FFAs) and the transesterification of triglycerides into a single step. This was achieved in the presence of a porous material (i.e., charcoal), and the optimal conditions for transformation into biodiesel via this noncatalytic method were assessed at the fundamental level.

  18. Current concepts on the pathophysiology of idiopathic chronic adult hydrocephalus: Are we facing another neurodegenerative disease?

    PubMed

    Martín-Láez, R; Valle-San Román, N; Rodríguez-Rodríguez, E M; Marco-de Lucas, E; Berciano Blanco, J A; Vázquez-Barquero, A

    2016-06-10

    Since its description five decades ago, the pathophysiology of idiopathic chronic adult hydrocephalus (iCAH) has been traditionally related to the effect that ventricular dilatation exerts on the structures surrounding the ventricular system. However, altered cerebral blood flow, especially a reduction in the CSF turnover rate, are starting to be considered the main pathophysiological elements of this disease. Compression of the pyramidal tract, the frontostriatal and frontoreticular circuits, and the paraventricular fibres of the superior longitudinal fasciculus have all been reported in iCAH. At the level of the corpus callosum, gliosis replaces a number of commissural tracts. Cerebral blood flow is also altered, showing a periventricular watershed region limited by the subependymal arteries and the perforating branches of the major arteries of the anterior cerebral circulation. The CSF turnover rate is decreased by 75%, leading to the reduced clearance of neurotoxins and the interruption of neuroendocrine and paracrine signalling in the CSF. iCAH presents as a complex nosological entity, in which the effects of subcortical microangiopathy and reduced CSF turnover play a key role. According to its pathophysiology, it is simpler to think of iCAH more as a neurodegenerative disease, such as Alzheimer disease or Binswanger disease than as the classical concept of hydrocephalus. Copyright © 2016 Sociedad Española de Neurología. Published by Elsevier España, S.L.U. All rights reserved.

  19. Current Evidence Regarding the Etiology, Prevalence, Natural History, and Prognosis of Pediatric Lumbar Spondylolysis: A Report from the Scoliosis Research Society Evidence-Based Medicine Committee.

    PubMed

    Crawford, Charles H; Ledonio, Charles G T; Bess, Robert Shay; Buchowski, Jacob M; Burton, Douglas C; Hu, Serena S; Lonner, Baron S H; Polly, David W; Smith, Justin S; Sanders, James O

    2015-01-01

    Structured literature review. To assess the current state of evidence as a first step in the development of practice guidelines for pediatric spondylolysis. Progress in published medical knowledge, changes in societal expectations, and developments in health care economics have led medical organizations to develop evidence-based documents and products. A comprehensive literature search for pediatric spondylolysis was performed with the assistance of a medical librarian. The authors reviewed citations and abstracts. Abstracts were reviewed for exclusions and data from included studies were analyzed by committee. A total of 44 articles provided the best available evidence for the questions of etiology, prevalence, natural history, and prognosis: 9 were graded as level I evidence, 23 were level II, 3 were level III, and 9 were level IV. No level V studies were included in the final list. There is good evidence that pediatric lumbar spondylolysis is an acquired fracture of the pars interarticularis that can occur unilaterally or bilaterally. Evidence shows that when chronic, bilateral pars defects develop, 43% to 74% of patients will progress to grade 1 or 2 spondylolisthesis. In addition, unilateral, incomplete, and early lesions can obtain bony union. With or without bony union or spondylolisthesis, short-term symptom resolution is the norm. Long-term prognosis is less clear, but there is fair evidence that most patients will have lumbar symptoms compared with the general population. There is also fair evidence that some patients will develop significant symptoms as adults and will undergo surgical treatment. There is insufficient knowledge to predict which patients will continue to do well in the long term with conservative or no treatment and which patients will develop symptoms significant enough to warrant early intervention. The current medical literature provides fair to good evidence for clinically relevant questions regarding the etiology, prevalence, natural

  20. Multimodality Imaging of the Painful Elbow: Current Imaging Concepts and Image-Guided Treatments for the Injured Thrower's Elbow.

    PubMed

    Gustas, Cristy N; Lee, Kenneth S

    2016-09-01

    Elbow pain in overhead sport athletes is not uncommon. Repetitive throwing can lead to chronic overuse and/or acute injury to tendons, ligaments, bones, or nerves about the elbow. A thorough history and physical examination of the thrower's elbow frequently establishes the diagnosis for pain. Imaging can provide additional information when the clinical picture is unclear or further information is necessary for risk stratification and treatment planning. This article focuses on current imaging concepts and image-guided treatments for injuries commonly affecting the adult throwing athlete's elbow.

  1. Longitudinal emittance: An introduction to the concept and survey of measurement techniques including design of a wall current monitor

    SciTech Connect

    Webber, R.C.

    1990-03-01

    The properties of charged particle beams associated with the distribution of the particles in energy and in time can be grouped together under the category of longitudinal emittance. This article is intended to provide an intuitive introduction to the concepts longitudinal emittance; to provide an incomplete survey of methods used to measure this emittance and the related properties of bunch length and momentum spread; and to describe the detailed design of a 6 Ghz bandwidth resistive wall current monitor useful for measuring bunch shapes of moderate to high intensity beams. Overall, the article is intended to be broad in scope, in most cases deferring details to cited original papers. 37 refs., 21 figs.

  2. Dumping Syndrome: A Review of the Current Concepts of Pathophysiology, Diagnosis, and Treatment.

    PubMed

    Berg, Patrick; McCallum, Richard

    2016-01-01

    Gastric surgery has long been known to be a cause of dumping syndrome (DS). However, the increasing incidence of gastric bypass surgery, as well as reports of DS unrelated to previous gastric surgeries, has increased the importance of understanding DS in recent years. DS is due to the gastrointestinal response to voluminous and hyperosmolar chyme that is rapidly expelled from the stomach into the small intestine. This response involves neural and hormonal mechanisms. This review encompasses the symptoms, diagnosis, and treatment approaches of DS and also focuses on the current research status of the pathophysiology of DS.

  3. Fever of unknown origin: clinical overview of classic and current concepts.

    PubMed

    Cunha, Burke A

    2007-12-01

    Fever of unknown origin (FUO) refers to disorders that present with prolonged and perplexing fevers that are difficult to diagnose. This article presents a clinical overview of classic and current causes of FUOs, which may be due to infectious, rheumatic/inflammatory, neoplastic, or miscellaneous disorders. Comprehensive but nonfocused diagnostic testing is ineffective and should be avoided. The FUO workup should be directed by the key history, physical, and laboratory findings in clinical presentation. The clinical syndromic approach in the differential diagnosis of FUOs is emphasized, and the diagnostic importance and significance of fever patterns are discussed.

  4. Leukocytes and the natural history of deep vein thrombosis: current concepts and future directions

    PubMed Central

    P, Saha; J, Humphries; B, Modarai; K, Mattock; M, Waltham; C, Evans; A, Ahmad; A, Patel; S, Premaratne; OTA, Lyons; A, Smith

    2011-01-01

    Observational studies have shown that inflammatory cells accumulate within the thrombus and surrounding vein wall during the natural history of venous thrombosis. More recent studies have begun to unravel the mechanisms that regulate this interaction and have confirmed that thrombosis and inflammation are intimately linked. This review outlines our current knowledge of the complex relationship between inflammatory cell activity and venous thrombosis and highlights new areas of research in this field. A better understanding of this relationship could lead to the development of novel therapeutic targets that inhibit thrombus formation or promote its resolution. PMID:21325673

  5. Injuries to the finger flexor pulley system in rock climbers: current concepts.

    PubMed

    Schöffl, Volker Rainer; Schöffl, Isabelle

    2006-04-01

    Closed traumatic ruptures of finger flexor tendon pulleys began to be recognized specifically over the past several decades. This injury, although rare in the general population, is seen more commonly in rock climbers. This article analyzes this type of injury and the current diagnostic and therapeutic criteria. Ultrasound and magnetic resonance imaging are used to differentiate between a pulley strain, partial rupture, complete rupture, or multiple ruptures. Grade I to III injuries (strains, partial rupture, single ruptures) are treated conservatively with initial immobilization and early functional therapy under pulley protection. Grade IV injuries (multiple ruptures) require surgical repair.

  6. Current Concepts in the Management of Ankle Osteoarthritis: A Systematic Review.

    PubMed

    Bloch, Benjamin; Srinivasan, Suresh; Mangwani, Jitendra

    2015-01-01

    Ankle osteoarthritis is less common than hip or knee osteoarthritis; however, it is a relatively common presentation and is predominantly related to previous trauma. Treatments have traditionally consisted of temporizing measures such as analgesia, physiotherapy, and injections until operative treatment in the form of arthrodesis is required. More recently, interest has been increasing in both nonoperative and alternative operative options, including joint-sparing surgery, minimal access arthrodesis, and new arthroplasty designs. The present systematic instructional review has summarized the current evidence for the treatment options available for ankle osteoarthritis. Copyright © 2015 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  7. Current concepts in targeting chronic obstructive pulmonary disease pharmacotherapy: making progress towards personalised management.

    PubMed

    Woodruff, Prescott G; Agusti, Alvar; Roche, Nicolas; Singh, Dave; Martinez, Fernando J

    2015-05-02

    Chronic obstructive pulmonary disease (COPD) is a common, complex, and heterogeneous disorder that is responsible for substantial and growing morbidity, mortality, and health-care expense worldwide. Of imperative importance to decipher the complexity of COPD is to identify groups of patients with similar clinical characteristics, prognosis, or therapeutic needs, the so-called clinical phenotypes. This strategy is logical for research but might be of little clinical value because clinical phenotypes can overlap in the same patient and the same clinical phenotype could result from different biological mechanisms. With the goal to match assessment with treatment choices, the latest iteration of guidelines from the Global Initiative for Chronic Obstructive Lung Disease reorganised treatment objectives into two categories: to improve symptoms (ie, dyspnoea and health status) and to decrease future risk (as predicted by forced expiratory volume in 1 s level and exacerbations history). This change thus moves treatment closer to individualised medicine with available bronchodilators and anti-inflammatory drugs. Yet, future treatment options are likely to include targeting endotypes that represent subtypes of patients defined by a distinct pathophysiological mechanism. Specific biomarkers of these endotypes would be particularly useful in clinical practice, especially in patients in which clinical phenotype alone is insufficient to identify the underlying endotype. A few series of potential COPD endotypes and biomarkers have been suggested. Empirical knowledge will be gained from proof-of-concept trials in COPD with emerging drugs that target specific inflammatory pathways. In every instance, specific endotype and biomarker efforts will probably be needed for the success of these trials, because the pathways are likely to be operative in only a subset of patients. Network analysis of human diseases offers the possibility to improve understanding of disease pathobiological

  8. Sleep and memory in the making. Are current concepts sufficient in children?

    PubMed

    Peigneux, P

    2014-01-01

    Memory consolidation is an active process wired in brain plasticity. How plasticity mechanisms develop and are modulated after learning is at the core of current models of sleep-dependent memory consolidation. Nowadays, two main classes of sleep-related memory consolidation theories are proposed, namely system consolidation and synaptic homeostasis. However, novel models of consolidation emerge, that might better account for the highly dynamic and interactive processes of encoding and memory consolidation. Processing steps can take place at various temporal phases and be modulated by interactions with prior experiences and ongoing events. In this perspective, sleep might support (or not) memory consolidation processes under specific neurophysiological and environmental circumstances leading to enduring representations in long-term memory stores. We outline here a discussion about how current and emergent models account for the complexity and apparent inconsistency of empirical data. Additionally, models aimed at understanding neurophysiological and/or cognitive processes should not only provide a satisfactory explanation for the phenomena at stake, but also account for their ontogeny and the conditions that disrupt their organisation. Looking at the available literature, this developmental condition appears to remain unfulfilled when trying to understand the relationships between sleep, learning and memory consolidation processes, both in healthy children and in children with pathological conditions.

  9. Acute occlusion of the retinal arteries: current concepts and recent advances in diagnosis and management

    PubMed Central

    Beatty, S; Eong, K

    2000-01-01

    Purpose/Background—Central retinal artery occlusion (CRAO) is usually a blinding event, and is not an infrequent presentation to the accident and emergency (A&E) department. The evidence-base in support of current treatment options is weak. Methods—This paper reviewed the literature germane to the diagnostic, therapeutic and prognostic aspects of retinal arterial occlusive disease. Results—The visual prognosis associated with CRAO remains poor, and current therapeutic practices are of unproven benefit. The non-ophthalmologist in the A&E department should lie the patient flat and give a stat dose of intravenous acetazolamide in an attempt to improve the retinal perfusion pressure. Conclusion—The management of acute occlusion of the central retinal artery has not changed over the past 30 years, although the potential benefits of superselective intra-arterial fibrinolytic therapy warrant evaluation in a randomised controlled trial. The identification of underlying pathology is an essential component of medical care, and all cases should be followed up by an ophthalmologist because of the possibility of ocular rubeosis. PMID:11005400

  10. Basic concepts regarding fracture healing and the current options and future directions in managing bone fractures.

    PubMed

    Bigham-Sadegh, Amin; Oryan, Ahmad

    2015-06-01

    Fracture healing is a complex physiological process, which involves a well-orchestrated series of biological events. Repair of large bone defects resulting from trauma, tumours, osteitis, delayed unions, non-unions, osteotomies, arthrodesis and multifragmentary fractures is a current challenge of surgeons and investigators. Different therapeutic modalities have been developed to enhance the healing response and fill the bone defects. Different types of growth factors, stem cells, natural grafts (autografts, allografts or xenografts) and biologic- and synthetic-based tissue-engineered scaffolds are some of the examples. Nevertheless, these organic and synthetic materials and therapeutic agents have some significant limitations, and there are still no well-approved treatment modalities to meet all the expected requirements. Bone tissue engineering is a newer option than the traditional grafts and may overcome many limitations of the bone graft. To select an appropriate treatment strategy in achieving a successful and secure healing, more information concerning injuries of bones, their healing process and knowledge of the factors involved are required. The main goals of this work are to present different treatment modalities of the fractured bones and to explain how fractures normally heal and what factors interfere with fracture healing. This study provides an overview of the processes of fracture healing and discusses the current therapeutic strategies that have been claimed to be effective in accelerating fracture healing.

  11. Current Concepts: Osteochondritis Dissecans of the Capitellum and the Role of Osteochondral Autograft Transplantation.

    PubMed

    Kirsch, Jacob M; Thomas, Jared; Bedi, Asheesh; Lawton, Jeffrey N

    2016-12-01

    Background: Osteochondritis dissecans (OCD) of the capitellum is a painful condition, which often affects young throwing athletes. Our current understanding regarding the etiology, risks factors, diagnosis, and efficacy of the available treatment options has expanded over recent years, however remains suboptimal. Recent data on patient-reported outcomes following osteochondral autograft transplantation (OAT) for the treatment of large osteochondral lesions of the capitellum have been promising but limited. This review seeks to critically analyze and summarize the available literature on the etiology, diagnosis, and reported outcomes associated with OCD of the capitellum and the use of OAT for its treatment. Methods: A comprehensive literature search was conducted. Unique and customized search strategies were formulated in PubMed, Embase, Scopus, Web of Science, and CENTRAL. Combinations of keywords and controlled vocabulary terms were utilized in order to cast a broad net. Relevant clinical, biomechanical, anatomic and imaging studies were reviewed along with recent review articles, and case series. Results: Forty-three articles from our initial literature search were found to be relevant for this review. The majority of these articles were either review articles, clinical studies, anatomic or imaging studies or biomechanical studies. Conclusions: Current evidence suggests that OAT may lead to better and more consistent outcomes than previously described methods for treating large OCD lesions of the capitellum.

  12. Neuroimaging Assessment of Cerebrovascular Reactivity in Concussion: Current Concepts, Methodological Considerations, and Review of the Literature

    PubMed Central

    Ellis, Michael J.; Ryner, Lawrence N.; Sobczyk, Olivia; Fierstra, Jorn; Mikulis, David J.; Fisher, Joseph A.; Duffin, James; Mutch, W. Alan C.

    2016-01-01

    Concussion is a form of traumatic brain injury (TBI) that presents with a wide spectrum of subjective symptoms and few objective clinical findings. Emerging research suggests that one of the processes that may contribute to concussion pathophysiology is dysregulation of cerebral blood flow (CBF) leading to a mismatch between CBF delivery and the metabolic needs of the injured brain. Cerebrovascular reactivity (CVR) is defined as the change in CBF in response to a measured vasoactive stimulus. Several magnetic resonance imaging (MRI) techniques can be used as a surrogate measure of CBF in clinical and laboratory studies. In order to provide an accurate assessment of CVR, these sequences must be combined with a reliable, reproducible vasoactive stimulus that can manipulate CBF. Although CVR imaging currently plays a crucial role in the diagnosis and management of many cerebrovascular diseases, only recently have studies begun to apply this assessment tool in patients with concussion. In order to evaluate the quality, reliability, and relevance of CVR studies in concussion, it is important that clinicians and researchers have a strong foundational understanding of the role of CBF regulation in health, concussion, and more severe forms of TBI, and an awareness of the advantages and limitations of currently available CVR measurement techniques. Accordingly, in this review, we (1) discuss the role of CVR in TBI and concussion, (2) examine methodological considerations for MRI-based measurement of CVR, and (3) provide an overview of published CVR studies in concussion patients. PMID:27199885

  13. Systemic sclerosis and localized scleroderma--current concepts and novel targets for therapy.

    PubMed

    Distler, Oliver; Cozzio, Antonio

    2016-01-01

    Systemic sclerosis (SSc) is a chronic autoimmune disease with a high morbidity and mortality. Skin and organ fibrosis are key manifestations of SSc, for which no generally accepted therapy is available. Thus, there is a high unmet need for novel anti-fibrotic therapeutic strategies in SSc. At the same time, important progress has been made in the identification and characterization of potential molecular targets in fibrotic diseases over the recent years. In this review, we have selected four targeted therapies, which are tested in clinical trials in SSc, for in depths discussion of their preclinical characterization. Soluble guanylate cyclase (sGC) stimulators such as riociguat might target both vascular remodeling and tissue fibrosis. Blockade of interleukin-6 might be particularly promising for early inflammatory stages of SSc. Inhibition of serotonin receptor 2b signaling links platelet activation to tissue fibrosis. Targeting simultaneously multiple key molecules with the multityrosine kinase-inhibitor nintedanib might be a promising approach in complex fibrotic diseases such as SSc, in which many partially independent pathways are activated. Herein, we also give a state of the art overview of the current classification, clinical presentation, diagnostic approach, and treatment options of localized scleroderma. Finally, we discuss whether the novel targeted therapies currently tested in SSc could be used for localized scleroderma.

  14. Biomarkers for rheumatoid arthritis: From molecular processes to diagnostic applications-current concepts and future perspectives.

    PubMed

    Nakken, Britt; Papp, Gábor; Bosnes, Vidar; Zeher, Margit; Nagy, György; Szodoray, Peter

    2017-09-01

    Early diagnosis and immediately started appropriate treatment are mandatory for the prevention of radiographic progression, functional disability and unfavourable disease outcome in rheumatoid arthritis (RA). The current classification criteria for RA include two different types of biomarkers representing inflammatory processes, such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) or immune processes including autoantibodies, such as rheumatoid factor (RF) and antibodies against citrullinated proteins (ACPA). After the discovery of RF, the recent recognition of various autoantibodies against post-translationally modified proteins opened new avenues to diagnosing RA and predicting the course of the disease. Citrullination and carbamylation of amino acids generate new epitopes that can potentially promote the production of novel autoantibodies. In spite of growing knowledge, the pathogenic role of these autoantibodies is still not fully elucidated in RA. In this paper, we review the currently available and novel promising immune biomarkers, which may help in early diagnosis and estimating prognosis in RA. Copyright © 2017 European Federation of Immunological Societies. Published by Elsevier B.V. All rights reserved.

  15. Arthrodesis of the Metacarpophalangeal and Interphalangeal Joints of the Hand: Current Concepts.

    PubMed

    Beldner, Steven; Polatsch, Daniel B

    2016-05-01

    Metacarpophalangeal arthrodesis and interphalangeal arthrodesis are excellent tools in the surgeon's armamentarium to restore function of the disabled hand. Typical indications for these procedures are pain, deformity, and/or stiffness. Arthrodesis is generally considered a salvage procedure to be used when other reconstructive procedures, such as arthroplasty, are not possible or would be associated with a high rate of complication or failure. To determine the most functional position for arthrodesis in each patient, the surgeon should preoperatively evaluate the compromised joint in the context of the disease process, determine the initial cause of the joint pathology, and assess the condition of the surrounding joints. Current methods of achieving fusion of metacarpophalangeal and interphalangeal joints include options for incisions, bone preparation techniques, and surgical implants; each has advantages and associated risks.

  16. The current concepts in management of animal (dog, cat, snake, scorpion) and human bite wounds.

    PubMed

    Aziz, Hassan; Rhee, Peter; Pandit, Viraj; Tang, Andrew; Gries, Lynn; Joseph, Bellal

    2015-03-01

    Animal and human bite wounds represent a significant global health issue. In the United States, animal and human bites are a very common health issue, causing significant morbidity and even, in rare scenarios, mortality. Most animal bite wounds in the United States are caused by dogs, with cat bites being a distant second. Human bite wounds constitute a dominant subset of all bite wounds. Several studies of bite wounds have reported improved outcomes with early diagnosis and immediate treatment. However, the available literature on the initial treatment provides a plethora of conflicting opinions and results. In this review, our aim was to identify and assess the current evidence on the management of animal (dog, cat, insects, scorpions, and snakes) and human bite wounds. Review article, level III.

  17. Transfusion-related acute lung injury (TRALI): current concepts and misconceptions.

    PubMed

    Silliman, Christopher C; Fung, Yoke Lin; Ball, J Bradley; Khan, Samina Y

    2009-11-01

    Transfusion-related acute lung injury (TRALI) is the most common cause of serious morbidity and mortality due to hemotherapy. Although the pathogenesis has been related to the infusion of donor antibodies into the recipient, antibody negative TRALI has been reported. Changes in transfusion practices, especially the use of male-only plasma, have decreased the number of antibody-mediated cases and deaths; however, TRALI still occurs. The neutrophil appears to be the effector cell in TRALI and the pathophysiology is centered on neutrophil-mediated endothelial cell cytotoxicity resulting in capillary leak and ALI. This review will detail the pathophysiology of TRALI including recent pre-clinical data, provide insight into newer areas of research, and critically assess current practices to decrease it prevalence and to make transfusion safer.

  18. Genetics of Age-Related Macular Degeneration: Current Concepts, Future Directions

    PubMed Central

    DeAngelis, Margaret M.; Silveira, Alexandra C.; Carr, Elizabeth A.; Kim, Ivana K.

    2014-01-01

    Age-related macular degeneration (AMD) is a progressive degenerative disease which leads to blindness, affecting the quality of life of millions of Americans. More than 1.75 million individuals in the United States are affected by the advanced form of AMD. The etiological pathway of AMD is not yet fully understood, but there is a clear genetic influence on disease risk. To date, the 1q32 (CFH) and 10q26 (PLEKHA1/ARMS2/HTRA1) loci are the most strongly associated with disease; however, the variation in these genomic regions alone is unable to predict disease development with high accuracy. Therefore, current genetic studies are aimed at identifying new genes associated with AMD and their modifiers, with the goal of discovering diagnostic or prognostic biomarkers. Moreover, these studies provide the foundation for further investigation into the pathophysiology of AMD by utilizing a systems-biology-based approach to elucidate underlying mechanistic pathways. PMID:21609220

  19. Stuttering in Lima, Peru: a qualitative case study of current concepts, theories, and treatment facilities.

    PubMed

    Gorin, L C

    1980-07-01

    The purpose of this study was to investigate within an ethnographic framework, certain cultural variables which may be factors in the etiology and presentation of stuttering as well as in the care provided for those who stutter. An assessment was made of the cultural influences upon the following variables of the transcultural investigation of stuttering: 1) epidemiological characteristics of stuttering; 2) attitudes of the stutterer and the stutterer's family, friends, therapists towards the defect; 3) cultural expectations which may be part of the etiology/perpetuation of the problem of stuttering, including an examination of these cultural expectations within the context of the stutterer's past and present home, work, and recreational lifestyles: 4) current theories and therapies.

  20. Birdshot chorioretinopathy: current knowledge and new concepts in pathophysiology, diagnosis, monitoring and treatment.

    PubMed

    Minos, Evangelos; Barry, Robert J; Southworth, Sue; Folkard, Annie; Murray, Philip I; Duker, Jay S; Keane, Pearse A; Denniston, Alastair K

    2016-05-12

    Birdshot chorioretinopathy (BCR) is a rare form of chronic, bilateral, posterior uveitis with a distinctive clinical phenotype, and a strong association with HLA-A29. It predominantly affects people in middle age. Given its rarity, patients often encounter delays in diagnosis leading to delays in adequate treatment, and thus risking significant visual loss. Recent advances have helped increase our understanding of the underlying autoimmune mechanisms involved in disease pathogenesis, and new diagnostic approaches such as multimodality imaging have improved our ability to both diagnose and monitor disease activity. Whilst traditional immunosuppressants may be effective in BCR, increased understanding of immune pathways is enabling development of newer treatment modalities, offering the potential for targeted modulation of immune mediators. In this review, we will discuss current understanding of BCR and explore recent developments in diagnosis, monitoring and treatment of this disease. Synonyms for BCR: Birdshot chorioretinopathy, Birdshot retinochoroiditis, Birdshot retino-choroidopathy, Vitiliginous choroiditis. Orphanet number: ORPHA179 OMIM: 605808.

  1. Augmented Reality in Neurosurgery: A Review of Current Concepts and Emerging Applications.

    PubMed

    Guha, Daipayan; Alotaibi, Naif M; Nguyen, Nhu; Gupta, Shaurya; McFaul, Christopher; Yang, Victor X D

    2017-05-01

    Augmented reality (AR) superimposes computer-generated virtual objects onto the user's view of the real world. Among medical disciplines, neurosurgery has long been at the forefront of image-guided surgery, and it continues to push the frontiers of AR technology in the operating room. In this systematic review, we explore the history of AR in neurosurgery and examine the literature on current neurosurgical applications of AR. Significant challenges to surgical AR exist, including compounded sources of registration error, impaired depth perception, visual and tactile temporal asynchrony, and operator inattentional blindness. Nevertheless, the ability to accurately display multiple three-dimensional datasets congruently over the area where they are most useful, coupled with future advances in imaging, registration, display technology, and robotic actuation, portend a promising role for AR in the neurosurgical operating room.

  2. [Current audiovisual technologies are a constituent of the continuing professional development concept].

    PubMed

    Bezrukova, E Iu; Zatsepa, S A

    2009-01-01

    The paper is devoted to the topical problems of using innovation, information and communication technologies (ICT) in the higher medical education system, including in postgraduate professional education. The paper shows the key principles for organizing an audiovisual technology-based educational process and gives numerous practical examples of the real use of ICT in the education of not only medical, but also other specialists and the results of studies of applying the current technical aids of innovation professional education. Since each area of manpower training has its specificity and unique goals, the authors propose the highly effective decisions to organize an educational process, which fully take into consideration of the specific features of professional education. These technologies substantially expand access to educational resources, which is of great importance for a strategy of continuing professional development.

  3. A shift in the current: new applications and concepts for microbe-electrode electron exchange.

    PubMed

    Lovley, Derek R; Nevin, Kelly P

    2011-06-01

    Perceived applications of microbe-electrode interactions are shifting from production of electric power to other technologies, some of which even consume current. Electrodes can serve as stable, long-term electron acceptors for contaminant-degrading microbes to promote rapid degradation of organic pollutants in anaerobic subsurface environments. Solar and other forms of renewable electrical energy can be used to provide electrons extracted from water to microorganisms on electrodes at suitably low potentials for a number of groundwater bioremediation applications as well as for the production of fuels and other organic compounds from carbon dioxide. The understanding of how microorganisms exchange electrons with electrodes has improved substantially and is expected to be helpful in optimizing practical applications of microbe-electrode interactions, as well as yielding insights into related natural environmental phenomena. Copyright © 2011 Elsevier Ltd. All rights reserved.

  4. The Abdominal Aortic Aneurysm and Intraluminal Thrombus: Current Concepts of Development and Treatment

    PubMed Central

    Piechota-Polanczyk, Aleksandra; Jozkowicz, Alicja; Nowak, Witold; Eilenberg, Wolf; Neumayer, Christoph; Malinski, Tadeusz; Huk, Ihor; Brostjan, Christine

    2015-01-01

    The pathogenesis of the abdominal aortic aneurysm (AAA) shows several hallmarks of atherosclerotic and atherothrombotic disease, but comprises an additional, predominant feature of proteolysis resulting in the degradation and destabilization of the aortic wall. This review aims to summarize the current knowledge on AAA development, involving the accumulation of neutrophils in the intraluminal thrombus and their central role in creating an oxidative and proteolytic environment. Particular focus is placed on the controversial role of heme oxygenase 1/carbon monoxide and nitric oxide synthase/peroxynitrite, which may exert both protective and damaging effects in the development of the aneurysm. Treatment indications as well as surgical and pharmacological options for AAA therapy are discussed in light of recent reports. PMID:26664891

  5. Current concepts in the etiopathogenesis and treatment of systemic lupus erythematosus (SLE).

    PubMed

    Manolios, N; Schrieber, L

    1986-10-01

    Systemic lupus erythematosus is an autoimmune disorder that occurs spontaneously in humans and mice. Genetic factors play an important role in the predisposition to and expression of disease. Environmental factors augment the expression of illness and in the absence of normal control mechanisms may provide the stimulus to autoimmunity. Sex hormones modulate the immune response and tend to modify disease expression. Disordered immune regulation may be due to a primary or secondary abnormality in cellular, cytokine, and/or humoral function. Therapy for SLE is directed towards suppression of exaggerated immunological and inflammatory activity. This review will re-evaluate current therapy and describe newer approaches including the use of pharmacological, hormonal, immunological, dietary, and physical modalities.

  6. Towards an ankle neuroprosthesis for hybrid robotics: Concepts and current sources for functional electrical stimulation.

    PubMed

    Casco, S; Fuster, I; Galeano, R; Moreno, J C; Pons, J L; Brunetti, F

    2017-07-01

    Hybrid rehabilitation robotics combine neuro-prosthetic devices (close-loop functional electrical stimulation systems) and traditional robotic structures and actuators to explore better therapies and promote a more efficient motor function recovery or compensation. Although hybrid robotics and ankle neuroprostheses (NPs) have been widely developed over the last years, there are just few studies on the use of NPs to electrically control both ankle flexion and extension to promote ankle recovery and improved gait patterns in paretic limbs. The aim of this work is to develop an ankle NP specifically designed to work in the field of hybrid robotics. This article presents early steps towards this goal and makes a brief review about motor NPs and Functional Electrical Stimulation (FES) principles and most common devices used to aid the ankle functioning during the gait cycle. It also shows a current sources analysis done in this framework, in order to choose the best one for this intended application.

  7. Current Concept of Stem Cell Therapy for Spinal Cord Injury: A Review

    PubMed Central

    Oh, Sun Kyu

    2016-01-01

    Spinal cord injury (SCI) is a catastrophic condition associated with significant neurological deficit, social, and financial burdens. Over the past decades, various treatments including medication, surgery, and rehabilitation therapy for SCI have been performed, but there were no definite treatment option to improve neurological function of patients with chronic SCI. Therefore, new treatment trials with stem cells have been studied to regenerate injured spinal cord. Among various types of stem cells, bone marrow derived mesenchymal stem cells is highly expected as candidates for the stem cell therapy. The result of the current research showed that direct intramedullary injection to the injured spinal cord site in subacute phase is most effective. Neurological examination, electrophysiologic studies, and magnetic resonance imaging are commonly used to assess the effectiveness of treatment. Diffusion tensor imaging visualizing white matter tract can be also alternative option to identify neuronal regeneration. Despite various challenging issues, stem cell therapy will open new perspectives for SCI treatment. PMID:27857906

  8. Current Concepts of Bone Tissue Engineering for Craniofacial Bone Defect Repair

    PubMed Central

    Fishero, Brian Alan; Kohli, Nikita; Das, Anusuya; Christophel, John Jared; Cui, Quanjun

    2014-01-01

    Craniofacial fractures and bony defects are common causes of morbidity and contribute to increasing health care costs. Successful regeneration of bone requires the concomitant processes of osteogenesis and neovascularization. Current methods of repair and reconstruction include rigid fixation, grafting, and free tissue transfer. However, these methods carry innate complications, including plate extrusion, nonunion, graft/flap failure, and donor site morbidity. Recent research efforts have focused on using stem cells and synthetic scaffolds to heal critical-sized bone defects similar to those sustained from traumatic injury or ablative oncologic surgery. Growth factors can be used to augment both osteogenesis and neovascularization across these defects. Many different growth factor delivery techniques and scaffold compositions have been explored yet none have emerged as the universally accepted standard. In this review, we will discuss the recent literature regarding the use of stem cells, growth factors, and synthetic scaffolds as alternative methods of craniofacial fracture repair. PMID:25709750

  9. Current Concepts in Pediatric Philadelphia Chromosome-Positive Acute Lymphoblastic Leukemia

    PubMed Central

    Bernt, Kathrin M.; Hunger, Stephen P.

    2014-01-01

    The t(9;22)(q34;q11) or Philadelphia chromosome creates a BCR–ABL1 fusion gene encoding for a chimeric BCR–ABL1 protein. It is present in 3–4% of pediatric acute lymphoblastic leukemia (Ph+ ALL), and about 25% of adult ALL cases. Prior to the advent of tyrosine kinase inhibitors (TKI), Ph+ ALL was associated with a very poor prognosis despite the use of intensive chemotherapy and frequently hematopoietic stem-cell transplantation (HSCT) in first remission. The development of TKIs revolutionized the therapy of Ph+ ALL. Addition of the first generation ABL1 class TKI imatinib to intensive chemotherapy dramatically increased the survival for children with Ph+ ALL and established that many patients can be cured without HSCT. In parallel, the mechanistic understanding of Ph+ ALL expanded exponentially through careful mapping of pathways downstream of BCR–ABL1, the discovery of mutations in master regulators of B-cell development such as IKZF1 (Ikaros), PAX5, and early B-cell factor (EBF), the recognition of the complex clonal architecture of Ph+ ALL, and the delineation of genomic, epigenetic, and signaling abnormalities contributing to relapse and resistance. Still, many important basic and clinical questions remain unanswered. Current clinical trials are testing second generation TKIs in patients with newly diagnosed Ph+ ALL. Neither the optimal duration of therapy nor the optimal chemotherapy backbone are currently defined. The role of HSCT in first remission and post-transplant TKI therapy also require further study. In addition, it will be crucial to continue to dig deeper into understanding Ph+ ALL at a mechanistic level, and translate findings into complementary targeted approaches. Expanding targeted therapies hold great promise to decrease toxicity and improve survival in this high-risk disease, which provides a paradigm for how targeted therapies can be incorporated into treatment of other high-risk leukemias. PMID:24724051

  10. Yaw Systems for wind turbines - Overview of concepts, current challenges and design methods

    NASA Astrophysics Data System (ADS)

    Kim, M.-G.; Dalhoff, P. H.

    2014-06-01

    Looking at the upscaling of the rotor diameter not only the loss in power production but the aerodynamic loads arising from yaw misalignment will have an increasing impact on the yaw system design in future wind turbines. This paper presents an overview of yaw systems used in current wind turbines and a review of patents with regards to the yaw system. The current state of the art of yaw systems has been analyzed through a systematic literature review. Further a patent analysis has been done through the European Patent Office. Todays design and strength requirements as per IEC and GL standards will be reviewed and alternative design calculations will be discussed. Over 100 patents have been identified as relevant to the yaw system and have been analyzed. It has been found that most patents are dealing with load reduction possibilities on the yaw system, where fatigue loads seem more of a problem than ultimate loads. Most of these patents concern especially the yaw actuator, which consists of multiple electrical motors, reduction gears and shaft pinions. This is due to the nature of the gearing in the actuator and the gearing between the shaft pinion and the ring gear. This coincides with the patents for yaw brakes, which mostly aim to reduce the fatigue loads during yaw maneuverer and during nacelle standstill. Patents for the yaw bearing are incorporating the reduction of loads through the usage of friction bearings or different bearing arrangement approaches. The paper shows that the conventional yaw system designs are still trying to meet the high requirements regarding the lifetime of a wind turbine and turbulent wind loads. New designs for yaw systems in general are hard to find. Many patents concentrate on control algorithms that depend on additional instruments and incorporate electromechanical systems.

  11. Current concepts in penetrating and blast injury to the central nervous system.

    PubMed

    Rosenfeld, Jeffrey V; Bell, Randy S; Armonda, Rocco

    2015-06-01

    To review the current management, prognostic factors and outcomes of penetrating and blast injuries to the central nervous system and highlight the differences between gunshot wound, blast injury and stabbing. A review of the current literature was performed. Of patients with craniocerebral GSW, 66-90% die before reaching hospital. Of those who are admitted to hospital, up to 51% survive. The patient age, GCS, pupil size and reaction, ballistics and CT features are important factors in the decision to operate and in prognostication. Blast injury to the brain is a component of multisystem polytrauma and has become a common injury encountered in war zones and following urban terrorist events. GSW to the spine account for 13-17% of all gunshot injuries. Urgent resuscitation, correction of coagulopathy and early surgery with wide cranial decompression may improve the outcome in selected patients with severe craniocerebral GSW. More limited surgery is undertaken for focal brain injury due to GSW. A non-operative approach may be taken if the clinical status is very poor (GCS 3, fixed dilated pupils) or GCS 4-5 with adverse CT findings or where there is a high likelihood of death or poor outcome. Civilian spinal GSWs are usually stable neurologically and biomechanically and do not require exploration. The indications for exploration are as follows: (1) compressive lesions with partial spinal cord or cauda equina injury, (2) mechanical instability and (3) complications. The principles of management of blast injury to the head and spine are the same as for GSW. Multidisciplinary specialist management is required for these complex injuries.

  12. A Critical Analysis of Rejection in Vascularized Composite Allotransplantation: Clinical, Cellular and Molecular Aspects, Current Challenges, and Novel Concepts

    PubMed Central

    Sarhane, Karim A.; Tuffaha, Sami H.; Broyles, Justin M.; Ibrahim, Amir E.; Khalifian, Saami; Baltodano, Pablo; Santiago, Gabriel F.; Alrakan, Mohammed; Ibrahim, Zuhaib

    2013-01-01

    Advances in microsurgical techniques and immunomodulatory protocols have contributed to the expansion of vascularized composite allotransplantation (VCA) with very encouraging immunological, functional, and cosmetic results. Rejection remains however a major hurdle that portends serious threats to recipients. Rejection features in VCA have been described in a number of studies, and an international consensus on the classification of rejection was established. Unfortunately, current available diagnostic methods carry many shortcomings that, in certain cases, pose a great diagnostic challenge to physicians especially in borderline rejection cases. In this review, we revisit the features of acute skin rejection in hand and face transplantation at the clinical, cellular, and molecular levels. The multiple challenges in diagnosing rejection and in defining chronic and antibody-mediated rejection in VCA are then presented, and we finish by analyzing current research directions and novel concepts aiming at improving available diagnostic measures. PMID:24324470

  13. Methadone, QTc prolongation and torsades de pointes: Current concepts, management and a hidden twist in the tale?

    PubMed

    Mujtaba, Sobia; Romero, Jorge; Taub, Cynthia C

    2013-12-01

    Methadone is a drug that has found widespread utility in the management of opioid addiction and pain. Along with its popularity, methadone has also earned an infamous reputation for causing prolongation of the QT interval and an increased risk of torsades de pointes. In this article we will give a brief overview of the long QT syndromes, followed by an in-depth look at the current pathophysiologic mechanisms of methadone induced QT prolongation, a review of the existing literature and the current concepts regarding the prevention and management of methadone induced torsades de pointes. In addition, we explore the idea and implications of a genetic link between methadone induced prolongation of the QT interval and torsades de pointes.

  14. Nonlinear current-voltage characteristics based on semiconductor nanowire networks enable a new concept in thermoelectric device optimization

    NASA Astrophysics Data System (ADS)

    Diaz Leon, Juan J.; Norris, Kate J.; Hartnett, Ryan J.; Garrett, Matthew P.; Tompa, Gary S.; Kobayashi, Nobuhiko P.

    2016-08-01

    Thermoelectric (TE) devices that produce electric power from heat are driven by a temperature gradient (Δ T = T_{{hot}} - T_{{cold}}, T hot: hot side temperature, T cold: cold side temperature) with respect to the average temperature ( T). While the resistance of TE devices changes as Δ T and/or T change, the current-voltage ( I- V) characteristics have consistently been shown to remain linear, which clips generated electric power ( P gen) within the given open-circuit voltage ( V OC) and short-circuit current ( I SC). This P gen clipping is altered when an appropriate nonlinearity is introduced to the I- V characteristics—increasing P gen. By analogy, photovoltaic cells with a large fill factor exhibit nonlinear I- V characteristics. In this paper, the concept of a unique TE device with nonlinear I- V characteristics is proposed and experimentally demonstrated. A single TE device with nonlinear I- V characteristics is fabricated by combining indium phosphide (InP) and silicon (Si) semiconductor nanowire networks. These TE devices show P gen that is more than 25 times larger than those of comparable devices with linear I- V characteristics. The plausible causes of the nonlinear I- V characteristics are discussed. The demonstrated concept suggests that there exists a new pathway to increase P gen of TE devices made of semiconductors.

  15. Nursing theory and concept development: a theoretical model of clinical nurses' intentions to stay in their current positions.

    PubMed

    Cowden, Tracy L; Cummings, Greta G

    2012-07-01

    We describe a theoretical model of staff nurses' intentions to stay in their current positions. The global nursing shortage and high nursing turnover rate demand evidence-based retention strategies. Inconsistent study outcomes indicate a need for testable theoretical models of intent to stay that build on previously published models, are reflective of current empirical research and identify causal relationships between model concepts. Two systematic reviews of electronic databases of English language published articles between 1985-2011. This complex, testable model expands on previous models and includes nurses' affective and cognitive responses to work and their effects on nurses' intent to stay. The concepts of desire to stay, job satisfaction, joy at work, and moral distress are included in the model to capture the emotional response of nurses to their work environments. The influence of leadership is integrated within the model. A causal understanding of clinical nurses' intent to stay and the effects of leadership on the development of that intention will facilitate the development of effective retention strategies internationally. Testing theoretical models is necessary to confirm previous research outcomes and to identify plausible sequences of the development of behavioral intentions. Increased understanding of the causal influences on nurses' intent to stay should lead to strategies that may result in higher retention rates and numbers of nurses willing to work in the health sector. © 2012 Blackwell Publishing Ltd.

  16. Treatment of juvenile osteochondritis dissecans of the talus: current concepts review

    PubMed Central

    VANNINI, FRANCESCA; CAVALLO, MARCO; BALDASSARRI, MATTEO; CASTAGNINI, FRANCESCO; OLIVIERI, ALESSANDRA; FERRANTI, ENRICO; BUDA, ROBERTO; GIANNINI, SANDRO

    2014-01-01

    Juvenile osteochondritis dissecans of the talus (JODT) affects the subchondral bone primarily and, in a skeletally immature population, articular cartilage secondarily. It probably consists of aseptic bone necrosis whose spontaneous healing is impaired by microtraumas, resulting in an osteochondral injury and, in some cases, in osteoarthritis. In many cases the clinical presentation is asymptomatic. Mild chronic pain is frequent, sometimes accompanied by swelling, stiffness or locking. Few data are currently available on this topic and, moreover, most existing data were obtained from mixed groups and populations; it is therefore difficult to outline a scheme for the treatment of JODT. However, the most suitable treatment in the first stages of the disease is conservative. The presence of a loose body is an indication for surgical fixation, drilling or regenerative procedures, depending on the presence/extent of subchondral bone sclerosis and the surgeon’s experience. Drilling has been shown to promote the healing of lesions with minimal surgical trauma. Microfractures, since they induce fibrocartilage repair, are to be considered only for small injuries. Mosaicplasty and osteochondral autograft transplantation may cause donor site morbidity and are techniques little reported in JODT. Regenerative techniques and fresh allografts give good results in osteochondral lesions, but further studies are required to describe the results that can be obtained in JODT alone. PMID:25750908

  17. Treatment of juvenile osteochondritis dissecans of the talus: current concepts review.

    PubMed

    Vannini, Francesca; Cavallo, Marco; Baldassarri, Matteo; Castagnini, Francesco; Olivieri, Alessandra; Ferranti, Enrico; Buda, Roberto; Giannini, Sandro

    2014-01-01

    Juvenile osteochondritis dissecans of the talus (JODT) affects the subchondral bone primarily and, in a skeletally immature population, articular cartilage secondarily. It probably consists of aseptic bone necrosis whose spontaneous healing is impaired by microtraumas, resulting in an osteochondral injury and, in some cases, in osteoarthritis. In many cases the clinical presentation is asymptomatic. Mild chronic pain is frequent, sometimes accompanied by swelling, stiffness or locking. Few data are currently available on this topic and, moreover, most existing data were obtained from mixed groups and populations; it is therefore difficult to outline a scheme for the treatment of JODT. However, the most suitable treatment in the first stages of the disease is conservative. The presence of a loose body is an indication for surgical fixation, drilling or regenerative procedures, depending on the presence/extent of subchondral bone sclerosis and the surgeon's experience. Drilling has been shown to promote the healing of lesions with minimal surgical trauma. Microfractures, since they induce fibrocartilage repair, are to be considered only for small injuries. Mosaicplasty and osteochondral autograft transplantation may cause donor site morbidity and are techniques little reported in JODT. Regenerative techniques and fresh allografts give good results in osteochondral lesions, but further studies are required to describe the results that can be obtained in JODT alone.

  18. Hair Follicle Regeneration in Skin Grafts: Current Concepts and Future Perspectives

    PubMed Central

    Mahjour, Seyed Babak; Ghaffarpasand, Fariborz

    2012-01-01

    The repair and management of full-thickness skin defects resulting from burns and chronic wounds remain a significant unmet clinical challenge. For those skin defects exceeding 50%–60% of total body surface area, it is impractical to treat with autologous skin transplants because of the shortage of donor sites. The possibility of using tissue-engineered skin grafts for full-thickness wound repair is a promising approach. The primary goal of tissue-engineered skin grafts is to restore lost barrier function, but regeneration of appendages, such as hair follicles, has to be yet achieved. The successful regeneration of hair follicles in immunodeficient mice suggests that creating human hair follicles in tissue-engineered skin grafts is feasible. However, many limitations still need to be explored, particularly enriching isolated cells with trichogenic capacity, maintaining this ability during processing, and providing the cells with proper environmental cues. Current advances in hair follicle regeneration, in vitro and in vivo, are concisely summarized in this report, and key requirements to bioengineer a hair follicle are proposed, with emphasis on a three-dimensional approach. PMID:21883016

  19. Anti-IgE therapy with omalizumab for severe asthma: current concepts and potential developments.

    PubMed

    Pelaia, Girolamo; Vatrella, Alessandro; Busceti, Maria Teresa; Gallelli, Luca; Terracciano, Rosa; Maselli, Rosario

    2015-01-01

    The humanized monoclonal anti-IgE antibody omalizumab is currently the only biologic drug approved for asthma treatment. Omalizumab inhibits allergic responses by binding to serum immunoglobulins E (IgE), thus preventing their interactions with cellular IgE receptors. Omalizumab is also capable of down-regulating the expression of high affinity IgE receptors on inflammatory cells, as well as the numbers of eosinophils in both peripheral blood and induced sputum. The clinical effects of omalizumab include relevant improvements in respiratory symptoms and quality of life, paralleled by a marked reduction of asthma exacerbations, emergency room visits, and use of systemic corticosteroids and rescue bronchodilators. Moreover, some recent studies suggest potential benefits of omalizumab also in non allergic phenotypes of severe asthma. Very interesting are also further recent reports referring to the potential inhibitory effect of omalizumab with regard to bronchial structural changes, especially occurring in severe asthma and globally defined as airway remodeling. Omalizumab is relatively well tolerated, and only very rarely induces anaphylactic reactions. Therefore, this drug represents a valid option as add-on therapy for patients with severe persistent asthma, inadequately controlled by high doses of standard inhaled treatments.

  20. Variable uses of alternative conceptions: A case study in current electricity

    NASA Astrophysics Data System (ADS)

    Heller, Patricia M.; Finley, Fred N.

    Recent research related to the design of science instruction is often based on conceptual change theory and requires assessments of what knowledge students bring to instruction. The premise of this study was that it is also important to understand when and how students apply their knowledge. Fourteen elementary and middle school teachers in an in-service physics course were asked to solve qualitatively a variety of series and parallel circuit problems and explicate their reasoning. These teachers were found to share a common core of strongly held propositions that formed a coherent, but incorrect and contradictory model of sequential current flow. Yet their predictions about the circuits were highly variable. The variability in predictions resulted from differences and contradictions in additional protective belts of propositions, and differences in the ways in which the teachers changed and selectively applied those propositions to different problems. Understanding the variations in not only what teachers knew, but also the differences in when and how they applied their knowledge complicated the task of designing instruction. However, it also made possible the design of more precise instruction in which the teachers were required to recognize, confront, and reconcile specific inconsistencies in their beliefs.

  1. Hand Blisters in Major League Baseball Pitchers: Current Concepts and Management.

    PubMed

    McNamara, Andrew R; Ensell, Scott; Farley, Timothy D

    2016-01-01

    Friction blisters are a common sequela of many athletic activities. Their significance can range from minor annoyance to major performance disruptions. The latter is particularly true in baseball pitchers, who sustain repeated trauma between the baseball seams and the fingers of the pitching hand, predominately at the tips of the index and long fingers. Since 2010, 6 Major League Baseball (MLB) players accounted for 7 stints on the disabled list (DL) due to blisters. These injuries resulted in a total of 151 days spent on the DL. Since 2012, 8 minor league players spent time on the DL due to blisters. Moreover, there have been several documented and publicized instances of professional baseball pitchers suffering blisters that did not require placement on the DL but did result in injury time and missed starts. The purpose of this article is to review the etiology and pathophysiology of friction blisters with particular reference to baseball pitchers; provide an overview of past and current prevention methods; and discuss our experience in treating friction blisters in MLB pitchers.

  2. Orthopedic disorders of the knee in hemophilia: A current concept review

    PubMed Central

    Rodriguez-Merchan, E Carlos; Valentino, Leonard A

    2016-01-01

    The knee is frequently affected by severe orthopedic changes known as hemophilic arthropathy (HA) in patients with deficiency of coagulation factor VIII or IX and thus this manuscript seeks to present a current perspective of the role of the orthopedic surgeon in the management of these problems. Lifelong factor replacement therapy (FRT) is optimal to prevent HA, however adherence to this regerous treatment is challenging leading to breakthrough bleeding. In patients with chronic hemophilic synovitis, the prelude to HA, radiosynovectomy (RS) is the optimal to ameliorate bleeding. Surgery in people with hemophilia (PWH) is associated with a high risk of bleeding and infection, and must be performed with FRT. A coordinated effort including orthopedic surgeons, hematologists, physical medicine and rehabilitation physicians, physiotherapists and other team members is key to optimal outcomes. Ideally, orthopedic procedures should be performed in specialized hospitals with experienced teams. Until we are able to prevent orthopedic problems of the knee in PWH will have to continue performing orthopedic procedures (arthrocentesis, RS, arthroscopic synovectomy, hamstring release, arthroscopic debridement, alignment osteotomy, and total knee arthroplasty). By using the aforementioned procedures, the quality of life of PWH will be improved. PMID:27335812

  3. Intralesional antigen immunotherapy for the treatment of warts: current concepts and future prospects.

    PubMed

    Nofal, Ahmad; Salah, Eman; Nofal, Eman; Yosef, Ayman

    2013-08-01

    Many destructive and immunotherapeutic modalities have been used for the management of warts; however, an optimal treatment with high efficacy and absent or low recurrence has not been explored to date. Recently, the use of intralesional immunotherapy with different antigens has shown promising efficacy in the treatment of warts. We review the different aspects of this new modality, including candidates, types of warts treated, dosage, number and interval between treatment sessions, mode of action, efficacy, adverse effects, recurrence rate, advantages, disadvantages, current place and future prospects. A literature review revealed that healthy immune subjects are the best candidates, and a pre-sensitization test is usually done before the start of therapy. The dosage, the number and interval between sessions, and the success rates varied among the different studies. The mode of action is still uncertain, but is essentially mediated through stimulation of T helper-1 cell cytokine response. Adverse effects are mild and generally insignificant, and the recurrence rate is absent or low. Intralesional antigen immunotherapy seems to be a promising, effective and safe treatment modality for viral warts. Future well-designed and controlled studies would help to more clearly define its place in the challenging field of wart therapy.

  4. Anti-tumor necrosis factor alpha for retinal diseases: current knowledge and future concepts.

    PubMed

    Mirshahi, Alireza; Hoehn, René; Lorenz, Katrin; Kramann, Christina; Baatz, Holger

    2012-01-01

    Tumor necrosis factor alpha (TNF-α) is a pro-inflammatory cytokine produced by macrophages and T-cells. It plays an important role both in inflammation and apoptosis. In the eye, TNF-α appears to have a role in the pathogenesis of inflammatory, edematous, neovascular and neurodegenerative disorders. Several TNF-blocking drugs have been developed and approved, and are in clinical use for inflammatory diseases such as rheumatoid arthritis, psoriasis and ankylosing spondylitis. TNF-α blockers are widely used in ophthalmology as an off-label alternative to "traditional" immunosuppressive and immune-modulatory treatments in noninfectious uveitis. Preliminary studies suggest a positive effect of intravenously administered TNF-α blockers, mainly infliximab, for treating refractory diabetic macular edema and neovascular age-related macular degeneration. Unfortunately, much of the current data raises considerable safety concerns for intravitreal use of TNF-α inhibitors, in particular, intraocular inflammatory responses have been reported after intravitreal injection of infliximab. Results of dose-finding studies and humanized antibody or antibody fragments (e.g. adalimumab) are anticipated in the coming years; these will shed light on potential benefits and risks of local and systemic TNF-α blockers used for treatment of diseases of the retina and choroid.

  5. Current concepts in the treatment of intra-articular calcaneal fractures: results of a nationwide survey

    PubMed Central

    van Lieshout, E. M. M.; van Ginhoven, T. M.; Heetveld, M. J.; Patka, P.

    2007-01-01

    The treatment of intra-articular calcaneal fractures is controversial and randomised clinical trials are scarce. Moreover, the socio-economic cost remains unclear. The aim of this study was to estimate the incidence, treatment preferences and socio-economic cost of this complex fracture in the Netherlands. This data may aid in planning future clinical trials and support education. The method of study was of a cross-sectional survey design. A written survey was sent to one representative of both the traumatology and the orthopaedic staff in each hospital in the Netherlands. Data on incidence, treatment modalities, complications and follow-up strategies were recorded. The socio-economic cost was calculated. The average response rate was 70%. Fracture classifications, mostly by Sanders and Essex-Lopresti, were applied by 29%. Annually, 920 intra-articular calcaneal fractures (0.4% incidence rate) were treated, mainly with ORIF (46%), conservative (39%) and percutaneous (10%) treatment. The average non-weight-bearing mobilisation was 9 weeks (SD 2 weeks). An outcome score, mainly AOFAS, was documented by 7%. A secondary arthrodesis was performed in 21% of patients. The socio-economic cost was estimated to be €21.5–30.7 million. Dutch intra-articular calcaneal fracture incidence is at least 0.4% of all fractures presenting to hospitals. Better insight into treatment modalities currently employed and costs in the Netherlands was obtained. PMID:17564705

  6. Microsurgical reconstruction of the head and neck--current concepts of maxillofacial surgery in Europe.

    PubMed

    Kansy, Katinka; Mueller, Andreas Albert; Mücke, Thomas; Kopp, Jean-Baptiste; Koersgen, Friederike; Wolff, Klaus Dietrich; Zeilhofer, Hans-Florian; Hölzle, Frank; Pradel, Winnie; Schneider, Matthias; Kolk, Andreas; Smeets, Ralf; Acero, Julio; Hoffmann, Jürgen

    2014-12-01

    Microvascular surgery following tumour resection has become an important field of oral maxillofacial surgery (OMFS). This paper aims to evaluate current microsurgical practice in Europe. The questionnaire of the DOESAK collaborative group for Microsurgical Reconstruction was translated into English, transformed into an online based survey and distributed to 200 OMFS units with the aid of the European Association for Cranio-Maxillo-Facial Surgery (EACMFS). 65 complete and 72 incomplete questionnaires were returned. Hospitals from the United Kingdom, France, Italy, the Netherlands, Spain, Belgium, Greece, Slovenia and Lithuania participated. 71% of contributing centres were university hospitals, 87% out of these perform microvascular tumour surgery at least on a two-weekly base. Overall complication rate was at around five percent. Most frequently used transplants were the radial forearm flap and the fibular flap. The perioperative management varied widely. Success factors for flap survival, however, were uniformly rated, with the surgical skill being the most important factor, followed by the quality of postoperative management. Medication seems to play a less important role. Within Europe microvascular surgery is a common and safe procedure for maxillofacial reconstructive surgery in the field of OMFS. While there is a major accordance for the surgical procedure itself and the most frequently used flaps, perioperative management shows a wide variety of protocols with low presumed impact on surgical outcome. Copyright © 2014 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  7. An insight into current concepts and techniques in resin bonding to high strength ceramics.

    PubMed

    Luthra, R; Kaur, P

    2016-06-01

    Reliable bonding between high strength ceramics and resin composite cement is difficult to achieve because of their chemical inertness and lack of silica content. The aim of this review was to assess the current literature describing methods for resin bonding to ceramics with high flexural strength such as glass-infiltrated alumina and zirconia, densely sintered alumina and yttria-partially stabilized tetragonal zirconia polycrystalline ceramic (Y-TZP) with respect to bond strength and bond durability. Suitable peer reviewed publications in the English language were identified through searches performed in PubMed, Google Search and handsearches. The keywords or phrases used were 'resin-ceramic bond', 'silane coupling agents', 'air particle abrasion', 'zirconia ceramic' and 'resin composite cements'. Studies from January 1989 to June 2015 were included. The literature demonstrated that there are multiple techniques available for surface treatments but bond strength testing under different investigations have produced conflicting results. Within the scope of this review, there is no evidence to support a universal technique of ceramic surface treatment for adhesive cementation. A combination of chemical and mechanical treatments might be the recommended solution. The hydrolytic stability of the resin ceramic bond should be enhanced. © 2016 Australian Dental Association.

  8. Current Concepts and Diagnosis of IgG4-Related Pancreatitis (Type 1 AIP).

    PubMed

    Kawa, Shigeyuki

    2016-08-01

    Although now considered to be a member of the systemic entity of immunoglobulin G4- (IgG4-) related disease, IgG4-related pancreatitis is generally referred to as type 1 autoimmune pancreatitis (AIP). Type 1 AIP was established based on a pathological background of lymphoplasmacytic sclerosing pancreatitis, high serum IgG4 concentration, and abundant IgG4-bearing plasma cell infiltration. The characteristic clinical features of type 1 AIP, such as elderly male preponderance, obstructive jaundice, and mass-forming lesions in the pancreas, often mimic those of pancreatic cancer. However, because AIP responds favorably to corticosteroid treatment, careful differentiation from pancreatic cancer is required. An AIP diagnosis is currently based on the 2011 International Consensus Diagnostic Criteria for AIP, which are based on high sensitivity, selectivity, and accuracy. Over the long term, AIP can progress to a chronic condition, with pancreatic stone formation and atrophy resembling that of chronic pancreatitis. Although AIP has been linked to the complication of malignancies, it remains controversial whether an association exists between the disease and tumor formation.

  9. Organ Preservation: Current Concepts and New Strategies for the Next Decade

    PubMed Central

    Guibert, Edgardo E.; Petrenko, Alexander Y.; Balaban, Cecilia L.; Somov, Alexander Y.; Rodriguez, Joaquín V.; Fuller, Barry J.

    2011-01-01

    Summary Organ transplantation has developed over the past 50 years to reach the sophisticated and integrated clinical service of today through several advances in science. One of the most important of these has been the ability to apply organ preservation protocols to deliver donor organs of high quality, via a network of organ exchange to match the most suitable recipient patient to the best available organ, capable of rapid resumption of life-sustaining function in the recipient patient. This has only been possible by amassing a good understanding of the potential effects of hypoxic injury on donated organs, and how to prevent these by applying organ preservation. This review sets out the history of organ preservation, how applications of hypothermia have become central to the process, and what the current status is for the range of solid organs commonly transplanted. The science of organ preservation is constantly being updated with new knowledge and ideas, and the review also discusses what innovations are coming close to clinical reality to meet the growing demands for high quality organs in transplantation over the next few years. PMID:21566713

  10. Current concepts on the virulence mechanisms of meticillin-resistant Staphylococcus aureus

    PubMed Central

    David, Michael Z.; Salata, Robert A.

    2012-01-01

    Meticillin-resistant Staphylococcus aureus (MRSA) strains are prevalent bacterial pathogens that cause both health care and community-associated infections. Increasing resistance to commonly prescribed antibiotics has made MRSA a serious threat to public health throughout the world. The USA300 strain of MRSA has been responsible for an epidemic of community-associated infections in the US, mostly involving skin and soft tissue but also more serious invasive syndromes such as pneumonia, severe sepsis and endocarditis. MRSA strains are particularly serious and potentially lethal pathogens that possess virulence mechanisms including toxins, adhesins, enzymes and immunomodulators. One of these is Panton–Valentine leukocidin (PVL), a toxin associated with abscess formation and severe necrotizing pneumonia. Earlier studies suggested that PVL was a major virulence factor in community-associated MRSA infections. However, some recent data have not supported this association while others have, leading to controversy. Therefore, investigators continue to search for additional mechanisms of pathogenesis. In this review, we summarize the current understanding of the biological basis of MRSA virulence and explore future directions for research, including potential vaccines and antivirulence therapies under development that might allow clinicians to more successfully treat and prevent MRSA infections. PMID:22745137

  11. Cell-based therapies for intervertebral disc and cartilage regeneration- Current concepts, parallels, and perspectives.

    PubMed

    Vedicherla, Srujana; Buckley, Conor T

    2017-01-01

    Lower back pain from degenerative disc disease represents a global health burden, and presents a prominent opportunity for regenerative therapeutics. While current regenerative therapies such as autologous disc chondrocyte transplantation (ADCT), allogeneic juvenile chondrocyte implantation (NuQu®), and immunoselected allogeneic adipose derived precursor cells (Mesoblast) show exciting clinical potential, limitations remain. The heterogeneity of preclinical approaches and the paucity of clinical guidance have limited translational outcomes in disc repair, lagging almost a decade behind cartilage repair. Advances in cartilage repair have evolved to single step approaches with improved orthopedic repair and regeneration. Elements from cartilage regeneration endeavors could be adopted and applied to harness translatable approaches and deliver a clinically and economically feasible regenerative surgery for back pain. In this article, we trace the developments behind the translational success of cartilage repair, examine elements to consider in achieving disc regeneration, and the need for surgical redesign. We further discuss clinical parameters, objectives, and coordination required to deliver improved regenerative surgery. Cell source, processing, and delivery modalities are key issues to be addressed in considering surgical redesign. Advances in biomanufacturing, tissue cryobanking, and point of care cell processing technology may enable intraoperative solutions for single step procedures. To maximize translational success a triad partnership between clinicians, industry, and researchers will be critical in providing instructive clinical guidelines for design as well as practical and economic considerations. This will allow a consensus in research ventures and add regenerative surgery into the algorithm in managing and treating a debilitating condition such as back pain. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35

  12. Evaluation and Classification of Stress Urinary Incontinence: Current Concepts and Future Directions.

    PubMed

    Osman, Nadir I; Marzi, Vincenzo Li; Cornu, Jean N; Drake, Marcus J

    2016-08-01

    Stress urinary incontinence (SUI) is a common and bothersome problem that frequently requires operative management. Over the past two decades, novel techniques have been introduced into clinical practice. With the greater variety of surgical options now available, there is an increasing focus on selecting the appropriate procedure for the individual patient based on the likely underlying pathophysiologic mechanism. To review the methods used in the evaluation of SUI and the proposed classification systems. A search of the PubMed database for the relevant search terms was conducted, and selected articles were retrieved and reviewed. Standardised terminology for the description of SUI has been produced by the International Continence Society describing the problem in terms of symptoms, clinical signs, and urodynamic observations. The two major pathophysiologic theories that have emerged over the past 50 yr, urethral hypermobility and intrinsic sphincteric deficiency, have influenced the development and adoption of surgical techniques. It is now recognised that these two entities are not dichotomous but often coexist. The primary aim of the evaluation of the patient presenting with SUI is to confirm the diagnosis and assess symptom severity before instituting conservative treatments. Secondary evaluation consists of more sophisticated techniques that assess anatomy of the bladder neck and urethra under rest and stress (eg, videourodynamics, ultrasound) or direct or indirect physiologic measures of the integrity of the sphincter mechanism. Classification of patients with SUI into distinct groups based on probable pathophysiologic mechanism could help guide the choice of surgical procedure, but current systems are likely too simplistic, and methods of assessment lack standardisation in techniques and sensitivity. Urinary leakage on exertion, termed stress incontinence, is a common problem that affects many women. There is a need to develop better ways of categorising

  13. Current concepts of team training in surgical residency: a survey of North American program directors.

    PubMed

    Dedy, Nicolas J; Zevin, Boris; Bonrath, Esther M; Grantcharov, Teodor P

    2013-01-01

    The purpose of the present survey was to (1) establish the prevalence of Crew Resource Management (CRM)- and team-training interventions among general surgery residency programs of the United States and Canada; (2) to characterize current approaches to training and assessment of nontechnical skills; and (3) to inquire about program directors' (PDs') recommendations for future curricula in graduate medical education. An online questionnaire was developed by the authors and distributed via email to the directors of all accredited general surgery residency programs across the United States and Canada. After 3 email reminders, paper versions were sent to all nonresponders. PDs of accredited general surgery residency programs in the United States and Canada. One hundred twenty (47%) PDs from the United States and 9 (53%) from Canada responded to the survey. Of all respondents, 32% (n = 40) indicated conducting designated team-training interventions for residents. Three main instructional strategies were identified: combined approaches using simulation and didactic methods (42%, n = 16); predominantly simulation-based approaches (37%, n = 14); and didactic approaches (21%, n = 8). Correspondingly, 83% (n = 93) of respondents recommended a combination of didactic methods and opportunities for practice for future curricula. A high agreement between responding PDs was shown regarding learning objectives for a proposed team-based training curriculum (α = 0.95). The self-reported prevalence of designated CRM- and team-training interventions among responding surgical residency programs was low. For the design of future curricula, the vast majority of responding PDs advocated for the combination of interactive didactic methods and opportunities for practice. Copyright © 2013 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  14. Current Concepts and Unresolved Questions in Dietary Protein Requirements and Supplements in Adults.

    PubMed

    Phillips, Stuart M

    2017-01-01

    Protein needs for otherwise healthy individuals older than 19 years are defined by the recommended dietary allowance (RDA) at 0.80 g protein/kg/day. There is no recommendation in the current RDA for subpopulations of older adults or people in various pathological situations. Despite the lack of a separate recommendation, there exists a growing body of evidence that is strongly suggestive of an increased need and/or benefit for protein in older persons. That is, intakes beyond the RDA are, in older persons, associated with benefits. In addition, a number of catabolic states including critical illness also result in a sharp elevation in the needs for protein and amino acids. An underappreciated issue in protein nutrition is the impact of protein quality on clinically relevant outcomes. The introduction of a new protein scoring system-the digestible indispensable amino acid score (DIAAS)-for protein quality has raised a forgotten awareness of protein quality. The DIAAS, which replaces the protein digestibility-corrected amino acid score (PDCAAS), is based on ileal digestibility of protein and a different test protein than PDCAAS and has values greater than 1.0. The aim of this article is a brief review and summary recommendations for protein nutrition and protein requirements in populations who would benefit from more protein than the RDA. The emphasis of the review is on muscle protein turnover, and there is a discussion of the impact of protein quality, particularly as it applies to commercially available protein sources. The evidence for more optimal protein intakes is considered in light of the potential health risks of consumption of protein at levels greater than the RDA.

  15. Current concepts in diagnosis and perioperative management of carcinoid heart disease.

    PubMed

    Castillo, Javier G; Silvay, George; Solís, Jorge

    2013-09-01

    Carcinoid tumors are neuroendocrine tumors with a very unpredictable clinical behavior. In the setting of hepatic metastases, the tumor's release of bioactive substances into the systemic circulation results in carcinoid syndrome: a constellation of symptoms among which cutaneous flushing, gastrointestinal hypermotility, and cardiac involvement are the most prominent. Cardiac manifestations, also known as carcinoid heart disease, are secondary to a severe fibrotic reaction which frequently involves the right-sided valves and may extend towards the subvalvular apparatus leading to valve thickening and retraction. Left-sided involvement is rare and mostly observed in the presence of an interatrial shunt, endobronchial tumor localization, and high tumor activity. Echocardiographic techniques often reveal noncoaptation of the valves, which are fixed in a semiopen position. In patients with advanced lesions and severe valvular dysfunction, surgery is currently the only definitive treatment to potentially improve quality of life and provide survival benefit. Although cardiac surgery has been traditionally reserved for those patients with symptomatic right ventricular failure, a significant trend towards improved surgical outcomes has triggered a more liberal referral for valve replacement. Carcinoid heart disease poses two distinct challenges for the anesthesiologist: carcinoid crisis and low cardiac output syndrome secondary to right ventricular failure. Carcinoid crisis, characterized by flushing, hypotension, and bronchospasm, may be precipitated by catecholamines and histamine releasing drugs used routinely in patients undergoing valve surgery. Although a broader utilization of octreotide have significantly simplified the anesthetic and perioperative management of these patients, a very balanced anesthetic technique is required to identify and manage low cardiac output syndrome.

  16. Current Concepts and Unresolved Questions in Dietary Protein Requirements and Supplements in Adults

    PubMed Central

    Phillips, Stuart M.

    2017-01-01

    Protein needs for otherwise healthy individuals older than 19 years are defined by the recommended dietary allowance (RDA) at 0.80 g protein/kg/day. There is no recommendation in the current RDA for subpopulations of older adults or people in various pathological situations. Despite the lack of a separate recommendation, there exists a growing body of evidence that is strongly suggestive of an increased need and/or benefit for protein in older persons. That is, intakes beyond the RDA are, in older persons, associated with benefits. In addition, a number of catabolic states including critical illness also result in a sharp elevation in the needs for protein and amino acids. An underappreciated issue in protein nutrition is the impact of protein quality on clinically relevant outcomes. The introduction of a new protein scoring system—the digestible indispensable amino acid score (DIAAS)—for protein quality has raised a forgotten awareness of protein quality. The DIAAS, which replaces the protein digestibility-corrected amino acid score (PDCAAS), is based on ileal digestibility of protein and a different test protein than PDCAAS and has values greater than 1.0. The aim of this article is a brief review and summary recommendations for protein nutrition and protein requirements in populations who would benefit from more protein than the RDA. The emphasis of the review is on muscle protein turnover, and there is a discussion of the impact of protein quality, particularly as it applies to commercially available protein sources. The evidence for more optimal protein intakes is considered in light of the potential health risks of consumption of protein at levels greater than the RDA. PMID:28534027

  17. Tribology and total hip joint replacement: current concepts in mechanical simulation.

    PubMed

    Affatato, S; Spinelli, M; Zavalloni, M; Mazzega-Fabbro, C; Viceconti, M

    2008-12-01

    Interest in the rheology and effects of interacting surfaces is as ancient as man. This subject can be represented by a recently coined word: tribology. This term is derived from the Greek word "tribos" and means the "science of rubbing". Friction, lubrication, and wear mechanism in the common English language means the precise field of interest of tribology. Wear of total hip prosthesis is a significant clinical problem that involves, nowadays, a too high a number of patients. In order to acquire further knowledge on the tribological phenomena that involve hip prosthesis wear tests are conducted on employed materials to extend lifetime of orthopaedic implants. The most basic type of test device is the material wear machine, however, a more advanced one may more accurately reproduce some of the in vivo conditions. Typically, these apparatus are called simulators, and, while there is no absolute definition of a joint simulator, its description as a mechanical rig used to test a joint replacement, under conditions approximating those occurring in the human body, is acceptable. Simulator tests, moreover, can be used to conduct accelerated protocols that replicate/simulate particularly extreme conditions, thus establishing the limits of performance for the material. Simulators vary in their level of sophistication and the international literature reveals many interpretations of the design of machines used for joint replacement testing. This paper aims to review the current state of the art of the hip joint simulators worldwide. This is specified through a schematic overview by describing, in particular, constructive solutions adopted to reproduce in vivo conditions. An exhaustive commentary on the evolution and actually existing simulation standards is proposed by the authors. The need of a shared protocol among research laboratories all over the world could lead to a consensus conference.

  18. Satellite missions, global environment, and the concept of a global satellite observation information network - The role of the Committee on Earth Observation Satellites (CEOS)

    NASA Astrophysics Data System (ADS)

    Smith, D. B.; Williams, David F.; Fujita, Akihiro

    1993-10-01

    The efforts of the Committee on Earth Observation Satellites (CEOS) to assure broad user access to satellite-produced data is discussed. The role of CEOS in fostering acceptance of applications of those data in areas such as disaster monitoring and mitigation, land cover change, weather forecasting, and long-term climate modeling is addressed. The initiative of UK Prime Minister John Major calling for increased attention to CEOS is discussed along with the related CEOS Dossier effort. The tasks of the CEOS Secretariat in these areas are examined, and the role of CEOS is developing a global satellite network is considered. The future of CEOS is discussed.

  19. A List of Currently Credible Biology Concepts Judged by a National Panel To Be Important for Inclusion in K-12 Curricula, Parts 1, 2, and 3.

    ERIC Educational Resources Information Center

    Thompson, Benjamin Edwin

    This three-part document identified 114 currently credible biology concepts judged important for inclusion in the K-12 curriculum. The literature related to the production of lists of scientific concepts was reviewed, emphasizing the techniques available for such studies. The technique for this study was to ask individual biological scientists at…

  20. Is tissue an issue? Current practice and opinion in Western Australia for routine histopathology on products of conception.

    PubMed

    Yap, Shui-Jean; Watts, Jared C; Faithfull, Tiffany J; Wong, Sabrina Z; Wylde, Kate L; McGurgan, Paul M

    2014-10-01

    An anonymous questionnaire-based survey was used to determine current practices and opinions of senior health professionals working in Western Australian (WA) hospitals performing gynaecological procedures, regarding the routine use of histopathology for products of conception (POC) obtained either from the surgical management of miscarriage or termination of pregnancy. Sixty-one senior health professionals completed the survey. Tissue histopathology on POC was routinely requested for miscarriage and termination of pregnancy (TOP) by 87 and 59% of respondents, respectively. Respondents listed the main reasons for requesting routine histopathology as avoidance of misdiagnosis, medico-legal and quality assurance. There were inconsistent practices among WA health professionals regarding sending POC for histopathology; 63% of gynaecology head of departments recommend the introduction of state or national guidelines for the use of histopathology in the surgical management of miscarriages or terminations of pregnancy. © 2014 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

  1. The regulation of mammalian mRNA transcription by lncRNAs: recent discoveries and current concepts.

    PubMed

    Kugel, Jennifer F; Goodrich, James A

    2013-02-01

    Transcription by RNA Pol II is a tightly controlled process that is critical to normal cellular metabolism. Understanding how transcriptional regulation is orchestrated has mainly involved identifying and characterizing proteins that function as transcription factors. During the past decade, however, an increasing number of lncRNAs have been identified as transcriptional regulators. This revelation has spurred new discoveries, novel techniques and paradigm shifts, which together are redefining our understanding of transcriptional control and broadening our view of RNA function. Here, we summarize recent discoveries concerning the role of lncRNAs as regulators of mammalian mRNA transcription, with a focus on key concepts that are guiding current research in the field.

  2. Current Concepts in Dyslexia.

    ERIC Educational Resources Information Center

    Hartstein, Jack, Ed.

    The purpose of this book is to provide the reader with an overall view of the terms, people, and studies involved in the evaluation of dyslexic children. The topics discussed in the nine chapters are: "Introduction to Learning Disorders for the Ophthalmologist," by Jack Hartstein; "Interdisciplinary Approach to the Diagnosis of Reading Problems,"…

  3. Stroke: current concepts.

    PubMed

    Albertson, Megan; Sharma, Jitendra

    2014-11-01

    Cerebrovascular accidents (CVAs) are the leading cause of disability and the fourth leading cause of death in the U.S. The WHO defines stroke as "rapidly developing clinical signs of focal disturbance of cerebral function lasting more than 24 hours with no apparent cause other than of vascular origin." Strokes are subdivided into two major classifications: ischemic (80-87 percent) andhemorrhagic (13-20 percent). Ischemic strokes occur from thrombi, emboli, or global hypoperfusion. Hemorrhagic strokes are either parenchymal (10 percent of all strokes) or subarachnoid (3 percent of all strokes). There are a variety of recognized risk factors for stroke which include: age, race, family history, hypertension, diabetes mellitus, atherosclerosis, cardiac arrhythmias, prosthetic valves, hyperlipidemia, cigarette smoking, and others (drugs or hormones). The initial assessment of a patient suspected of stroke should be done quickly enough to ensure maximal reperfusion of brain tissue. The steps to achieve this goal are: 1) exclude an intracranial hemorrhage, 2) assess for contraindications to thrombolytics, 3) characterize the infarct. The workup for a patient should first include a history (especially the time when neurologic symptoms began), a physical exam (including the NIHSS), and imaging studies (to rule out hemorrhagic components). In addition, several lab studies can also be obtained including: PT/INR, glucose, complete blood count, metabolic panel, creatine kinase, ECG, echocardiogram, lipid panel, carotid Doppler, MRA or CTA. Acute management of a stroke is primarily focused on stabilizing the patient and allowing as much reperfusion as possible for at-risk brain tissue. Stroke management in the acute setting includes: use of thrombolytics if indicated, and re-assessment to monitor progression. Several trials have been completed in pursuit of safety and effectiveness of intra-arterial stroke therapy for patients outside the recommended thrombolytic time window, but so far they are only experimental treatment options. The best preventative measures for first time or recurrent stroke are: starting or switching antiplatelet therapy, treatment of cardiovascular risk factors (atrial fibrillation and carotid stenosis), optimization of hypertension, dyslipidemia and diabetes mellitus management, and smoking cessation.

  4. Current concepts: mallet finger.

    PubMed

    Alla, Sreenivasa R; Deal, Nicole D; Dempsey, Ian J

    2014-06-01

    Loss of the extensor mechanism at the distal interphalangeal (DIP) joint leads to mallet finger also known as baseball finger or drop finger. This can be secondary to tendon substance disruption or to a bony avulsion. Soft tissue mallet finger is the result of a rupture of the extensor tendon in Zone 1, and a bony mallet finger is the result of an avulsion of the extensor tendon from the distal phalanx with a small fragment of bone attached to the avulsed tendon. Mallet finger leads to an imbalance in the distribution of the extensor force between the proximal interphalangeal (PIP) and DIP joints. If left untreated, mallet finger leads to a swan neck deformity from PIP joint hyper extension and DIP joint flexion. Most mallet finger injuries can be managed non-surgically, but occasionally surgery is recommended for either an acute or a chronic mallet finger or for salvage of failed prior treatment.

  5. Current Concepts in Dermatology

    PubMed Central

    Jackson, Robert

    1963-01-01

    Many systemic diseases have cutaneous manifestations. In some diseases skin involvement is the predominant factor (Behçet's syndrome, urticaria pigmentosa, discoid lupus erythematosus and pseudoxanthoma elasticum); in others the skin manifestations, when present, are an important part of the condition (sarcoidosis, systemic lupus erythematosus, hypersensitivity angiitis, porphyria). This report includes descriptions of and comments on these cutaneous manifestations. Erythema nodosum and erythema multiforme are reaction patterns of the skin and mucous membrane which may have many causes. The relationship between discoid and systemic lupus erythematosus is discussed. There is little doubt that these are variations of the same basic disease process, even though the prognoses are very different. ImagesFig. 1Fig. 2Fig. 3Fig. 4Fig. 5Fig. 6 PMID:14063940

  6. Phaeochromocytoma: current concepts.

    PubMed

    Alderazi, Yaser; Yeh, Michael W; Robinson, Bruce G; Benn, Diana E; Sywak, Mark S; Learoyd, Diana L; Delbridge, Leigh W; Sidhu, Stan B

    2005-08-15

    The discovery of novel mutations in genes encoding succinate dehydrogenase subunits has revealed that familial phaeochromocytomas are much more common than previously thought. Genetic screening should be offered to patients with apparently sporadic phaeochromocytomas and their first-degree relatives. An increasing proportion of phaeochromocytomas present preclinically on genetic testing or as "incidentalomas" on abdominal imaging, rather than with classic symptoms and signs. Clinical suspicion should prompt measurement of plasma levels of free metanephrine or 24-hour urinary catecholamine and metanephrine levels, followed, if positive, by tumour localisation studies. With appropriate perioperative care, surgical management of phaeochromocytomas is safe and effective. Most tumours can be removed laparoscopically.

  7. Anaphyllaxis management: Current concepts

    PubMed Central

    Mali, Shrikant; Jambure, Rajesh

    2012-01-01

    Anaphylactic shock is medical emergency characterized by circulatory collapse resulted from severe acute allergic reactions, namely anaphylaxis and anaphylactoid reaction. Anaphylaxis is an acute, systemic, IgE-mediated, and immediate hypersensitivity reaction caused by the release of mediators by mast cells and basophils after exposure to antigens. The pathophysiology involves activated mast cells and basophils releasing preformed, granule-associated mediators, and newly formed lipid mediators, as well as generating cytokines and chemokines. These cause vasodilatation, increased capillary permeability, and smooth muscle contraction, and attract new cells to the area. Positive feedback mechanisms amplify the reaction, although conversely reactions can self-limit. Anaphylaxis is a clinical diagnosis with a combinations of symptoms and signs that include weakness, dizziness, flushing, angioedema, urticaria of the skin, congestion, and sneezing. More severe symptoms include bronchial constriction, hypotension, vascular collapse associated with angioedema and urticaria, gastrointestinal distress, cardiovascular arrhythmias, and arrest. Prompt administration of epinephrine is critical for the success in the treatment of acute anaphylaxis. PMID:25885603

  8. Current concept of photocarcinogenesis.

    PubMed

    Nishisgori, Chikako

    2015-09-26

    There is ample evidence demonstrating that solar ultraviolet light (UV) induces human skin cancers. First, epidemiological studies have demonstrated a negative correlation between the latitude of residence and incidence and mortality rates of both melanoma and non-melanoma skin cancers in homogeneous populations. Second, skin cancer can be produced in mice by UV irradiation; the action spectrum of photocarcinogenesis falls into UVB (280-320 nm). Third, patients with genetic disorders that lead to deficiencies in repairing UV-induced DNA damage are prone to develop cancers in sun-exposed areas of the skin. Photocarcinogenesis is a multistage process that involves initiation, promotion, and progression. In addition UV induced immunosuppression is closely involved in photocarcinogenesis. Accumulation of DNA lesions caused by UV in several cancer related genes plays a crucial role in carcinogenesis. Indeed, even in actinic keratosis, precancerous lesions, genetic alterations can be observed. A conventional knowledge demonstrated that UVB induced DNA lesion causes genetic mutation (initiation) and UVB-inflammation (sunburn) induces promotion. However recent findings revealed that the photocarcinogenesis pathway is more complex consequences where each of these processes, mediated by various cellular, biochemical, and molecular changes, are closely related to each other. The pyrimidine photoproducts that result from direct DNA damage induced by UV are involved in developing skin cancer through mutations that lead to the upregulation or downregulation of signal transduction pathways, cell cycle dysregulation, and depletion of antioxidant defenses. In addition pyrimidine dimers have been shown to trigger UV induced immunosuppression, which also plays an important role in photocarcinogenesis, partly by upregulation of IL-10, an immunosuppressive cytokine. UV also produces oxidative stress and oxidative DNA damage in skin cells, which cause alteration of the genes involved in the cell cycle, apoptosis and modification of cell signaling by redox regulation, resulting in inflammation. It has been shown that in Ogg1 knockout mice which are deficient in repairing 8-oxo-7, 8-dihydroguanine (8-oxoG), UVB irradiation up-regulates the inflammatory gene, implying that 8-oxoG is involved in triggering inflammation. In this review I summarize the state of the art knowledge regarding photocarcinogenesis including experimental data and implication for clinical viewpoints.

  9. Current concepts in psychodermatology.

    PubMed

    Gupta, Madhulika A; Gupta, Aditya K

    2014-06-01

    Several diagnoses in the new DSM-5 chapter on 'Obsessive-Compulsive and Related Disorders' directly relate to psychodermatology. The new excoriation (skin-picking) disorder (SPD) and trichotillomania (TTM) both manifest as recurrent body-focused repetitive behaviors that have compulsive and dissociative features, the latter being more prevalent in TTM than SPD. The DSM-5 refers to SPD and TTM occurring without full awareness or preceding tension, however does not specifically mention the possible role of dissociation. This has important treatment implications, as patients with high dissociative symptoms are not likely to respond to the standard treatments for obsessive-compulsive disorder. Body dysmorphic disorder (BDD), which is frequently associated with cutaneous body image (CBI) dissatisfaction, is present in 9%-15% of dermatology patients. Treatment guidelines in dermatology are increasingly considering the psychosocial morbidity related to CBI in their treatment outcome measures. The presence of BDD, if unrecognized, may therefore directly affect the dermatologic treatment regimens offered to the patient.

  10. Dance medicine: current concepts.

    PubMed

    Miller, Clay

    2006-11-01

    Dance medicine has grown exponentially over the past 10 to 15 years and continues to grow every year as more former professional dancers and students of dance enter into the field of medicine. Dance medicine is part of the field of performing arts medicine, which specializes in evaluating and treating performing artists such as musicians, dancers, actors/actresses, and vocalists. This article reviews the literature on dance medicine for various health-related medical issues, for the types of injuries commonly found, for the common surgical and rehabilitation interventions, and for injury prevention used in this unique group of patients.

  11. [Report from the Committee for Advanced Therapies (CAT). Pitfalls on the way from concept to medical treatment with advanced therapy medicinal products].

    PubMed

    Reiss, M; Büttel, I C; Schneider, C K

    2011-07-01

    Advanced therapy medicinal products (ATMP) are highly innovative and complex medicines. They comprise gene therapy medicinal products, somatic cell therapy medicinal products, and tissue-engineered products (TEP). With the European Regulation on ATMP that came into force in 2008, a consolidated regulatory framework was created, where the Committee for Advanced Therapies (CAT) at the European Medicines Agency (EMA) plays a central role. This article discusses pitfalls and challenges that the CAT has experienced in its discussions of various procedures. Often ATMPs are developed by small and medium-sized enterprises (SME) which also face nonscientific challenges. The CAT wishes to meet these challenges on a scientific and regulatory level during its 2010-2015 work program.

  12. Molecular and cellular biology of cerebral arteriovenous malformations: a review of current concepts and future trends in treatment.

    PubMed

    Rangel-Castilla, Leonardo; Russin, Jonathan J; Martinez-Del-Campo, Eduardo; Soriano-Baron, Hector; Spetzler, Robert F; Nakaji, Peter

    2014-09-01

    Arteriovenous malformations (AVMs) are classically described as congenital static lesions. However, in addition to rupturing, AVMs can undergo growth, remodeling, and regression. These phenomena are directly related to cellular, molecular, and physiological processes. Understanding these relationships is essential to direct future diagnostic and therapeutic strategies. The authors performed a search of the contemporary literature to review current information regarding the molecular and cellular biology of AVMs and how this biology will impact their potential future management. A PubMed search was performed using the key words "genetic," "molecular," "brain," "cerebral," "arteriovenous," "malformation," "rupture," "management," "embolization," and "radiosurgery." Only English-language papers were considered. The reference lists of all papers selected for full-text assessment were reviewed. Current concepts in genetic polymorphisms, growth factors, angiopoietins, apoptosis, endothelial cells, pathophysiology, clinical syndromes, medical treatment (including tetracycline and microRNA-18a), radiation therapy, endovascular embolization, and surgical treatment as they apply to AVMs are discussed. Understanding the complex cellular biology, physiology, hemodynamics, and flow-related phenomena of AVMs is critical for defining and predicting their behavior, developing novel drug treatments, and improving endovascular and surgical therapies.

  13. Update of technical coordinating committee activities

    SciTech Connect

    Alvarado, R.A.

    1995-12-31

    The Technical Coordinating Committee has its origins in the earliest days of implementing the Low-Level Radioactive Waste Policy Act. Between 1982 and 1985, individuals in several of the states felt that coordination among the states would be beneficial to all by affording states a cost-effective method for sharing ideas, discussing alternatives, and presenting solutions to common problems. At the current time, the committee comprises members from each of the sited states. Various compacts, federal agencies, and industry groups participate in committee activities. The Low-Level Management Program provides support for the committee through the provision of logistical support and limited manpower allocation. Activities of the committee have recently focused on waste treatment and minimization technologies. The committee also has worked diligently to see the review of the 3RSTAT computer code completed. The committee has taken a position on various regulatory proposals the past year. The committee expects to continue its work until new sites are brought online.

  14. 49 CFR 95.11 - Meetings; industry advisory committees.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 1 2010-10-01 2010-10-01 false Meetings; industry advisory committees. 95.11... Meetings; industry advisory committees. (a) Meetings of an industry advisory committee may be held only at...) No industry advisory committee may receive, compile, or discuss data or reports showing the current...

  15. A Systemic View of the Learning and Differentiation of Scientific Concepts: The Case of Electric Current and Voltage Revisited

    ERIC Educational Resources Information Center

    Koponen, Ismo T.; Kokkonen, Tommi

    2014-01-01

    In learning conceptual knowledge in physics, a common problem is the incompleteness of a learning process, where students' personal, often undifferentiated concepts take on more scientific and differentiated form. With regard to such concept learning and differentiation, this study proposes a systemic view in which concepts are considered as…

  16. CCCT - NCTN Steering Committees - Gynecologic Cancers

    Cancer.gov

    The Gynecologic Cancers Steering Committee evaluates and prioritizes concepts for phase 2 and 3 clinical trials in adult gynecologic cancers. The GCSC is also intent on fostering collaboration with international groups and institutions conducting trials.

  17. Chronic daily headache in children and adolescents: current status and recommendations for the future. Pediatric Committee of the American Association for the Study of Headache.

    PubMed

    Gladstein, J; Holden, E W; Winner, P; Linder, S

    1997-01-01

    The Pediatric Committee of the American Association for the Study of Headache was created in 1994 to develop a plan for comprehensively addressing global issues of headache in childhood. It was the impression of clinicians and researchers with an interest in childhood headaches that a clearer focus was needed to facilitate progress in the study and management of pediatric headache. It was further felt that approaches to treatment and outcomes, as well as assessment and classification schema for pediatric patients needed to be examined separately. The goal of the committee is to integrate anecdotal, clinical, and research expertise into a plan for addressing headaches in the pediatric population in the future. During the last 5 years, substantial attention has been devoted to chronic daily headache, primarily in adult populations. It is the purpose of this paper to review the literature of chronic daily headache in children, and propose areas for further exploration, given the recent emergence of interest in this diagnostic entity.

  18. Current trends in tendinopathy: consensus of the ESSKA basic science committee. Part I: biology, biomechanics, anatomy and an exercise-based approach.

    PubMed

    Abat, F; Alfredson, H; Cucchiarini, M; Madry, H; Marmotti, A; Mouton, C; Oliveira, J M; Pereira, H; Peretti, G M; Romero-Rodriguez, D; Spang, C; Stephen, J; van Bergen, C J A; de Girolamo, L

    2017-12-01

    Chronic tendinopathies represent a major problem in the clinical practice of sports orthopaedic surgeons, sports doctors and other health professionals involved in the treatment of athletes and patients that perform repetitive actions. The lack of consensus relative to the diagnostic tools and treatment modalities represents a management dilemma for these professionals. With this review, the purpose of the ESSKA Basic Science Committee is to establish guidelines for understanding, diagnosing and treating this complex pathology.

  19. The Development Committee. Effective Committees. Board Basics.

    ERIC Educational Resources Information Center

    Evans, Gary

    1997-01-01

    A college or university governing board's development committee (or foundation board in a public institution) has both oversight of and broad responsibility for institutional fund-raising activities. Committee members have an additional role that colleagues on other committees do not--active participation in fund-raising. The committee sets goals,…

  20. Regenerative healing, scar-free healing and scar formation across the species: current concepts and future perspectives.

    PubMed

    Ud-Din, Sara; Volk, Susan W; Bayat, Ardeshir

    2014-09-01

    All species have evolved mechanisms of repair to restore tissue function following injury. Skin scarring is an inevitable and permanent endpoint for many postnatal organisms except for non-amniote vertebrates such as amphibians, which are capable of tissue regeneration. Furthermore, mammalian foetuses through mid-gestation are capable of rapid wound repair in the absence of scar formation. Notably, excessive cutaneous scar formation, such as hypertrophic and keloid scars, is a species limited clinical entity as it occurs only in humans, although wounds on the distal limbs of horses are also prone to heal with fibroproliferative pathology known as equine exuberant granulation tissue. Currently, there are no reliable treatment options to eradicate or prevent scarring in humans and vertebrates. The limited number of vertebrate models for either hypertrophic or keloid scarring has been an impediment to mechanistic studies of these diseases and the development of therapies. In this viewpoint essay, we highlight the current concepts of regenerative, scar-free and scar-forming healing compared across a number of species and speculate on areas for future research. Furthermore, in-depth investigative research into the mechanisms of scarless repair may allow for the development of improved animal models and novel targets for scar prevention. As the ability to heal in both a scarless manner and propensity for healing with excessive scar formation is highly species dependent, understanding similarities and differences in healing across species as it relates to the regenerative process may hold the key to improve scarring and guide translational wound-healing studies. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  1. Drug reaction with Eosinophilia and Systemic Symptoms (DRESS) / Drug-induced Hypersensitivity Syndrome (DIHS): a review of current concepts.

    PubMed

    Criado, Paulo Ricardo; Criado, Roberta Fachini Jardim; Avancini, João de Magalhães; Santi, Claudia Giuli

    2012-01-01

    The Drug Reaction with Eosinophilia and Systemic Symptoms syndrome, also known as Drug Induced Hypersensitivity Syndrome presents clinically as an extensive mucocutaneous rash, accompanied by fever, lymphadenopathy, hepatitis, hematologic abnormalities with eosinophilia and atypical lymphocytes, and may involve other organs with eosinophilic infiltration, causing damage to several systems, especially to the kidneys, heart, lungs, and pancreas. Recognition of this syndrome is of paramount importance, since the mortality rate is about 10% to 20%, and a specific therapy may be necessary. The pathogenesis is related to specific drugs, especially the aromatic anticonvulsants, altered immune response, sequential reactivation of herpes virus and association with HLA alleles. Early recognition of the syndrome and withdrawal of the offending drug are the most important and essential steps in the treatment of affected patients. Corticosteroids are the basis of the treatment of the syndrome, which may be associated with intravenous immunoglobulin and, in selected cases, Ganciclovir. The article reviews the current concepts involving this important manifestation of adverse drug reaction.

  2. Allergen exposure chambers: harmonizing current concepts and projecting the needs for the future - an EAACI Position Paper.

    PubMed

    Pfaar, O; Calderon, M A; Andrews, C P; Angjeli, E; Bergmann, K C; Bønløkke, J H; de Blay, F; Devillier, P; Ellis, A K; Gerth van Wijk, R; Hohlfeld, J M; Horak, F; Jacobs, R L; Jacobsen, L; Jutel, M; Kaul, S; Larché, M; Larenas-Linnemann, D; Mösges, R; Nolte, H; Patel, P; Peoples, L; Rabin, R L; Rather, C; Salapatek, A M; Sigsgaard, T; Thaarup, S; Yang, J; Zieglmayer, P; Zuberbier, T; Demoly, P

    2017-07-01

    Allergen exposure chambers (AECs) are clinical facilities allowing for controlled exposure of subjects to allergens in an enclosed environment. AECs have contributed towards characterizing the pathophysiology of respiratory allergic diseases and the pharmacological properties of new therapies. In addition, they are complementary to and offer some advantages over traditional multicentre field trials for evaluation of novel therapeutics. To date, AEC studies conducted have been monocentric and have followed protocols unique to each centre. Because there are technical differences among AECs, it may be necessary to define parameters to standardize the AECs so that studies may be extrapolated for driving basic immunological research and for marketing authorization purposes by regulatory authorities. For this task force initiative of the European Academy of Allergy and Clinical Immunology (EAACI), experts from academia and regulatory agencies met with chamber operators to list technical, clinical and regulatory unmet needs as well as the prerequisites for clinical validation. The latter covered the validation process, standardization of challenges and outcomes, intra- and interchamber variability and reproducibility, in addition to comparability with field trials and specifics of paediatric trials and regulatory issues. This EAACI Position Paper aims to harmonize current concepts in AECs and to project unmet needs with the intent to enhance progress towards use of these facilities in determining safety and efficacy of new therapeutics in the future. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  3. Current concepts on microscopic colitis: evidence-based statements and recommendations of the Spanish Microscopic Colitis Group.

    PubMed

    Fernández-Bañares, F; Casanova, M J; Arguedas, Y; Beltrán, B; Busquets, D; Fernández, J M; Fernández-Salazar, L; García-Planella, E; Guagnozzi, D; Lucendo, A J; Manceñido, N; Marín-Jiménez, I; Montoro, M; Piqueras, M; Robles, V; Ruiz-Cerulla, A; Gisbert, J P

    2016-02-01

    Microscopic colitis (MC) is an underdiagnosed inflammatory bowel disease. To develop an evidence-based clinical practice guide on MC current concepts. Literature search was done on the Cochrane Library, EMBASE and MEDLINE electronic databases, which were consulted covering the period up until March 2015. Work groups were selected for each of the reviewed topics, with the purpose of drafting the initial statements and recommendations. They subsequently underwent a voting process based on the Delphi method. Each statement/recommendation was accompanied by the result of the vote the level of evidence, and discussion of the corresponding evidence. The grade of recommendation (GR) using the GRADE approach was established for diagnosis and treatment recommendations. Some key statements and recommendations are: advancing age increases the risk of developing MC, mainly in females. The symptoms of MC and IBS-D may be similar. If MC is suspected, colonoscopy taking biopsies is mandatory. Treatment with oral budesonide is recommended to induce clinical remission in patients with MC. Oral mesalazine is not recommended in patients with collagenous colitis for the induction of clinical remission. The use of anti-TNF-alpha drugs (infliximab, adalimumab) is recommended for the induction of remission in severe cases of MC that fail to respond to corticosteroids or immunomodulators, as an alternative to colectomy. This is the first consensus paper on MC based on GRADE methodology. This initiative may help physicians involved in care of these patients in taking decisions based on evidence. © 2015 John Wiley & Sons Ltd.

  4. St. Augustine’s Reflections on Memory and Time and the Current Concept of Subjective Time in Mental Time Travel

    PubMed Central

    Manning, Liliann; Cassel, Daniel; Cassel, Jean-Christophe

    2013-01-01

    Reconstructing the past and anticipating the future, i.e., the ability of travelling in mental time, is thought to be at the heart of consciousness and, by the same token, at the center of human cognition. This extraordinary mental activity is possible thanks to the ability of being aware of ‘subjective time’. In the present study, we attempt to trace back the first recorded reflections on the relations between time and memory, to the end of the fourth century’s work, the Confessions, by the theologian and philosopher, St. Augustine. We concentrate on Book 11, where he extensively developed a series of articulated and detailed observations on memory and time. On the bases of selected paragraphs, we endeavor to highlight some concepts that may be considered as the product of the first or, at least, very early reflections related to our current notions of subjective time in mental time travel. We also draw a fundamental difference inherent to the frameworks within which the questions were raised. The contribution of St. Augustine on time and memory remains significant, notwithstanding the 16 centuries elapsed since it was made, likely because of the universality of its contents. PMID:25379236

  5. St. Augustine's Reflections on Memory and Time and the Current Concept of Subjective Time in Mental Time Travel.

    PubMed

    Manning, Liliann; Cassel, Daniel; Cassel, Jean-Christophe

    2013-06-01

    Reconstructing the past and anticipating the future, i.e., the ability of travelling in mental time, is thought to be at the heart of consciousness and, by the same token, at the center of human cognition. This extraordinary mental activity is possible thanks to the ability of being aware of 'subjective time'. In the present study, we attempt to trace back the first recorded reflections on the relations between time and memory, to the end of the fourth century's work, the Confessions, by the theologian and philosopher, St. Augustine. We concentrate on Book 11, where he extensively developed a series of articulated and detailed observations on memory and time. On the bases of selected paragraphs, we endeavor to highlight some concepts that may be considered as the product of the first or, at least, very early reflections related to our current notions of subjective time in mental time travel. We also draw a fundamental difference inherent to the frameworks within which the questions were raised. The contribution of St. Augustine on time and memory remains significant, notwithstanding the 16 centuries elapsed since it was made, likely because of the universality of its contents.

  6. Current concepts in the treatment of Anderson Type II odontoid fractures in the elderly in Germany, Austria and Switzerland.

    PubMed

    Löhrer, L; Raschke, M J; Thiesen, D; Hartensuer, R; Surke, C; Ochman, S; Vordemvenne, T

    2012-04-01

    Although currently there are many different recommendations and strategies in the therapy of odontoid fractures in the elderly, there are still no generally accepted guidelines for a structured and standardised treatment. Moreover, the current opinion of spine surgeons regarding the optimal treatment of odontoid fractures Type II of the elderly is unknown. In order to have an objective insight into the diverging strategies for the management of Anderson Type II odontoid fractures and form a basis for future comparisons, this study investigated the current concepts and preferences of orthopaedic, neuro- and trauma surgeons. Spine surgeons from 34 medical schools and 8 hospitals in Germany, 4 university hospitals in Austria and 5 in Switzerland were invited to participate in an online survey using a 12-item 1-sided questionnaire. A total of 44 interviewees from 34 medical institutions participated in the survey, consisting of trauma (50%), orthopaedic (20.5%) and neurosurgeons (27.3%). Out of these, 70.5% treated 1-20 fractures per year; 63.6% favoured the anterior screw fixation as therapy for Type II odontoid fractures, the open posterior Magerl transarticular C1/C2 fusion, the posterior Harms C1/C2 fusion, and conservative immobilisation by cervical orthosis was preferred by 9.1% in each case. 59.1% preferred the anterior odontoid screw fixation as an appropriate treatment of Anderson Type II odontoid fractures in the elderly. 79.5% chose cervical orthosis for postsurgical treatment. Following operative treatment, nonunion rates were reported to be <10% and <20% by 40.9% and 70% of the surgeons, respectively. 56.8% reported changing from primary conservative to secondary operative treatment in <10% of cases. The most favoured technique in revision surgery of nonunions was the open posterior Magerl transarticular fusion technique, chosen by 38.6% of respondents. 18.2% preferred the posterior Harms C1/C2 fusion technique, 11.4% the percutaneous posterior Magerl

  7. CURRENT VFARS ONGOING RESEARCH AND WHAT NEEDS TO BE DONE TO EVALUATE THE VFARS CONCEPT AND DETERMINE ITS FEASIBILITY

    EPA Science Inventory

    The VFARs concept predicts that pathogens can be identified using structural similarities among virulence genes from diverse species. This concept is of interest to the EPA for several reasons: the Agency's need to discriminate between virulent and avirulent isolates of pathogen...

  8. CURRENT VFARS ONGOING RESEARCH AND WHAT NEEDS TO BE DONE TO EVALUATE THE VFARS CONCEPT AND DETERMINE ITS FEASIBILITY

    EPA Science Inventory

    The VFARs concept predicts that pathogens can be identified using structural similarities among virulence genes from diverse species. This concept is of interest to the EPA for several reasons: the Agency's need to discriminate between virulent and avirulent isolates of pathogen...

  9. A brief overview of current relationships of geography, statistics, and taxonomy with the classical integrated control concept

    USDA-ARS?s Scientific Manuscript database

    A classic paper on the integrated control concept appeared in the later part of the 1950’s, led by Vernon Stern, Ray Smith, Robert van den Bosch, and Kenneth Hagen. Numerous concepts and definitions were formulated at that time. In this presentation, a short philosophical summary will be presented...

  10. 76 FR 621 - Commercial Space Transportation Advisory Committee-Public Teleconference

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-01-05

    ... Space Transportation Advisory Committee (COMSTAC). The teleconference will take place on Thursday... Working Groups. The Committee will examine the current Working Groups and discuss whether it should make...

  11. Effective translation of current dietary guidance: understanding and communicating the concepts of minimal and optimal levels of dietary protein.

    PubMed

    Rodriguez, Nancy R; Miller, Sharon L

    2015-04-29

    Dietitians and health care providers have critical roles in the translation of the dietary guidance to practice. The protein content of diets for adults can be based on the Recommended Dietary Allowance (RDA) of 0.80 g/kg per day. Alternatively, the most recent Dietary Reference Intakes (DRIs) for macronutrients reflect expanded guidance for assessing protein needs and consider the relative relation of absolute amounts of protein, carbohydrate, and fat to total energy intake in the context of chronic disease prevention. The Acceptable Macronutrient Distribution Range (AMDR) reflects the interrelation between the macronutrients and affords dietitians and clinicians additional flexibility in diet planning. Accounting for the caloric value of RDAs for carbohydrate and fat, "flexible calories" emerge as an opportunity to create varied eating plans that provide for protein intakes in excess of the RDA but within the AMDR. Protein Summit 2.0 highlighted the growing body of scientific evidence documenting the benefits of higher protein intakes at amounts approximating twice the RDA, which include promotion of healthy body weight and preservation of lean body mass and functional ability with age. The essential amino acid (EAA) density of a food also emerged as a novel concept analogous to "nutrient density," which can enable the practitioner to calculate the caloric cost associated with a specific protein source to attain the daily requirement of EAAs to accomplish various health outcomes because these indispensable nutrients have a significant role in protein utilization and metabolic regulation. Tailoring recommendations unique to an individual's varying goals and needs remains a challenge. However, flexibility within the application of DRIs to include consideration of the AMDR provides a sound framework to guide practitioners in effective translation of current dietary guidance with a specific regard for the documented benefits of higher protein intakes.

  12. Activities of the O&M committee history & future perspectives

    SciTech Connect

    Poulis, D.S.

    1996-12-01

    This paper gives an overview of the Committee on Operation and Maintenance of Nuclear Power Plants, hereafter referred to as the O&M Committee, formed in June 1975 when the American National Standard Institute`s Committee on Reactor Plants and their Maintenance was disbanded. The O&M Committee`s history, structure, current focus and future perspectives will be presented. The purpose of this paper is to give information to industry and the public of the Committee`s on-going effort to make accurate and timely responses to the needs of the nuclear industry.

  13. Complex trauma to the shoulder girdle, including the proximal humerus, the clavicle, and the scapula: current concepts in diagnosis and treatment.

    PubMed

    Mighell, Mark A; Hatzidakis, Armodios M; Otto, Randall J; Watson, J Tracy; Cottrell, Benjamin J; Cusick, Michael C; Pappou, Ioannis P

    2015-01-01

    Fractures to the shoulder girdle are common injuries in an aging population. Many techniques and theories lie behind the treatment of such injuries. Knowledge and understanding of current concepts for diagnosing and treating proximal humeral, clavicular, and scapular fractures and the theory behind them will help surgeons make informed decisions with regard to patient care.

  14. Executive committee

    NASA Astrophysics Data System (ADS)

    Xiao, Guoqing; Cai, Xiaohong; Ding, Dajun; Ma, Xinwen; Zhao, Yongtao

    2014-04-01

    ChairVice Chair Toshiyuki AzumaRoberto Rivarola Atomic, Molecular & Optical Physics LabUniversidad Nacional de Rosario and Advanced Science InstituteInstituto de Fisica Rosario RIKEN, JapanRosario, Argentina SecretaryMembers Dominique VernhetJoachim Burgdörfer, Austria Institut des NanoSciences de Paris Birgit Lohmann, Australia Université Pierre et Marie Curie Hossein Sadeghpour, USA Paris, FranceThomas Stöhlker, Germany Past ChairJim McCann, UK Barry DunningGuoqing Xiao, China Physics & AstronomyXiaohong Cai, China Rice University, HoustonXinwen Ma, China Texas, USAYongtao Zhao, China TreasurerFernando Martin, Spain Henrik CederquistLuis Mendez, Spain Alba Nova University CenterAnatoli Kheifets, Australia Stockholm University Stockholm, Sweden Details of the general committee are available in the PDF

  15. Conference Committees

    NASA Astrophysics Data System (ADS)

    2015-11-01

    Scientific Committee Silvia Arrese-Igor Irigoyen (CFM, CSIC - UPV/EHU, Donostia), Javier Campo (ICMA-CSIC, Zaragoza), Carlos Frontera (ICMAB-CSIC, Barcelona), Victoria García Sakai (ISIS, Chilton), Cristina Gómez-Polo (UPNa, Pamplona), Miguel Ángel González (ILL, Grenoble), Pedro Gorría (Universidad Oviedo), Jon Gutiérrez Echevarría (EHU/UPV, Bilbao), J. Iñaki Pérez Landazábal (UPNa, Pamplona), Vicente Recarte (UPNa, Pamplona), Jesús Ruíz Hervías (UPM, Madrid), Vicente Sánchez-Alarcos (UPNa, Pamplona), Antonio Urbina (UPC, Cartagena) Organizing Committee J. Iñaki Pérez Landazábal (Co-Chair), Vicente Recarte ( Co-Chair), Cristina Gómez-Polo, Silvia Larumbe Abuin, Vicente Sánchez-Alarcos Editors of the Proceedings J. Iñaki Pérez Landazábal, Vicente Recarte Plenary speakers Charles Simon (Institut Laue-Langevin, Grenoble, France), Miguel Angel Alario Franco (Universidad Complutense, Madrid, Spain), Dieter Richter (Jülich Centre for Neutron Science, Jülich, Germany), James Yeck (European Spallation Source, Lund, Sweden) Invited speakers Manu Barandiarán (BCMaterials & EHU/UPV), Arantxa Arbe (MFC, CSIC- UPV/EHU), José Luis Martínez (Consorcio ESS-Bilbao), Marta Castellote, IETcc-CSIC), Josep Lluis Tamarit (UPC), Diego Alba-Venero (ISIS), Elizabeth Castillo (CIC Energigune), Josu M. Igartua (EHU/UPV), Antonio Dos Santos (UPM), Alex Masalles (Museu Nacional d'Art de Catalunya), José Abad (UPCT), Claudia Mondelli (ILL), Oscar Fabelo (ILL), Aurora Nogales (IEM-CSIC), Jesús Rodríguez (UC), Gerardo

  16. The Investment Committee. AGB Effective Committee Series

    ERIC Educational Resources Information Center

    Yoder, Jay A.

    2011-01-01

    This publication is part of an AGB series devoted to strengthening the role of key standing committees of governing boards. While there is no optimum committee system for institutions of higher education, certain principles, practices, and procedures prevail. The best practices included in this text support the objectives of board committees:…

  17. The Investment Committee. AGB Effective Committee Series

    ERIC Educational Resources Information Center

    Yoder, Jay A.

    2011-01-01

    This publication is part of an AGB series devoted to strengthening the role of key standing committees of governing boards. While there is no optimum committee system for institutions of higher education, certain principles, practices, and procedures prevail. The best practices included in this text support the objectives of board committees:…

  18. Hospital executives and ethics committees: an effective collaboration.

    PubMed

    Hilliard, B B; Coffey, B S; Johnson, R B

    1999-03-01

    Should hospital and healthcare executives participate on their organization's ethics committee? This question becomes more relevant in the current healthcare environment as nurses and physicians assume more managerial responsibilities. This article reviews functions of the ethics committee and discusses moral, conceptual, and practical issues surrounding managerial participation on these committees. The authors conclude that executive management's participation on ethics committees is both appropriate and necessary in the current healthcare environment.

  19. Developing a New Teaching Approach for the Chemical Bonding Concept Aligned with Current Scientific and Pedagogical Knowledge

    ERIC Educational Resources Information Center

    Nahum, Tami Levy; Mamlok-Naaman, Rachel; Hofstein, Avi; Krajcik, Joseph

    2007-01-01

    The traditional pedagogical approach for teaching chemical bonding is often overly simplistic and not aligned with the most up-to-date scientific models. As a result, high-school students around the world lack fundamental understanding of chemical bonding. In order to improve students' understanding of this concept, it was essential to propose a…

  20. Using Concept-Based Instruction in the L2 Classroom: Perspectives from Current and Future Language Teachers

    ERIC Educational Resources Information Center

    Williams, Lawrence; Abraham, Lee B.; Negueruela-Azarola, Eduardo

    2013-01-01

    A number of recent studies (see, for example, Lantolf, 2010; Negueruela & Lantolf, 2006; van Compernolle, 2011) have focused on the use of learning tools developed according to the principles of concept-based instruction (CBI). Using videorecorded data from interviews and observations of classroom instruction, our study seeks to contribute to…

  1. Developing a New Teaching Approach for the Chemical Bonding Concept Aligned with Current Scientific and Pedagogical Knowledge

    ERIC Educational Resources Information Center

    Nahum, Tami Levy; Mamlok-Naaman, Rachel; Hofstein, Avi; Krajcik, Joseph

    2007-01-01

    The traditional pedagogical approach for teaching chemical bonding is often overly simplistic and not aligned with the most up-to-date scientific models. As a result, high-school students around the world lack fundamental understanding of chemical bonding. In order to improve students' understanding of this concept, it was essential to propose a…

  2. Radiotherapy of high-grade gliomas: current standards and new concepts, innovations in imaging and radiotherapy, and new therapeutic approaches

    PubMed Central

    Dhermain, Frederic

    2014-01-01

    The current standards in radiotherapy of high-grade gliomas (HGG) are based on anatomic imaging techniques, usually computed tomography (CT) scanning and magnetic resonance imaging (MRI). The guidelines vary depending on whether the HGG is a histological grade 3 anaplastic glioma (AG) or a grade 4 glioblastoma multiforme (GBM). For AG, T2-weighted MRI sequences plus the region of contrast enhancement in T1 are considered for the delineation of the gross tumor volume (GTV), and an isotropic expansion of 15 to 20 mm is recommended for the clinical target volume (CTV). For GBM, the Radiation Therapy Oncology Group favors a two-step technique, with an initial phase (CTV1) including any T2 hyperintensity area (edema) plus a 20 mm margin treated with up to 46 Gy in 23 fractions, followed by a reduction in CTV2 to the contrast enhancement region in T1 with an additional 25 mm margin. The European Organisation of Research and Treatment of Cancer recommends a single-phase technique with a unique GTV, which comprises the T1 contrast enhancement region plus a margin of 20 to 30 mm. A total dose of 60 Gy in 30 fractions is usually delivered for GBM, and a dose of 59.4 Gy in 33 fractions is typically given for AG. As more than 85% of HGGs recur in field, dose-escalation studies have shown that 70 to 75 Gy can be delivered in 6 weeks with relevant toxicities developing in < 10% of the patients. However, the only randomized dose-escalation trial, in which the boost dose was guided by conventional MRI, did not show any survival advantage of this treatment over the reference arm. HGGs are amongst the most infiltrative and heterogeneous tumors, and it was hypothesized that the most highly aggressive areas were missed; thus, better visualization of these high-risk regions for radiation boost could decrease the recurrence rate. Innovations in imaging and linear accelerators (LINAC) could help deliver the right doses of radiation to the right subvolumes according to the dose

  3. Citizen Advisory Committees.

    ERIC Educational Resources Information Center

    Miller, Leann R.

    This guide, describing community involvement through citizen advisory committees, is a summary of the literature on such committees. Its main concern is district committees created by school boards. Citations in the bibliography contain all points of view on committees and present many alternatives on most of the topics covered in the guide.…

  4. Student Affairs Committee.

    ERIC Educational Resources Information Center

    Goodale, Thomas G.

    1984-01-01

    The agenda, structure, and responsibilities of a board of trustees standing committee--the campus student affairs committee--are discussed. The size, selection, and rotation of student affairs committee members will vary with the traditions and policies of the individual institution. If possible, the committee should include students among its…

  5. Hagerstown Junior College Advisory Committee Handbook.

    ERIC Educational Resources Information Center

    Hagerstown Junior Coll., MD.

    The use of advisory committees in occupational education is a natural and desirable extension of lay participation in education and an efficient and logical way of keeping programs current. At Hagerstown Junior College (HJC), the primary functions of an advisory committee are to provide advice and counsel regarding the development, maintenance,…

  6. Science: The Recombinant DNA Advisory Committee.

    ERIC Educational Resources Information Center

    Wright, Susan

    1979-01-01

    Reports on the status of the Recombinant DNA Advisory Committee (RAC) and attempts to rationalize Suburban Highway Policy. Effective communication among members of the RAC is a current problem facing the committee. A federal transportation priority spending policy is suggested during these times of money and fuel shortages. (MA)

  7. Science: The Recombinant DNA Advisory Committee.

    ERIC Educational Resources Information Center

    Wright, Susan

    1979-01-01

    Reports on the status of the Recombinant DNA Advisory Committee (RAC) and attempts to rationalize Suburban Highway Policy. Effective communication among members of the RAC is a current problem facing the committee. A federal transportation priority spending policy is suggested during these times of money and fuel shortages. (MA)

  8. MHD Technology Transfer, Integration and Review Committee

    SciTech Connect

    Not Available

    1992-01-01

    This fifth semi-annual status report of the MHD Technology Transfer, Integration, and Review Committee (TTIRC) summarizes activities of the TTIRC during the period April 1990 through September 1990. It includes summaries and minutes of committee meetings, progress summaries of ongoing Proof-of-Concept (POC) contracts, discussions pertaining to technical integration issues in the POC program, and planned activities for the next six months.

  9. An Examination of the Total Quality Management (TQM) Concept Given Current Federal/DoD Competition Initiatives

    DTIC Science & Technology

    1992-06-01

    Japanese concept of Kaizen , which means "continuous improvement by doing little things better, and setting and achieving ever-higher standards." The...engineer Shigeo Shingo. Toyota had previously contracted Shingo to reduce the setup time for a 1,000 ton press from four hours to one hour and a half... Toyota was not satisfied. Due to their belief in continuous improvement they again contracted with Shingo in 1969 to further reduce the setup time to

  10. Revision concepts and distinctive points of the new Japanese classification for biliary tract cancers in comparison with the 7(th) edition of the Union for International Cancer Control and the American Joint Committee on Cancer staging system.

    PubMed

    Ohtsuka, Masayuki; Miyakawa, Shuichi; Nagino, Masato; Takada, Tadahiro; Miyazaki, Masaru

    2015-03-01

    The 3(rd) English edition of the Japanese classification of the biliary tract cancers (JC) is now available in this journal. The primary aim of this revision is to provide all clinicians and researchers with a common language of cancer staging at an international level. On the other hand, there are several important issues that should be solved for the optimization of the staging system. Revision concepts and major revision points of the 3(rd) English edition of the JC were reviewed. Furthermore, comparing with the 7(th) edition of staging system developed by the Union for International Cancer Control (UICC) and the American Joint Committee on Cancer (AJCC), distinctive points in the JC was discussed. In this edition of the JC, the same stage groupings as those in the UICC/AJCC staging system were basically adopted. T, N, and M categories were also identical in principle with those in the UICC/AJCC staging system, although slight modifications were proposed as the "Japanese rules". As distinctive points, perihilar cholangiocarcinomas and ampullary region carcinomas were clearly defined. Intraepithelial tumor was discriminated from invasive carcinoma at ductal resection margins. Classifications of site-specific surgical margin status remained in this edition. Histological classification was based on that in the former editions of the JC, but adopted some parts of the World Health Organization classification. The JC now share its staging system of the biliary tact carcinomas with the UICC/AJCC staging system. Future validation of the "Japanese rules" could provide important evidence to make globally standardized staging system. © 2015 Japanese Society of Hepato-Biliary-Pancreatic Surgery.

  11. The concept of "intercultural opening": the development of an assessment tool for the appraisal of its current implementation in the mental health care system.

    PubMed

    Penka, S; Kluge, U; Vardar, A; Borde, T; Ingleby, D

    2012-06-01

    The German concept of "intercultural opening" is an approach to facilitating migrants' access to the health care system and improving the care they receive. No data exist concerning the current status of the implementation of this approach in Germany, and the concept has never been analysed in practice. To assess the status of "intercultural opening" in the German mental health care system and to further analyse the concept, we developed a tool by combining pre-existing instruments. In order to review the preliminary tool we combined experts' knowledge by carrying out a consensusoriented, expert-based Delphi process with actual practice by piloting the instrument in each type of institution to be assessed. The assessment tool thus developed(1) is the first one to evaluate the current status of "intercultural opening" in the community mental health care system in Germany from a broad perspective. This paper is intended to present the development process of our assessment tool for demonstrating the benefits of this approach and as a model for future studies, as well as to increase transparency in relation to the current German approach to health care structures in dealing with migrants. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

  12. Automotive Technology. Technical Committee Report.

    ERIC Educational Resources Information Center

    Idaho State Dept. of Education, Boise. Div. of Vocational Education.

    This Technical Committee Report prepared by industry representatives in Idaho lists the skills currently necessary for an employee in that state to obtain a job in automotive technology, retain a job once hired, and advance in that occupational field. (Task lists are grouped according to duty areas generally used in industry settings, and are used…

  13. Autobody Technology. Technical Committee Report.

    ERIC Educational Resources Information Center

    Idaho State Dept. of Education, Boise. Div. of Vocational Education.

    This Technical Committee Report prepared by industry representatives in Idaho lists the skills currently necessary for an employee in that state to obtain a job in autobody technology, retain a job once hired, and advance in that occupational field. (Task lists are grouped according to duty areas generally used in industry settings and are used as…

  14. Automotive Technology. Technical Committee Report.

    ERIC Educational Resources Information Center

    Idaho State Dept. of Education, Boise. Div. of Vocational Education.

    This Technical Committee Report prepared by industry representatives in Idaho lists the skills currently necessary for an employee in that state to obtain a job in automotive technology, retain a job once hired, and advance in that occupational field. (Task lists are grouped according to duty areas generally used in industry settings, and are used…

  15. Electronic Technology. Technical Committee Report.

    ERIC Educational Resources Information Center

    Idaho State Dept. of Education, Boise. Div. of Vocational Education.

    This Technical Committee Report prepared by industry representatives in Idaho lists the skills currently necessary for an employee in that state to obtain a job in electronic technology, retain a job once hired, and advance in that occupational field. (Task lists are grouped according to duty areas generally used in industry settings, and are used…

  16. Autobody Technology. Technical Committee Report.

    ERIC Educational Resources Information Center

    Idaho State Dept. of Education, Boise. Div. of Vocational Education.

    This Technical Committee Report prepared by industry representatives in Idaho lists the skills currently necessary for an employee in that state to obtain a job in autobody technology, retain a job once hired, and advance in that occupational field. (Task lists are grouped according to duty areas generally used in industry settings and are used as…

  17. Electronic Technology. Technical Committee Report.

    ERIC Educational Resources Information Center

    Idaho State Dept. of Education, Boise. Div. of Vocational Education.

    This Technical Committee Report prepared by industry representatives in Idaho lists the skills currently necessary for an employee in that state to obtain a job in electronic technology, retain a job once hired, and advance in that occupational field. (Task lists are grouped according to duty areas generally used in industry settings, and are used…

  18. [Current modalities and concepts on access and use of biospecimen samples and associated data for research from human biobanks].

    PubMed

    Siddiqui, Roman; Semler, Sebastian Claudius

    2016-03-01

    It is accepted worldwide that biospecimen and data sharing (BDS) play an essential role for the future of medical research to improve diagnostics and prognostics, e.g. by validated biomarkers. BDS is also pivotal to the development of new therapeutic treatments and for the improvement of population health. Human biobanks can generate an added value to this need by providing biospecimens and/or associated data to researchers. An inspection of several examples of epidemiological as well as clinical/disease-oriented biobanks in Germany shows that best practice procedures (BPP) that are internationally agreed on are being installed for biospecimen and/or data access. In general, fair access is aimed at requiring a written application by the requesting scientist, which is then peer-reviewed for scientific and ethical validity by the Biobank. Applied BPP take into account (i) patient education/agreement according to the informed consent model, (ii) privacy protection, (iii) intellectual property rights, the (iv) notification obligation of health-related findings (including incidental findings), the (v) use of material (MTA) and data transfer agreements (DTA) for mutual legal security, the avoidance of conflicts of interests, as well as for cost recovery/fee for service as a basis for sustainability of the biobank. BPP are rooted in the self-regulation efforts of life sciences and are supported by parent ethics committees in Germany. Central biobank registries displaying aggregated information on biospecimens stored and the research foci constitute an important tool to make biobanks that are scattered across the country visible to each other, and, can thus promote access to hitherto unknown biospecimen and data resources.

  19. The integrated control concept and its relevance to current integrated pest management in California fresh market grapes.

    PubMed

    Bentley, Walter J

    2009-12-01

    The foundation of an integrated pest management program involves valid treatment thresholds, accurate and simple monitoring methods, effective natural controls, selective pesticides and trained individuals who can implement the concept. The Integrated Control Concept written by Stern, Smith, van den Bosch and Hagen elucidated each of these points in an alfalfa ecosystem. Alfalfa hay (Medicago sativa L.) has a low per acre value, requires little hand labor and is primarily marketed in the USA. In contrast, fresh market table grape (Vitis vinifera L.) has a high per acre value, requires frequent hand labor operations, suffers unacceptable cosmetic damage and is marketed throughout both the USA and the world. Each of the components of a working IPM program is present in table grape production. Marketing grapes to foreign countries presents special problems with pests considered invasive and where residue tolerances for some selective insecticides are lacking. However, fresh market grape farmers are still able to deal with these special problems and utilize an IPM program that has resulted in a 42% reduction in broad-spectrum insecticide use from 1995 to 2007.

  20. [The Basic-Symptom Concept and its Influence on Current International Research on the Prediction of Psychoses].

    PubMed

    Schultze-Lutter, F

    2016-12-01

    The early detection of psychoses has become increasingly relevant in research and clinic. Next to the ultra-high risk (UHR) approach that targets an immediate risk of developing frank psychosis, the basic symptom approach that targets the earliest possible detection of the developing disorder is being increasingly used worldwide. The present review gives an introduction to the development and basic assumptions of the basic symptom concept, summarizes the results of studies on the specificity of basic symptoms for psychoses in different age groups as well as on studies of their psychosis-predictive value, and gives an outlook on future results. Moreover, a brief introduction to first recent imaging studies is given that supports one of the main assumptions of the basic symptom concept, i. e., that basic symptoms are the most immediate phenomenological expression of the cerebral aberrations underlying the development of psychosis. From this, it is concluded that basic symptoms might be able to provide important information on future neurobiological research on the etiopathology of psychoses.

  1. Current Issues in Mental Retardation and Human Development: Selected Papers from the 1970 Staff Development Conferences of the President's Committee on Mental Retardation (Washington, D.C., 1971).

    ERIC Educational Resources Information Center

    Stedman, Donald J., Ed.

    Six papers discuss some of the current issues in the field of mental retardation and human development. Epidemiology of mental retardation from a sociological and clinical point of view is analyzed by Jane R. Mercer, based on studies of mental retardation in the community in Pomona, California. The role of genetics and intra-uterine diagnosis of…

  2. Narcotic analgesic utilization amongst injured workers: using concept mapping to understand current issues from the perspectives of physicians and pharmacists

    PubMed Central

    2011-01-01

    Background Work-related injuries result in considerable morbidity, as well as social and economic costs. Pain associated with these injuries is a complex, contested topic, and narcotic analgesics (NA) remain important treatment options. Factors contributing to NA utilization patterns are poorly understood. This qualitative study sought to characterize the factors contributing to NA utilization amongst injured workers from the perspectives of physicians and pharmacists. Methods The study employed concept mapping methodology, a structured process yielding a conceptual framework of participants' views on a particular topic. A visual display of the ideas/concepts generated is produced. Eligible physicians and pharmacists (n = 22) serving injured workers in the province of Ontario (Canada) were recruited via purposive sampling, and participated in concept mapping activities (consisting of brainstorming, sorting, rating, and map exploration). Participants identified factors influencing NA utilization, and sorted these factors into categories (clusters). Next, they rated the factors on two scales: 'strength of influence on NA over-utilization' and 'amenability to intervention'. During follow-up focus groups, participants refined the maps and discussed the findings and their implications. Results 82 factors were sorted into 7 clusters: addiction risks, psychosocial issues, social/work environment factors, systemic-third party factors, pharmacy-related factors, treatment problems, and physician factors. These clusters were grouped into 2 overarching categories/regions on the map: patient-level factors, and healthcare/compensation system-level factors. Participants rated NA over-utilization as most influenced by patient-level factors, while system-level factors were rated as most amenable to intervention. One system-level cluster was rated highly on both scales (treatment problems - e.g. poor continuity of care, poor interprofessional communication, lack of education

  3. 78 FR 45592 - Shipping Coordinating Committee; Notice of Committee Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-07-29

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF STATE Shipping Coordinating Committee; Notice of Committee Meeting The Shipping Coordinating Committee (SHC) will conduct an..., 2013. Marc Zlomek, Executive Secretary, Shipping Coordinating Committee, Department of State. BILLING...

  4. 77 FR 16316 - Shipping Coordinating Committee; Notice of Committee Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-03-20

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF STATE Shipping Coordinating Committee; Notice of Committee Meeting The Shipping Coordinating Committee (SHC) will conduct an... . Dated: March 9, 2012. Brian Robinson, Executive Secretary, Shipping Coordinating Committee, Department...

  5. 76 FR 70529 - Shipping Coordinating Committee; Notice of Committee Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-11-14

    ... From the Federal Register Online via the Government Publishing Office ] DEPARTMENT OF STATE Shipping Coordinating Committee; Notice of Committee Meeting The Shipping Coordinating Committee (SHC) will...: November 7, 2011. Brian Robinson, Executive Secretary, Shipping Coordinating Committee, Department of State...

  6. 77 FR 12641 - Shipping Coordinating Committee; Notice of Committee Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-03-01

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF STATE Shipping Coordinating Committee; Notice of Committee Meeting The Shipping Coordinating Committee (SHC) will conduct an..., 2012. Brian Robinson, Executive Secretary, Shipping Coordinating Committee, Department of State...

  7. 77 FR 47490 - Shipping Coordinating Committee; Notice of Committee Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-08-08

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF STATE Shipping Coordinating Committee; Notice of Committee Meeting The Shipping Coordinating Committee (SHC) will conduct open.... Brian Robinson, Executive Secretary, Shipping Coordinating Committee, Department of State. BILLING CODE...

  8. Biologic Treatments for Sports Injuries II Think Tank—Current Concepts, Future Research, and Barriers to Advancement, Part 2

    PubMed Central

    Murray, Iain R.; LaPrade, Robert F.; Musahl, Volker; Geeslin, Andrew G.; Zlotnicki, Jason P.; Mann, Barton J.; Petrigliano, Frank A.

    2016-01-01

    Rotator cuff tears are common and result in considerable morbidity. Tears within the tendon substance or at its insertion into the humeral head represent a considerable clinical challenge because of the hostile local environment that precludes healing. Tears often progress without intervention, and current surgical treatments are inadequate. Although surgical implants, instrumentation, and techniques have improved, healing rates have not improved, and a high failure rate remains for large and massive rotator cuff tears. The use of biologic adjuvants that contribute to a regenerative microenvironment have great potential for improving healing rates and function after surgery. This article presents a review of current and emerging biologic approaches to augment rotator cuff tendon and muscle regeneration focusing on the scientific rationale, preclinical, and clinical evidence for efficacy, areas for future research, and current barriers to advancement and implementation. PMID:27099865

  9. The Facilities Committee. AGB Effective Committee Series

    ERIC Educational Resources Information Center

    Kaiser, Harvey H.

    2012-01-01

    This publication is part of an Association of Governing Boards of Universities and Colleges (AGB) series devoted to strengthening the role of key standing committees of governing boards. While there is no optimum committee system for institutions of higher education, certain principles, practices, and procedures prevail. The best practices…

  10. The Investment Committee. Effective Committees. Board Basics.

    ERIC Educational Resources Information Center

    Biggs, John H.

    1997-01-01

    The investment committee of the college or university governing board is charged with determining, overseeing, and assessing the policies and processes by which institutional funds are invested. The committee has fiduciary duty to ensure that the terms of investment of donors' gifts are met and to maximize investment returns within an appropriate…

  11. The Audit Committee. AGB Effective Committee Series

    ERIC Educational Resources Information Center

    Staisloff, Richard L.

    2011-01-01

    This publication is part of an Association of Governing Boards of Universities and Colleges (AGB) series devoted to strengthening the role of key standing committees of governing boards. While there is no optimum committee system for institutions of higher education, certain principles, practices, and procedures prevail. The best practices…

  12. The Compensation Committee. AGB Effective Committee Series

    ERIC Educational Resources Information Center

    Hyatt, Thomas K.

    2013-01-01

    This publication is part of an Association of Governing Boards of Universities and Colleges (AGB) series devoted to strengthening the role of key standing committees of governing boards. While there is no optimum committee system for institutions of higher education, certain principles, practices, and procedures prevail. The best practices…

  13. The Executive Committee. AGB Effective Committee Series

    ERIC Educational Resources Information Center

    Legon, Richard D.

    2012-01-01

    This publication is part of an Association of Governing Boards of Universities and Colleges (AGB) series devoted to strengthening the role of key standing committees of governing boards. While there is no optimum committee system for institutions of higher education, certain principles, practices, and procedures prevail. The best practices…

  14. The Audit Committee. AGB Effective Committee Series

    ERIC Educational Resources Information Center

    Staisloff, Richard L.

    2011-01-01

    This publication is part of an Association of Governing Boards of Universities and Colleges (AGB) series devoted to strengthening the role of key standing committees of governing boards. While there is no optimum committee system for institutions of higher education, certain principles, practices, and procedures prevail. The best practices…

  15. The Investment Committee. Effective Committees. Board Basics.

    ERIC Educational Resources Information Center

    Biggs, John H.

    1997-01-01

    The investment committee of the college or university governing board is charged with determining, overseeing, and assessing the policies and processes by which institutional funds are invested. The committee has fiduciary duty to ensure that the terms of investment of donors' gifts are met and to maximize investment returns within an appropriate…

  16. The Executive Committee. AGB Effective Committee Series

    ERIC Educational Resources Information Center

    Legon, Richard D.

    2012-01-01

    This publication is part of an Association of Governing Boards of Universities and Colleges (AGB) series devoted to strengthening the role of key standing committees of governing boards. While there is no optimum committee system for institutions of higher education, certain principles, practices, and procedures prevail. The best practices…

  17. The Compensation Committee. AGB Effective Committee Series

    ERIC Educational Resources Information Center

    Hyatt, Thomas K.

    2013-01-01

    This publication is part of an Association of Governing Boards of Universities and Colleges (AGB) series devoted to strengthening the role of key standing committees of governing boards. While there is no optimum committee system for institutions of higher education, certain principles, practices, and procedures prevail. The best practices…

  18. Evaluation of the current treatment concepts in Germany, Austria and Switzerland for acute traumatic lesions to the prepatellar and olecranon bursa.

    PubMed

    Baumbach, Sebastian F; Domaszewski, Florian; Wyen, Hendrick; Kalcher, Klaudius; Mutschler, Wolf; Kanz, Karl-Georg

    2013-11-01

    Although traumatic lacerations of the olecranon (OB) and praepatellar bursae (PB) are common entities often associated with complications, no study could be found on this injury. The aim of this study was to survey the current treatment concepts for acute traumatic laceration of the OB and PB in Germany, Austria and Switzerland. An international online survey was conducted among orthopaedic and trauma surgeons in Germany (TraumaNetwork DGU), Austria (Austrian Society of Trauma (ÖGU) and Orthopaedic (ÖGO) Surgeons) and Switzerland (Swiss Orthopaedic Surgeons and Swiss Society of Infectious Disease (CH)) (n=1967). The survey comprised of five demographical questions, the current treatment concepts were evaluated using a case study. The overall-response-rate was 16% (12-46%). 88% of the responding physicians were male, aged 47.5 ± 10.2 years with a mean working experience of 20.1 ± 10.6 years. 54% of the surveyed physicians were either senior or chief physicians. Treatment concepts varied significantly between DGU and ÖGO/CH (p=0.02/p=0.006), no significant differences could be found between DGU and ÖGU. Generally, German and Austrian trauma surgeons favoured bursectomy (86.7%/90.9%) and immobilisation (68.3%/77.3%). Austrian orthopaedic surgeons performed fewer bursectomies (69.3%) but had the highest proportion for administering antibiotics (73.9%). Less than 50% of Swiss physicians indicated bursectomy as a treatment option. Overall, this survey revealed a significant heterogeneity in treatment approaches in Central Europe. Further evidence is needed to identify the best treatment concepts for traumatic lacerations of the OB and PB. Copyright © 2012 Elsevier Ltd. All rights reserved.

  19. An examination of the Total Quality Management (TQM) concept given current Federal/DoD competition initiatives

    NASA Astrophysics Data System (ADS)

    Stabile, Michael E.

    1992-06-01

    Quality is vital to our defense and quality improvement is key to increasing productivity. The Department of Defense (DoD) Total Quality Management (TQM) effort has been given top priority by the Secretary of Defense. Many questions exist concerning the problems encountered when implementing TQM throughout DoD. This thesis looks at the compatibility of the TQM philosophy with current Federal Acquisition Regulation competition requirements. The writer concludes that the TQM philosophy implementation is compatible with existing competition policy.

  20. System performance and cost sensitivity comparisons of stretched membrane heliostat reflectors with current generation glass/metal concepts

    SciTech Connect

    Murphy, L.M.; Anderson, J.V.; Short, W.; Wendelin, T.

    1985-12-01

    Heliostat costs have long been recognized as a major factor in the cost of solar central receiver plants. Research on stretched membrane heliostats has been emphasized because of their potential as a cost-effective alternative to current glass/metal designs. However, the cost and performance potential of stretched membrane heliostats from a system perspective has not been studied until this time. The optical performance of individual heliostats is predicted here using results established in previous structural studies. These performance predictions are used to compare both focused and unfocused stretched membrane heliostats with state-of-the-art glass/metal heliostats from a systems perspective. We investigated the sensitivity of the relative cost and performance of fields of heliostats to a large number of parameter variations, including system size, delivery temperature, heliostat module size, surface specularity, hemispherical reflectance, and macroscopic surface quality. The results indicate that focused stretched membrane systems should have comparable performance levels to those of current glass/metal heliostat systems. Further, because of their relatively lower cost, stretched membrane heliostats should provide an economically attractive alternative to current glass/metal heliostats over essentially the entire range of design parameters studied. Unfocused stretched membrane heliostats may also be attractive for a somewhat more limited range of applications, including the larger plant sizes and lower delivery temperatures.

  1. Advisory Committee Handbook.

    ERIC Educational Resources Information Center

    Black Hawk Coll., Moline, IL.

    An advisory committee is generally comprised of persons outside the education profession who have specialized knowledge in a given area. The committee advises, makes recommendations, and gives service to the college and its students, instructors, and administrators. At Black Hawk College, there are four types of advisory committees: community,…

  2. Report of the joint ESOT and TTS basic science meeting 2013: current concepts and discoveries in translational transplantation.

    PubMed

    Ebner, Susanne; Fabritius, Cornelia; Ritschl, Paul; Oberhuber, Rupert; Günther, Julia; Kotsch, Katja

    2014-10-01

    A joint meeting organized by the European (ESOT) and The Transplantation (TTS) Societies for basic science research was organized in Paris, France, on November 7-9, 2013. Focused on new ideas and concepts in translational transplantation, the meeting served as a venue for state-of-the-art developments in basic transplantation immunology, such as the potential for tolerance induction through regulation of T-cell signaling. This meeting report summarizes important insights which were presented in Paris. It not only offers an overview of established aspects, such as the role of Tregs in transplantation, presented by Nobel laureate Rolf Zinkernagel, but also highlights novel facets in the field of transplantation, that is cell-therapy-based immunosuppression or composite tissue transplantation as presented by the emotional story given by Vasyly Rohovyy, who received two hand transplants. The ESOT/TTS joint meeting was an overall productive and enjoyable platform for basic science research in translational transplantation and fulfilled all expectations by giving a promising outlook for the future of research in the field of immunological transplantation research. © 2014 Steunstichting ESOT.

  3. Current Concepts in Diabetes Mellitus and Chronic Liver Disease: Clinical Outcomes, Hepatitis C Virus Association, and Therapy.

    PubMed

    García-Compeán, Diego; González-González, José Alberto; Lavalle-González, Fernando Javier; González-Moreno, Emmanuel Irineo; Villarreal-Pérez, Jesús Zacarías; Maldonado-Garza, Héctor J

    2016-02-01

    Hereditary type 2 diabetes mellitus is a risk factor for chronic liver disease, and ~30 % of patients with liver cirrhosis develop diabetes. Diabetes mellitus has been associated with cirrhotic and non-cirrhotic hepatitis C virus liver infection, can aggravate the course the liver infection, and can induce a lower sustained response to antiviral treatment. Evidences that HCV may induce metabolic and autoimmune disturbances leading to hypobetalipoproteinemia, steatosis, insulin resistance, impaired glucose tolerance, thyroid disease, and gonadal dysfunction have been found. Prospective studies have demonstrated that diabetes increases the risk of liver complications and death in patients with cirrhosis. However, treatment of diabetes in these patients is complex, as antidiabetic drugs can promote hypoglycemia and lactic acidosis. There have been few therapeutic studies evaluating antidiabetic treatments in patients with liver cirrhosis published to date; thus, the optimal treatment for diabetes and the impact of treatment on morbidity and mortality are not clearly known. As numbers of patients with chronic liver disease and diabetes mellitus are increasing, largely because of the global epidemics of obesity and nonalcoholic fatty liver disease, evaluation of treatment options is becoming more important. This review discusses new concepts on hepatogenous diabetes, the diabetes mellitus–hepatitis C virus association, and clinical implications of diabetes mellitus in patients with chronic liver disease. In addition, the effectiveness and safety of old and new antidiabetic drugs, including incretin-based therapies, will be described.

  4. An Overview of Literature Topics Related to Current Concepts, Methods, Tools, and Applications for Cumulative Risk Assessment (2007–2016)

    PubMed Central

    Fox, Mary A.; Brewer, L. Elizabeth; Martin, Lawrence

    2017-01-01

    Cumulative risk assessments (CRAs) address combined risks from exposures to multiple chemical and nonchemical stressors and may focus on vulnerable communities or populations. Significant contributions have been made to the development of concepts, methods, and applications for CRA over the past decade. Work in both human health and ecological cumulative risk has advanced in two different contexts. The first context is the effects of chemical mixtures that share common modes of action, or that cause common adverse outcomes. In this context two primary models are used for predicting mixture effects, dose addition or response addition. The second context is evaluating the combined effects of chemical and nonchemical (e.g., radiation, biological, nutritional, economic, psychological, habitat alteration, land-use change, global climate change, and natural disasters) stressors. CRA can be adapted to address risk in many contexts, and this adaptability is reflected in the range in disciplinary perspectives in the published literature. This article presents the results of a literature search and discusses a range of selected work with the intention to give a broad overview of relevant topics and provide a starting point for researchers interested in CRA applications. PMID:28387705

  5. An Overview of Literature Topics Related to Current Concepts, Methods, Tools, and Applications for Cumulative Risk Assessment (2007-2016).

    PubMed

    Fox, Mary A; Brewer, L Elizabeth; Martin, Lawrence

    2017-04-07

    Cumulative risk assessments (CRAs) address combined risks from exposures to multiple chemical and nonchemical stressors and may focus on vulnerable communities or populations. Significant contributions have been made to the development of concepts, methods, and applications for CRA over the past decade. Work in both human health and ecological cumulative risk has advanced in two different contexts. The first context is the effects of chemical mixtures that share common modes of action, or that cause common adverse outcomes. In this context two primary models are used for predicting mixture effects, dose addition or response addition. The second context is evaluating the combined effects of chemical and nonchemical (e.g., radiation, biological, nutritional, economic, psychological, habitat alteration, land-use change, global climate change, and natural disasters) stressors. CRA can be adapted to address risk in many contexts, and this adaptability is reflected in the range in disciplinary perspectives in the published literature. This article presents the results of a literature search and discusses a range of selected work with the intention to give a broad overview of relevant topics and provide a starting point for researchers interested in CRA applications.

  6. “Our hands are tied up”: Current state of safer conception services suggests the need for an integrated care model

    PubMed Central

    Goggin, Kathy; Mindry, Deborah; Beyeza-Kashesya, Jolly; Finocchario-Kessler, Sarah; Wanyenze, Rhoda; Nabiryo, Christine; Wagner, Glenn

    2014-01-01

    We conducted in-depth interviews with a variety of healthcare providers (n=33) in Uganda to identify current services that could support and barriers to the provision of safer conception counseling (SCC). Consistent with their training and expertise, providers of all types reported provision of services for people living with a diagnosis of HIV or AIDS (PLHIV) who desire a child. Important barriers including a lack of service integration, poor communication between stakeholders and the absence of policy guidelines were identified. Drawing on these data, we propose a model of integrated care that includes both prevention of unplanned pregnancies and SCC services. PMID:24901882

  7. Biologic Treatments for Sports Injuries II Think Tank-Current Concepts, Future Research, and Barriers to Advancement, Part 1: Biologics Overview, Ligament Injury, Tendinopathy.

    PubMed

    LaPrade, Robert F; Geeslin, Andrew G; Murray, Iain R; Musahl, Volker; Zlotnicki, Jason P; Petrigliano, Frank; Mann, Barton J

    2016-12-01

    Biologic therapies, including stem cells, platelet-rich plasma, growth factors, and other biologically active adjuncts, have recently received increased attention in the basic science and clinical literature. At the 2015 AOSSM Biologics II Think Tank held in Colorado Springs, Colorado, a group of orthopaedic surgeons, basic scientists, veterinarians, and other investigators gathered to review the state of the science for biologics and barriers to implementation of biologics for the treatment of sports medicine injuries. This series of current concepts reviews reports the summary of the scientific presentations, roundtable discussions, and recommendations from this think tank.

  8. GPS for low-cost attitude determination. A review of concepts, in-flight experiences, and current developments

    NASA Astrophysics Data System (ADS)

    Chu, Q. P.; Van Woerkom, P. Th. L. M.

    accuracy requirements. As carrier phase difference measurements are ambiguous because of the unknown number of GPS signal cycles received, the estimated attitude is in principle ambiguous as well. Therefore, resolution of the GPS signal cycle ambiguity becomes a necessary task before determining the attitude for a stand-alone GPS attitude sensing system. This problem may be solved by introducing additional low-cost reference attitude sensors like three-axis magnetometers. This is also one of the advantages of integrated sensor systems. The paper is organized as follows. Global Positioning System and GPS observables are described in the first two sections. The main attitude determination concepts are presented in the next section. For small spacecraft, GPS integrated with other low-cost attitude sensors results in a data fusion concept, to be discussed next. The last section highlights experiences and on-going projects related to the spacecraft attitude determination using GPS.

  9. Spaceborne synthetic aperture radar: Current status and future directions. A report to the Committee on Earth Sciences, Space Studies Board, National Research Council

    NASA Technical Reports Server (NTRS)

    Evans, D. L. (Editor); Apel, J.; Arvidson, R.; Bindschadler, R.; Carsey, F.; Dozier, J.; Jezek, K.; Kasischke, E.; Li, F.; Melack, J.

    1995-01-01

    This report provides a context in which questions put forth by NASA's Office of Mission to Planet Earth (OMPTE) regarding the next steps in spaceborne synthetic aperture radar (SAR) science and technology can be addressed. It summarizes the state-of-the-art in theory, experimental design, technology, data analysis, and utilization of SAR data for studies of the Earth, and describes potential new applications. The report is divided into five science chapters and a technology assessment. The chapters summarize the value of existing SAR data and currently planned SAR systems, and identify gaps in observational capabilities needing to be filled to address the scientific questions. Cases where SAR provides complementary data to other (non-SAR) measurement techniques are also described. The chapter on technology assessment outlines SAR technology development which is critical not only to NASA's providing societally relevant geophysical parameters but to maintaining competitiveness in SAR technology, and promoting economic development.

  10. Is the current concept of recurrent ovarian carcinoma as a chronic disease also applicable in platinum resistant patients?

    PubMed

    Güth, Uwe; Huang, Dorothy Jane; Schötzau, Andreas; Wight, Edward

    2010-02-01

    The treatment of recurrent ovarian carcinoma (ROC) has become increasingly oriented according to the therapy principles of a chronic disease. We evaluated whether it is justifiable to also apply this concept to the treatment of platinum resistant patients with their known poor prognosis and short overall survival (OS). We analyzed the overall courses of 85 unselected ROC patients and defined the following groups: A, platinum resistant patients (n=39); subgroup A.1, those who received no or at maximum one line of palliative chemotherapy (n=15, 38.5%); subgroup A.2, those who received>or=two therapy lines (n=24, 61.5%); B, platinum sensitive patients, n=46. Group A had significantly lower OS than group B (median: 16 vs. 25 months; p=0.019). Group A.1 had significantly worse outcome compared to group A.2 (median: 5 vs. 21.5 months; p<0.001). The comparison between study group A.2 and group B showed comparable survival rates (p=0.738). Considering only the patients who had completed treatment courses, the median number of therapy lines administered was higher in group A.2 than in group B (4 vs. 3; p=0.008). There is not only the known dichotomy between platinum sensitive and resistant ROC patients, but rather also within the platinum resistant subgroup itself. There is a considerably large subgroup of platinum resistant patients who will subsequently enter a phase where multiple treatment programs will be considered and administered. These patients have similar survival rates compared to those from the platinum sensitive patient group and the therapy principles of a chronic disease are applicable.

  11. Current concepts in the prevention of pathogen transmission via blood/plasma-derived products for bleeding disorders.

    PubMed

    Di Minno, Giovanni; Perno, Carlo Federico; Tiede, Andreas; Navarro, David; Canaro, Mariana; Güertler, Lutz; Ironside, James W

    2016-01-01

    The pathogen safety of blood/plasma-derived products has historically been a subject of significant concern to the medical community. Measures such as donor selection and blood screening have contributed to increase the safety of these products, but pathogen transmission does still occur. Reasons for this include lack of sensitivity/specificity of current screening methods, lack of reliable screening tests for some pathogens (e.g. prions) and the fact that many potentially harmful infectious agents are not routinely screened for. Methods for the purification/inactivation of blood/plasma-derived products have been developed in order to further reduce the residual risk, but low concentrations of pathogens do not necessarily imply a low level of risk for the patient and so the overall challenge of minimising risk remains. This review aims to discuss the variable level of pathogenic risk and describes the current screening methods used to prevent/detect the presence of pathogens in blood/plasma-derived products.

  12. Current concepts of immune based treatments for patients with HCC: from basic science to novel treatment approaches.

    PubMed

    Greten, Tim F; Wang, Xin W; Korangy, Firouzeh

    2015-05-01

    The recent approval of two immune checkpoint inhibitors for the treatment of malignant melanoma has sparked great interest by physicians and basic scientists searching for novel therapeutics for GI cancer. Chronic inflammation is recognised as a major risk factor for the development of hepatocellular carcinoma (HCC) and makes this type of cancer a potentially ideal target for an immune based treatment approach. Further evidence for a critical role of immune responses in patients with HCC is derived from the fact that immune signatures and profiles predict patients' outcome as well as the fact that tumour-induced spontaneous antitumour immunity can be detected. In addition ablative therapies can lead to changes in the number, phenotype and function of different immune cell subsets, which correlate with patients' survival. Various HCC-specific mouse models have been developed, which improve our understanding of hepatocarcinogenesis and tumour-immune cell interactions, and lead to the development of novel immune based treatment approaches, which are currently being evaluated in preclinical and in early clinical settings. Immune checkpoint blockade along with adoptive immune cell therapy and vaccine approaches are currently being evaluated either alone or in combination with other treatments. Here, we provide an overview for the rationale of immunotherapy in HCC, summarise ongoing studies and provide a perspective for immune based approaches in patients with HCC.

  13. Biologic Treatments for Sports Injuries II Think Tank—Current Concepts, Future Research, and Barriers to Advancement, Part 3

    PubMed Central

    Zlotnicki, Jason P.; Geeslin, Andrew G.; Murray, Iain R.; Petrigliano, Frank A.; LaPrade, Robert F.; Mann, Barton J.; Musahl, Volker

    2016-01-01

    Focal chondral defects of the articular surface are a common occurrence in the field of orthopaedics. These isolated cartilage injuries, if not repaired surgically with restoration of articular congruency, may have a high rate of progression to posttraumatic osteoarthritis, resulting in significant morbidity and loss of function in the young, active patient. Both isolated and global joint disease are a difficult entity to treat in the clinical setting given the high amount of stress on weightbearing joints and the limited healing potential of native articular cartilage. Recently, clinical interest has focused on the use of biologically active compounds and surgical techniques to regenerate native cartilage to the articular surface, with the goal of restoring normal joint health and overall function. This article presents a review of the current biologic therapies, as discussed at the 2015 American Orthopaedic Society for Sports Medicine (AOSSM) Biologics Think Tank, that are used in the treatment of focal cartilage deficiencies. For each of these emerging therapies, the theories for application, the present clinical evidence, and specific areas for future research are explored, with focus on the barriers currently faced by clinicians in advancing the success of these therapies in the clinical setting. PMID:27123466

  14. [The current trend of the Pharmacopoeia of Japan].

    PubMed

    Uchiyama, M

    1994-01-01

    The Pharmacopoeia of Japan (JP) has played an important leading role in establishing standards of quality and official test methods for drugs and drug preparations in Japan. The JP XII's second supplement and the JP XIII are scheduled to come out by the end of 1994 and on April of 1996, respectively. To provide a more open revision process for JP and to announce the revision and future conception of the JP committees, the outlines of the current progress of each JP sub-committee were introduced.

  15. Current Titles

    SciTech Connect

    Various

    2006-06-01

    This booklet is published for those interested in current research being conducted at the National Center for Electron Microscopy. The NCEM is a DOE-designated national user facility and is available at no charge to qualified researchers. Access is controlled by an external steering committee. Interested researchers may contact Jane Cavlina, Administrator, at 510/486-6036.

  16. Low-level radioactive waste disposal in the United States: An overview of current commercial regulations and concepts

    SciTech Connect

    Kennedy, W.E. Jr.

    1993-08-01

    Commercial low-level radioactive waste disposal in the United States is regulated by the US Nuclear Regulatory Commission (NRC) under 10 CFR 61 (1991). This regulation was issued in 1981 after a lengthy and thorough development process that considered the radionuclide concentrations and characteristics associated with commercial low-level radioactive waste streams; alternatives for waste classification; alternative technologies for low-level radioactive waste disposal; and data, modeling, and scenario analyses. The development process also included the publication of both draft and final environmental impact statements. The final regulation describes the general provisions; licenses; performance objectives; technical requirements for land disposal; financial assurances; participation by state governments and Indian tribes; and records, reports, tests, and inspections. This paper provides an overview of, and tutorial on, current commercial low-level radioactive waste disposal regulations in the United States.

  17. [Histocompatibility HLA system of man. Considerations in the light of current concepts. VII. Nonclassical HLA- E, F, and H loci].

    PubMed

    Kedzierska, A; Turowski, G

    2001-01-01

    Current opinions connected with HLA-E and HLA-F genes determining "nonclassical" (HLA-Ib) class I antigens of the Main Histocompatibility Complex MHC, and formed in the consequence of mutation or partial deletion of HLA-H pseudogene loci were presented. The expression of protein products of HLA-E and -F genes on some cells and tissues, their polymorphism, and also their biological functions in organisms were qualified by the use of molecular technics. The kind and frequency of occurrence of mutations 845 A (C282Y) and 187 G (H63D) in gene HLA-H were analysed, and in this context some genetic aspects of hereditary hemochromatozy (HH) were discussed.

  18. NASA science committee appointments

    NASA Astrophysics Data System (ADS)

    Zielinski, Sarah

    2006-10-01

    NASA Administrator Michael Griffin has made three new appointments to the NASA Advisory Council's (NAC' Science Committee, NASA announced on 22 September. Edward David, president of EED, Inc., and science advisor to the President from 1970 to 1973, will serve as the committee-s chair. Also appointed to the committee were Owen Garriott, a retired scientist astronaut, and Alan Stern, executive director of the Space Science and Engineering Division of the Southwest Research Institute (San Antonio, Tex.). David, Garriott, and Stern-who are among nine new members of the full advisory committee that were announced on 22 September-will replace three members of the Science Committee who resigned in August: Science Committee Chair Charles Kennel (Scripps Institution of Oceanography), Wesley Huntress (Carnegie Institution of Washington), and Eugene Levy (Rice University). The NAC's next public meeting will be held on 12 October at Goddard Space Flight Center in Greenbelt, Md.

  19. CCCT - NCTN Steering Committees - Pediatric and Adolescent Tumor

    Cancer.gov

    The Pediatric and Adolescent Solid Tumor Steering Committee addresses the design, prioritization and evaluation of concepts for large phase 2 and phase 3 clinical trials in extracranial solid tumors of children and youth.

  20. Role Playing Using a Simulated Pharmacy and Therapeutics Committee Model

    ERIC Educational Resources Information Center

    Fletcher, H. Patrick; Popvich, Nicholas G.

    1977-01-01

    Within a simulated Pharmacy and Therapeutics Committee format, role play is used at Purdue University to illustrate to students the concepts of drug product evaluation and selection as these apply to a hospital formulary system. (Author/LBH)

  1. Current Concepts for the IND-Directed Development of Microbicide Products to Prevent the Sexual Transmission of HIV.

    PubMed

    Buckheit, Karen W; Furlan-Freguia, Christian; Ham, Anthony S; Buckheit, Robert W

    2016-01-01

    In the absence of an approved and effective vaccine, topical microbicides have become the strategy of choice to provide women with the ability to prevent the sexual transmission of HIV. Topical microbicides are chemical and physical agents specifically developed and formulated for use in either the vaginal or rectal environment to prevent the sexual transmission of infectious organisms. Although a microbicide product will have many of the same properties as other anti-infective therapeutic agents, the microbicide development pathway has significant differences which reflect the complex biological environment in which the products must act. These challenges to the development of an effective microbicide are reflected in the recently released FDA Guidance document which defines the microbicide development algorithm and includes the evaluation of preclinical efficacy and toxicity, and safety and toxicology, and indicates the necessity of testing of the active pharmaceutical product as well as an optimal formulation for delivery of the microbicide product. The microbicide development algorithm requires evaluation of the potential microbicidal agent and final formulated product in assays which mimic the microenvironment of the vagina and rectum during the sexual transmission of HIV, including the evaluation of activity and cytotoxicity in the appropriate biological matrices, toxicity testing against normal vaginal flora and at standard vaginal pH, testing in ectocervical and colorectal explant tissue, and irritation studies to vaginal, rectal and penile tissue. Herein, we discuss currently accepted practices required for the development of a successful microbicide product which will prevent virus transmission in the vaginal and rectal vaults.

  2. Current concepts and future directions for the assessment of autoantibodies to cellular antigens referred to as anti-nuclear antibodies.

    PubMed

    Mahler, Michael; Meroni, Pier-Luigi; Bossuyt, Xavier; Fritzler, Marvin J

    2014-01-01

    The detection of autoantibodies that target intracellular antigens, commonly termed anti-nuclear antibodies (ANA), is a serological hallmark in the diagnosis of systemic autoimmune rheumatic diseases (SARD). Different methods are available for detection of ANA and all bearing their own advantages and limitations. Most laboratories use the indirect immunofluorescence (IIF) assay based on HEp-2 cell substrates. Due to the subjectivity of this diagnostic platform, automated digital reading systems have been developed during the last decade. In addition, solid phase immunoassays using well characterized antigens have gained widespread adoption in high throughput laboratories due to their ease of use and open automation. Despite all the advances in the field of ANA detection and its contribution to the diagnosis of SARD, significant challenges persist. This review provides a comprehensive overview of the current status on ANA testing including automated IIF reading systems and solid phase assays and suggests an approach to interpretation of results and discusses meeting the problems of assay standardization and other persistent challenges.

  3. Current concepts on oxidative/carbonyl stress, inflammation and epigenetics in pathogenesis of chronic obstructive pulmonary disease

    PubMed Central

    Yao, Hongwei; Rahman, Irfan

    2011-01-01

    Chronic obstructive pulmonary disease (COPD) is a global health problem, and current therapy for COPD is poorly effective and the mainstays of pharmacotherapy are bronchodilators. A better understanding of the pathobiology of COPD is critical for the development of novel therapies. In the present review, we have discussed the roles of oxidative/aldehyde stress, inflammation/immunity, and chromatin remodeling in the pathogenesis of COPD. Imbalance of oxidant/antioxidant balance caused by cigarette smoke and other pollutants/biomass fuels plays an important role in the pathogenesis of COPD by regulating redox-sensitive transcription factors (e.g. NF-κB), autophagy and unfolded protein response leading to chronic lung inflammatory response. Cigarette smoke also activates canonical/alternative NF-κB pathways and their upstream kinases leading to sustained inflammatory response in lungs. Recently, epigenetic regulation has been shown to be critical for the development of COPD because the expression/activity of enzymes that regulate these epigenetic modifications have been reported to be abnormal in airways of COPD patients. Hence, the significant advances made in understanding the pathophysiology of COPD as described herein will identify novel therapeutic targets for intervening COPD. PMID:21296096

  4. Current Concepts and Future Directions for the Assessment of Autoantibodies to Cellular Antigens Referred to as Anti-Nuclear Antibodies

    PubMed Central

    Mahler, Michael; Meroni, Pier-Luigi; Bossuyt, Xavier; Fritzler, Marvin J.

    2014-01-01

    The detection of autoantibodies that target intracellular antigens, commonly termed anti-nuclear antibodies (ANA), is a serological hallmark in the diagnosis of systemic autoimmune rheumatic diseases (SARD). Different methods are available for detection of ANA and all bearing their own advantages and limitations. Most laboratories use the indirect immunofluorescence (IIF) assay based on HEp-2 cell substrates. Due to the subjectivity of this diagnostic platform, automated digital reading systems have been developed during the last decade. In addition, solid phase immunoassays using well characterized antigens have gained widespread adoption in high throughput laboratories due to their ease of use and open automation. Despite all the advances in the field of ANA detection and its contribution to the diagnosis of SARD, significant challenges persist. This review provides a comprehensive overview of the current status on ANA testing including automated IIF reading systems and solid phase assays and suggests an approach to interpretation of results and discusses meeting the problems of assay standardization and other persistent challenges. PMID:24868563

  5. Cognitive development, memory, trauma, treatment: An integration of psychoanalytic and behavioral concepts in light of current neuroscience research.

    PubMed

    Hutterer, Jeffrey; Liss, Miriam

    2006-01-01

    The goal of Freud's Project was to place all psychological functioning on a neurological foundation; however, the resources of his time were inadequate for the task. This article attempts to link basic psychoanalytic and behavioral constructs to current neuroscience, specifically the memory paradigm of multiple trace theory. We propose that Freud's theory of early cognitive development, in which primary process is succeeded by secondary process, corresponds to the progression from a noncontextual taxon-based memory system to a locale system (mediated by hippocampal and cortical structures) in which memories are formed within space/time contexts. The effects of trauma within these models is then examined by noting how Freud's views of repression and regression parallel neuropsychological hypotheses about the ways in which traumatic experience impacts specific brain areas. Finally, the treatment implications of this theoretical synthesis are explored. We posit that transference resembles the learning theory construct of generalization, and the non-contextualized coding of the taxon system. In conclusion, we suggest that orthodox psychoanalytic approaches may have overestimated the efficacy of words and intellectual vectors in effecting therapeutic change. Nonverbal strategies may be required to reach material that is stored in early developing brain areas that may be inaccessible to words.

  6. Current concepts on oxidative/carbonyl stress, inflammation and epigenetics in pathogenesis of chronic obstructive pulmonary disease

    SciTech Connect

    Yao Hongwei; Rahman, Irfan

    2011-07-15

    Chronic obstructive pulmonary disease (COPD) is a global health problem. The current therapies for COPD are poorly effective and the mainstays of pharmacotherapy are bronchodilators. A better understanding of the pathobiology of COPD is critical for the development of novel therapies. In the present review, we have discussed the roles of oxidative/aldehyde stress, inflammation/immunity, and chromatin remodeling in the pathogenesis of COPD. An imbalance of oxidants/antioxidants caused by cigarette smoke and other pollutants/biomass fuels plays an important role in the pathogenesis of COPD by regulating redox-sensitive transcription factors (e.g., NF-{kappa}B), autophagy and unfolded protein response leading to chronic lung inflammatory response. Cigarette smoke also activates canonical/alternative NF-{kappa}B pathways and their upstream kinases leading to sustained inflammatory response in lungs. Recently, epigenetic regulation has been shown to be critical for the development of COPD because the expression/activity of enzymes that regulate these epigenetic modifications have been reported to be abnormal in airways of COPD patients. Hence, the significant advances made in understanding the pathophysiology of COPD as described herein will identify novel therapeutic targets for intervention in COPD.

  7. The role of gene-environment interplay in occupational and environmental diseases: current concepts and knowledge gaps.

    PubMed

    Kwo, Elizabeth; Christiani, David

    2017-03-01

    The interplay between genetic susceptibilities and environmental exposures in the pathogenesis of a variety of diseases is an area of increased scientific, epidemiologic, and social interest. Given the variation in methodologies used in the field, this review aims to create a framework to help understand occupational exposures as they currently exist and provide a foundation for future inquiries into the biological mechanisms of the gene-environment interactions. Understanding of this complex interplay will be important in the context of occupational health, given the public health concerns surrounding a variety of occupational exposures. Studies found evidence that suggest genetics influence the progression of disease postberyllium exposure through genetically encoded major histocompatibility complex, class II, DP alpha 2 (HLA-DP2)-peptide complexes as it relates to T-helper cells. This was characterized at the molecular level by the accumulation of Be-responsive CD4 T cells in the lung, which resulted in posttranslational change in the HLA-DPB1 complex. These studies provide important evidence of gene-environment association, and many provide insights into specific pathogenic mechanisms. The following includes a review of the literature regarding gene-environment associations with a focus on pulmonary diseases as they relate to the workplace.

  8. Low-level environmental lead exposure and intellectual impairment in children--the current concepts of risk assessment.

    PubMed

    Jakubowski, Marek

    2011-03-01

    Lead is an environmental contaminant. The majority of epidemiological research on the health effects of lead has been focused on children, because they are more vulnerable to lead than adults. In children, an elevated blood lead (B-Pb) is associated with reduced Intelligence Quotient (IQ) score. This paper summarizes the current opinions on the assessment of the health risk connected with the children's environmental exposure to lead. The B-Pb level of concern of 100 μg/l proposed by the US Centers of Disease Control in 1991 was for a long time accepted as the guideline value. In the meantime there has been a significant worldwide decrease of B-Pb levels in children and present geometric mean values in the European countries range from 20 to 30 μg/l. The recent analyses of the association of intelligence test scores and B-Pb levels have revealed that the steepest declines in IQ occur at blood levels < 100 μg/l and that no threshold below which lead does not cause neurodevelopmental toxicity can be defended. European Food Safety Authority (EFSA) concluded in 2010, on the basis of results of Benchmark Dose (BMD) analysis, that an increase in B-Pb of 12 μg/l (BMDL₀₁) could decrease the IQ score by one point. It seems that this value can be used as a "unit risk" to calculate the possible decrease of IQ and, consequently, influence of the low-level exposure to lead (< 100 μg/l) on the health and socioeconomic status of the exposed population.

  9. Reconstruction of the anterior cruciate ligament in the skeletally immature athlete: a review of current concepts: AAOS exhibit selection.

    PubMed

    Fabricant, Peter D; Jones, Kristofer J; Delos, Demetris; Cordasco, Frank A; Marx, Robert G; Pearle, Andrew D; Warren, Russell F; Green, Daniel W

    2013-03-06

    Intrasubstance tears of the anterior cruciate ligament (ACL) were once considered a rare injury in skeletally immature athletes but are now observed with increasing frequency. Treatment strategies have evolved as recent studies have identified unique considerations specific to the skeletally immature patient. The current literature now supports the trend toward early operative treatment to restore knee stability and prevent progressive meniscal and/or articular cartilage damage, but the optimal approach to ACL reconstruction in this age group remains controversial. Despite the reported clinical success of transphyseal reconstruction, iatrogenic growth disturbance secondary to physeal damage remains a genuine concern. The reluctance to place drill-holes across open physes has led to the development of numerous "physeal-sparing" reconstruction techniques using anatomic femoral and tibial footprints that have adequately restored anteroposterior and rotational knee stability in biomechanical studies but have demonstrated mixed results in the clinical setting. The intent of this review is to (1) highlight the unique anatomic considerations pertaining to ACL reconstruction in the skeletally immature athlete, (2) discuss preoperative clinical and radiographic assessment of the pediatric patient with a suspected ACL injury, (3) review transphyseal and physeal-sparing reconstruction techniques and highlight surgical technical considerations, (4) present clinical outcomes according to patient and technique-specific factors, and (5) review age-specific injury prevention treatment strategies and a novel treatment algorithm based on skeletal maturity. ACL reconstruction in the skeletally immature athlete typically results in a successful clinical outcome, yet the optimal surgical technique is still controversial. This review will help guide the management of ACL injuries in the pediatric athlete.

  10. CURRENT CONCEPTS ON THE GENETIC FACTORS IN ROTATOR CUFF PATHOLOGY AND FUTURE IMPLICATIONS FOR SPORTS PHYSICAL THERAPISTS.

    PubMed

    Orth, Travis; Paré, Jessica; Froehlich, John E

    2017-04-01

    Recent advances within the field of genetics are currently changing many of the methodologies in which medicine is practiced. These advances are also beginning to influence the manner in which physical therapy services are rendered. Rotator cuff pathology is one of the most common diagnoses treated by the sports physical therapist. The purpose of this commentary is to educate sports physical therapists on the recent advances regarding how genetics influences rotator cuff pathology, including rotator cuff tears, and provide a perspective on how this information will likely influence post-operative shoulder rehabilitation in the near future. A comprehensive review of the literature was completed using the Medline database along with individual searches of relevant physical therapy, surgical, cell biology, and sports medicine journals. Search terms included: shoulder, rotator cuff pathology, genetics, apoptosis, and physical therapy. Search results were compiled and evaluated; relevant primary studies and review articles were gathered; the results from this comprehensive review are summarized here. Clinical Commentary, Review of the Literature. Recent advances within the understanding of rotator cuff pathology have further elucidated the cellular and molecular mechanisms associated with rotator cuff tears. There appears to be a hypoxic-induced apoptotic cellular pathway that contributes to rotator cuff tears. Activation of specific proteins termed matrix metalloproteinases appear to be involved in not only primary rotator cuff tears, but also may influence the re-tear rate after surgical intervention. Further advancements in the understanding of the cellular mechanisms contributing to rotator cuff tears and postoperative techniques to help prevent re-tears, may soon influence the methodology in which physical therapy services are provided to patients sustaining a rotator cuff injury. At this time continued research is required to more fully develop a comprehensive

  11. CURRENT CONCEPTS ON THE GENETIC FACTORS IN ROTATOR CUFF PATHOLOGY AND FUTURE IMPLICATIONS FOR SPORTS PHYSICAL THERAPISTS

    PubMed Central

    Paré, Jessica; Froehlich, John E

    2017-01-01

    Context Recent advances within the field of genetics are currently changing many of the methodologies in which medicine is practiced. These advances are also beginning to influence the manner in which physical therapy services are rendered. Rotator cuff pathology is one of the most common diagnoses treated by the sports physical therapist. The purpose of this commentary is to educate sports physical therapists on the recent advances regarding how genetics influences rotator cuff pathology, including rotator cuff tears, and provide a perspective on how this information will likely influence post-operative shoulder rehabilitation in the near future. Evidence Acquisition A comprehensive review of the literature was completed using the Medline database along with individual searches of relevant physical therapy, surgical, cell biology, and sports medicine journals. Search terms included: shoulder, rotator cuff pathology, genetics, apoptosis, and physical therapy. Search results were compiled and evaluated; relevant primary studies and review articles were gathered; the results from this comprehensive review are summarized here. Study Design Clinical Commentary, Review of the Literature Results Recent advances within the understanding of rotator cuff pathology have further elucidated the cellular and molecular mechanisms associated with rotator cuff tears. There appears to be a hypoxic-induced apoptotic cellular pathway that contributes to rotator cuff tears. Activation of specific proteins termed matrix metalloproteinases appear to be involved in not only primary rotator cuff tears, but also may influence the re-tear rate after surgical intervention. Further advancements in the understanding of the cellular mechanisms contributing to rotator cuff tears and postoperative techniques to help prevent re-tears, may soon influence the methodology in which physical therapy services are provided to patients sustaining a rotator cuff injury. Conclusions At this time continued

  12. Current chemical concepts of acids and bases and their application to anionic ("acid") and cationic ("basic") dyes.

    PubMed

    Puchtler, H; Meloan, S N; Spencer, M

    1985-01-01

    In biomedical studies, dyes are divided into "acid" and "basic" dyes. This classification cannot be reconciled with current chemical definitions of acids and bases. Brönsted-Lowry acids are compounds that can donate protons; bases are proton acceptors. The definition of acids and bases is independent of the electric charge, i.e. acids and bases can be neutral, anionic or cationic. Reactions between acids and bases result in formation of new acid-base pairs. Lewis acids and bases do not depend on a particular element, but are characterized by their electronic configurations. Lewis bases are electron donors; Lewis acids are electron acceptors. This classification is also unrelated to the electric charge. Lewis acids and bases interact by formation of coordinate covalent bonds. In histochemistry and histology, dyes containing -SO3-, -COO- and/or -O- groups are classified as "acid" dyes. However, such compounds are electron pair donors and hence Brönsted-Lowry and Lewis anionic bases. Dyes carrying a positive charge are termed "basic" dyes. Chemically, many cationic dyes are Lewis acids because they can add a base, e.g. OH-, acetate, halides. The hypothesis that transformation of -NH2 into ammonium groups imparts "basic" properties to dyes is untenable; ammonium groups are proton donors and hence acids. Furthermore, conversion of an amino into an ammonium group blocks a lone electron pair and the color of the dye changes drastically, e.g. from violet to green and yellow. It appears therefore highly unlikely that ammonium groups are responsible for binding of cationic ("basic") dyes. In histochemistry, it is usually not of critical importance whether anionic or cationic dyes are chemically acids or bases.(ABSTRACT TRUNCATED AT 250 WORDS)

  13. 75 FR 26846 - Genomic Medicine Program Advisory Committee; Notice of Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-05-12

    ...] [FR Doc No: 2010-11322] DEPARTMENT OF VETERANS AFFAIRS Genomic Medicine Program Advisory Committee... Advisory Committee Act) that the Genomic Medicine Program Advisory Committee will meet on May 21, 2010, at... genomic medicine delivery within VHA and proof of concept for genome-phenome associations using...

  14. The new IASLC/ATS/ERS lung adenocarcinoma classification from a clinical perspective: current concepts and future prospects

    PubMed Central

    Enguita, Ana Belen; Nuñez, Juan Antonio; Iglesias, Lara; Ponce, Santiago

    2014-01-01

    The new the International Association for the Study of Lung Cancer (IASLC)/the American Thoracic Society (ATS)/the European Respiratory Society (ERS) pathologic classification of lung cancer has markedly changed the pathologic diagnosis of lung adenocarcinoma. This classification deals with many aspects that directly affect clinical practice, and opens new gateways for future research. By means of a multidisciplinary approach, it differs significantly from the former 2004 the World Health Organization (WHO) classification, which was mainly written by pathologist. The present review, in line with the consensus article, is divided in two components: the diagnosis and classification of lung adenocarcinoma in resection specimens and the diagnosis of lung cancer in small biopsies and cytology. Resection specimens are currently classified according to the predominant histologic pattern after comprehensive subtyping in 5% increments. This approach has led to the addition of new pathologic subtypes [adenocarcinoma in situ (AIS), minimally invasive adenocarcinoma (MIA) and micropapillary predominant adenocarcinoma)] and to the discontinuation of some heterogeneous entities included in the former 2004 WHO classification (mixed subtype adenocarcinoma and bronchioloalveolar carcinoma). Overall, these changes have resulted in a better stratification of lung adenocarcinoma tumors in more homogeneous morphologic, clinical and biological subgroups. Pathologic subtyping has demonstrated prognostic utility in resected stage I-III patients, and recent data support their predictive role for the benefit of adjuvant chemotherapy. Moreover, comprehensive pathologic subtyping may potentially affect TNM staging and surgical management or early-stage tumors. On the other hand, for the first time, the novel pathologic classification provides standardized terminology and diagnostic criteria of small biopsies and cytology. Criteria are proposed not only for adenocarcinoma but also for other

  15. 75 FR 31509 - Executive Committee of the Aviation Rulemaking Advisory Committee; Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-06-03

    ... Administration, 800 Independence Avenue, SW., Washington, DC 20591. The agenda includes: 1. Continuous Improvement (Committee Process) ARAC Task--Advice and Recommendations to FAA about current ARAC process. FAA...

  16. 7 CFR 945.11 - Committee.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... and Orders; Fruits, Vegetables, Nuts), DEPARTMENT OF AGRICULTURE IRISH POTATOES GROWN IN CERTAIN... Committee. Committee means the administrative committee, called the Idaho-Eastern Oregon Potato Committee...

  17. Committee Reports, May 2008

    NASA Astrophysics Data System (ADS)

    2008-08-01

    The Division's Executive Committee conducted several items of business at the New Orleans meeting. Elsewhere in this issue [see p 1032] is a listing of the candidates for Division offices for Fall 2008 election, approved by the Committee and later affirmed at the Division business meeting. Among items of specific interest to Division members is a plan to have the Journal of Chemical Education send an announcement to members when each issues goes online, and the Committee approved this use of the Division email list. It also approved plans presented by Amina El-Ashmawy and the BCCE committee to proceed with a bid from Pennsylvania State University for the 2012 BCCE.

  18. Consensus, contracts, and committees.

    PubMed

    Moreno, J D

    1991-08-01

    Following a brief account of the puzzle that ethics committees present for the Western Philosophical tradition, I will examine the possibility that social contract theory can contribute to a philosophical account of these committees. Passing through classical as well as contemporary theories, particularly Rawls' recent constructivist approach, I will argue that social contract theory places severe constraints on the authority that may legitimately be granted to ethics committees. This, I conclude, speaks more about the suitability of the theory to this level of analysis than about the ethics committee phenomenon itself.

  19. Highlights of Publications Committee Meeting

    NASA Astrophysics Data System (ADS)

    The Publications Committee has the responsibility for the oversight of the entire publications program of the Union. They are the chief advisors to the Council on all matters relating to publication policy and practice. The committee meets twice each year for an all-day review of current areas of concern relating to journals, books, and translations. At its April 22, 1987, meeting in Washington, D.C., the following actions were taken: Decided to alter the Information for Contributors to clarify the expectations of AGU with regard to journal papers that have more than one author.Agreed to take several steps to inform the AGU members about the responsibilities and authorities of AGU journal editors and to reinforce the responsibilities of reviewers and authors as they relate to papers published by AGU.Approved a mechanism for evaluating AGU journals against other journals that compete with AGU for authors and readers.Endorsed a proposal of the Budget and Finance Committee that defines the target for the Council-designated reserve fund for publications. Recommended to the Budget and Finance Committee that future budgets carry a specific designation for investment in new technology for the publications activities.Reaffirmed the policy that only one subscription per member be provided at the special member rate. Urged staff to review the pricing structure for single issues to make it easier for members to purchase the occasional single issue.Encouraged the Translations Board to develop further their proposal for a data base on materials available in translation. Also requested the Translations Board to investigate translation of Japanese scientific literature, especially in hydrology.Agreed to support the Education and Human Resources Committee proposal to Council for testing a high school magazine based on items published in Eos. Made several suggestions for ways to improve the proposal with regard to the content of the magazine.

  20. Frontotemporal dementia linked to chromosome 3 (FTD-3)--current concepts and the detection of a previously unknown branch of the Danish FTD-3 family.

    PubMed

    Lindquist, S G; Braedgaard, H; Svenstrup, K; Isaacs, A M; Nielsen, J E

    2008-07-01

    Among patients with onset of dementia below the age of 65 years, frontotemporal dementia (FTD) is the second most prevalent cause, secondary only to Alzheimer's disease. Recent advances in understanding the heterogeneous genetic background for different clinical and neuropathological entities of FTD have involved identification of several new causative genes. We report the finding of a truncating mutation in the CHMP2B gene (c.532-1G>C) in a patient with early onset dementia. The patient was previously not known to be related to the single Danish pedigree known to have this specific mutation. Subsequently he has turned out to represent a new branch of the family with several affected individuals. Our findings highlight the need for awareness of the CHMP2B mutation and associated clinical phenotype for neurological assessment in Denmark. Further, we discuss recent advances and current concepts in the understanding of CHMP2B-related dementia.