Science.gov

Sample records for compromised patients part

  1. [Guidelines for chagas disease: Part IV. Chagas disease in immune compromised patients].

    PubMed

    Apt B, Werner; Heitmann G, Ingrid; Jercic L, M Isabel; Jotré M, Leonor; Muñoz C Del V, Patricia; Noemí H, Isabel; San Martin V, Ana M; Sapunar P, Jorge; Torres H, Marisa; Zulantay A, Inés

    2008-08-01

    A summary of different kind of immune suppressed hosts and the importance of Trypanosoma cruzi infection in this group of patients is presented. Then, most relevant aspects of immune compromised host-parasite interaction are analyzed such as the moment of acquiring the infection, immune compromise level, mechanisms of acquisition the infection and geographic region. Clinical features of primary infection and reactivation of infection in chronic Chagasic patients are described making special emphasis in solid organ transplant and BMT. Chagas disease in AIDS patients is discussed including its treatment, follow up, monitoring the immune compromise level and prophylaxis.

  2. The dental management of medically compromised patients.

    PubMed

    Goss, A N

    1984-12-01

    There is an increasing population of apparently well, but in fact medically compromised people in the community. Most will require dental treatment at some stage and will usually seek it away from a hospital environment. In a recent survey of a general dental practice in Australia it was found that up to 55 per cent of some age groups had concurrent medical problems. Thus there is a real risk that adverse interactions between medical conditions and dental treatment may occur--on some occasions, even fatal ones. It is not possible for any one individual to know the details of all medical conditions, their treatment and the possible interactions with dental treatment. However, by the application of some sound general principles the risks of any potential interactions can be evaluated. The essential steps are: knowledge of the medical history of all patients; knowledge of the potential interactions; and knowledge of the management of medical emergencies. These principles will be discussed and illustrated by examples of medically compromised patients who may experience common or potentially serious sequelae as a result of dental treatment.

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

    PubMed Central

    Gheorghiu, IM; Stoian, IM

    2014-01-01

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

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

    PubMed Central

    2012-01-01

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

  5. Treatment of Lung Cancer in Medically Compromised Patients.

    PubMed

    Crawford, Jeffrey; Wheatley-Price, Paul; Feliciano, Josephine Louella

    2016-01-01

    Outcomes for patients with lung cancer have been improved substantially through the integration of surgery, radiation, and systemic therapy for patients with early-stage disease. Meanwhile, advances in our understanding of molecular mechanisms have substantially advanced our treatment of patients with advanced lung cancer through the introduction of targeted therapies, immune approaches, improvements in chemotherapy, and better supportive care. However, the majority of these advances have occurred among patients with good functional status, normal organ function, and with the social and economic support systems to be able to benefit most from these treatments. The aim of this article is to bring greater attention to management of lung cancer in patients who are medically compromised, which remains a major barrier to care delivery. Impaired performance status is associated with poor outcomes and correlates with the high prevalence of cachexia among patients with advanced lung cancer. CT imaging is emerging as a research tool to quantify muscle loss in patients with cancer, and new therapeutics are on the horizon that may provide important adjunctive therapy in the future. The benefits of cancer therapy for patients with organ failure are poorly understood because of their exclusion from clinical trials. The availability of targeted therapy and immunotherapy may provide alternatives that may be easier to deliver in this population, but clinical trials of these new agents in this population are vital. Patients with lower socioeconomic status are disproportionately affected by lung cancer because of higher rates of tobacco addiction and the impact of socioeconomic status on delay in diagnosis, treatment, and outcomes. For all patients who are medically compromised with lung cancer, multidisciplinary approaches are particularly needed to evaluate these patients and to incorporate rapidly changing therapeutics to improve outcomes.

  6. A one-appointment impression and centric relation record technique for compromised complete denture patients.

    PubMed

    Ansari, I H

    1997-09-01

    This article describes a two-in-one modified custom tray and record block system that is recommended for compromised elderly patients. Custom trays, which are made on primary casts and formed from a patient's functionally corrected old dentures, are used to make final impressions and centric jaw relation records in one clinical appointment. The clinical visits are reduced without compromising the quality of denture construction.

  7. Respiratory Compromise as a New Paradigm for the Care of Vulnerable Hospitalized Patients.

    PubMed

    Morris, Timothy A; Gay, Peter C; MacIntyre, Neil R; Hess, Dean R; Hanneman, Sandra K; Lamberti, James P; Doherty, Dennis E; Chang, Lydia; Seckel, Maureen A

    2017-04-01

    Acute respiratory compromise describes a deterioration in respiratory function with a high likelihood of rapid progression to respiratory failure and death. Identifying patients at risk for respiratory compromise coupled with monitoring of patients who have developed respiratory compromise might allow earlier interventions to prevent or mitigate further decompensation. The National Association for the Medical Direction of Respiratory Care (NAMDRC) organized a workshop meeting with representation from many national societies to address the unmet needs of respiratory compromise from a clinical practice perspective. Respiratory compromise may arise de novo or may complicate preexisting lung disease. The group identified distinct subsets of respiratory compromise that present similar opportunities for early detection and useful intervention to prevent respiratory failure. The subtypes were characterized by the pathophysiological mechanisms they had in common: impaired control of breathing, impaired airway protection, parenchymal lung disease, increased airway resistance, hydrostatic pulmonary edema, and right-ventricular failure. Classification of acutely ill respiratory patients into one or more of these categories may help in selecting the screening and monitoring strategies that are most appropriate for the patient's particular pathophysiology. Standardized screening and monitoring practices for patients with similar mechanisms of deterioration may enhance the ability to predict respiratory failure early and prevent its occurrence.

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

    PubMed

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

    2013-04-01

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

  9. Fungemia and interstitial lung compromise caused by Malassezia sympodialis in a pediatric patient.

    PubMed

    Aguirre, Clarisa; Euliarte, Cristina; Finquelievich, Jorge; Sosa, María de los Ángeles; Giusiano, Gustavo

    2015-01-01

    A case of fungemia with interstitial lung compromise caused by Malassezia sympodialis is reported in an obese pediatric patient on long-term treatment with inhaled corticosteroids for asthma. The patient was hospitalized due to a post-surgical complication of appendicitis. The patient was treated with amphotericin B for 3 weeks, with good clinical evolution and subsequent negative cultures.

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

    PubMed

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

    2014-07-01

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

  11. Full Mouth Rehabilitation in a Medically Compromised Patient with Fluorosis

    PubMed Central

    Bansal, Ramta; Mittal, Sunandan; Kumar, Tarun

    2014-01-01

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

  12. Clinicopathologic subtypes and compromise of lymph nodes in patients with breast cancer

    PubMed Central

    Jaime Jans, B; Nicolás Escudero, M; Dahiana Pulgar, B; Francisco Acevedo, C; César Sánchez, R; Camus, A Mauricio

    2014-01-01

    Breast cancer (BC) is currently a heterogeneous disease with variations in clinical behaviour. Classification according to subtypes has allowed progress in the individualisation of treatment. The objective of this study is to evaluate the risk of axillary node compromise in patients with BC, according to clinicopathologic subtypes. Materials and methods are a retrospective, descriptive-analytical study. All patients that had undergone surgery for invasive BC were included, with the study of sentinel lymph nodes (SLNs) at Hospital Clínico de la Pontificia Universidad Católica, between May 1999 and December 2012. The results showed 632 patients fulfilled the inclusion criteria, with the median age being 55 years (range: 28–95), and 559 (88.4%) patients presented with estrogen receptor and/or progesterone receptor positive tumours. Luminal A: 246 patients (38.9%), luminal B: 243 (38.4%), luminal not otherwise specified: 70 (11.1%) triple negative (TN): 60 (9.5%) and over expression of epidermal growth factor type 2 receptor (HER2 positive): 13 (2.1%). Luminal tumours displayed a greater risk of metastasis in the SLNs, but this difference was not statistically significant (p = 0.67). TN and HER2 positive tumours presented the greatest proportion of metastatic compromise in non-sentinel lymph nodes (non-SLNs) (57.1% and 50%, respectively). The presence of macrometastasis (MAM) in the SLN was associated with a greater risk of compromise of the non-SLN. Conclusions: Luminal tumours are the most frequent and present a greater proportion of axillary lymph node compromise, without being statistically significant. TN and HER2 positive tumours tend to have a higher axillary compromise; however, this was not statistically significant in either. Only the presence of MAM in SLNs displayed a statistically significantly association in the compromise of non-SLNs. PMID:25114720

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

    PubMed

    Wallace, Ilse M

    2015-02-01

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

  14. The appropriateness of referral of medically compromised dental patients to hospital.

    PubMed

    Absi, E G; Satterthwaite, J; Shepherd, J P; Thomas, D W

    1997-04-01

    Hospital departments of oral and maxillofacial surgery make a substantial contribution to both managing and treating medically-compromised dental patients. Contracting arrangements should take account of this. Demographic data suggest that the treatment of medically-compromised elderly dentate patients will become increasingly important in the General Dental Service (GDS). To determine the medical conditions and treatment requirements prompting referral of these patients to hospital, a prospective study was undertaken of 75 consecutive adults referred for hospital treatment specifically because of a medical condition which prevented delivery of routine dental care in the GDS. Patients (mean age: 56 years) were referred mainly from general medical (33%) and dental (62%) practitioners. Cardiovascular disease was the most frequently cited medical condition requiring referral (43%; n = 32 cases). Forty-eight patients (64%) were symptomatic on presentation and on average had attended on 2.3 occasions before definitive treatment was instituted. Fifty-two patients (70%) had no special treatment requirements other than those available in the GDS, 11 patients (15%) simply required antibiotic prophylaxis and 81% were treated by undergraduates or junior staff. These data suggest that many patients referred for dental hospital treatment because of underlying medical condition are not in fact medically-compromised and may be treated in the primary care setting.

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

    PubMed

    Zuo, Kevin J; Wilkes, Gordon H

    2016-01-01

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

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

    PubMed Central

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

    2014-01-01

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

  17. Home intravenous antibiotic treatment for febrile episodes in immune-compromised pediatric patients.

    PubMed

    Shemesh, E; Yaniv, I; Drucker, M; Hadad, S; Goshen, Y; Stein, J; Ash, S; Fisher, S; Zaizov, R

    1998-02-01

    The purpose of this work was to assess the feasibility of home intravenous antibiotic treatment (HIAT) for febrile episodes in immune-compromised (neutropenic, splenectomized), low-risk pediatric patients. Thirty hematology-oncology patients who presented to our emergency room from January 1993 to January 1995 and who suffered from a febrile episode and were considered at low risk for septic complications were immediately discharged on HIAT. Patients were followed for at least 3 weeks after recovery. Patients and parents were retrospectively questioned about adverse effects and about their degree of satisfaction with home treatment. Patients who required hospitalization during this period were considered unresponsive to HIAT and were analyzed for causes and adverse effects. Thirteen out of 60 (22%) febrile episodes, or eight out of 42 (19%) episodes of fever and neutropenia eventually led to hospitalization. Pseudomonas species infections were associated with the highest rate of unresponsiveness (88%). A central venous catheter infection developed in two cases following HIAT (two cases out of 640 days of therapy). No other complications were identified. No infection-related morbidity was observed. Patients and parents were highly satisfied with HIAT and wanted to use it again, if necessary. Immediate discharge on HIAT for low-risk pediatric immune-compromised patients suffering from a febrile episode is feasible, safe, and well accepted by patients and families. Patients who are found to have Pseudomonas infections should probably be hospitalized. Our results are preliminary and must be confirmed by a prospective, randomized trial before definite recommendations can be made.

  18. Indications and contraindications of dental implants in medically compromised patients: update.

    PubMed

    Gómez-de Diego, Rafael; Mang-de la Rosa, María del Rocío; Romero-Pérez, María-Jesús; Cutando-Soriano, Antonio; López-Valverde-Centeno, Antonio

    2014-09-01

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

  19. Interdisciplinary treatment of a periodontally compromised adult patient with multiple missing posterior teeth.

    PubMed

    Agarwal, Sachin; Gupta, Sumita; Chugh, Vinay K; Jain, Eety; Valiathan, Ashima; Nanda, Ravindra

    2014-02-01

    This article reports the comprehensive, interdisciplinary treatment of a 50-year-old periodontally compromised adult patient with multiple missing posterior teeth. After initial periodontal treatment, the maxillary first molars and right central incisor were intruded orthodontically. Miniscrews were used to intrude the maxillary first molars by 3 mm. The mandibular arch was restored with a tooth-supported overdenture. Root coverage of the maxillary right central incisor was performed using Alloderm (Biohorizons, Birmingham, Ala). At the end of the interdisciplinary therapy, the results were esthetically pleasing, with the patient's oral functions restored to the optimum. The emphasis of this report is to highlight the importance of integrating various specialties such as periodontics, orthodontics, endodontics, and restorative dentistry toward a common goal of improving the patient's oral health, function, and esthetics.

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

    PubMed

    Boffeli, Troy J; Waverly, Brett J

    2016-01-01

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

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

    PubMed

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

    2010-10-01

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

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

    PubMed

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

    2014-11-15

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

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

    PubMed

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

    2011-03-01

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

  4. Low-grade elastic compression regimen for venous leg ulcers--an effective compromise for patients requiring daily dressing changes.

    PubMed

    Dabiri, Ganary; Hammerman, Scott; Carson, Polly; Falanga, Vincent

    2015-12-01

    Venous leg ulcers (VLUs) affect millions of patients worldwide and are a tremendous financial burden on our health care system. The hallmark of venous disease of the lower extremities is venous hypertension, and compression is the current mainstay of treatment. However, many patients are non-compliant, partly because of the complexity of the dressings and the difficulties with application and removal. The aim of our study was to test an effective compression dressing regimen for patients with VLUs who require changing the ulcer primary dressing twice daily. We used two layers of a latex-free tubular elastic bandage for compression. The primary endpoint of our study was increased wound-healing rate and our secondary endpoint was complete wound closure. All active study subjects had positive healing rates at week 4 and week 8. Two subjects achieved complete wound closure by week 8. We conclude that compression with a latex-free tubular elastic bandage can be safely used in patients with VLUs requiring frequent dressing changes. This type of compression allows for daily inspection of wounds, dressing changes at home, flexibility in the context of clinical trials, and is a compromise for patients who are intolerant to compression dressings.

  5. Low Grade Elastic Compression Regimen for Venous Leg Ulcers-An Effective Compromise for Patients Requiring Daily Dressing Changes

    PubMed Central

    Dabiri, Ganary; Hammerman, Scott; Falanga, Vincent

    2014-01-01

    Venous leg ulcers affect millions of patients worldwide and are a tremendous financial burden on our healthcare system. The hallmark of venous disease of the lower extremities is venous hypertension, and compression is the current mainstay of treatment. However, many patients are noncompliant, in part because of the complexity of the dressings and the difficulties with application and removal. The aim of our study was to determine an effective compression dressing regimen for patients with venous leg ulcers who require changing the ulcer primary dressing twice daily. We used two layers of a latex free tubular elastic bandage for compression. The primary endpoint of our study was increased wound healing rate and our secondary endpoint was complete wound closure. All active study subjects had positive healing rates at week 4 and week 8. Two subjects achieved complete wound closure by week 8. We conclude that compression with a latex-free tubular elastic bandage can be safely used in patients with venous leg ulcers requiring frequent dressing changes. This type of compression allows for daily inspection of wounds, dressing changes at home, flexibility in the context of clinical trials, and is a compromise for patients that are intolerant to compression dressings. PMID:24267477

  6. Vaccination of the immune-compromised patients with focus on patients with autoimmune-inflammatory diseases.

    PubMed

    Bijl, M; Kallenberg, C G M; van Assen, S

    2011-01-01

    Among immunocompromised patients morbidity and mortality due to vaccine-preventable infections is high. Although vaccination seems indicated, controversy exists about which vaccines should be offered, at what moment, and to whom. Guidelines are needed as the number of immunocompromised individuals increases due to the wider use of immunosuppressive drugs and, in particular, because since the introduction of biological agents, the spectrum of immunosuppressive drugs is rapidly expanding. In this review we will highlight controversies about vaccination in immunocompromised patients and will discuss indications for the several vaccines available to prevent infectious diseases with the focus on patients with autoimmune-inflammatory diseases.

  7. Orthodontics in the adult patient, with special reference to the periodontally compromised patient.

    PubMed

    Johal, A; Ide, M

    1999-04-01

    There is increasing demand from adult patients for orthodontic treatment, either purely for aesthetics, to improve aesthetics or function following previous disease, or to facilitate the stabilization, restoration or replacement of teeth. Orthodontics may have a major role in the rehabilitation of patients suffering the effects of advanced periodontal disease, but there are a number of important factors to be considered in the management of such patients if the optimal outcome is to be obtained. This paper summarizes important aspects of treatment and the potential complications and how to avoid them.

  8. Oral health promotion interventions on oral yeast in hospitalised and medically compromised patients: a systematic review.

    PubMed

    Lam, Otto L T; Bandara, H M H N; Samaranayake, Lakshman P; McGrath, Colman; Li, Leonard S W

    2012-03-01

    Yeast are major aetiological agents of localised oral mucosal lesions, and are also leading causes of nosocomial bloodstream infections. The purpose of this systematic review was to examine the effectiveness of oral health promotion interventions on the prevalence and incidence of these opportunistic oral pathogens in hospitalised and medically compromised patients. The PubMed, ISI Web of Science and Cochrane Library databases were searched for clinical trials assessing the effect of oral health promotion interventions on oral yeast. Chlorhexidine delivered in a variety of oral hygiene products appeared to have some effect on oral yeast, although some studies found equivocal effects. Although a wide array of other compounds have also been investigated, their clinical effectiveness remains to be substantiated. Likewise, the utility of mechanical oral hygiene interventions and other oral health promotion measures such as topical application of salivary substitute, remains unsettled. Although many chemical agents contained in oral hygiene products have proven in vitro activity against oral yeast, their clinical effectiveness and potential role as adjuncts or alternative therapies to conventional treatment remains to be confirmed by further high-quality randomised controlled trials. This is pertinent, given the recent emergence of yeast resistance to conventional antifungal agents.

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

    SciTech Connect

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

    1985-12-01

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

  10. A simplified protocol for evaluating and monitoring urethral stricture patients minimizes cost without compromising patient outcome.

    PubMed

    Okorie, Chukwudi O; Pisters, Louis L; Ndasi, Henry T; Fekadu, Arega

    2010-07-01

    Uroflowmetry, urethrocystoscopy and urethrography are either not readily available or the cost is prohibitive for many patients in low-resource countries. This paper examines the use of clinical history in post-urethroplasty follow-up. We retrospectively reviewed the outcome of 54 post-urethroplasty patients. Preoperative diagnostic work-up included simple blood tests and a retrograde urethrography, and postoperatively we did not perform any immediate diagnostic work-up. Follow-up of these patients was done through mobile phone calls and personal contacts. Eighty-nine per cent of our patients reported acceptable voiding over a mean follow-up period of 48.4 months - 79.6% were followed using mobile phone contact. In the majority of the urethral strictures cases, diagnostic work up can be kept to a minimum, thereby reducing cost. Follow-up can be done via phone calls and personal contact in many African countries where compliance is frequently less than encouraging. The spread of mobile phone networks across the continent has been remarkable.

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

    NASA Astrophysics Data System (ADS)

    Zhan, Yimin; Mechefske, Chris K.

    2007-07-01

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

  12. Abdominal aortic occlusion and vascular compromise secondary to acute gastric dilatation in a patient with bulimia.

    PubMed

    Elsharif, M; Doulias, T; Aljundi, W; Balchandra, S

    2014-11-01

    Acute gastric dilation is a rare but recognised complication in patients with bulimia and anorexia following binge episodes owing to decreased bowel motility. We present a rare case of acute gastric dilation secondary to bulimia in an otherwise healthy 18-year-old female patient that resulted in compression and complete occlusion of the abdominal aorta, leading to acute mesenteric and bilateral lower limb ischaemia. This resolved immediately following a laparotomy and gastric decompression. Management of these patients is very challenging owing to the lack of a successful precedent. To our knowledge, such a catastrophic complication has only ever been reported once in the literature and the outcome was fatal. Our case is of additional importance as it offers a successful management strategy for these patients.

  13. Impact of treatment variability on survival in immuno-competent and immuno-compromised patients with primary central nervous lymphoma.

    PubMed

    Karmali, Reem; Nabhan, Chadi; Petrich, Adam M; Raizer, Jeffrey; Peace, David; Lukas, Rimas; Gordon, Leo I; Basu, Sanjib; Chukkapalli, Vineela; Venugopal, Parameswaran

    2017-02-17

    Patients with primary central nervous system lymphoma (PCNSL) treated in the 'real-world' setting do not represent those treated on clinical trials and might not be treated similarly. We studied characteristics and variability in care for 113 newly diagnosed PCNSL patients treated at 5 institutions in the Chicago area between 2000 and 2012. In 111 patients, single modality therapy with a high dose methotrexate (HD-MTX) regimen +/- rituximab, was most commonly employed (n = 65), and 34 underwent radiotherapy (+/- systemic therapy). Fifty-eight of 108 patients received rituximab. Twenty-nine of 110 patients (26%) received intrathecal chemotherapy (ITC). Overall response rate was 80% (47% complete responses). With a median follow-up of 18·7 months, median overall survival (OS) was 65·2 months. In univariate analysis, HD-MTX (median OS 72·7 vs. 2·7 months, P < 0·001) and rituximab (median not reached versus 28·4 months, P = 0·005) impacted OS favourably. This significance was sustained regardless of immune status and in multivariate analysis. Whole brain radiotherapy (WBRT) resulted in a trend for improved OS as compared with systemic therapy alone (P = 0·09), while ITC did not impact survival. Clinical practice has evolved to exclude WBRT and ITC while incorporating rituximab with clinical outcomes comparable in immuno-competent/compromised patients and similar to those achieved in recent clinical trials.

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

    PubMed Central

    Wells, Jennie L; Dumbrell, Andrea C

    2006-01-01

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

  15. Vascular Compromise from Soft Tissue Augmentation

    PubMed Central

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

    2014-01-01

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

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

    PubMed Central

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

    2016-01-01

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

  17. Visuomotor integration is compromised in Alzheimer's disease patients reaching for remembered targets.

    PubMed

    Tippett, William J; Krajewski, Adam; Sergio, Lauren E

    2007-01-01

    This study examined the ability of neurologically healthy individuals and individuals with Alzheimer's disease (AD) to successfully complete procedures involving short-term spatial visuomotor memory tasks, and tasks involving increasingly complex visuomotor transformations. Participants made sliding finger movements over a clear touch-sensitive screen on two separate spatial planes (vertical and horizontal), to visually constant and remembered target positions. Significant main effects were observed between participant groups on reaction time and movement time measures. As well, significant changes in reaction time and movement time were observed within the patient group over the different of any experimental procedures. In addition, as task increased in complexity significant increases in errors were observed in the AD group. Overall, the results reveal that AD patients show substantial declines in their ability to process and integrate visual information to produce motor responses. Therefore, we believe that this psychophysical research provides further evidence that AD, even early stages of AD, can affect anatomical regions supporting vision for action.

  18. A case of multifocal lupus vulgaris that preceded pulmonary tuberculosis in an immune compromised patient.

    PubMed

    Hamada, Manabu; Urabe, Kazunori; Moroi, Yoichi; Koga, Tetsuya; Takeishi, Masaaki; Fujita, Masaki; Nakanishi, Yoichi; Furue, Masutaka

    2004-02-01

    We describe the rare case of a Japanese male with multifocal lupus vulgaris that preceded asymptomatic pulmonary tuberculosis and adult T-cell leukemia/lymphoma (ATL). He visited our hospital with multiple reddish plaques and erythema of 4-12 months duration. A skin biopsy revealed non-caseating epithelioid granulomas. Mycobacterium tuberculosis was detected by polymerase chain reaction (PCR)-hybridization from a skin biopsy specimen and was also isolated from a culture of the skin biopsy sample. The result of chest roentogenography was compatible with pulmonary tuberculosis. In addition, the diagnosis of ATL was based upon the presence of atypical lymphocytes with convoluted nuclei in his peripheral blood and a positive anti-ATL antibody reaction. Cases of cutaneous tuberculosis presenting with unusual clinical features may be on the increase, accompanying the spread of tuberculosis in immunosuppressed patients, including those with ATL and acquired immunodeficiency syndrome (AIDS).

  19. Development of a novel antimicrobial dental resin root surface treatment for compromised open flap debridement patients

    NASA Astrophysics Data System (ADS)

    Battle-Siatita, Shelrethia

    Heating, ventilation, and air conditioning systems are widely used in buildings to provide occupants with conditioned air and acceptable indoor air quality. The chilled water system is one of the most commonly used HVAC systems in the both commercial and industrial buildings. These systems are currently used to provide thermal comfort for a wide array of building types, sizes, and in different climates. The design of these systems constitutes a large impact on the energy usage and operating cost of buildings they serve. Buildings stand for a substantial part of the total energy consumption in the Unites States, and with an increase focus on cost reductions and energy savings, it is necessary to use intelligent and energy-saving models. The ability to accurately predict the performance of these systems is integral to designing more energy efficient and sustainable building systems. In this thesis, the modeling of a chilled water air handling unit using system identification methods is proposed. System identification is the procedure of building mathematical models of dynamic systems from measured data. Two MISO (Multiple Input-Single Output) models are created to find the supply air temperature and fan power of an investigated chilled water air handling unit. The models are identified following the black-box approach, and data for a span of five months is collected and pre-processed. The system identification models are then trained using the measured data. Different model structures along with various time delays and orders were then tested to determine the most optimal structure. The prediction results are later compared to the actual data using the mean square error and coefficient of variance. In addition, an optimization method is developed to automate the process of finding the best model structure that can produce the best accurate prediction against the actual data. The obtained results validate the use of system identification methodologies as an accurate

  20. 22 CFR 309.20 - Compromise.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 22 Foreign Relations 2 2010-04-01 2010-04-01 true Compromise. 309.20 Section 309.20 Foreign Relations PEACE CORPS DEBT COLLECTION Salary Offset § 309.20 Compromise. Peace Corps may attempt to effect compromise in accordance with the standards set forth in the FCCS (31 CFR part 902)....

  1. 22 CFR 309.20 - Compromise.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 22 Foreign Relations 2 2014-04-01 2014-04-01 false Compromise. 309.20 Section 309.20 Foreign Relations PEACE CORPS DEBT COLLECTION Salary Offset § 309.20 Compromise. Peace Corps may attempt to effect compromise in accordance with the standards set forth in the FCCS (31 CFR part 902)....

  2. 22 CFR 309.20 - Compromise.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 22 Foreign Relations 2 2012-04-01 2009-04-01 true Compromise. 309.20 Section 309.20 Foreign Relations PEACE CORPS DEBT COLLECTION Salary Offset § 309.20 Compromise. Peace Corps may attempt to effect compromise in accordance with the standards set forth in the FCCS (31 CFR part 902)....

  3. 22 CFR 309.20 - Compromise.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 22 Foreign Relations 2 2011-04-01 2009-04-01 true Compromise. 309.20 Section 309.20 Foreign Relations PEACE CORPS DEBT COLLECTION Salary Offset § 309.20 Compromise. Peace Corps may attempt to effect compromise in accordance with the standards set forth in the FCCS (31 CFR part 902)....

  4. 22 CFR 309.20 - Compromise.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 22 Foreign Relations 2 2013-04-01 2009-04-01 true Compromise. 309.20 Section 309.20 Foreign Relations PEACE CORPS DEBT COLLECTION Salary Offset § 309.20 Compromise. Peace Corps may attempt to effect compromise in accordance with the standards set forth in the FCCS (31 CFR part 902)....

  5. [pH values in the pharynx of the patients presenting with compromised nasal breathing of inflammatory and non-inflammatory genesis concomitant with gastroesophageal reflux disease].

    PubMed

    Subbotina, M V; Temnikova, I V; Onuchina, E V

    2015-01-01

    The objective of the present study was to estimate the influence of gastroesophageal reflux disease (GERD) on the pH values in the pharynx and nose. It included 87 patients at the age varying from 18 to 81 years admitted to the Irkutsk-based Railway Clinical Hospital and allocated to four groups. Group 1 was comprised of 25 patients presenting with gastroesophageal reflux disease and chronic rhinosinusitis (CRS), group 2 consisted of 29 patients with CRS in the absence of GERD, group 3 included 22 patients with nasal septum deformations (NSD) and GERD, group 4 included 11 patients with NSD and motor rhinitis without GERD. The control group was formed from 10 volunteers. pH was measured by the contact method with the use ofEkokhim indicator paper. Gastroesophageal reflux disease was diagnosed following the recommendations of the Montreal consensus. It was shown that pH values in the pharynx of the patients with compromised nasal breathing of any origin in combination with GERD were lower than in the absence of GERD and in the healthy volunteers. The study groups did not differ in terms of pH values in the nasal cavity. It is concluded that pH values 4 or lower may serve as the criterion for pharyngo-laryngeal reflux (PLR) concomitant with HERD while pH 5 occurs more frequently in the patients with compromised nasal breathing of any etiology, regardless of the presence or absence of GERD.Disordered nasal breathing of any genesis in the patients presenting with gastroesophageal reflux disease was associated with the feeling of the lump in the throat, congestion of the respiratory tract and the nose, pain in the ears, cardialgia, and irregular heartbeat. It isrecommended to use pH measurements as a criterion for diagnostics of pharyngo-laryngeal reflux in the patients presenting with gastroesophageal reflux disease.

  6. Innate-like and conventional T cell populations from hemodialyzed and kidney transplanted patients are equally compromised.

    PubMed

    Baron, Marine; Belo, Renata; Cathelin, Dominique; Moreira-Teixeira, Lucia; Cartery, Claire; Rondeau, Eric; Mesnard, Laurent; Leite-de-Moraes, Maria

    2014-01-01

    Clinicians are well aware of existing pharmacologically-induced immune deficient status in kidney-transplanted patients that will favor their susceptibility to bacterial or viral infections. Previous studies indicated that advanced Stage 4-5 Chronic Kidney Disease might also be regarded as an immune deficiency-like status as well, even though the mechanisms are not fully understood. Here, we analyzed the ex vivo frequency and the functional properties of both conventional and innate-like T (ILT) lymphocyte subsets in the peripheral blood of 35 patients on hemodialysis, 29 kidney transplanted patients and 38 healthy donors. We found that peripheral blood cell count of ILT cells, as iNKT (invariant Natural Killer T) and MAIT (mucosal-associated invariant T), were significantly decreased in hemodialyzed patients compared to healthy controls. This deficiency was also observed regarding conventional T cells, including the IL-17-producing CD4(+) Th17 cells. Pertaining to regulatory T cells, we also noticed major modifications in the global frequency of CD4(+)CD25(+)Foxp3(+) T lymphocytes, including the resting suppressive CD45RA(+)Foxp3lo and activated suppressive CD45RA-Foxp3hi T cell subpopulations. We found no significant differences between the immune status of hemodialyzed and kidney-transplanted subjects. In conclusion, we demonstrated that both ILT and conventional T cell numbers are equally impaired in hemodialyzed and kidney-transplanted patients.

  7. Phagocytosis via Complement or Fc-Gamma Receptors Is Compromised in Monocytes from Type 2 Diabetes Patients with Chronic Hyperglycemia

    PubMed Central

    Restrepo, Blanca I.; Twahirwa, Marcel; Rahbar, Mohammad H.; Schlesinger, Larry S.

    2014-01-01

    Type 2 diabetes patients (DM2) have a higher risk of tuberculosis (TB) that may be attributed to functional defects in their mononuclear phagocytes given the critical role of these cells in Mycobacterium tuberculosis containment. Our previous findings suggest that monocytes from DM2 have reduced association with serum-opsonized M. tuberculosis. To determine if this alteration is due to defects in phagocytosis via complement or Fc-gamma receptors (FcγRs), in this study we evaluated the uptake of sheep red blood cells coated with IgG or complement, respectively, by monocytes from individuals with and without DM2. We found that chronic hyperglycemia was significantly associated with reduced phagocytosis via either receptor by univariable and multivariable analyses. This defect was independent of host serum opsonins and flow cytometry data indicated this was not attributed to reduced expression of these phagocytic receptors on DM2 monocytes. The positive correlation between both pathways (R = 0.64; p = 0.003) indicate that monocytes from individuals with chronic hyperglycemia have a defect in the two predominant phagocytic pathways of these cells. Given that phagocytosis is linked to activation of effector mechanisms for bacterial killing, it is likely that this defect is one factor contributing to the higher susceptibility of DM2 patients to pathogens like M. tuberculosis. PMID:24671137

  8. Basic Knee Arthroscopy Part 1: Patient Positioning

    PubMed Central

    Ward, Benjamin D.; Lubowitz, James H.

    2013-01-01

    Knee arthroscopy is an important diagnostic and therapeutic tool in the management of disorders of the knee. In a series of 4 articles, the basics of knee arthroscopy are reviewed. In this article (part 1), patient positioning, tourniquet placement, and draping are reviewed. Meticulous attention to these details allows surgical access to the compartments of the knee. A circumferential leg holder or a lateral post allows the application of varus and valgus forces to open the medial and lateral compartments of the knee. PMID:24892015

  9. CYP2B6 18492T->C polymorphism compromises efavirenz concentration in coinfected HIV and tuberculosis patients carrying CYP2B6 haplotype *1/*1.

    PubMed

    Manosuthi, Weerawat; Sukasem, Chonlaphat; Thongyen, Supeda; Nilkamhang, Samruay; Manosuthi, Sukanya; Sungkanuparph, Somnuek

    2014-01-01

    Data regarding the effect of the CYP2B6 18492T→C polymorphism on plasma efavirenz concentrations and 96-week virologic responses in patients coinfected with HIV and tuberculosis (TB) are still unavailable. A total of 139 antiretroviral-naive HIV-infected adults with active TB were prospectively enrolled to receive efavirenz 600 mg-tenofovir 300 mg-lamivudine 300 mg. Eight single nucleotide polymorphisms (SNPs) within CYP2B6 were genotyped. Seven SNPs, including 64C→T, 499C→G, 516G→T, 785A→G, 1375A→G, 1459C→T, and 21563C→T, were included for CYP2B6 haplotype determination. The CYP2B6 18492T→C polymorphism was studied in 48 patients who carried haplotype *1/*1. At 12 and 24 weeks after antiretroviral therapy, plasma efavirenz concentrations at 12 h after dosing were measured. Plasma HIV RNA was monitored every 12 weeks for 96 weeks. Of 48 patients {body weight [mean±standard deviation (SD)], 56±10 kg}, 77% received a rifampin-containing anti-TB regimen. No drug resistance-associated mutation was detected at baseline. The frequencies of the wild type (18492TT) and the heterozygous (18492TC) and homozygous (18492CC) mutants of the CYP2B6 18492T→C polymorphism were 39%, 42%, and 19%, respectively. At 12 weeks, mean (±SD) efavirenz concentrations of patients who carried the 18492TT, 18492TC, and 18492CC mutants were 2.8±1.6, 1.7±0.9, and 1.4±0.5 mg/liter, respectively (P=0.005). At 24 weeks, the efavirenz concentrations of the corresponding groups were 2.4±0.8, 1.7±0.8, and 1.2±0.4 mg/liter, respectively (P=0.003). A low efavirenz concentration was independently associated with 18492T→C (β=-0.937, P=0.004) and high body weight (β=-0.032, P=0.046). At 96 weeks, 19%, 17%, and 28% of patients carrying the 18492TT, 18492TC, and 18492CC mutants, respectively, had plasma HIV RNA levels of >40 copies/ml and developed efavirenz-associated mutations (P=0.254). In summary, the CYP2B6 18492T→C polymorphism compromises efavirenz concentrations in

  10. Patient satisfaction with anaesthesia - Part 1: satisfaction as part of outcome - and what satisfies patients.

    PubMed

    Heidegger, T; Saal, D; Nübling, M

    2013-11-01

    Patients' involvement in all decision processes is becoming increasingly important in modern healthcare. Patient satisfaction is a sensitive measure of a well-functioning health service system. The objective of this review is to discuss patient satisfaction as part of outcome quality, to define the somewhat abstract term 'satisfaction', and to discuss the role of surrogate markers within the field of satisfaction with anaesthesia care. We critically discuss what is relevant to satisfy patients with anaesthesia care, and we provide guidance on improving satisfaction.

  11. Compromised ventilation caused by tracheoesophageal fistula and gastrointestinal endoscope undergoing removal of disk battery on esophagus in pediatric patient -A case report-.

    PubMed

    Kim, Kyung-Woo; Kim, Ji Yeon; Kim, Jung Won; Park, Jang Su; Choe, Won Joo; Kim, Kyung-Tae; Lee, Sangil

    2011-09-01

    Ingestion of disk batteries may have serious complications such as esophageal burn, perforation, and tracheoesophageal fistula, particularly when the battery is caught in the esophagus. Proper placement of the tracheal tube is critical when tracheoesophageal fistula was occurred from esophageal impaction the battery. Endoscopy of upper gastrointestinal tract in infants and children is an important and effective tool for the diagnosis and treatment of foreign body ingestion. But upper gastrointestinal endoscopy in infant and children has very high risk of tracheal compression and airway compromise. We present a case of ventilatory compromise during insertion of the upper gastrointestinal endoscopy in 16-month-old child with tracheoesophageal fistula secondary to disk battery ingestion.

  12. Radiosurgical planning of meningiomas: compromises with conformity.

    PubMed

    Rowe, Jeremy G; Walton, Lee; Vaughan, Paul; Malik, Irfan; Radatz, Matthias; Kemeny, Andras

    2004-01-01

    The radiosurgical planning of meningiomas frequently necessitates compromises between irradiating tumour and risking damage to adjacent structures. In selected cases, we resolved this by excluding part of the tumour from the prescription isodose volume. Most of these compromises or 'suboptimal' plans achieved growth control. Growth control could not be related to conformity indices or to various measures of the radiation dose received by the meningioma. Examining recurrences, 75% arose from dura outside the original treatment field. These findings are discussed in terms of dose prescription protocols and the use of conformity indices in planning. The importance of the dural origin of meningiomas is well established in surgical practice, as reflected by Simpson's grades, but may be equally significant in radiosurgical practice.

  13. Concurrent Radiotherapy with Carboplatin and Cetuximab for the Treatment of Medically Compromised Patients with Locoregionally Advanced Head and Neck Squamous Cell Carcinoma

    PubMed Central

    Saigal, Kunal; Santos, Edgardo S.; Tolba, Khaled; Kwon, Deukwoo; Elsayyad, Nagy; Abramowitz, Matthew C.; Mandalia, Amar; Samuels, Michael Andrew

    2014-01-01

    Background: Cetuximab (Cx) + radiation therapy (RT) is well-tolerated and has improved survival in patients (pts) with locoregionally advanced head and neck squamous cell carcinomas (LA-HNSCC). However, its efficacy when compared to HD-DDP + RT has been questioned. At our institution, low-dose weekly carboplatin is added to Cx + RT for patients unsuitable for HD-DDP. Methods: We reviewed records of 16 patients with LA-HNSCC treated with definitive Cx + carboplatin + RT at the University of Miami from 2007 to 2011. Median follow-up was 24 months (range: 1–69 months). Results: Median age: 71.5 years (range: 57–90 years); 15 male, 1 female. ECOG PS 0 = 15, 1 = 1. TNM staging was: T1 = 1, T2 = 5, T3 = 8, T4 = 2; N stage: N0 = 8, N1 = 5, N2a = 2, N2b = 1. All patients received weekly carboplatin (AUC 1.5–2), Cx given conventionally and daily conventionally fractionated RT. Median total weeks of concurrent systemic therapy = 7 (range: 3–8 weeks). RT was delivered to a median total dose of 70 Gy (range 30–74 Gy). Of the 15 evaluable patients, there were: 12 CR, 2 PR, and 1 PD. There were three local in-field failures, two regional failures, and three distant failures. At last follow-up, 8/15 patients remained with NED. Three-year locoregional recurrence was 28.3% (95% CI: 7.7–53.9%). Mean percentage of weight loss was 14% (range: 6–26%). Two patients required systemic therapy dose reduction. Three patients experienced a treatment delay and three did not finish RT as planned including a patient who received only 30 Gy due to death secondary to MI during treatment. Conclusion: In this small retrospective series, carboplatin/Cx/RT was well-tolerated and efficacious in patients unsuitable for HD-DDP having LA-HNSCC. Acute toxicities were similar to Cx + RT, likely due to the non-overlapping toxicity profiles of the two systemic agents. We hypothesize that the addition of a well

  14. Compassionate care: enhancing physician-patient communication and education in dermatology: Part II: Patient education.

    PubMed

    Hong, Judith; Nguyen, Tien V; Prose, Neil S

    2013-03-01

    Patient education is a fundamental part of caring for patients. A practice gap exists, where patients want more information, while health care providers are limited by time constraints or difficulty helping patients understand or remember. To provide patient-centered care, it is important to assess the needs and goals, health beliefs, and health literacy of each patient. This allows health care providers to individualize education for patients. The use of techniques, such as gaining attention, providing clear and memorable explanations, and assessing understanding through "teach-back," can improve patient education. Verbal education during the office visit is considered the criterion standard. However, handouts, visual aids, audiovisual media, and Internet websites are examples of teaching aids that can be used as an adjunct to verbal instruction. Part II of this 2-part series on patient-physician interaction reviews the importance and need for patient education along with specific guidelines and techniques that can be used.

  15. Prescription Patterns for Tigecycline in Severely Ill Patients for Non-FDA Approved Indications in a Developing Country: A Compromised Outcome

    PubMed Central

    Moghnieh, Rima A.; Abdallah, Dania I.; Fawaz, Ismail A.; Hamandi, Tarek; Kassem, Mohammad; El-Rajab, Nabila; Jisr, Tamima; Mugharbil, Anas; Droubi, Nabila; Al Tabah, Samaa; Sinno, Loubna; Ziade, Fouad; Daoud, Ziad; Ibrahim, Ahmad

    2017-01-01

    Introduction: With the rise in antibiotic resistance, tigecycline has been used frequently in off-label indications, based on its in-vitro activity against multidrug-resistant organisms. In this study, our aim was to assess its use in approved and unapproved indications. Materials and Methods: This is a retrospective chart review evaluating a 2-year experience of tigecycline use for > 72 h in 153 adult patients inside and outside critical care unit from January 2012 to December 2013 in a Lebanese tertiary-care hospital. Results: Tigecycline was mostly used in off-label indications (81%) and prescribed inside the critical care area, where the number of tigecycline cycles was 16/1,000 patient days. Clinical success was achieved in 43.4% of the patients. In the critically ill group, it was significantly higher in patients with a SOFA score <7 using multivariate analysis (Odds Ratio (OR) = 12.51 [4.29–36.51], P < 0.0001). Microbiological success was achieved in 43.3% of patients. Yet, the univariate and adjusted multivariate models failed to show a significant difference in this outcome between patients inside vs. outside critical care area, those with SOFA score <7 vs. ≥ 7, and in FDA-approved vs. off-label indications. Total mortality reached ~45%. It was significantly higher in critically ill patients with SOFA score ≥7 (OR = 5.17 [2.43–11.01], P < 0.0001) and in off-label indications (OR = 4.00 [1.30–12.31], P = 0.01) using an adjusted multivariate model. Gram-negative bacteria represented the majority of the clinical isolates (81%) and Acinetobacter baumannii predominated (28%). Carbapenem resistance was present in 85% of the recovered Acinetobacter, yet, more than two third of the carbapenem-resistant Acinetobacter species were still susceptible to tigecycline. Conclusion: In our series, tigecycline has been mostly used in off-label indications, specifically in severely ill patients. The outcome of such infections was not inferior to that of FDA

  16. Hemodynamic Responses to Two Different Anesthesia Regimens in Compromised Left Ventricular Function Patients Undergoing Coronary Artery Bypass Graft Surgery: Etomidate-Midazolam Versus Propofol-Ketamine

    PubMed Central

    Aghdaii, Nahid; Ziyaeifard, Mohsen; Faritus, Seyedeh Zahra; Azarfarin, Rasoul

    2015-01-01

    Background: Various methods have been suggested to prevent hemodynamic instability caused by propofol and adverse effects caused by etomidate induction. The current study evaluated hemodynamic effects of propofol-ketamine mixture in comparison to etomidate-midazolam mixture during anesthesia induction. Objectives: The aim of this study was to evaluate the hemodynamic effects of etomidate-midazolam by comparing it with propofol-ketamine for the induction of anesthesia in patients with left ventricular dysfunction undergoing coronary artery bypass graft surgery. Patients and Methods: One-hundred patients aged between 40 and 65 with coronary artery disease and low ejection fraction scheduled for elective coronary artery bypass surgery participated in this study. The patients were randomly allotted to one of the two groups to receive either propofol-ketamine or etomidate-midazolam combination. Two groups were compared for pain on injection and myoclonus, Heart Rate (HR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Mean Arterial Pressure (MAP), Cardiac Index (CI) and Systemic Vascular Resistance (SVR), before and one minute after induction of anesthesia, and one, three and five minutes after intubation. Results: Incidence of pain on injection (2 - 4%) and myoclonus (10%) was less in both groups. The hemodynamic response was similar in the two groups for all variables over the time interval, except for CI at one and three minutes after intubation (P = 0.024 and P = 0.048, respectively), and SVR in five minutes after intubation (P = 0.009), with differences being statistically significant. Conclusions: Both anesthetic regimens were acceptable for induction in patients with coronary artery disease and left ventricular dysfunction undergoing coronary artery bypass graft surgery. PMID:26161330

  17. Compromised bone strength index in the hemiparetic distal tibia epiphysis among chronic stroke patients: the association with cardiovascular function, muscle atrophy, mobility, and spasticity

    PubMed Central

    Pang, Marco Y.C.; Ashe, Maureen C.; Eng, Janice J.

    2011-01-01

    Purpose To identify the determinants of the bone strength index (BSI) at the distal tibia in chronic stroke patients. Methods Sixty-three chronic stroke survivors underwent scanning of the distal tibia at the 4% site on both sides using peripheral quantitative computed tomography. The primary outcomes were trabecular bone mineral density (BMD) (mg/cm3), total BMD (mg/cm3), total bone area (mm2), and BSI (g2/cm4). Cardiovascular fitness, leg lean mass, gait velocity, and spasticity were also measured. Results Scans from 45 subjects were deemed to have acceptable quality and were included for subsequent analysis. The paretic side had significantly lower trabecular BMD, total BMD, and BSI than the non-paretic side (p<0.05). However, the total bone area demonstrated no significant side-to-side difference (p>0.05). After adjusting for relevant biological factors, peakoxygen consumption, leg muscle mass, gait velocity remained positively associated with tibial BSI on both sides (R2 change=6.9–14.2%), whereas spasticity of the paretic leg was negatively associated with tibial BSI on the same side (R2 change=4.8%). Conclusions Cardiovascular function, muscle atrophy, mobility, and spasticity are independently associated with BSI of the distal tibia epiphysis among chronic stroke patients. PMID:19882095

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

    PubMed

    Fair, Brian

    2010-05-01

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

  19. Activity of P-glycoprotein, a β-amyloid Transporter at the Blood-Brain Barrier, is Compromised in Patients with Mild Alzheimer’s Disease

    PubMed Central

    Deo, Anand K.; Borson, Soo; Link, Jeanne M.; Domino, Karen; Eary, Janet F.; Ke, Ban; Richards, Todd L.; Mankoff, David A.; Minoshima, Satoshi; O’Sullivan, Finbarr; Eyal, Sara; Hsiao, Peng; Maravilla, Ken; Unadkat, Jashvant D.

    2015-01-01

    Animal and histopathological studies of human brain support a role for P-glycoprotein (P-gp) in clearance of cerebral β-amyloid (Aβ) across the blood brain barrier (BBB). We tested the hypothesis that BBB P-gp activity is diminished in Alzheimer’s disease (AD) by accounting for AD-related reduction in regional cerebral blood flow (rCBF). Methods We compared P-gp activity in mild AD patients (n=9) and cognitively normal, age-matched controls (n=9) using positron emission tomography (PET) with a labeled P-gp substrate, [11C]-verapamil, and [15O]-water to measure rCBF. BBB P-gp activity was expressed as the [11C]-verapamil radioactivity extraction ratio (ER={[11C]-verapamil brain distributional clearance, K1}/rCBF). Results Compared to controls, BBB P-gp activity was significantly lower in the parietotemporal, frontal, posterior cingulate cortices and hippocampus of mild AD subjects. Conclusion BBB P-gp activity in brain regions affected by AD is reduced and is independent of rCBF. This study improves on prior work by eliminating the confounding effect that reduced rCBF has on assessment of BBB P-gp activity and suggests that impaired P-gp activity may contribute to cerebral Aβ accumulation in AD. P-gp induction/activation to increase cerebral Aβ clearance could constitute a novel preventive or therapeutic strategy for AD. PMID:24842892

  20. Identification of G8969>A in mitochondrial ATP6 gene that severely compromises ATP synthase function in a patient with IgA nephropathy

    PubMed Central

    Wen, Shuzhen; Niedzwiecka, Katarzyna; Zhao, Weiwei; Xu, Shutian; Liang, Shaoshan; Zhu, Xiaodong; Xie, Honglang; Tribouillard-Tanvier, Déborah; Giraud, Marie-France; Zeng, Caihong; Dautant, Alain; Kucharczyk, Róża; Liu, Zhihong; di Rago, Jean-Paul; Chen, Huimei

    2016-01-01

    Here we elucidated the pathogenesis of a 14-year-old Chinese female who initially developed an isolated nephropathy followed by a complex clinical presentation with brain and muscle problems, which indicated that the disease process was possibly due to a mitochondrial dysfunction. Careful evaluation of renal biopsy samples revealed a decreased staining of cells induced by COX and NADH dehydrogenase activities, and a strong fragmentation of the mitochondrial network. These anomalies were due to the presence of a mutation in the mitochondrial ATP6 gene, G8969>A. This mutation leads to replacement of a highly conserved serine residue at position 148 of the a-subunit of ATP synthase. Increasing the mutation load in cybrid cell lines was paralleled by the appearance of abnormal mitochondrial morphologies, diminished respiration and enhanced production of reactive oxygen species. An equivalent of the G8969>A mutation in yeast had dramatic consequences on ATP synthase, with a block in proton translocation. The mutation was particularly abundant (89%) in the kidney compared to blood and urine, which is likely the reason why this organ was affected first. Based on these findings, we suggest that nephrologists should pay more attention to the possibility of a mitochondrial dysfunction when evaluating patients suffering from kidney problems. PMID:27812026

  1. Upfront lower dose lenalidomide is less toxic and does not compromise efficacy for vulnerable patients with relapsed refractory multiple myeloma: final analysis of the phase II RevLite study.

    PubMed

    Quach, Hang; Fernyhough, Liam; Henderson, Ross; Corbett, Gillian; Baker, Bart; Browett, Peter; Blacklock, Hilary; Forsyth, Cecily; Underhill, Craig; Cannell, Paul; Trotman, Judith; Neylon, Annette; Harrison, Simon; Link, Emma; Swern, Arlene; Cowan, Linda; Dimopoulos, Meletios A; Miles Prince, H

    2017-02-15

    The combination of lenalidomide and dexamethasone is an established treatment for patients with multiple myeloma (MM). Increasingly, treatment attenuation is advocated for frail/elderly patients to minimize toxicity even though there have been no prospective studies to demonstrate whether lenalidomide dose attenuation impacts on response and survival outcome. This prospective multicentre phase II study assessed the efficacy and tolerability of lower dose lenalidomide (15 mg) and dexamethasone (20 mg) in 149 eligible patients with relapsed/refractory MM aged over 59 years and/or with renal impairment. The overall response rate was 71% (complete response 15%). Median (range) progression-free survival (PFS) and overall survival (OS) were 8·9 (6·9-11·5) and 30·5 (20·0-36·2) months, respectively. Upon formal statistical comparison of these endpoints to that of a matched cohort of patients from the pivotal phase III MM009/MM010 studies who received standard-dose lenalidomide (25 mg) and high-dose dexamethasone (40 mg) no difference was seen in PFS (P = 0·34) and OS (P = 0·21). Importantly, grade 3-4 toxicities were reduced with low-dose lenalidomide, mainly lower neutropenia (29% vs. 41%), infections (23% vs. 31%) and venous thromboembolism (3% vs. 13%). This study supports a strategy of lenalidomide dose reduction at the outset for at-risk patients, and prospectively confirms that such an approach reduces adverse events while not compromising patient response or survival outcomes.

  2. 22 CFR 34.19 - Compromise.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Compromise. 34.19 Section 34.19 Foreign Relations DEPARTMENT OF STATE CLAIMS AND STOLEN PROPERTY DEBT COLLECTION Collection Adjustments § 34.19 Compromise. STATE may attempt to effect compromise in accordance with the standards set forth in the FCCS,...

  3. Deferred radiotherapy and upfront procarbazine–ACNU–vincristine administration for 1p19q codeleted oligodendroglial tumors are associated with favorable outcome without compromising patient performance, regardless of WHO grade

    PubMed Central

    Hata, Nobuhiro; Yoshimoto, Koji; Hatae, Ryusuke; Kuga, Daisuke; Akagi, Yojiro; Suzuki, Satoshi O; Iwaki, Toru; Shono, Tadahisa; Mizoguchi, Masahiro; Iihara, Koji

    2016-01-01

    Recently updated phase III trials revealed the favorable effect of add-on procarbazine-lomustine-vincristine chemotherapy (CT) to radiotherapy (RT) in treating anaplastic oligodendrogliomas with 1p19q codeletion (codel). However, the underlying rationality of deferring RT and upfront CT administration for these tumors is yet to be elucidated. Here, we retrospectively analyzed the long-term outcome of our case series with oligodendroglial tumors treated with deferred RT and upfront procarbazine+nimustine+vincristine (PAV) in the introduction administration. We enrolled 36 patients with newly diagnosed oligodendroglial tumors (17, grade II and 19, grade III) treated during 1999–2012 and followed up for a median period of 69.0 months. Their clinical and genetic prognostic factors were analyzed, and progression-free survival, overall survival (OS), and deterioration-free survival (DFS) were evaluated. Regardless of the WHO grade, the 25 patients with 1p19q codel tumors never received RT initially, and of these 25, 23 received PAV treatment upfront. The 75% OS of patients with 1p19q codel tumor was 135.3 months (did not reach the median OS), indicating a favorable outcome. Multivariate analysis revealed that IDH mutation and 1p19q, not WHO grade, are independent prognostic factors; furthermore, IDH and 1p19q status stratified the cohort into 3 groups with significantly different OS. The DFS explained the prolonged survival without declining performance in patients with both grade II and III 1p19q codel tumors. Deferred RT and upfront PAV treatment for 1p19q codel oligodendrogliomas were associated with favorable outcomes without compromising performance status, regardless of WHO grade. PMID:27895504

  4. Forensic Analysis of Compromised Computers

    NASA Technical Reports Server (NTRS)

    Wolfe, Thomas

    2004-01-01

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

  5. The acute abdomen in the immune compromised host

    PubMed Central

    Power, Niall

    2008-01-01

    Abstract Recent advances in transplantation, oncology and AIDS therapy have greatly increased life expectancies of patients diagnosed with malignancy, auto-immune disorders and organ failure. However, as this immune compromised population grows, complications of such therapies have become a major source of morbidity and mortality. Classical clinical and laboratory evidence of intra-abdominal pathology may be absent in the immune compromised host. Consequently, the radiologist is increasingly called upon to diagnose acute intra-abdominal complications associated with immunodeficiency. This review explores the aetiology of the acute abdomen in the immune compromised host. The typical radiological appearances of the commonest conditions are illustrated. The challenges and limitations in the radiological diagnosis of these conditions are discussed. PMID:18442955

  6. 48 CFR 1432.610 - Compromising debts.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

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

  7. 26 CFR 301.7122-1 - Compromises.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... for taxes, interest, or penalties. Unless the terms of the offer and acceptance expressly provide otherwise, acceptance of an offer to compromise a civil liability does not remit a criminal liability, nor does acceptance of an offer to compromise a criminal liability remit a civil liability. (b) Grounds...

  8. 48 CFR 1432.610 - Compromising debts.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 48 Federal Acquisition Regulations System 5 2014-10-01 2014-10-01 false Compromising debts. 1432.610 Section 1432.610 Federal Acquisition Regulations System DEPARTMENT OF THE INTERIOR GENERAL CONTRACTING REQUIREMENTS CONTRACT FINANCING Contract Debts 1432.610 Compromising debts. The CO may...

  9. Clayton's compromises and the assisted dying debate.

    PubMed

    Parker, Malcolm

    2015-03-01

    Richard Huxtable has recently argued that while assisted dying has been both repeatedly condemned and commended, a compromise resolution is possible. Following critique of other purported solutions, he argues for a new legal offence of "compassionate killing" as a plausible compromise between supporters and opponents of legalised assisted dying, because it offers something of significance to both sides. However, it turns out that "compassionate killing" would leave both sides with insufficient net benefit for the proposal to qualify as a compromise between them. By analogy with another apparently intractable bioethical debate, concerning destructive embryo research, this column rejects Huxtable's solution as another "Clayton's compromise". True compromise is not possible in bioethical debates involving divisions over deeply held values and world views. Resolving such debates inevitably involves the substitution of one dominant world view with another.

  10. Hyperbaric Oxygen Therapy for the Compromised Graft or Flap

    PubMed Central

    Francis, Ashish; Baynosa, Richard C.

    2017-01-01

    Significance: Tissue grafts and flaps are used to reconstruct wounds from trauma, chronic disease, tumor extirpation, burns, and infection. Despite careful surgical planning and execution, reconstructive failure can occur due to poor wound beds, radiation, random flap necrosis, vascular insufficiency, or ischemia–reperfusion (IR). Traumatic avulsions and amputated composite tissues—compromised tissue—may fail from crush injury and excessively large sizes. While never intended, these complications result in tissue loss, additional surgery, accrued costs, and negative psychosocial patient effects. Recent Advances: Hyperbaric oxygen (HBO) has demonstrated utility in the salvage of compromised grafts/flaps. It can increase the likelihood and effective size of composite graft survival, improve skin graft outcomes, and enhance flap survival. Mechanisms underlying these beneficial effects include increased oxygenation, improved fibroblast function, neovascularization, and amelioration of IR injury. Critical Issues: Common strategies for the compromised graft or flap include local wound care, surgical debridement, and repeated reconstruction. These modalities are associated with added costs, time, need for reoperation, morbidity, and psychosocial effects. Preservation of the amputated/avulsed tissues minimizes morbidity and maximizes the reconstructive outcome by salvaging the compromised tissue and obviating additional surgery. HBO is often overlooked as a potential tool that can limit these issues. Future Directions: Animal studies demonstrate a benefit of HBO in the treatment of compromised tissues. Clinical studies support these findings, but are limited to case reports and series. Further research is needed to provide multicenter prospective clinical studies and cost analyses comparing HBO to other adjunctive therapies in the treatment of compromised grafts/flaps. PMID:28116225

  11. 10 CFR 15.41 - When a claim may be compromised.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... it has not been referred to DOJ for litigation. (b) Unless otherwise provided by law, when the... with the DOJ. The NRC will evaluate the compromise offer, using the factors set forth in this part. If an offer to compromise any debt in excess of $100,000 is acceptable to the NRC, the NRC shall...

  12. Nanocomposites: The End of Compromise

    NASA Astrophysics Data System (ADS)

    van Damme, H.

    Increase the Young's modulus of a glassy resin by a factor of ten without making it heavier, for a new ski design, for example? Triple the rupture strength of an elastomer? Improve the thermal behaviour of an object made from a thermoplastic polymer by 100 degrees, to make a car dashboard, for example, or a part for the engine? Double the fire resistance time for the sheath around an electricity cable? Reduce the oxygen permeability of a film by a factor of ten, to make long conservation food packaging? All these things have been made possible by incorporating a few percent of inorganic nanoparticles in a polymer matrix. Figures 14.1 and 14.2 illustrate two such nanocomposites: the first was obtained by incorporating lamellar clay particles, and the second by incorporating fibrous nanoparticles, in fact, carbon nanotubes.

  13. Female genital alteration: a compromise solution.

    PubMed

    Arora, Kavita Shah; Jacobs, Allan J

    2016-03-01

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

  14. Obesity May Not Compromise Knee Surgery Success

    MedlinePlus

    ... page: https://medlineplus.gov/news/fullstory_164282.html Obesity May Not Compromise Knee Surgery Success Results similar ... over 35, so it's unclear if more severe obesity might increase the risk of meniscal repair failure, ...

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

    PubMed

    Roett, Michelle A; Coleman, Mary Thoesen

    2013-11-01

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

  16. 45 CFR 30.22 - Bases for compromise.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 45 Public Welfare 1 2013-10-01 2013-10-01 false Bases for compromise. 30.22 Section 30.22 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION CLAIMS COLLECTION Debt Compromise § 30.22 Bases for compromise. (a) Compromise. The Secretary may compromise a debt if the full...

  17. 45 CFR 30.22 - Bases for compromise.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 45 Public Welfare 1 2014-10-01 2014-10-01 false Bases for compromise. 30.22 Section 30.22 Public Welfare Department of Health and Human Services GENERAL ADMINISTRATION CLAIMS COLLECTION Debt Compromise § 30.22 Bases for compromise. (a) Compromise. The Secretary may compromise a debt if the full...

  18. 45 CFR 30.22 - Bases for compromise.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 45 Public Welfare 1 2012-10-01 2012-10-01 false Bases for compromise. 30.22 Section 30.22 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION CLAIMS COLLECTION Debt Compromise § 30.22 Bases for compromise. (a) Compromise. The Secretary may compromise a debt if the full...

  19. 45 CFR 30.22 - Bases for compromise.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 45 Public Welfare 1 2011-10-01 2011-10-01 false Bases for compromise. 30.22 Section 30.22 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION CLAIMS COLLECTION Debt Compromise § 30.22 Bases for compromise. (a) Compromise. The Secretary may compromise a debt if the full...

  20. The theory of compromised eating behavior.

    PubMed

    Furman, Ellen

    2014-01-01

    The purpose of this inquiry was to develop substantive theory that describes the social process that influences the eating behavior of hospitalized older adults. Undernutrition contributes to negative health outcomes, such as increased morbidity and mortality in hospitalized older adults. Despite the availability of vast nutritional resources within the hospital environment, hospitalized older adults often have inadequate dietary intake. A grounded theory methodology was used to explore this phenomenon. The Theory of Compromised Eating Behavior describes the process of compromise that older adults experience related to eating behavior while hospitalized. The theory has four stages: self-indication, joint action, negotiation, and action. The meaning of hospital food and mealtimes differs from at-home food and mealtimes for the older adult, resulting in compromise. Intervention, which enhances the meaning of food and mealtimes for the older adult during hospitalization, may improve dietary intake and nutritional outcomes.

  1. Modeling the Dynamics of Compromised Networks

    SciTech Connect

    Soper, B; Merl, D M

    2011-09-12

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

  2. Political Compromise Makes the World Go 'Round

    ERIC Educational Resources Information Center

    Everett, Diana

    2007-01-01

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

  3. Funhaler spacer: improving adherence without compromising delivery

    PubMed Central

    Watt, P; Clements, B; Devadason, S; Chaney, G

    2003-01-01

    A novel asthma spacer device, the "Funhaler", incorporates incentive toys which are isolated from the main inspiratory circuit by a valve. Here we show that its use does not compromise drug delivery. Improved adherence combined with satisfactory delivery characteristics suggest that the Funhaler may be useful for management of young asthmatics. PMID:12818901

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

    SciTech Connect

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

    1983-08-01

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

  5. The ethics of moral compromise for stem cell research policy.

    PubMed

    Master, Zubin; Crozier, G K D

    2012-03-01

    In the US, stem cell research is at a moral impasse-many see this research as ethically mandated due to its potential for ameliorating major diseases, while others see this research as ethically impermissible because it typically involves the destruction of embryos and use of ova from women. Because their creation does not require embryos or ova, induced pluripotent stem cells offer the most promising path for addressing the main ethical objections to stem cell research; however, this technology is still in development. In order for scientists to advance induced pluripotent stem cell research to a point of translational readiness, they must continue to use ova and embryos in the interim. How then are we to ethically move forward with stem cell research? We argue that there is personal integrity and value in adopting a 'moral compromise' as a means for moving past the moral impasse in stem cell research. In a moral compromise, each party concedes part of their desired outcome in order to engage in a process that respects the values and desires of all parties equitably. Whereas some contend that moral compromise in stem cell research necessarily involves self-contradiction or loss of personal integrity, we argue that in the US context, stem cell research satisfies many of the key pre-conditions of an effective moral compromise. To illustrate our point, we offer a model solution wherein eggs and embryos are temporarily used until non-egg and non-embryonic sources of pluripotent stem cells are developed to a state of translational readiness.

  6. Delirium: assessment and treatment of patients with cancer. PART 2.

    PubMed

    Brown, Michelle; Hardy, Kersten

    Delirium at the end of life may present significant ethical dilemmas in clinical practice: whether to simply treat it in order to maximise symptom relief, with the resulting side effect being palliative sedation, or to attempt to reverse delirium and risk prolonging suffering. Determining whether the delirium can be reversed involves comprehensive assessment using established tools, which may or may not provide the answer to the question posed. This article examines the evidence surrounding several assessment tools that have been suggested as effective in identifying delirium, and the consequences of various approaches to the management of delirium in a patient with a cancer diagnosis. It also considers the impact delirium may have on the health professional and those close to the patient.

  7. 19 CFR 171.32 - Acceptance of offers in compromise.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 19 Customs Duties 2 2010-04-01 2010-04-01 false Acceptance of offers in compromise. 171.32 Section... OF THE TREASURY (CONTINUED) FINES, PENALTIES, AND FORFEITURES Offers in Compromise § 171.32 Acceptance of offers in compromise. An offer in compromise will be considered accepted only when the...

  8. 19 CFR 172.33 - Acceptance of offers in compromise.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 19 Customs Duties 2 2010-04-01 2010-04-01 false Acceptance of offers in compromise. 172.33 Section... OF THE TREASURY (CONTINUED) CLAIMS FOR LIQUIDATED DAMAGES; PENALTIES SECURED BY BONDS Offers in Compromise § 172.33 Acceptance of offers in compromise. An offer in compromise will be considered...

  9. [Amputation or reconstruction of a circulatory compromised severely injured extremity?].

    PubMed

    Høiness, P; Røise, O

    1999-11-20

    18 patients treated with primary or secondary amputations after severe lower limb open fractures were studied. All limbs had clinical signs of a compromised circulation at the primary evaluation. The various injuries are described and discussed with respect to the general guidelines for primary amputation. The Mangled Extremity Severity Score (MESS) and Nerve, Ischemia, Soft tissues, Skeletal, Shock, Age (NISSSA) scores were calculated. In view of the described injuries, primary amputation was indicated in ten patients according to the general recommendations, 11 patients according to NISSSA and 15 patients according to MESS. Delayed amputation leads t a significantly (p = 0.005) higher number of operative procedures than early amputation (9.2 vs. 2.9 treatments). The decision of whether to amputate or not should be based on sound clinical judgement, but injury scores such as MESS and NISSSA may be helpful.

  10. Advise condom users to follow 10-part patient instructions.

    PubMed

    Reese, M; Hatcher, R A

    1984-09-01

    This article outlines 10 rules for condom users: 1) use condoms at every intercourse, 2) use spermicidal condoms, 3) out the condom on the penis before the penis is inserted into the vagina, 4) do not use petroleum products such as Vaseline for additional lubrication, 5) use a backup method of contraception to increase the effectiveness of condoms, 6) after intercourse hold onto the rim part of the condom to avoid spillage of semen as the penis is withdrawn, 7) check to make sure the condom is intact before throwing the condom away, 8) do not reuse condoms, 9) use each condom definitely only once if it is being used as protection against sexually transmissible diseases, and 10) store condoms in a cool and dry place to avoid deterioration of the rubber.

  11. Recognizing and caring for the medically compromised child: 4. Children with other chronic medical conditions.

    PubMed

    Johnstone, S C; Barnard, K M; Harrison, V E

    1999-01-01

    This is the fourth and final part of a series on recognizing and caring for medically compromised children. In this article, an outline of appropriate dental management for children with other more commonly encountered chronic medical conditions is given, together with a description of the disorders and their significance in dentistry. This group includes children with physically handicapping conditions and children with learning difficulties, as well as those who are medically compromised.

  12. Chinese medicine and biomodulation in cancer patients--Part one.

    PubMed

    Sagar, S M; Wong, R K

    2008-01-01

    Traditional Chinese Medicine (tcm) may be integrated with conventional Western medicine to enhance the care of patients with cancer. Although tcm is normally implemented as a whole system, recent reductionist research suggests mechanisms for the effects of acupuncture, herbs, and nutrition within the scientific model of biomedicine. The health model of Chinese medicine accommodates physical and pharmacologic interventions within the framework of a body-mind network. A Cartesian split does not occur within this model, but to allow for scientific exploration within the restrictions of positivism, reductionism, and controls for confounding factors, the components must necessarily be separated. Still, whole-systems research is important to evaluate effectiveness when applying the full model in clinical practice. Scientific analysis provides a mechanistic understanding of the processes that will improve the design of clinical studies and enhance safety. Enough preliminary evidence is available to encourage quality clinical trials to evaluate the efficacy of integrating tcm into Western cancer care.

  13. [Hiking and useful advices to patients (part 1)].

    PubMed

    Labgaa, I; Pasche, O; Bart, P-A; Cornuz, J

    2011-11-30

    The attraction of walking as a pastime has grown enormously in Switzerland over the past few years. Synonym of health and well-being, this activity carries some risks which more and more patients are questioning; answering these questions is not always obvious, so we wanted to tackle the subject. Risks linked to certain animals will be covered. One of these risks is insect stings, particularly wasps and bees. This is a major problem which affects the whole population and more seriously those who are allergic, accounting for around 5% of the population. Another problem: snake bites. In Switzerland, there are about 20-25 bites each year. Poisoning from these can be divided into two categories: local or systemic. The effects are multiple and diverse, ranging from renal failure to discrasia to hypovolemic shock. Pre-hospitalisation measures are of paramount importance in the treatment.

  14. [Hiking and useful advices to patients: part II].

    PubMed

    Labgaa, I; Pasche, O; Halkic, N; Cornuz, J

    2011-11-30

    The attraction of walking as a pastime has grown enormously in Switzerland over the past few years. Synonym of health and wellbeing, this activity carries some risks which more and more patients are questioning; answering these questions is not always obvious, so we wanted to tackle the subject. This second section concerns risks linked to food which can be found in the forest. Echinococcosis is an underestimated parasite which affects a large proportion of foxes in Switzerland. This infectious disease can also affect man following contamination which usually occurs through eating berries. Prevention is the most effective way to avoid poisoning by mushrooms. In case of poisoning, the physician must try and determine the toxidrome. The key element is the length of time before symptoms develop. Treatment is always symptomatic, using activated charcoal.

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

    PubMed Central

    Thomas, R. E.

    2000-01-01

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

  16. Compromises in career-related decisions: examining the role of compromise severity.

    PubMed

    Wee, Serena

    2014-10-01

    This study tested L. S. Gottfredson's (1996) revised compromise theory by examining whether the relative importance of job sex type, job prestige, and person-job interest congruence for predicting job choice changed as the level of compromise required changed. The fully within-persons design had participants engage in a simulated occupational choice task where job sex type and job prestige were manipulated to be experimentally independent. Participants 1st categorized jobs as unacceptable, acceptable, or preferred. Then, within each category, they made further pairwise choices among jobs in that category. In Study 1, participants were 168 college seniors (124 women, 44 men) from a large Midwestern university. In Study 2, participants were 262 (146 women, 116 men) individuals residing in the United States and recruited via Amazon's Mechanical Turk platform. Across both studies, job sex type predicted choice when large compromises were required. Across both studies, job prestige did not predict choice when moderate compromises were required. In Study 2 but not Study 1, person-job interest congruence predicted choice when minimal compromises were required.

  17. Voices of discontent? Conscience, compromise, and assisted dying.

    PubMed

    Huxtable, Richard; Mullock, Alexandra

    2015-01-01

    If some form of assisted dying is to be legalised, we are likely to hear voices of discontent, not least from the medical profession and some of its members, who might be expected to provide the service. The profession generally favours a position of opposition, premised on an ethic of 'caring not killing', which might be said to convey its 'professional conscience'. There will, of course, also be individual conscientious objectors. In this article, we initially explore the nature and sources of conscience and we argue that conscience does merit respect. We also recognise that professionals, qua professionals, are bound to serve their patients, some of whom will want (and may be entitled to) that which their doctors do not wish to provide. Reflecting on the different values in issue, we suggest that there is a case for principled compromise which would afford professionals a limited right to conscientiously object, while also protecting patients. We then relate these reflections to assisted dying specifically. In the absence of any definitive steer from the purported integrity of medicine, we suspect that the profession could adopt a neutral stance on this divisive issue. We nevertheless anticipate individual objections if the law does move to embrace assisted dying, and we argue that such objections should be respected, according to the terms of the compromise model we defend.

  18. Frontostriatal fiber bundle compromise in HIV infection without dementia

    PubMed Central

    Pfefferbaum, Adolf; Rosenbloom, Margaret J.; Rohlfing, Torsten; Kemper, Carol A.; Deresinski, Stanley; Sullivan, Edith V.

    2010-01-01

    Background Quantitative fiber tracking derived from diffusion tensor imaging (DTI) was used to determine whether white matter association, projection, or commissural tracts are affected in nondemented individuals with HIV infection and to identify the regional distribution of sparing and impairment of fiber systems. Methods DTI measured fractional anisotropy and diffusivity, quantified separately for longitudinal (λL) diffusivity (index of axonal injury) and transverse (λT) diffusivity (index of myelin injury), in 11 association and projection white matter tracts and six commissural tracts in 29 men and 13 women with HIV infection and 88 healthy, age-matched controls (42 men and 46 women). Results The total group of HIV-infected individuals had higher diffusivity (principally longitudinal) than controls in the posterior sectors of the corpus callosum, internal and external capsules, and superior cingulate bundles. High longitudinal diffusivity, indicative of axonal compromise, was especially prominent in posterior callosal sectors, fornix, and superior cingulate bundle in HIV with AIDS. Unmedicated patients had notably high transverse diffusivity, indicative of myelin compromise, in the occipital forceps, inferior cingulate bundle, and superior longitudinal fasciculus. Pontocerebellar projection fibers were resistant to HIV effects as were commissural fibers coursing through premotor and sensorimotor callosal sectors. Conclusion This quantitative survey of brain fiber tract integrity indicates that even nondemented HIV patients can have neuroradiological evidence for damage to association and commissural tracts. These abnormalities were vulnerable to exacerbation with AIDS and possibly mitigated by HAART. PMID:19730350

  19. Central nervous system compromise in primary Sjögren's syndrome.

    PubMed

    Anaya, Juan-Manuel; Villa, Luis A; Restrepo, Lucas; Molina, Jose F; Mantilla, Rubén D; Vargas, Sergio

    2002-08-01

    Central nervous system (CNS) involvement in primary Sjögren's syndrome (SS) is poorly understood, and its frequency as well as its manifestations are subjects of controversy. The current study was undertaken to determine the prevalence and the clinical and immunogenetic characteristics of CNS compromise in a well defined group of patients with primary SS. In this retrospective study, patients fulfilled the European classification criteria. Among 120 patients with primary SS, 3 (2.5%) had CNS compromise (multiple sclerosis-like illness, complicated migraine, and optic neuritis with epilepsy). The CNS involvement coincided with the onset of sicca symptoms in 1 case. All 3 patients carried the human leukocyte antigen (HLA) DQB1*0303 allele and tested positive for anti-Ro antibodies, but not for anti-cardiolipin antibodies. Although rare, CNS compromise in primary SS can be the presenting manifestation of the disease in a few cases, and may be severe and varied.

  20. Spirituality 1: Should spiritual and religious beliefs be part of patient care?

    PubMed

    Sartori, Penny

    Despite spirituality being an important aspect of patient care, few nurses feel they meet patients' needs in this area. This first in a two part series examines definitions of spirituality and the difference between this concept and religion. It also discusses spirituality at certain points in t hepatient pathway, such as at the end of life, and finding meaning in illness.

  1. CE: Improving Outcomes for Patients with Chronic Kidney Disease: Part 2.

    PubMed

    Norton, Jenna M; Newman, Eileen P; Romancito, Gayle; Mahooty, Stephanie; Kuracina, Theresa; Narva, Andrew S

    2017-03-01

    : Coping with chronic kidney disease (CKD) is challenging for many people, since symptoms often don't appear until the disease is advanced and the patient is close to requiring dialysis. This two-part article aims to provide nurses with the basic information necessary to assess and manage patients with CKD. Part 1, which appeared last month, offered an overview of the disease, described identification and etiology, and discussed ways to slow disease progression. Part 2 addresses disease complications and treatment for kidney failure.

  2. Food irradiation: Special solutions for the immuno-compromised

    NASA Astrophysics Data System (ADS)

    Mohácsi-Farkas, Csilla

    2016-12-01

    Safety of food is particularly important for immuno-compromised patients, because these people are vulnerable to all sorts of infectious complications and foodborne pathogens as well, and even organisms normally considered non-pathogenic may cause problems. According to the guidelines published by the FDA, immunocompromised patients have to avoid high-risk foods, and advised to consume only pasteurized juice, milk or cheese, and well-cooked eggs, poultry, meat and fish. In the frame of an IAEA CRP the objective was to develop, in collaborations with the healthcare community, the use of irradiation to increase the variety, availability and acceptability of foods for immunocompromised, for example irradiated fresh produce (fruits, vegetables, salads) and ready-to-eat meals. Further aim was to widen the acceptance of irradiated foods by the healthcare and regulatory communities.

  3. The Psychiatry of Family Practice: Personality Disorders Part 2: Interviewing the Patient

    PubMed Central

    Steinberg, Paul

    1983-01-01

    Part 1 of this article, published on page 1942, encourages family doctors to consider their patients' personalities in clinical assessment and management. This section discusses patient interviewing, demonstrating how family physicians can listen for `themes' in a patient's conversation that may hold clues to what is bothering him. It is also best to avoid giving a patient too much support in an attempt `to make him feel better' because such support may also prevent him from making mature decisions. It is equally important generally to avoid giving specific advice, because it may prevent patients from taking responsibility for their own actions. The clinician can use his own feelings and reactions to the patient to better understand the patient's personality and problems. Consultation with a psychiatrist can help clarify the family physician's role in assisting a particular patient. Balint groups are recommended for family doctors who are interested in further developing their interviewing skills. PMID:21283433

  4. 40 CFR 13.26 - Payment of compromised claims.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... will be required to execute a confess-judgment agreement which accelerates payment of the balance due... 40 Protection of Environment 1 2011-07-01 2011-07-01 false Payment of compromised claims. 13.26... STANDARDS Compromise of Debts § 13.26 Payment of compromised claims. The Administrator normally will...

  5. 40 CFR 13.26 - Payment of compromised claims.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... will be required to execute a confess-judgment agreement which accelerates payment of the balance due... 40 Protection of Environment 1 2010-07-01 2010-07-01 false Payment of compromised claims. 13.26... STANDARDS Compromise of Debts § 13.26 Payment of compromised claims. The Administrator normally will...

  6. Telomere shortening and metabolic compromise underlie dystrophic cardiomyopathy

    PubMed Central

    Chang, Alex Chia Yu; Ong, Sang-Ging; LaGory, Edward L.; Kraft, Peggy E.; Giaccia, Amato J.; Wu, Joseph C.; Blau, Helen M.

    2016-01-01

    Duchenne muscular dystrophy (DMD) is an incurable X-linked genetic disease that is caused by a mutation in the dystrophin gene and affects one in every 3,600 boys. We previously showed that long telomeres protect mice from the lethal cardiac disease seen in humans with the same genetic defect, dystrophin deficiency. By generating the mdx4cv/mTRG2 mouse model with “humanized” telomere lengths, the devastating dilated cardiomyopathy phenotype seen in patients with DMD was recapitulated. Here, we analyze the degenerative sequelae that culminate in heart failure and death in this mouse model. We report progressive telomere shortening in developing mouse cardiomyocytes after postnatal week 1, a time when the cells are no longer dividing. This proliferation-independent telomere shortening is accompanied by an induction of a DNA damage response, evident by p53 activation and increased expression of its target gene p21 in isolated cardiomyocytes. The consequent repression of Pgc1α/β leads to impaired mitochondrial biogenesis, which, in conjunction with the high demands of contraction, leads to increased oxidative stress and decreased mitochondrial membrane potential. As a result, cardiomyocyte respiration and ATP output are severely compromised. Importantly, treatment with a mitochondrial-specific antioxidant before the onset of cardiac dysfunction rescues the metabolic defects. These findings provide evidence for a link between short telomere length and metabolic compromise in the etiology of dilated cardiomyopathy in DMD and identify a window of opportunity for preventive interventions. PMID:27799523

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

    PubMed

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

    2016-03-21

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

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

    NASA Astrophysics Data System (ADS)

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

    2016-03-01

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

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

    SciTech Connect

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

    2011-01-15

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

  10. [Hand hygiene--part of patient safety from Semmelweis to the present].

    PubMed

    Anttila, Veli-Jukka

    2014-01-01

    Hand disinfection is one of the most important part of patient safety. By adequate hand disinfection healthcare workers can prevent about 40 per cent of healthcare-associated infections and about 50 per cent of patients' MRSA contaminations in hospitals. Adherence to hand disinfection has been observed in an average of 40 per cent of patient contacts. One of the risk factors leading to poor adherence is the "doctor" status of a healthcare worker. Introduction of an alcohol-based hand rub close to the patient is one of the most significant factors for improved hand hygiene.

  11. Neglecting legumes has compromised human health and sustainable food production.

    PubMed

    Foyer, Christine H; Lam, Hon-Ming; Nguyen, Henry T; Siddique, Kadambot H M; Varshney, Rajeev K; Colmer, Timothy D; Cowling, Wallace; Bramley, Helen; Mori, Trevor A; Hodgson, Jonathan M; Cooper, James W; Miller, Anthony J; Kunert, Karl; Vorster, Juan; Cullis, Christopher; Ozga, Jocelyn A; Wahlqvist, Mark L; Liang, Yan; Shou, Huixia; Shi, Kai; Yu, Jingquan; Fodor, Nandor; Kaiser, Brent N; Wong, Fuk-Ling; Valliyodan, Babu; Considine, Michael J

    2016-08-02

    The United Nations declared 2016 as the International Year of Pulses (grain legumes) under the banner 'nutritious seeds for a sustainable future'. A second green revolution is required to ensure food and nutritional security in the face of global climate change. Grain legumes provide an unparalleled solution to this problem because of their inherent capacity for symbiotic atmospheric nitrogen fixation, which provides economically sustainable advantages for farming. In addition, a legume-rich diet has health benefits for humans and livestock alike. However, grain legumes form only a minor part of most current human diets, and legume crops are greatly under-used. Food security and soil fertility could be significantly improved by greater grain legume usage and increased improvement of a range of grain legumes. The current lack of coordinated focus on grain legumes has compromised human health, nutritional security and sustainable food production.

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

    PubMed

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

    2016-01-01

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

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

    PubMed Central

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

    2016-01-01

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

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

    PubMed

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

    2014-09-01

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

  15. Glutathione synthesis is compromised in erythrocytes from individuals with HIV.

    PubMed

    Morris, Devin; Ly, Judy; Chi, Po-Ting; Daliva, John; Nguyen, Truongson; Soofer, Charleen; Chen, Yung C; Lagman, Minette; Venketaraman, Vishwanath

    2014-01-01

    We demonstrated that the levels of enzymes responsible for the synthesis of glutathione (GSH) such as glutathione synthase (GSS), glutamate-cysteine ligase-catalytic subunit (GCLC), and glutathione reductase (GSR) were significantly reduced in the red blood cells (RBCs) isolated from individuals with human immunodeficiency virus (HIV) infection and this reduction correlated with decreased levels of intracellular GSH. GSH content in RBCs can be used as a marker for increased overall oxidative stress and immune dysfunctions caused by HIV infection. Our data supports our hypothesis that compromised levels of GSH in HIV infected individuals' is due to decreased levels of GSH-synthetic enzymes. The role of GSH in combating oxidative stress and improving the functions of immune cells in HIV patients' indicates the benefit of an antioxidant supplement which can reduce the cellular damage and promote the functions of immune cells.

  16. Compromised natural killer cells in pulmonary embolism

    PubMed Central

    Zhang, Xiaoyu; Wang, Qiang; Shen, Yuqin; Song, Haoming; Gong, Zhu; Wang, Lemin

    2015-01-01

    Objective: The high morbidity, mortality and misdiagnosis rate render pulmonary embolism (PE) as a worldwide health problem. However, the etiology and pathogenesis of this disease have not been well characterized. Increasing studies indicate infection and immunity play a crucial role in PE. Natural killer (NK) cells act as a bridge between the innate immune and acquired immune. This study aimed to investigate the possible function of NK cells in PE. Methods: Human cDNA microarray analysis was employed to detect genes associated with NK cells in peripheral blood mononuclear cells (PBMCs). Random variance model corrected t-test was used for statistical analysis of differential gene expression. Flow cytometry was performed to detect the CD16+CD56+ NK cells. Results: In the present study, based on gene expression microarray analysis, we showed four inhibitory receptors (KLRB1, KLRD1, KLRF1, KLRG1) and four activating receptors (KLRC1, KLRC3, KLRK1 and NCR1) on NK cells were remarkably down-regulated and the cytological experiment demonstrated the proportion of CD16+CD56+ NK cells among PBMCs decreased in the PE group. Conclusions: We confirmed the presence of reduced expression of critical activating as well as inhibitory NK cell receptors and low proportion of CD16+CD56+ NK cells in PE. The consistence between genomic and cytological examination suggests compromised NK cells may contribute to the pathogenesis of PE. PMID:26339393

  17. Morphine induces albuminuria by compromising podocyte integrity.

    PubMed

    Lan, Xiqian; Rai, Partab; Chandel, Nirupama; Cheng, Kang; Lederman, Rivka; Saleem, Moin A; Mathieson, Peter W; Husain, Mohammad; Crosson, John T; Gupta, Kalpna; Malhotra, Ashwani; Singhal, Pravin C

    2013-01-01

    Morphine has been reported to accelerate the progression of chronic kidney disease. However, whether morphine affects slit diaphragm (SD), the major constituent of glomerular filtration barrier, is still unclear. In the present study, we examined the effect of morphine on glomerular filtration barrier in general and podocyte integrity in particular. Mice were administered either normal saline or morphine for 72 h, then urine samples were collected and kidneys were subsequently isolated for immunohistochemical studies and Western blot. For in vitro studies, human podocytes were treated with morphine and then probed for the molecular markers of slit diaphragm. Morphine-receiving mice displayed a significant increase in albuminuria and showed effacement of podocyte foot processes. In both in vivo and in vitro studies, the expression of synaptopodin, a molecular marker for podocyte integrity, and the slit diaphragm constituting molecules (SDCM), such as nephrin, podocin, and CD2-associated protein (CD2AP), were decreased in morphine-treated podocytes. In vitro studies indicated that morphine modulated podocyte expression of SDCM through opiate mu (MOR) and kappa (KOR) receptors. Since morphine also enhanced podocyte oxidative stress, the latter seems to contribute to decreased SDCM expression. In addition, AKT, p38, and JNK pathways were involved in morphine-induced down regulation of SDCM in human podocytes. These findings demonstrate that morphine has the potential to alter the glomerular filtration barrier by compromising the integrity of podocytes.

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

    PubMed Central

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

    2016-01-01

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

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

    PubMed Central

    Li, Jing; Chen, Aimin

    2013-01-01

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

  20. Clinical outcomes of compromised side branch (stent jail) after coronary stenting with the NIR stent.

    PubMed

    Bhargava, B; Waksman, R; Lansky, A J; Kornowski, R; Mehran, R; Leon, M B

    2001-11-01

    Acute side-branch (SB) compromise or occlusion stent jail after native coronary stenting is a matter of concern. Attempts at maintaining SB patency can be a technical challenge. The purpose of this study was to determine the clinical impact of SB compromise or occlusion in patients undergoing stenting of parent vessel lesions. We evaluated in-hospital and long-term clinical outcomes (death, Q-wave myocardial infarction, and repeat revascularization rates at 6 months) in 318 consecutive patients undergoing NIR stent implantation across an SB. Based on independent angiographic analysis, 218 (68.6%) patients had no poststent SB compromise, 85 (26.7%) patients had narrowed SB (> 70% narrowing, without total occlusion), and 15 (4.7%) patients had an occluded SB after stent implantation. The baseline patient and lesion characteristics were similar between the groups. Procedural success was 100%. Patients with SB occlusion had a higher stents/lesion ratio (P < 0.006). Side-branch occlusion was associated with higher in-hospital ischemic complications (Q-wave myocardial infarction, 7%; non-Q-wave myocardial infarction, 20%; P < 0.05) compared to patients with SB compromise or normal SB. At 6-month follow-up, there was a trend for more myocardial infarctions in the group with SB occlusion during the index procedure (Q-wave myocardial infarction, 7% vs. 1% in the narrowed and 0% in normal SB; P = 0.09). However, late target lesion revascularization and mortality were similar in the three groups (P = 0.91). SB occlusion after parent vessel stenting is associated with more frequent in-hospital Q-wave and non-Q-wave myocardial infarctions. However, with the NIR stent, side-branch compromise or occlusion does not influence late (6 month) major adverse events, including death, myocardial infarction, or need for repeat revascularization.

  1. Unconsciously competing goals can collaborate or compromise as well as win or lose.

    PubMed

    Carruthers, Peter

    2014-04-01

    This commentary offers a friendly extension of Huang & Bargh's (H&B's) account. Not only do active goals sometimes operate unconsciously to dominate or preempt others, but simultaneously active goals can also collaborate or compromise in shaping behavior. Because neither goal wins complete control of behavior, the result may be that each is only partly satisfied.

  2. 45 CFR 30.4 - Compromise, waiver, or disposition under other statutes not precluded.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 45 Public Welfare 1 2012-10-01 2012-10-01 false Compromise, waiver, or disposition under other statutes not precluded. 30.4 Section 30.4 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL... States Code and the Federal Claims Collection Standards, 31 CFR parts 900 through 904. Any statute...

  3. 45 CFR 30.4 - Compromise, waiver, or disposition under other statutes not precluded.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 45 Public Welfare 1 2010-10-01 2010-10-01 false Compromise, waiver, or disposition under other statutes not precluded. 30.4 Section 30.4 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL... States Code and the Federal Claims Collection Standards, 31 CFR parts 900 through 904. Any statute...

  4. 10 CFR 1015.104 - Compromise, waiver, or disposition under other statutes not precluded.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 10 Energy 4 2013-01-01 2013-01-01 false Compromise, waiver, or disposition under other statutes not precluded. 1015.104 Section 1015.104 Energy DEPARTMENT OF ENERGY (GENERAL PROVISIONS) COLLECTION... applicable laws and regulations will generally take precedence over this part....

  5. Anesthetic considerations in diabetic patients. Part II: intraoperative and postoperative management of patients with diabetes mellitus.

    PubMed

    Kadoi, Yuji

    2010-10-01

    Some studies have reported that tight glycemic control in diabetic patients undergoing major surgery improves perioperative morbidity and mortality rates. Recently, however, large randomized studies have shown such control increases the mortality rate, since aggressive glycemic control induces more frequent incidences of hypoglycemia. Diabetic patients have cerebral complications during the perioperative period more often than their nondiabetic counterparts. Further, anesthetic agents have some effects on cerebral circulation and cerebrovascular carbon dioxide reactivity. Hence, anesthesiologists should have adequate knowledge about anesthetic agents that maintain the integrity of the cerebral circulation. Patients with diabetes mellitus (DM) have an increased susceptibility to perioperative infections. Recent work confirmed that a combination of intravenous and subcutaneous insulin as a glucose management strategy had beneficial effects identical with intravenous insulin therapy alone on the reduction of infection rates during the postoperative period.

  6. Differential pattern of hand-tapping compromise in vascular versus idiopathic parkinsonism: a study based on computerized movement analysis.

    PubMed

    Bäzner, Hansjörg; Schanz, Jurik; Blahak, Christian; Grips, Eva; Wöhrle, Johannes C; Hennerici, Michael

    2005-04-01

    We tested the characteristics and the differential pattern of upper extremity motor compromise, comparing hand tapping in patients with subcortical vascular encephalopathy (SVE; n = 18), idiopathic Parkinson's disease (PD; n = 18), and in healthy controls (n = 18). Both patient groups showed significant compromise in hand tapping compared with that in controls, with higher coefficients of variability (CV) regarding tapping amplitude and angular velocity, determined using a computerized movement analysis system. A differential tapping pattern in both patient groups could be demonstrated in that patients with PD showed lower tapping amplitudes than patients with SVE. Both patient groups displayed abnormalities in tapping rhythmicity compared with that in the control group.

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

    ERIC Educational Resources Information Center

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

    2012-01-01

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

  8. Predicting early nonelective hospital readmission in nutritionally compromised older adults.

    PubMed

    Friedmann, J M; Jensen, G L; Smiciklas-Wright, H; McCamish, M A

    1997-06-01

    This study determined predictors of early nonelective hospital readmission in 92 (49 women and 43 men) nutritionally compromised Medicare patients. Subjects ranged in age from 65 to 92 y and represented patients hospitalized previously for medical or surgical services. The study used a repeated-measures design of multiple variables representing demographics, anthropometric and clinical values, and functional status. Data were collected during hospitalization and during home visits at 1 and 3 mo postdischarge. There were 26 readmissions, making the 4-mo nonelective readmission rate 26%. Subjects who were readmitted nonelectively were compared with those not readmitted. Univariate analyses suggested strong relations between readmission outcome and serum albumin, total lymphocyte count, change in weight, and change in white blood cell count. Sociodemographic variables were less useful in predicting readmission than were measurements of patients' clinical status. Measurements of change in clinical variables were generally more predictive of readmission than was any one single measurement. Multivariate-logistic-regression analyses suggested a model consisting of change in weight and change in serum albumin from hospitalization to 1 mo after discharge as being highly predictive of early nonelective readmission. Individuals with any amount of weight loss and no improvement in albumin concentrations during the first month after hospitalization were at a much higher risk of readmission than were those who maintained or increased their postdischarge weight and had repleted their serum albumin concentrations. More study is warranted to clarify whether routine monitoring of changes in weight and serum albumin after hospitalization is appropriate in older adults.

  9. Anesthetic considerations in diabetic patients. Part I: preoperative considerations of patients with diabetes mellitus.

    PubMed

    Kadoi, Yuji

    2010-10-01

    Diabetes mellitus is an increasingly common disease that affects people of all ages, resulting in significant morbidity and mortality. Diabetic patients require perioperative care more frequently than their nondiabetic counterparts. The major risk factors for diabetics undergoing surgery are the associated end-organ diseases: cardiovascular disease, autonomic neuropathy, joint collagen tissue, and immune deficiency. Physicians need to pay extra attention to preoperative and preprocedure evaluation and treatment of these diseases to ensure optimal perioperative management.

  10. Involvement in research without compromising research quality.

    PubMed

    Stewart, Ruth; Liabo, Kristin

    2012-10-01

    Health research funders in the UK now ask applicants to state how their research will involve patients and members of the public. Such involvement can help with questions that researchers repeatedly face: about improving trial recruitment, response rates and follow-up. Patient and Public Involvement (PPI) in research is usually presented in the form of a ladder, from a low rung where studies are led by researchers with no patient involvement, to a high rung where studies are patient-led. This hierarchy does not sit well with many clinicians and academics whose expertise appears to have been downgraded. This article argues that research quality and relevance are optimised when patient expertise is integrated with researchers' and policy-makers' expertise, and each role acknowledged and valued, illustrated by an alternative model for PPI which places research and expertise at the centre of the involvement enterprise.

  11. Metabolic Stress and Compromised Identity of Pancreatic Beta Cells

    PubMed Central

    Swisa, Avital; Glaser, Benjamin; Dor, Yuval

    2017-01-01

    Beta cell failure is a central feature of type 2 diabetes (T2D), but the molecular underpinnings of the process remain only partly understood. It has been suggested that beta cell failure in T2D involves massive cell death. Other studies ascribe beta cell failure to cell exhaustion, due to chronic oxidative or endoplasmic reticulum stress leading to cellular dysfunction. More recently it was proposed that beta cells in T2D may lose their differentiated identity, possibly even gaining features of other islet cell types. The loss of beta cell identity appears to be driven by glucotoxicity inhibiting the activity of key beta cell transcription factors including Pdx1, Nkx6.1, MafA and Pax6, thereby silencing beta cell genes and derepressing alternative islet cell genes. The loss of beta cell identity is at least partly reversible upon normalization of glycemia, with implications for the reversibility of T2D, although it is not known if beta cell failure reaches eventually a point of no return. In this review we discuss current evidence for metabolism-driven compromised beta cell identity, key knowledge gaps and opportunities for utility in the treatment of T2D. PMID:28270834

  12. Mental rotation of body parts and non-corporeal objects in patients with idiopathic cervical dystonia.

    PubMed

    Fiorio, Mirta; Tinazzi, Michele; Ionta, Silvio; Fiaschi, Antonio; Moretto, Giuseppe; Edwards, Mark J; Bhatia, Kailash P; Aglioti, Salvatore M

    2007-06-11

    Mental rotation of body parts is performed through inner simulation of actual movements, and is likely to rely upon cortical and subcortical systems (e.g. motor and premotor areas and basal ganglia) involved in motor planning and execution. Studies indicate that sensory and motor deficits, such as for example pain, limb amputation or focal hand dystonia, bring about a specific impairment in mental rotation of the affected body parts. Here we explored the ability of patients affected by idiopathic cervical dystonia (CD) to mentally rotate affected (neck) and unaffected (hands and feet) body districts. The experimental stimuli consisted of realistic photos of left or right hands or feet and the head of a young men with a black patch on the left or the right eye. As non-corporeal stimulus the front view of a car with a black patch on the left or the right headlight was used. The stimuli were presented at six different degrees of orientations. Twelve CD patients and 12 healthy participants were asked to verbally report whether the hands or feet were left or right, or whether the patch was on the left or the right eye or headlight. Reaction times and accuracy in performing the laterality tasks on the four stimuli were collected. Results showed that CD patients are slow in mental rotation of stimuli representing body parts, namely hand, foot and head. This abnormality was not due to a general impairment in mental rotation per se, since patients' ability to rotate a non-corporeal object (a car) was not significantly different from that of healthy participants. We posit that the deficit in mental rotation of body parts in CD patients may derive from a defective integration of body- and world-related knowledge, a process that is likely to allow a general representation of "me in the external world".

  13. Choosing to Compromise: Women Studying Childcare

    ERIC Educational Resources Information Center

    Wright, Hazel R.

    2013-01-01

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

  14. 32 CFR 757.19 - Waiver and compromise.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... REGULATIONS Medical Care Recovery Act (MCRA) Claims and Claims Asserted Pursuant to 10 U.S.C. 1095 § 757.19 Waiver and compromise. (a) General. OJAG Code 15 (Claims and Tort Litigation) may authorize waiver or... with Code 15 approval. (b) Waiver and compromise. The JAG designee may waive the Federal...

  15. 19 CFR 161.5 - Compromise of Government claims.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

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

  16. 41 CFR 105-55.020 - Bases for compromise.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... risks involved, GSA will consider the probable amount of court costs and attorney fees pursuant to the... for repayment in the manner set forth in § 105-55.015. (g) To assess the merits of a compromise offer... financial information to assess compromise offers. GSA may use their own financial information form or...

  17. 38 CFR 1.970 - Standards for compromise.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Committee respecting acceptance or rejection of a compromise offer shall be in conformity with the standards in §§ 1.930 through 1.936. In loan guaranty cases the offer of a veteran or other obligor to effect a... shall be reviewed by the Committee. An offer to effect a compromise may be accepted if it is...

  18. 26 CFR 300.3 - Offer to compromise fee.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... taxpayer if the offer is accepted, rejected, withdrawn, or returned as nonprocessable after acceptance for... 26 Internal Revenue 18 2010-04-01 2010-04-01 false Offer to compromise fee. 300.3 Section 300.3... ADMINISTRATION USER FEES § 300.3 Offer to compromise fee. (a) Applicability. This section applies to...

  19. 5 CFR 1312.30 - Loss or possible compromise.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 5 Administrative Personnel 3 2013-01-01 2013-01-01 false Loss or possible compromise. 1312.30 Section 1312.30 Administrative Personnel OFFICE OF MANAGEMENT AND BUDGET OMB DIRECTIVES CLASSIFICATION... Classified Information § 1312.30 Loss or possible compromise. Any person who has knowledge of the loss...

  20. 38 CFR 42.46 - Compromise and settlement.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 2 2010-07-01 2010-07-01 false Compromise and settlement. 42.46 Section 42.46 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS (CONTINUED) STANDARDS IMPLEMENTING THE PROGRAM FRAUD CIVIL REMEDIES ACT § 42.46 Compromise and settlement. (a)...

  1. 38 CFR 42.46 - Compromise and settlement.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 2 2011-07-01 2011-07-01 false Compromise and settlement. 42.46 Section 42.46 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS (CONTINUED) STANDARDS IMPLEMENTING THE PROGRAM FRAUD CIVIL REMEDIES ACT § 42.46 Compromise and settlement. (a)...

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

    PubMed

    Lee, Ju-Hyoung

    2015-04-01

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

  3. Alexithymia partly predicts pain, poor health and social difficulties in patients with temporomandibular disorders.

    PubMed

    Mingarelli, A; Casagrande, M; Di Pirchio, R; Nizzi, S; Parisi, C; Loy, B C; Solano, L; Rampello, A; Di Paolo, C

    2013-10-01

    Temporomandibular disorders (TMD) are functional diseases of the masticatory system; their symptoms are clicking, difficulty opening the mouth wide, ear pain, facial pain and headaches. The relationships among distress, emotional factors and TMD are well known. It was shown that patients with TMD have little awareness of their inner states and emotions, and it was found that those reporting oro-facial pain presented higher alexithymia than did asymptomatic people. Other authors confirmed that alexithymia was higher in the painful TMD group than controls. This study was aimed to evaluate whether alexithymia and its components can be considered as predisposing factors for pain severity, poor health and greater social difficulties in patients with TMD. One hundred thirty-three patients received a diagnosis of TMD and completed the 20-item Toronto Alexithymia Scale. Multiple stepwise regressions showed that alexithymia and age explained 10% of the pain and 31% of poor health and also that alexithymia explained 7% of social difficulty. A direct comparison of patients with TMD based on alexithymia revealed a higher presence of pain in alexithymic patients with TMD than in those characterised by moderate or no alexithymia. In conclusion, alexithymia partly predicts pain, poor health and social difficulties in patients with TMD. Furthermore, alexithymic patients have more pain than those with moderate or low alexithymia.

  4. [Family models and mental anorexia. Part I. Patterns in patient's family origin].

    PubMed

    Józefik, B

    1999-01-01

    The paper presents family models which associate the development of anorexia nervosa with the specific functioning of the patient's family of origin. The described conceptions are based on systems theory which assumes circular conception of family relations. This allows for avoiding one-sidedness of approach, i.e. perceiving a patient as a victim of the family system. In fact, these models emphasize the patient's part in the specific "game" taking place within the family. The conceptions indicate a number of characteristic patterns of relations between the patient's parents as a married couple as well as between the patient and her parents, which, in the period of adolescence become the source of a crisis that assumes the form of anorexia nervosa. The presented approach, focussed on an analysis of family relations, does not question the importance of other aetiological factors. It only points out that the dynamics of mutual relations within a family is an important mechanism influencing the development of the patient's identification and her psychosexual role as well as the course of the separation/individuation process. These aspects seem pivotal for understanding and treatment of anorexia nervosa.

  5. [Helsinki Declaration on Patient Safety in Anaesthesiology--Part 8: SOP for checking equipment and drugs].

    PubMed

    Happel, Oliver; Roewer, Norbert; Kranke, Peter

    2013-09-01

    In 2010 the Helsinki Declaration on Patient Safety in Anaesthesiology was launched. In this joined statement under the auspice of the European Society of Anaesthesiology the need for protocols for different aspects of perioperative procedures that could affect patient safety was stated. All participating institutions should have--among others--protocols for checking equipment and drugs required for the delivery of safe anaesthesia. The background for this being the fact that the lack of carefully checking equipment and drugs--or not adhering to existing checklists--is a latent threat to patient safety and thus may increase morbidity and mortality.In this part of a series the authors present protocols existing in their clinic for checking anaesthesia equipment and drugs.

  6. Psychoeducational Interventions with Pediatric Cancer Patients: Part II. Effects of Information and Skills Training on Health-Related Outcomes

    ERIC Educational Resources Information Center

    Beale, Ivan L.; Bradlyn, Andrew S.; Kato, Pamela M.

    2003-01-01

    In Part I of this paper, we described a model that was used as a framework for reviewing studies of psychoeducational interventions intended to influence illness- and treatment-related behaviors and attitudes in pediatric cancer patients. In Part II, we distinguish between interventions that attempt to influence patients' behaviors just by…

  7. Calcium ameliorates diarrhea in immune compromised children

    PubMed Central

    Cheng, Sam X.; Bai, Harrison X.; Gonzalez-Peralta, Regino; Mistry, Pramod K.; Gorelick, Fred S.

    2015-01-01

    Treatment of infectious diarrheas remains a challenge, particularly in immunocompromised patients in whom infections usually persist and resultant diarrhea is often severe and protracted. Children with infectious diarrhea who become dehydrated are normally treated with oral or intravenous rehydration therapy. Although rehydration therapy can replace the loss of fluid, it does not ameliorate diarrhea. Thus, over the past decades, there has been continuous effort to search for ways to safely stop diarrhea. Herein, we report three cases of immunocompromised children who developed severe and/or protracted infectious diarrhea. Their diarrheas were successfully “halted” within 1-2 days following the administration of calcium. PMID:23343935

  8. Hippocampus Glutamate and N-Acetyl Aspartate Markers of Excitotoxic Neuronal Compromise in Posttraumatic Stress Disorder.

    PubMed

    Rosso, Isabelle M; Crowley, David J; Silveri, Marisa M; Rauch, Scott L; Jensen, J Eric

    2017-03-08

    Hippocampus atrophy is implicated in posttraumatic stress disorder (PTSD), and may partly reflect stress-induced glutamate excitotoxicity that culminates in neuron injury and manifests as re-experiencing symptoms and other memory abnormalities. This study used high-field proton magnetic resonance spectroscopy (MRS) to determine whether PTSD is associated with lower hippocampus levels of the neuron marker N-acetyl aspartate (NAA), along with higher levels of glutamate (Glu) and Glu/NAA. We also predicted that metabolite levels would correlate with re-experiencing symptoms and lifetime trauma load. Twenty-four adult PTSD patients and 23 trauma-exposed normal controls (TENC) underwent 4T MRS of the left and right hippocampus. Participants received psychiatric interviews, and completed the Traumatic Life Events Questionnaire to define lifetime trauma load. Relative to TENC participants, PTSD patients exhibited significantly lower NAA in right and left hippocampi, and significantly higher Glu and Glu/NAA in the right hippocampus. Re-experiencing symptoms were negatively correlated with left and right NAA, and positively correlated with right Glu and right Glu/NAA. Trauma load was positively correlated with right Glu/NAA in PTSD patients. When re-experiencing symptoms and trauma load were examined together in relation to right Glu/NAA, only re-experiencing symptoms remained a significant correlate. This represents the first report that PTSD is associated with MRS markers of hippocampus Glu excess, together with indices of compromised neuron integrity. Their robust associations with re-experiencing symptoms affirm that MRS indices of hippocampus neuron integrity and glutamate metabolism may reflect biomarkers of clinically significant disease variation in PTSD.Neuropsychopharmacology advance online publication, 8 March 2017; doi:10.1038/npp.2017.32.

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

    NASA Astrophysics Data System (ADS)

    Butterweck, Joseph S.

    1995-02-01

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

  10. Compromised central tolerance of ICA69 induces multiple organ autoimmunity

    PubMed Central

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

    2015-01-01

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

  11. 15 CFR 904.106 - Compromise of civil penalty.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

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

  12. 15 CFR 904.106 - Compromise of civil penalty.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

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

  13. 15 CFR 904.106 - Compromise of civil penalty.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

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

  14. 15 CFR 904.106 - Compromise of civil penalty.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

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

  15. 15 CFR 904.106 - Compromise of civil penalty.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

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

  16. 22 CFR 213.25 - Standards for compromise.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... other evidentiary data required to support the Government's claim. In determining the litigative risks.... (d) To assess the merits of a compromise offer, USAID may obtain a current financial statement...

  17. 32 CFR 2400.33 - Loss or possible compromise.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... measures taken to negate or minimize any adverse effect of the compromise. (b) The Security Officer shall initiate an inquiry to: (1) Determine cause, (2) Place responsibility, and (3) Take corrective measures...

  18. Third-space fluid shift in elderly patients undergoing gastrointestinal surgery: Part II: nursing assessment.

    PubMed

    Wotton, Karen; Redden, Maurine

    2002-08-01

    Third-space fluid shift is the mobilisation of body fluid to a non-contributory space rendering it unavailable to the circulatory system. It is a recurrent clinical phenomenon requiring swift identification to minimise deleterious effects. Nurses experience difficulties however in its early identification, diagnosis and subsequent treatment because of the lack of consensual and consistent information regarding third-spacing. This article, part II, building on the previous article, explores the clinical validly and reliability of signs and symptoms of both phases of third-space fluid shift. In addition it reinforces the use multiple patient assessment cues if nurses are to differentiate between, and accurately respond to, the various causes of both hypovolaemia and hypervolaemia. It assists nurses to increase their knowledge and uderstanding of third-space fluid shift in patients undergoing gastrointestinal surgery.

  19. Storytelling as part of cancer rehabilitation to support cancer patients and their relatives.

    PubMed

    la Cour, Karen; Ledderer, Loni; Hansen, Helle Ploug

    2016-01-01

    Previous research on psychosocial support for cancer-related concerns has primarily focused on either patients or their relatives, although limited research is available on how patients and their relatives can be supported together. The aim of this article is to explore the use of storytelling as a part of a residential cancer rehabilitation intervention for patients together with their relatives, with a specific focus on their management of cancer-related concerns. Ten pairs participated in the intervention and data were generated through ethnographic fieldwork, including participant observations, informal conversations and follow-up interviews conducted one month after completing the intervention. Analysis was performed drawing on narrative theory combined with social practice theory. The results demonstrate that the use of storytelling and metaphors intertwined with other course activities, such as dancing and arts & crafts, provided the patients and their relatives with strategies to manage cancer-related concerns, which they were later able to apply in their everyday lives. The study results may be useful to other professionals in clinical practice for rehabilitation purposes for addressing issues of fear and worry.

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

    PubMed

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

    2016-01-01

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

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

    PubMed Central

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

    2014-01-01

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

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

    PubMed

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

    2014-06-01

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

  3. [Pain sensitivity changes in schizophrenic patients and animal models--Part II].

    PubMed

    Tuboly, Gábor; Horváth, Gyöngyi

    2009-05-30

    Diminished pain sensitivity in schizophrenic patients has been reported for more than 50 years, however little is known about the substrate and the basic mechanisms underlying altered pain sensitivity in this disease, therefore, relevant animal models are of decisive importance in the study of psychiatric diseases. The authors report a review consisting of two parts focusing on pain sensitivity changes in patients and in different animal models which proved the eligibility as schizophrenia models and pain sensitivities have also been determined. The second part of this article analyzed the results regarding knock out mice as schizophrenia models. These data proved that several genes have significant role in the pathomechanism of schizophrenia; therefore deficiency in one gene does not produce animals showing all signs of this disease. As regards the pain sensitivity changes, only a few data are available with controversial results. Data originated from complex chronic animal models indicate that they might be more adequate methods for studying the mechanisms of schizophrenia including the pain-sensitivity changes.

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

    PubMed Central

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

    2016-01-01

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

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

    PubMed Central

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

    2016-01-01

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

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

    PubMed

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

    2013-10-01

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

  7. Posterior arthrodesis of C1-C3 for the stabilization of multiple unstable upper cervical fractures with spinal cord compromise

    PubMed Central

    Xue, Deting; Chen, Qixin; Chen, Gang; Zhuo, Wenhai; Li, Fangcai

    2017-01-01

    Abstract Background: Multiple fractures of the atlas and axis are rare. The management of multiple fragment axis fractures and unstable atlas fractures is still challenging for the spinal surgeon. There are no published reports of similar fractures with 3-part fracture of axis associated with an unstable atlas fracture. Case summary: We present a patient with concurrent axis and atlas fractures, which have not been reported. The patient suffered hyperextension injury with neck pain and numbness of the bilateral upper extremity associated with weakness after a 2-m fall. The axis fractures included an odontoid type IIA fracture and traumatic spondylolisthesis of C2-C3. The atlas fracture was unstable. The neurological examination manifested as central canal syndrome, which was due to the hyperextension injury of cervical spine and spondylolisthesis of C2-C3. The patient was diagnosed as multiple unstable upper cervical fractures with spinal cord compromise. We performed posterior arthrodesis of C1-C3. Postoperatively, the patient showed neurological improvement, and C1-C3 had fused at the 3-month follow-up. Conclusion: Posterior arthrodesis of C1-C3 could provide a stable fixation for the 3 parts of axis (an odontoid type IIA fracture and traumatic spondylolisthesis of C2-C3) combined an unstable atlas fracture. Both the patient and the doctor were satisfied with the results of the treatment. So posterior arthrodesis of C1-C3 is a suitable treatment option for the treatment of a concurrent unstable atlas fracture and multiple fractures of the axis. PMID:28072744

  8. Glutaric acid moderately compromises energy metabolism in rat brain.

    PubMed

    da C Ferreira, Gustavo; Viegas, Carolina M; Schuck, Patrícia F; Latini, Alexandra; Dutra-Filho, Carlos S; Wyse, Angela T S; Wannmacher, Clóvis M D; Vargas, Carmen R; Wajner, Moacir

    2005-12-01

    Glutaric acidemia type I is an inherited metabolic disorder biochemically characterized by tissue accumulation of predominantly glutaric acid (GA). Affected patients present frontotemporal hypotrophy, as well as caudate and putamen injury following acute encephalopathic crises. Considering that the underlying mechanisms of basal ganglia damage in this disorder are poorly known, in the present study we tested the effects of glutaric acid (0.2-5mM) on critical enzyme activities of energy metabolism, namely the respiratory chain complexes I-IV, succinate dehydrogenase and creatine kinase in midbrain of developing rats. Glutaric acid significantly inhibited creatine kinase activity (up to 26%) even at the lowest dose used in the assays (0.2mM). We also observed that CK inhibition was prevented by pre-incubation of the homogenates with reduced glutathione, suggesting that the inhibitory effect of GA was possibly mediated by oxidation of essential thiol groups of the enzyme. In addition, the activities of the respiratory chain complex I-III and of succinate dehydrogenase were also significantly inhibited by 20 and 30%, respectively, at the highest glutaric acid concentration tested (5mM). In contrast, complexes II-III and IV activities of the electron transport chain were not affected by the acid. The effect of glutaric acid on the rate of oxygen consumption in intact mitochondria from the rat cerebrum was also investigated. Glutaric acid (1mM) significantly lowered the respiratory control ratio (state III/state IV) up to 40% in the presence of the respiratory substrates glutamate/malate or succinate. Moreover, state IV respiration linked to NAD and FAD substrates was significantly increased in GA-treated mitochondria while state III was significantly diminished. The results indicate that the major metabolite accumulating in glutaric acidemia type I moderately compromises brain energy metabolism in vitro.

  9. [Pregnant opioid addicted patients and additional drug intake. Part I. Toxic effects and therapeutic consequences].

    PubMed

    Hoell, Imke; Havemann-Reinecke, Ursula

    2011-10-01

    Opioid dependent patients often are dependent from the illegal consumption of heroin and, in addition, perform a polytoxicomanic way of consuming drugs. They suffer of various somatic and psychiatric diseases. Moreover, pregnancies of drug addicted women are classified as high-risk pregnancies. With respect to the particular consumed drug substances other than opioids during pregnancy variable forms of teratogenic and toxic effects can be assigned to the baby. Critical values of maternal substance abuse referring to fetal impairment do not exist. With regard to the possible teratogenic and toxic fetal effects of maternal consume of alcohol, tobacco, sedativa, cannabis, cocaine and amphetamines, withdrawal treatment of polytoxicomanic pregnant patients under inpatient medical supervision including medication if necessary represent the first-line-treatment. With respect to smoking, it is possible to detoxicate the patients also by an outpatient treatment. However, referring to heroin addiction, a maintenance therapy with L-methadone, D/L-methadone or buprenorphine should be preferred since fetal withdrawal symptoms of opioids otherwise can cause severe complications which even can lead to the loss of the fetus and also increase the risks for the mother. Increasing the dose of the opioid substitute may be necessary, for example, to avoid premature uterus contractions. It is to be pointed out that substitution treatment with methadone or buprenorphine also improve the medicinal compliance and psychosocial circumstances of the pregnant patients. Subsequent to delivery, the maintenance treatment should initially be pursued over a further period of time. In the follow up, the question of continuing with maintenance treatment or starting a withdrawal treatment of opioids should be discussed on an individual basis. To sum up, proceeded interdisciplinary care during pregnancy and afterwards by all the professions involved like general practioners as well as social workers

  10. Compromising positions: emergent neo-Fordisms and embedded gender contracts.

    PubMed

    Gottfried, H

    2000-06-01

    This paper adopts a regulation framework to chart the emergence of neo-Fordism as a flexible accumulation regime and mode of social regulation. Neo-Fordism relies on old Fordist principles as well as incorporating new models of emergent post-Fordisms; old and new social relationships, in their particular combination, specify the trajectory of national variants. I argue that Fordist bargains institutionalized the terms of a compromise between labour, capital and the state. These bargains embedded a male-breadwinner gender contract compromising women's positions and standardizing employment contracts around the needs, interests and authority of men. A focus on compromises and contracts makes visible the differentiated gender effects of work transformation in each country.

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

    NASA Astrophysics Data System (ADS)

    Adams, Jonathan

    2007-06-01

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

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

    PubMed Central

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

    2014-01-01

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

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

    PubMed

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

    2014-02-01

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

  14. Critical appraisal. Reversal of compromised bonding after bleaching.

    PubMed

    Swift, Edward J

    2012-10-01

    Bleaching with peroxide agents compromises the adhesion of resin-based materials to enamel and dentin. The problem is likely caused by delayed release of oxygen from the teeth that inhibits resin polymerization at the interface. The typical method for avoiding problems with bonding to bleached teeth is simply to delay the bonding procedure for a week or two after bleaching. However, there is evidence that bonding can be done immediately if bleaching is followed by the application of an antioxidant. This Critical Appraisal reviews some of the published reports on the reversal of compromised bonding after bleaching via the use of antioxidants such as sodium ascorbate.

  15. Fuzzy compromise: An effective way to solve hierarchical design problems

    NASA Technical Reports Server (NTRS)

    Allen, J. K.; Krishnamachari, R. S.; Masetta, J.; Pearce, D.; Rigby, D.; Mistree, F.

    1990-01-01

    In this paper, we present a method for modeling design problems using a compromise decision support problem (DSP) incorporating the principles embodied in fuzzy set theory. Specifically, the fuzzy compromise decision support problem is used to study hierarchical design problems. This approach has the advantage that although the system modeled has an element of uncertainty associated with it, the solution obtained is crisp and precise. The efficacy of incorporating fuzzy sets into the solution process is discussed in the context of results obtained for a portal frame.

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

    PubMed

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

    2015-01-01

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

  17. Personalization of loco-regional care for primary breast cancer patients (part 2).

    PubMed

    Toi, Masakazu; Winer, Eric P; Benson, John R; Inamoto, Takashi; Forbes, John F; von Minckwitz, Gunter; Robertson, John F R; Grobmyer, Stephen R; Jatoi, Ismail; Sasano, Hironobu; Kunkler, Ian; Ho, Alice Y; Yamauchi, Chikako; Chow, Louis W C; Huang, Chiun-Sheng; Han, Wonshik; Noguchi, Shinzaburo; Pegram, Mark D; Yamauchi, Hideko; Lee, Eun-Sook; Larionov, Alexey A; Bevilacqua, Jose L B; Yoshimura, Michio; Sugie, Tomoharu; Yamauchi, Akira; Krop, Ian E; Noh, Dong Young; Klimberg, V Suzanne

    2015-01-01

    Kyoto Breast Cancer Consensus Conference, Kyoto, Japan, 18-20 February 2014 The loco-regional management of breast cancer is increasingly complex with application of primary systemic therapies, oncoplastic techniques and genetic testing for breast cancer susceptibility. Personalization of loco-regional treatment is integral to optimization of breast cancer care. Clinical and pathological tumor stage, biological features and host factors influence loco-regional treatment strategies and extent of surgical procedures. Key issues including axillary staging, axillary treatment, radiation therapy, primary systemic therapy (PST), preoperative hormonal therapy and genetic predisposition were identified and discussed at the Kyoto Breast Cancer Consensus Conference (KBCCC2014). In the second of a two part conference scene, consensus recommendations for radiation treatment, primary systemic therapies and management of genetic predisposition are reported and focus on the following topics: influence of both clinical response to PST and stage at presentation on recommendations for postmastectomy radiotherapy; use of regional nodal irradiation in selected node-positive patients and those with adverse pathological factors; extent of surgical resection following downstaging of tumors with PST; use of preoperative hormonal therapy in premenopausal women with larger, node-negative luminal A-like tumors and managing increasing demands for contralateral prophylactic mastectomy in patients with a unilateral sporadic breast cancer.

  18. Preventing the ITU syndrome or how not to torture an ITU patient! Part 2.

    PubMed

    Dyer, I

    1995-08-01

    Admission to an intensive therapy unit (ITU) has been described as a 'necessary evil' (Barrie-Shevlin 1987), and some of the 'tortures' described in Part I of this article (Dyer 1995) may be an inevitable result of ITU care. This does not mean that the development of the ITU syndrome should be regarded as inevitable. Many potential causes of the syndrome can be avoided or at least ameliorated. Some suggested means of preventing the syndrome include designing ITUs with windows (Keep et al 1980), use of noise reducing materials when building ITUs (Hopkinson 1994, Topf & Davis 1993), using noise level as a criterion when purchasing equipment (Dracup 1988) or using remote telemetry for monitoring (Fisher & Moxham 1984). These would undoubtedly be beneficial but they are not practical propositions for nurses who wish to improve psychological care in the short term. For this reason, this article, concentrates mainly on immediately applicable, relatively cost-free interventions. Methods of preventing the syndrome should begin, whenever possible, before admission and should continue throughout the patients' stay. The main emphasis should be placed on prevention, but early detection and treatment of problems should also be given high priority. If a patient exhibits symptoms of psychological disturbance physical causes should be considered, but at the same time the ITU syndrome should be suspected and attempts made to alleviate possible causes of this. Nurses play a vital role in any attempts to alleviate problems and in 'humanising' the technical ITU environment (Ashworth 1987, Mackellaig 1990).(ABSTRACT TRUNCATED AT 250 WORDS)

  19. Immediate Implant Loading in Compromised Maxillary Partially Edentulous Arch- A Case Report

    PubMed Central

    Ramesh, Sachhi; Patil, Veena; Jain, Anoop; Gaddale, Reetika

    2014-01-01

    As the aesthetic demands are increasing day by day, demand of immediate restoration or replacement of teeth is also increasing. Because of this, immediate implant placement, along with immediate loading of implant, is a favourite treatment option for patients as well as dentists. This case report discusses the immediate implant loading in compromised maxillary anterior region, in which patient got immediate restoration of edentulous area. More importantly, from the patients’ points of view, immediate loading can produce positive social and psychological effects. PMID:24959519

  20. Disturbed Mental Imagery of Affected Body-Parts in Patients with Hysterical Conversion Paraplegia Correlates with Pathological Limbic Activity

    PubMed Central

    Saj, Arnaud; Raz, Noa; Levin, Netta; Ben-Hur, Tamir; Arzy, Shahar

    2014-01-01

    Patients with conversion disorder generally suffer from a severe neurological deficit which cannot be attributed to a structural neurological damage. In two patients with acute conversion paraplegia, investigation with functional magnetic resonance imaging (fMRI) showed that the insular cortex, a limbic-related cortex involved in body-representation and subjective emotional experience, was activated not only during attempt to move the paralytic body-parts, but also during mental imagery of their movements. In addition, mental rotation of affected body-parts was found to be disturbed, as compared to unaffected body parts or external objects. fMRI during mental rotation of the paralytic body-part showed an activation of another limbic related region, the anterior cingulate cortex. These data suggest that conversion paraplegia is associated with pathological activity in limbic structures involved in body representation and a deficit in mental processing of the affected body-parts. PMID:24961768

  1. Codeswitching and Compromise Strategies: Implications for Lexical Structure.

    ERIC Educational Resources Information Center

    Jake, Janice L.; Myers-Scotton, Carol

    1997-01-01

    Deals with two compromise strategies: (1) embedded language islands (EL Islands), and (2) "bare forms" in code switching (CS) within the projection of complementizer. These elements are discussed within the framework of the Matrix Language Frame Model. Shows how this model provides an explanatory account for the occurrence of both EL…

  2. 42 CFR 401.613 - Compromise of claims.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Compromise of claims. 401.613 Section 401.613 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL... claim must— (1) Bear a reasonable relation to the amount of the claim; and (2) Be recoverable...

  3. 45 CFR 30.22 - Bases for compromise.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 45 Public Welfare 1 2010-10-01 2010-10-01 false Bases for compromise. 30.22 Section 30.22 Public... an amount that bears a reasonable relation to the amount that can be recovered by enforced collection... amount claimed, either because of the legal issues involved or because of a bona fide dispute as to...

  4. Tissue response: biomaterials, dental implants, and compromised osseous tissue.

    PubMed

    Babu RS, Arvind; Ogle, Orrett

    2015-04-01

    Tissue response represents an important feature in biocompatibility in implant procedures. This review article highlights the fundamental characteristics of tissue response after the implant procedure. This article also highlights the tissue response in compromised osseous conditions. Understanding the histologic events after dental implants in normal and abnormal bone reinforces the concept of case selection in dental implants.

  5. 14 CFR 1261.414 - Compromise of claims.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... Department of Justice for litigation. The Comptroller General may exercise such compromise authority with... weight should be given to the probable amount of court costs and attorney fees pursuant to the Equal... the settlement of small claims, but normally will not carry great weight in the settlement of...

  6. 41 CFR 105-70.046 - Compromise or settlement.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false Compromise or settlement. 105-70.046 Section 105-70.046 Public Contracts and Property Management Federal Property Management Regulations System (Continued) GENERAL SERVICES ADMINISTRATION Regional Offices-General...

  7. 32 CFR 310.50 - Lost, stolen, or compromised information.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... (CONTINUED) PRIVACY PROGRAM DOD PRIVACY PROGRAM Privacy Act Violations § 310.50 Lost, stolen, or compromised... reported to: (1) The United States Computer Emergency Readiness Team (US CERT) within one hour of...., computer incident, theft, loss of material, etc.) shall continue to be reported in accordance...

  8. 32 CFR 310.50 - Lost, stolen, or compromised information.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... (CONTINUED) PRIVACY PROGRAM DOD PRIVACY PROGRAM Privacy Act Violations § 310.50 Lost, stolen, or compromised... reported to: (1) The United States Computer Emergency Readiness Team (US CERT) within one hour of...., computer incident, theft, loss of material, etc.) shall continue to be reported in accordance...

  9. 32 CFR 2400.33 - Loss or possible compromise.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 32 National Defense 6 2012-07-01 2012-07-01 false Loss or possible compromise. 2400.33 Section 2400.33 National Defense Other Regulations Relating to National Defense OFFICE OF SCIENCE AND TECHNOLOGY POLICY REGULATIONS TO IMPLEMENT E.O. 12356; OFFICE OF SCIENCE AND TECHNOLOGY POLICY...

  10. 32 CFR 2400.33 - Loss or possible compromise.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 32 National Defense 6 2014-07-01 2014-07-01 false Loss or possible compromise. 2400.33 Section 2400.33 National Defense Other Regulations Relating to National Defense OFFICE OF SCIENCE AND TECHNOLOGY POLICY REGULATIONS TO IMPLEMENT E.O. 12356; OFFICE OF SCIENCE AND TECHNOLOGY POLICY...

  11. 32 CFR 2400.33 - Loss or possible compromise.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 32 National Defense 6 2010-07-01 2010-07-01 false Loss or possible compromise. 2400.33 Section 2400.33 National Defense Other Regulations Relating to National Defense OFFICE OF SCIENCE AND TECHNOLOGY POLICY REGULATIONS TO IMPLEMENT E.O. 12356; OFFICE OF SCIENCE AND TECHNOLOGY POLICY...

  12. 32 CFR 2400.33 - Loss or possible compromise.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 32 National Defense 6 2011-07-01 2011-07-01 false Loss or possible compromise. 2400.33 Section 2400.33 National Defense Other Regulations Relating to National Defense OFFICE OF SCIENCE AND TECHNOLOGY POLICY REGULATIONS TO IMPLEMENT E.O. 12356; OFFICE OF SCIENCE AND TECHNOLOGY POLICY...

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

    ERIC Educational Resources Information Center

    Waldron, Jennifer J.; Krane, Vikki

    2005-01-01

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

  14. CONCENTRATED AMBIENT PARTICULATE STUDIES IN HEALTHY AND COMPROMISED RODENTS

    EPA Science Inventory


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

  15. An Item Response Model for Characterizing Test Compromise.

    ERIC Educational Resources Information Center

    Segall, Daniel O.

    2002-01-01

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

  16. 49 CFR 107.327 - Compromise and settlement.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 49 Transportation 2 2011-10-01 2011-10-01 false Compromise and settlement. 107.327 Section 107.327 Transportation Other Regulations Relating to Transportation PIPELINE AND HAZARDOUS MATERIALS SAFETY... consent agreement to the Chief Counsel. If the Chief Counsel accepts the agreement, he issues an order...

  17. 49 CFR 107.327 - Compromise and settlement.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 2 2010-10-01 2010-10-01 false Compromise and settlement. 107.327 Section 107.327 Transportation Other Regulations Relating to Transportation PIPELINE AND HAZARDOUS MATERIALS SAFETY... consent agreement to the Chief Counsel. If the Chief Counsel accepts the agreement, he issues an order...

  18. 49 CFR 107.327 - Compromise and settlement.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 49 Transportation 2 2013-10-01 2013-10-01 false Compromise and settlement. 107.327 Section 107.327 Transportation Other Regulations Relating to Transportation PIPELINE AND HAZARDOUS MATERIALS SAFETY... consent agreement to the Chief Counsel. If the Chief Counsel accepts the agreement, he issues an order...

  19. 17 CFR 143.5 - Collection by compromise.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 17 Commodity and Securities Exchanges 1 2010-04-01 2010-04-01 false Collection by compromise. 143.5 Section 143.5 Commodity and Securities Exchanges COMMODITY FUTURES TRADING COMMISSION COLLECTION OF CLAIMS OWED THE UNITED STATES ARISING FROM ACTIVITIES UNDER THE COMMISSION'S JURISDICTION...

  20. 14 CFR 1261.414 - Compromise of claims.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... Justice. NASA should evaluate the offer, using the factors set forth in paragraphs (c) through (f) of this... offer of compromise which is substantial in amount and the agency is uncertain as to whether the offer should be accepted, it may refer the offer, the supporting data, and particulars concerning the claim...

  1. 22 CFR 213.25 - Standards for compromise.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... proceedings. In evaluating the acceptability of the offer, the CFO may consider, among other factors, the... applicable exemptions available to the debtor under State and Federal law in determining the Government's ability to enforce collection. (b) USAID may compromise a claim, or recommend acceptance of a...

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

    PubMed

    Gujjar, Meera; Banga, Ajay K

    2014-09-10

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

  3. Patients' Preference for Integrating Homoeopathy Services within the Secondary Health Care Settings in India: The Part 3 (PPIH-3) Study.

    PubMed

    Manchanda, Rajkumar; Koley, Munmun; Saha, Subhranil; Sarkar, Debabrata; Mondal, Ramkumar; Thakur, Prosenjit; Biswas, Debjyoti; Rawat, Birendra Singh; Rajachandrasekar, Bhuvaneswari; Mittal, Renu

    2016-05-23

    Indian patients' preference for integrated homoeopathy services remains underresearched. Two earlier surveys revealed favorable attitude toward and satisfaction from integrated services. The objectives of this study were to examine knowledge, attitudes, and practice of homoeopathy and to evaluate preference toward its integration into secondary-level health care. A cross-sectional survey was conducted during May to October 2015 among 659 adult patients visiting randomly selected secondary-level conventional health care setups in Kolkata, Mumbai, Kottayam, and New Delhi (India) using a self-administered 24-item questionnaire in 4 local vernaculars (Bengali, Marathi, Malayalam, and Hindi). Knowledge and practice scores were compromised; attitude scores toward integration and legal regulation were high. Respondents were uncertain regarding side effects of homoeopathy and concurrent use and interactions with conventional medicines. A total of 82.40% (95% confidence interval = 79.23, 85.19) of the participants were in favor of integrating homoeopathy services. Preference was significantly higher in Delhi and lower in Kottayam. Probable strategic measures for further development of integrated models are discussed.

  4. Glucocorticoids may compromise the effect of gefitinib in non-small cell lung cancer

    PubMed Central

    Wang, Hsian-Yu; Chang, Yu-Ling; Cheng, Chun-Chun; Chao, Min-Wu; Lin, Su-I; Pan, Shiow-Lin; Hsu, Chih-Cheng; Liu, Tsang-Wu; Cheng, Han-Chin; Tseng, Ching-Ping; Liu, Shih-Jen; Tsai, Hui-Ju; Chang, Hsing-Yi; Hsu, John T.-A.

    2016-01-01

    The epidermal growth factor receptor (EGFR)-targeting tyrosine kinase inhibitors (TKIs) have shown remarkable benefits in non-small cell lung cancer (NSCLC) patients with drug-sensitive mutations in the EGFR gene. Responsive patients are usually continuously prescribed with TKIs until disease progression. Glucocorticoids (GCs) are potent homeostasis maintaining drugs and are frequently used in cancer patients to alleviate discomforts caused by anti-cancer therapies. Several previous studies reported that concomitant use of GCs may compromise the efficacy of chemo-therapeutics in patients with solid tumors. Little is known in the concomitant use of target therapy with GCs in treating NSCLC. In this study, we hypothesized that concomitant use of GCs in EGFR-TKI therapy may be detrimental and addressed this issue using cell cultures and xenograft studies followed by a retrospective population study based on data from the Taiwan national health insurance system. In cell cultures and xenograft studies, GCs were shown to unequally compromise the anti-cancer efficacy of TKIs in both PC9 and NCI-H1975 NSCLC cells models. In the retrospective population study, patients with similar disease status that were co-medicated with GCs had a significantly higher risk of disease progression. PMID:27835586

  5. Natural Tooth Pontic: An Instant Esthetic Option for Periodontally Compromised Teeth—A Case Series

    PubMed Central

    Raj, Rishi; Narayan, Ipshita; Gowda, Triveni Mavinakote; Mehta, D. S.

    2016-01-01

    Sudden tooth loss in the esthetic zone of the maxillary or mandibular anterior region can be due to trauma, periodontal disease, or endodontic failure. The treatment options for replacing the missing tooth can vary between removable prosthesis, tooth-supported prosthesis, and implant-supported prosthesis. Irrespective of the final treatment, the first line of management would be to provisionally restore the patient's esthetic appearance at the earliest, while functionally stabilizing the compromised arch. Using the patient's own natural tooth as a pontic offers the benefits of being the right size, shape, and color and provides exact repositioning in its original intraoral three-dimensional position. Additionally, using the patient's platelet concentrate (platelet rich fibrin) facilitates early wound healing and preservation of alveolar ridge shape following tooth extraction. The abutment teeth can also be preserved with minimal or no preparation, thus keeping the technique reversible, and can be completed at the chair side thereby avoiding laboratory costs. This helps the patient better tolerate the effect of tooth loss psychologically. The article describes a successful, immediate, and viable technique for rehabilitation of three different patients requiring replacement of a single periodontally compromised tooth in an esthetic region. PMID:27994892

  6. Glucocorticoids may compromise the effect of gefitinib in non-small cell lung cancer.

    PubMed

    Wang, Hsian-Yu; Chang, Yu-Ling; Cheng, Chun-Chun; Chao, Min-Wu; Lin, Su-I; Pan, Shiow-Lin; Hsu, Chih-Cheng; Liu, Tsang-Wu; Cheng, Han-Chin; Tseng, Ching-Ping; Liu, Shih-Jen; Tsai, Hui-Ju; Chang, Hsing-Yi; Hsu, John T-A

    2016-12-27

    The epidermal growth factor receptor (EGFR)-targeting tyrosine kinase inhibitors (TKIs) have shown remarkable benefits in non-small cell lung cancer (NSCLC) patients with drug-sensitive mutations in the EGFR gene. Responsive patients are usually continuously prescribed with TKIs until disease progression. Glucocorticoids (GCs) are potent homeostasis maintaining drugs and are frequently used in cancer patients to alleviate discomforts caused by anti-cancer therapies. Several previous studies reported that concomitant use of GCs may compromise the efficacy of chemo-therapeutics in patients with solid tumors. Little is known in the concomitant use of target therapy with GCs in treating NSCLC. In this study, we hypothesized that concomitant use of GCs in EGFR-TKI therapy may be detrimental and addressed this issue using cell cultures and xenograft studies followed by a retrospective population study based on data from the Taiwan national health insurance system. In cell cultures and xenograft studies, GCs were shown to unequally compromise the anti-cancer efficacy of TKIs in both PC9 and NCI-H1975 NSCLC cells models. In the retrospective population study, patients with similar disease status that were co-medicated with GCs had a significantly higher risk of disease progression.

  7. Personalization of loco-regional care for primary breast cancer patients (part 1).

    PubMed

    Toi, Masakazu; Winer, Eric P; Benson, John R; Inamoto, Takashi; Forbes, John F; von Minckwitz, Gunter; Robertson, John F R; Grobmyer, Stephen R; Jatoi, Ismail; Sasano, Hironobu; Kunkler, Ian; Ho, Alice Y; Yamauchi, Chikako; Chow, Louis W C; Huang, Chiun-Sheng; Han, Wonshik; Noguchi, Shinzaburo; Pegram, Mark D; Yamauchi, Hideko; Lee, Eun-Sook; Larionov, Alexey A; Bevilacqua, Jose L B; Yoshimura, Michio; Sugie, Tomoharu; Yamauchi, Akira; Krop, Ian E; Noh, Dong Young; Klimberg, V Suzanne

    2015-01-01

    ABSTRACT  Kyoto Breast Cancer Consensus Conference, Kyoto, Japan, 18-20 February 2014 The loco-regional management of breast cancer is increasingly complex with application of primary systemic therapies, oncoplastic techniques and genetic testing for breast cancer susceptibility. Personalization of loco-regional treatment is integral to optimization of breast cancer care. Clinical and pathological tumor stage, biological features and host factors influence loco-regional treatment strategies and extent of surgical procedures. Key issues including axillary staging, axillary treatment, radiation therapy, primary systemic therapy (PST), preoperative hormonal therapy and genetic predisposition were identified and discussed at the Kyoto Breast Cancer Consensus Conference (KBCCC2014). In the first of a two part conference scene, consensus recommendations for axillary management are presented and focus on the following topics: indications for completion axillary lymph node dissection in primary surgical patients with ≤2 macrometastases or any sentinel nodal deposits after PST; the timing of sentinel lymph node biopsy in the context of PST; use of axillary irradiation as a component of primary treatment plans and the role of intraoperative node assessment in the post-Z0011 era.

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

    PubMed

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

    2013-01-01

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

  9. Compassionate care: enhancing physician-patient communication and education in dermatology: Part I: Patient-centered communication.

    PubMed

    Nguyen, Tien V; Hong, Judith; Prose, Neil S

    2013-03-01

    The motivation for developing patient-centered communication stems from a desire to enhance the quality of patient care, fulfill professional competency requirements, reduce medical errors, and improve health outcomes and patient satisfaction. Patient-centered communication skills can optimize the physician-patient relationship without significantly prolonging office visits. We propose a series of practical and generally effective techniques for verbal and nonverbal communication. We also suggest a targeted approach for specific difficult conversations that may occur frequently in the practice of dermatology.

  10. Securing Single Points of Compromise (SPoC)

    SciTech Connect

    Belangia, David Warren

    2015-06-25

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

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

    PubMed

    Adams, Nathan A

    2004-01-01

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

  12. Placental angiogenesis in sheep models of compromised pregnancy

    PubMed Central

    Reynolds, Lawrence P; Borowicz, Pawel P; Vonnahme, Kimberly A; Johnson, Mary Lynn; Grazul-Bilska, Anna T; Redmer, Dale A; Caton, Joel S

    2005-01-01

    Because the placenta is the organ that transports nutrients, respiratory gases and wastes between the maternal and fetal systems, development of its vascular beds is essential to normal placental function, and thus in supporting normal fetal growth. Compromised fetal growth and development have adverse health consequences during the neonatal period and throughout adult life. To establish the role of placental angiogenesis in compromised pregnancies, we first evaluated the pattern of placental angiogenesis and expression of angiogenic factors throughout normal pregnancy. In addition, we and others have established a variety of sheep models to evaluate the effects on fetal growth of various factors including maternal nutrient excess or deprivation and specific nutrients, maternal age, maternal and fetal genotype, increased numbers of fetuses, environmental thermal stress, and high altitude (hypobaric) conditions. Although placental angiogenesis is altered in each of these models in which fetal growth is adversely affected, the specific effect on placental angiogenesis depends on the type of ‘stress’ to which the pregnancy is subjected, and also differs between the fetal and maternal systems and between genotypes. We believe that the models of compromised pregnancy and the methods described in this review will enable us to develop a much better understanding of the mechanisms responsible for alterations in placental vascular development. PMID:15760944

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

    SciTech Connect

    Nguyen, H.P.

    1989-11-01

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

  14. Chronic Lymphocytic Leukemia as an Unusual Cause of Rapid Airway Compromise

    PubMed Central

    Ezzell, Erin E.; Renshaw, John S.

    2017-01-01

    Chronic Lymphocytic Leukemia (CLL) is the most prevalent form of non-Hodgkin's lymphoma (NHL) in Western countries predominantly affecting adults over the age of 65. CLL is commonly indolent in nature but can present locally and aggressively at extranodal sites. Although CLL may commonly present with cervical lymphadenopathy, manifestation in nonlymphoid regions of the head and neck is not well described. CLL causing upper airway obstruction is even more uncommon. We describe a case of a patient with known history of CLL and stable lymphocytosis that developed an enlarging lymphoid base of tongue (BOT) mass resulting in rapid airway compromise.

  15. The hemodialysis patient: object of diagnosis or part of the treatment team?

    PubMed

    Burnell, M S

    1997-04-01

    Through multidisciplinary diagnosis, the end-stage renal disease (ESRD) treatment team defines the patients's problems and sets goals to reach positive outcomes. Each of the team members has a voice in recommending strategies to reach these goals, because each has been trained in appropriate treatment objectives. Patient noncompliance (nonadherence) with team recommendations can be a major, ongoing problem for the team. The untrained, unhealthy, and often unconsulted amateur member of the team is the patient who is asked to carry out the team plan. Where is the patient's place on the team? There is no doubt that the patient can enhance the planning and development of the treatment objectives. But is the patient's presence seen as a hindrance to planning? More consideration needs to be given to this ongoing issue in an effort to achieve successful patient-oriented outcomes.

  16. Compromise - An effective approach for conceptual aircraft design

    NASA Technical Reports Server (NTRS)

    Mistree, Farrokh; Marinopoulos, Stergios; Jackson, david; Shupe, Jon

    1987-01-01

    The Decision Support Problem (DSP) technique for aircraft design is presently demonstrated through the development of a compromise DSP template for the conceptual design of subsonic transport aircraft. System variables are wing span and area, fuselage diameter and length, takeoff weight, and installed thrust. Such system constraints as range and wing loading are represented algebraically using standard subsonic aircraft theory, and economic efficiency is modeled in terms of rates-of-return. The DSP template thus obtained has been tested and validated using the known mission requirements and design constants of the B 727-200 airliner.

  17. [Cat-scratch disease with bone compromise: atypical manifestation].

    PubMed

    Rodríguez C, Magdalena; Giachetto L, Gustavo; Cuneo E, Alejandro; Gutiérrez B, María del C; Shimchack R, Mario; Pírez G, M Catalina

    2009-08-01

    Fever, headache, myalgias and lymphadenopathy are characteristic manifestations of cat-scratch disease but other less common findings are described in 2 to 10% of cases. We report two children that presented with hepatosplenic abscesses and bone involvement. One child, had multiple areas of increased uptake in the bone scintigram with a positive serology (IgG > 1/256, IgM slightly positive). The second child had destruction of the L2 vertebral body that compromised the channel and right foramen as visualized by MRI. In both cases, bacilli were observed in the bone biopsy by Warthing-Starry stain.

  18. Neonatal Airway Compromise by a Giant Cervicothoracic Venous Haemangioma

    PubMed Central

    Shenoy, Janardhan; Coutinho, Anita; Pai, Suresh; Rai, Santosh PV

    2017-01-01

    Haemangiomas are most common non-malignant vascular tumours of infancy. Here, we describe an antenatally detected mass over the neck causing compressive respiratory compromise at birth requiring resuscitative measures at birth. The mass showed increased vascularity on Contrast Enhanced Computed Tomography (CECT) with extension upto superior mediastinum. Surgical excision was required following failure to medical measures with steroids and propranolol. Histopathology confirmed it to be a venous haemangioma. This case highlights that these benign lesions may reach large sizes and antenatal detection may help in planning effective delivery and resuscitative measures. PMID:28384953

  19. Compromise budget gives extra funding for HIV programs.

    PubMed

    1999-06-25

    California lawmakers will vote soon on the proposed 1999-2000 State budget that would increase funding for HIV prevention, treatment, and housing programs by $16.9 million. The Senate and Assembly did not originally agree on the appropriation, but the Budget Conference Committee resolved the dispute. Details of the compromise are included. The plan must now go back to both chambers for final action, and the California HIV Advocacy Coalition is optimistic the budget measures will reach the governor's office intact. Governor Gray Davis has promised that the budget will be enacted by the start of the next fiscal year.

  20. Behavioral Health in the Patient Centered Medical Home: Meeting the Quadruple Aim Part 1

    DTIC Science & Technology

    2011-01-24

    visits)  Pre-clinician diagnostic aid  Patient education materials  Psychosocial options  Care Facilitator assisted follow-up option  Aggressive...clinician diagnostic aid  Patient education materials  Psychosocial options  Care Facilitator assisted follow-up option  Aggressive facilitator outreach...visits)  Pre-clinician diagnostic aid  Patient education materials  Psychosocial options  Care Facilitator assisted follow-up option  Aggressive

  1. 46 CFR Appendix A to Subpart W of... - Example of Compromise Agreement To Be Used Under 46 CFR 502.604

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 502.604 A Appendix A to Subpart W of Part 502 Shipping FEDERAL MARITIME COMMISSION GENERAL AND... Collection of Civil Penalties Pt. 502, Subpt. W, App. A Appendix A to Subpart W of Part 502—Example of... agree upon the following terms and conditions of compromise and settlement: 1. Respondent shall make...

  2. 46 CFR Appendix A to Subpart W of... - Example of Compromise Agreement To Be Used Under 46 CFR 502.604

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 502.604 A Appendix A to Subpart W of Part 502 Shipping FEDERAL MARITIME COMMISSION GENERAL AND... Collection of Civil Penalties Pt. 502, Subpt. W, App. A Appendix A to Subpart W of Part 502—Example of... agree upon the following terms and conditions of compromise and settlement: 1. Respondent shall make...

  3. Rules for improving pharmacotherapy in older adult patients: part 2 (rules 6-10).

    PubMed

    Wooten, James M

    2015-03-01

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

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

    PubMed

    Wooten, James M

    2015-02-01

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

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

    PubMed

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

    1995-01-01

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

  6. [Surgical therapy and critical care medicine in severely burned patients - Part 2: the basics in definite care].

    PubMed

    Deisz, Robert; Kauczok, Jens; Dembinski, Rolf; Pallua, Norbert; Marx, Gernot

    2013-01-01

    Critical care medicine in severely burned patients should be adapted to the different pathophysiological phases. Accordingly, surgical and non-surgical therapy must be coordinated adequately. Initial stabilization of the burn victim during the first 24 hours (Surgical therapy and critical care medicine in severely burned patients - Part 1: the first 24 ours, AINS 9/12) is followed by a long lasting reconstructive period. During this time calculated fluid replacement to compensate evaporative losses by large bourn wounds is as essential as reconstruction of the integrity of the skin and the modulation of metabolic consequences following severe burn injury. Special attention has to be paid to local and systemic infections.

  7. Acne vulgaris and acne rosacea as part of immune reconstitution disease in HIV-1 infected patients starting antiretroviral therapy.

    PubMed

    Scott, Christopher; Staughton, Richard C D; Bunker, Christopher J; Asboe, David

    2008-07-01

    Immune reconstitution disease (IRD) has been widely reported following the commencement of antiretrovirals. We report a case series from a cohort of HIV-1-infected patients of whom four developed acne vulgaris and one developed acne rosacea after the initiation of antiretroviral therapy. Acne vulgaris, as part of IRD, has been reported only once in the literature, whereas acne rosacea has not, to our knowledge, previously been described. This serves as a reminder not to overlook dermatological manifestations of disease in patients with HIV infection after starting antiretrovirals.

  8. Canadian consensus recommendations on the management of venous thromboembolism in patients with cancer. Part 2: treatment

    PubMed Central

    Easaw, J.C.; Shea–Budgell, M.A.; Wu, C.M.J.; Czaykowski, P.M.; Kassis, J.; Kuehl, B.; Lim, H.J.; MacNeil, M.; Martinusen, D.; McFarlane, P.A.; Meek, E.; Moodley, O.; Shivakumar, S.; Tagalakis, V.; Welch, S.; Kavan, P.

    2015-01-01

    Patients with cancer are at increased risk of venous thromboembolism (vte). Anticoagulation therapy is used to treat vte; however, patients with cancer have unique clinical circumstances that can often make decisions surrounding the administration of therapeutic anticoagulation complicated. No national Canadian guidelines on the management of established cancer-associated thrombosis have been published. We therefore aimed to develop a consensus-based, evidence-informed guideline on the topic. PubMed was searched for clinical trials and meta-analyses published between 2002 and 2013. Reference lists of key articles were hand-searched for additional publications. Content experts from across Canada were assembled to review the evidence and make recommendations. Low molecular weight heparin is the treatment of choice for cancer patients with established vte. Direct oral anticoagulants are not recommended for the treatment of vte at this time. Specific clinical scenarios, including the presence of an indwelling venous catheter, renal insufficiency, and thrombocytopenia, warrant modifications in the therapeutic administration of anticoagulation therapy. Patients with recurrent vte should receive extended (>3 months) anticoagulant therapy. Incidental vte should generally be treated in the same manner as symptomatic vte. There is no evidence to support the monitoring of anti–factor Xa levels in clinically stable cancer patients receiving prophylactic anticoagulation; however, levels of anti–factor Xa could be checked at baseline and periodically thereafter in patients with renal insufficiency. Follow-up and education about the signs and symptoms of vte are important components of ongoing patient care. PMID:25908913

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

    PubMed

    d'Ardenne, Patricia; Heke, Sarah

    2014-06-01

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

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

    PubMed Central

    d'Ardenne, Patricia; Heke, Sarah

    2014-01-01

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

  11. Cooling strategies for patients with severe cerebral insult in ICU (Part 2).

    PubMed

    Price, Theresa; McGloin, Sarah; Izzard, Julie; Gilchrist, Mollie

    2003-01-01

    Critically ill patients who have sustained a severe cerebral insult will be actively cooled should they develop an elevated body core temperature. Patients who require therapeutic hypothermia for neuroprotection may require the same cooling strategies. A literature review suggested limited evidence to support cooling strategies currently used within one intensive care unit. An experimental approach was used to examine the effects of paracetamol and four external cooling strategies on patients with severe cerebral insult It is suggested that paracetamol is effective in reducing body core temperature and that fans may not. However, data obtained from the study of the four external cooling strategies were inconclusive.

  12. Dysphagia and airway compromise as a result of retropharyngeal haematoma following undiagnosed odontoid peg fracture: a case report.

    PubMed

    Wronka, K S; Sznerch, N; Davies, J

    2011-09-01

    Airway compromise following a cervical spine injury is an unusual cause of respiratory distress. We describe a patient who developed a retropharyngeal haematoma that caused dysphagia, dysarthria and acute airway compromise seven days following a fall, with no other signs of cervical spine injury. The patient was found to have a type 2 fracture through the junction of the odontoid peg and body of C2 with an associated prevertebral haematoma and soft tissue oedema. Later, the patient developed stridor and required an emergency orotracheal intubation and admission to the intensive care unit. As presented in this case report, cervical fracture can result in mechanical airway compromise with an associated retropharyngeal haematoma and prevertebral soft tissue oedema. In elderly patients with a minor history of falls one should always think of possible fractures and appropriate investigations should be carried out. Retropharyngeal haematomas secondary to cervical spine fractures require a prompt multidisciplinary approach and appropriate management of both the airway and cervical spine. Joint care from the orthopaedic, anaesthetic, and ear, nose and throat teams is necessary.

  13. [Electronic patient records and teleophthalmology. Part 2: concrete projects in ophthalmology].

    PubMed

    Schargus, M; Michelson, G; Grehn, F

    2011-07-01

    Electronic storage of patient-related data will replace paper-based patient records in the near future. Because of the high visualization needed in ophthalmology integrated electronic data storage and usage will be very useful. Chronic diseases like glaucoma, macular degeneration and diabetic retinopathy would benefit from long-term data storage and analysis. Unfortunately there are nearly no widely accepted systems available providing these options. Another important point is the simplification of existing diagnostic procedures and nomenclature on an international level. Increasing mobility of patients requires a better portability of existing medical examination data between different physicians. This is the only way to provide continuously high levels of quality in patient care and to simultaneously reduce costs and prevent unnecessary secondary examinations.

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

    PubMed

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

    2016-05-01

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

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

    PubMed

    Parzeller, Markus; Zedler, Barbara

    2014-01-01

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

  16. Canadian consensus recommendations on the management of venous thromboembolism in patients with cancer. Part 1: prophylaxis

    PubMed Central

    Easaw, J.C.; Shea–Budgell, M.A.; Wu, C.M.J.; Czaykowski, P.M.; Kassis, J.; Kuehl, B.; Lim, H.J.; MacNeil, M.; Martinusen, D.; McFarlane, P.A.; Meek, E.; Moodley, O.; Shivakumar, S.; Tagalakis, V.; Welch, S.; Kavan, P.

    2015-01-01

    Patients with cancer are at increased risk of venous thromboembolism (vte). Anticoagulation therapy has been shown to prevent vte; however, unique clinical circumstances in patients with cancer can often complicate the decisions surrounding the administration of prophylactic anticoagulation. No national Canadian guidelines on the prevention of cancer-associated thrombosis have been published. We therefore aimed to develop a consensus-based, evidence-informed guideline on the topic. PubMed was searched for clinical trials and meta-analyses published between 2002 and 2013. Reference lists of key articles were hand-searched for additional publications. Content experts from across Canada were assembled to review the evidence and make recommendations. Low molecular weight heparin can be used prophylactically in cancer patients at high risk of developing vte. Direct oral anticoagulants are not recommended for vte prophylaxis at this time. Specific clinical scenarios, including renal insufficiency, thrombocytopenia, liver disease, and obesity can warrant modifications in the administration of prophylactic anticoagulant therapy. There is no evidence to support the monitoring of anti–factor Xa levels in clinically stable cancer patients receiving prophylactic anticoagulation; however, factor Xa levels could be checked at baseline and periodically in patients with renal insufficiency. The use of anticoagulation therapy to prolong survival in cancer patients without the presence of risk factors for vte is not recommended. PMID:25908912

  17. Dental management considerations for the patient with an acquired coagulopathy. Part 2: Coagulopathies from drugs.

    PubMed

    Lockhart, P B; Gibson, J; Pond, S H; Leitch, J

    2003-11-08

    Dental patients often give a medical history that suggests the possibility of a coagulopathy from drugs, with a corresponding risk for prolonged bleeding during and following an invasive procedure. Identification of patients who may be prone to oral bleeding requires specific medical history information and the proper use of laboratory tests. Some NSAIDs are reported to cause prolonged oral bleeding, but scientific evidence is lacking. Likewise, the risk of oral bleeding from anticoagulants such as warfarin is often over stated, and unnecessary adjustment of NSAID or warfarin dosage puts patients at risk for significant morbidity and mortality. Some commonly employed laboratory tests such as the prothrombin time provide helpful information when used in the appropriate setting, but others, such as the bleeding time test, provide little or no predictive value in the determination of patients at risk for oral bleeding. Dental management of patients with potential coagulopathies from medications requires an understanding of basic principles of coagulation. The vast majority of these patients can be managed in the community setting without risk and without alteration of anticoagulant drug regimes.

  18. Total Marrow Irradiation as Part of Autologous Stem Cell Transplantation for Asian Patients with Multiple Myeloma

    PubMed Central

    Lin, Shih-Chiang; Hsieh, Pei-Ying; Shueng, Pei-Wei; Tien, Hui-Ju; Wang, Li-Ying

    2013-01-01

    To compare the outcomes of melphalan 200 mg/m2 (HDM200) and 8 Gy total marrow irradiation (TMI) delivered by helical tomotherapy plus melphalan 140 mg/m2 (HDM140 + TMI 8 Gy) in newly diagnosed symptomatic multiple myeloma (MM) Asian patients. Between 2007 and 2010, nine consecutive myeloma patients who were scheduled to undergo autologous stem cell transplantation (ASCT) were studied. The patients received three cycles of vincristine-adriamycin-dexamethasone (VAD) regimen as induction chemotherapy, and if they had a partial response, peripheral blood stem cells were collected by dexamethasone-etoposide-cyclophosphamide-cisplatin (DECP). In arm A, six patients received the HDM200. In arm B, three patients received HDM140 + TMI 8 Gy. In arm B, the neutropenic duration was slightly longer than in arm A (P = 0.048). However, hematologic recovery (except for neutrophils), transfusion requirement, median duration of hospitalization, and the dose of G-CSF were similar in both arms. The median duration of overall survival and event-free survival was similar in the two arms (P = 0.387). As a conditioning regiment, HDM140 + TMI 8 Gy provide another chance for MM Asian patients who were not feasible for HDM200. PMID:24089671

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

    PubMed Central

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

    2012-01-01

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

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

    SciTech Connect

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

    2013-01-01

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

  1. Psychological stress compromises CD8+ T cell control of latent herpes simplex virus type 1 infections.

    PubMed

    Freeman, Michael L; Sheridan, Brian S; Bonneau, Robert H; Hendricks, Robert L

    2007-07-01

    Recurrent HSV-1 ocular disease results from reactivation of latent virus in trigeminal ganglia, often following immunosuppression or exposure to a variety of psychological or physical stressors. HSV-specific CD8+ T cells can block HSV-1 reactivation from latency in ex vivo trigeminal ganglia cultures through production of IFN-gamma. In this study, we establish that either CD8+ T cell depletion or exposure to restraint stress permit HSV-1 to transiently escape from latency in vivo. Restraint stress caused a reduction of TG-resident HSV-specific CD8+ T cells and a functional compromise of those cells that survive. Together, these effects of stress resulted in an approximate 65% reduction of cells capable of producing IFN-gamma in response to reactivating virus. Our findings demonstrate persistent in vivo regulation of latent HSV-1 by CD8+ T cells, and strongly support the concept that stress induces HSV-1 reactivation from latency at least in part by compromising CD8+ T cell surveillance of latently infected neurons.

  2. Hydraulic efficiency compromises compression strength perpendicular to the grain in Norway spruce trunkwood

    PubMed Central

    2011-01-01

    The aim of this study was to investigate bending stiffness and compression strength perpendicular to the grain of Norway spruce (Picea abies (L.) Karst.) trunkwood with different anatomical and hydraulic properties. Hydraulically less safe mature sapwood had bigger hydraulic lumen diameters and higher specific hydraulic conductivities than hydraulically safer juvenile wood. Bending stiffness (MOE) was higher, whereas radial compression strength lower in mature than in juvenile wood. A density-based tradeoff between MOE and hydraulic efficiency was apparent in mature wood only. Across cambial age, bending stiffness did not compromise hydraulic efficiency due to variation in latewood percent and because of the structural demands of the tree top (e.g. high flexibility). Radial compression strength compromised, however, hydraulic efficiency because it was extremely dependent on the characteristics of the “weakest” wood part, the highly conductive earlywood. An increase in conduit wall reinforcement of earlywood tracheids would be too costly for the tree. Increasing radial compression strength by modification of microfibril angles or ray cell number could result in a decrease of MOE, which would negatively affect the trunk’s capability to support the crown. We propose that radial compression strength could be an easily assessable and highly predictive parameter for the resistance against implosion or vulnerability to cavitation across conifer species, which should be topic of further studies. PMID:22058609

  3. 38 CFR 1.903 - Settlement, waiver, or compromise under other statutory or regulatory authority.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... compromise under other statutory or regulatory authority. 1.903 Section 1.903 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS GENERAL PROVISIONS Standards for Collection, Compromise, Suspension... Settlement, waiver, or compromise under other statutory or regulatory authority. Nothing in §§ 1.900...

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

    ERIC Educational Resources Information Center

    Tsaousides, Theodore; Jome, LaRae

    2008-01-01

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

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

    ERIC Educational Resources Information Center

    Heyman, Martha K.

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

  6. 7 CFR 3.19 - Standards for the compromise of claims.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 7 Agriculture 1 2012-01-01 2012-01-01 false Standards for the compromise of claims. 3.19 Section 3.19 Agriculture Office of the Secretary of Agriculture DEBT MANAGEMENT Standards for the Administrative Collection and Compromise of Claims § 3.19 Standards for the compromise of claims. An agency...

  7. 32 CFR 842.124 - Waiver and compromise of United States interest.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... damages. (c) A compromise can be made upon written request from the injured party or the injured party's... CLAIMS AND LITIGATION ADMINISTRATIVE CLAIMS Hospital Recovery Claims (42 U.S.C. 2651-2653) § 842.124 Waiver and compromise of United States interest. Waivers and compromises of government claims can be...

  8. Coronary heart disease in patients with diabetes: part I: recent advances in prevention and noninvasive management.

    PubMed

    Berry, Colin; Tardif, Jean-Claude; Bourassa, Martial G

    2007-02-13

    Diabetes mellitus (DM) is a worldwide epidemic. Its prevalence is rapidly increasing in both developing and developed countries. Coronary heart disease (CHD) is highly prevalent and is the major cause of morbidity and mortality in diabetic patients. The purpose of this review is to assess the clinical impact of recent advances in the epidemiology, prevention, and management of CHD in diabetic patients. A systematic review of publications in this area, referenced in MEDLINE in the past 5 years (2000 to 2005), was undertaken. Patients with CHD and prediabetic states should undergo lifestyle modifications aimed at preventing DM. Pharmacological prevention of DM is also promising but requires further study. In patients with CHD and DM, routine use of aspirin and an angiotensin-converting enzyme inhibitor (ACE-I)--unless contraindicated or not tolerated-and strict glycemic, blood pressure, and lipid control are strongly recommended. The targets for secondary prevention in these patients are relatively well defined, but the strategies to achieve them vary and must be individualized. Intense insulin therapy might be needed for glycemic control, and high-dose statin therapy might be needed for lipid control. For blood pressure control, ACE-Is and angiotensin receptor blockers are considered as first-line therapy. Noncompliance, particularly with lifestyle measures, and underprescription of evidence-based therapies remain important unsolved problems.

  9. Outcome measures in neurological physical therapy practice: part II. A patient-centered process.

    PubMed

    Sullivan, Jane E; Andrews, A Williams; Lanzino, Desiree; Perron, Aimee E; Peron, Aimee; Potter, Kirsten A

    2011-06-01

    Physical therapists working in neurological practice must make choices about which standardized outcome measures are most appropriate for each patient. Significant time constraints in the clinic limit the number of measures that one can reasonably administer. Therapists must choose measures that will provide results that guide the selection of appropriate interventions and are likely to show clinically meaningful change. Therefore, therapists must be able to compare the merits of available measures to identify those that are most relevant for each patient and setting. This article describes a process for selecting outcome measures and illustrates the use of that process with a patient who has had a stroke. The link between selecting objective outcome measures and tracking patient progress is emphasized. Comparisons are made between 2 motor function measures (the Fugl-Meyer Assessment [FMA] of Physical Performance vs the Stroke Rehabilitation Assessment of Movement), and 2 balance measures (Berg Balance Scale vs the Activities-specific Balance Confidence Scale). The use of objective outcome measures allows therapists to quantify information that previously had been described in subjective terms. This allows the tracking of progress, and the comparison of effectiveness and costs across interventions, settings, providers, and patient characteristics.

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

    PubMed Central

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

    2012-01-01

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

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

    DOE PAGES

    Cologne, John; Grant, Eric J.; Nakashima, Eiji; ...

    2012-01-01

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

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

    SciTech Connect

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

    1988-11-01

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

  13. Pneumocystis carinii, Toxoplasma gondii, Cytomegalovirus and the Compromised Host

    PubMed Central

    Ryning, Frank W.; Mills, John

    1979-01-01

    Pneumocystis carinii and Toxoplasma gondii are the two major parasitic protozoan pathogens in the immunocompromised host. Both organisms cause latent infection in humans and many animals. Cats are the definitive hosts for toxoplasmosis; the animal vector for pneumocystis (if any) has not been defined. Toxoplasma is an obligate intracellular parasite, whereas the available evidence suggests that Pneumocystis carinii exists primarily extracellularly. In compromised hosts, pneumocystis infection usually involves only lungs, whereas toxoplasma causes a generalized infection with encephalitis being the principal clinical manifestation. Both types of infection are treated with combinations of folate antagonists (trimethoprim or pyrimethamine with sulfonamide). Both parasites are associated with cytomegalovirus infection in immunosuppressed hosts, an association which may be due to symbiosis between parasites, or to an additive immunosuppressive effect of dual infection on the hosts. ImagesFigure 1.Figure 3.Figure 4.Figure 7.Figure 8.Figure 9. PMID:217182

  14. Glutathione synthesis is compromised in erythrocytes from individuals with HIV

    PubMed Central

    Morris, Devin; Ly, Judy; Chi, Po-Ting; Daliva, John; Nguyen, Truongson; Soofer, Charleen; Chen, Yung C.; Lagman, Minette; Venketaraman, Vishwanath

    2014-01-01

    We demonstrated that the levels of enzymes responsible for the synthesis of glutathione (GSH) such as glutathione synthase (GSS), glutamate-cysteine ligase-catalytic subunit (GCLC), and glutathione reductase (GSR) were significantly reduced in the red blood cells (RBCs) isolated from individuals with human immunodeficiency virus (HIV) infection and this reduction correlated with decreased levels of intracellular GSH. GSH content in RBCs can be used as a marker for increased overall oxidative stress and immune dysfunctions caused by HIV infection. Our data supports our hypothesis that compromised levels of GSH in HIV infected individuals’ is due to decreased levels of GSH-synthetic enzymes. The role of GSH in combating oxidative stress and improving the functions of immune cells in HIV patients’ indicates the benefit of an antioxidant supplement which can reduce the cellular damage and promote the functions of immune cells. PMID:24782776

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

    PubMed

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

    2016-03-01

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

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

    PubMed

    Woods, Dana K

    2002-04-01

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

  17. Cerebral autoregulation is compromised during simulated fluctuations in gravitational stress.

    PubMed

    Brown, Clive M; Dütsch, Matthias; Ohring, Susanne; Neundörfer, Bernhard; Hilz, Max J

    2004-03-01

    Gravity places considerable stress on the cardiovascular system but cerebral autoregulation usually protects the cerebral blood vessels from fluctuations in blood pressure. However, in conditions such as those encountered on board a high-performance aircraft, the gravitational stress is constantly changing and might compromise cerebral autoregulation. In this study we assessed the effect of oscillating orthostatic stress on cerebral autoregulation. Sixteen (eight male) healthy subjects [aged 27 (1) years] were exposed to steady-state lower body negative pressure (LBNP) at -15 and -40 mmHg and then to oscillating LBNP at the same pressures. The oscillatory LBNP was applied at 0.1 and 0.2 Hz. We made continuous recordings of RR-interval, blood pressure, cerebral blood flow velocity (CBFV), respiratory frequency and end-tidal CO(2). Oscillations in mean arterial pressure (MAP) and CBFV were assessed by autoregressive spectral analysis. Respiration was paced at 0.25 Hz to avoid interference from breathing. Steady-state LBNP at -40 mmHg significantly increased low-frequency (LF, 0.03-0.14 Hz) powers of MAP ( P<0.01) but not of CBFV. Oscillatory 0.1 Hz LBNP (0 to -40 mmHg) significantly increased the LF power of MAP to a similar level as steady-state LBNP but also resulted in a significant increase in the LF power of CBFV ( P<0.01). Oscillatory LBNP at 0.2 Hz induced oscillations in MAP and CBFV at 0.2 Hz. Cross-spectral analysis showed that the transfer of LBNP-induced oscillations in MAP onto the CBFV was significantly greater at 0.2 Hz than at 0.1 Hz ( P<0.01). These results show that the ability of the cerebral vessels to modulate fluctuations in blood pressure is compromised during oscillatory compared with constant gravitational stress. Furthermore, this effect seems to be more pronounced at higher frequencies of oscillatory stress.

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed Central

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

    2015-01-01

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

  20. A compromised liver alters polychlorinated biphenyl-mediated toxicity.

    PubMed

    Wahlang, Banrida; Perkins, Jordan T; Petriello, Michael C; Hoffman, Jessie B; Stromberg, Arnold J; Hennig, Bernhard

    2017-02-02

    Exposure to environmental toxicants namely polychlorinated biphenyls (PCBs) is correlated with multiple health disorders including liver and cardiovascular diseases. The liver is important for both xenobiotic and endobiotic metabolism. However, the responses of an injured liver to subsequent environmental insults has not been investigated. The current study aims to evaluate the role of a compromised liver in PCB-induced toxicity and define the implications on overall body homeostasis. Male C57Bl/6 mice were fed either an amino acid control diet (CD) or a methionine-choline deficient diet (MCD) during the 12-week study. Mice were subsequently exposed to either PCB126 (4.9mg/kg) or the PCB mixture, Arcolor1260 (20mg/kg) and analyzed for inflammatory, calorimetry and metabolic parameters. Consistent with the literature, MCD diet-fed mice demonstrated steatosis, indicative of a compromised liver. Mice fed the MCD-diet and subsequently exposed to PCB126 showed observable wasting syndrome leading to mortality. PCB126 and Aroclor1260 exposure worsened hepatic fibrosis exhibited by the MCD groups. Interestingly, PCB126 but not Aroclor1260 induced steatosis and inflammation in CD-fed mice. Mice with liver injury and subsequently exposed to PCBs also manifested metabolic disturbances due to alterations in hepatic gene expression. Furthermore, PCB exposure in MCD-fed mice led to extra-hepatic toxicity such as upregulated circulating inflammatory biomarkers, implicating endothelial cell dysfunction. Taken together, these results indicate that environmental pollution can exacerbate toxicity caused by diet-induced liver injury which may be partially due to dysfunctional energy homeostasis. This is relevant to PCB-exposed human cohorts who suffer from alcohol or diet-induced fatty liver diseases.

  1. Selected problems associated with the treatment and care for patients with colostomy – part 1

    PubMed Central

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

    2013-01-01

    The study presents a short historical background and practical application of intestinal ostomy as a treatment method of various intestinal disorders and injuries. Ostomy is a purposeful connection of the lumen of the intestine with abdominal integuments by surgery. After the surgical formation of the intestinal fistula, the patient must adjust to the new situation, gain basic knowledge and learn procedures of ostomy care. Thus, professional medical assistance is extremely important. The study aims to discuss basic notions concerning ostomy and ostomy equipment. Providing high-standard care and assistance for patients with ostomy requires both appropriate knowledge and practical skills. PMID:23788979

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

    PubMed Central

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

    2013-01-01

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

  3. Fixed reconstructions in partially edentulous patients using two-part ITI implants (Bonefit) as abutments.

    PubMed

    Brägger, U; Hämmerle, C; Weber, H P

    1990-12-01

    Fixed reconstructions on implant abutments may be a welcome modality in the treatment of partially edentulous patients following the principles of a prophylactically oriented comprehensive care. The option to create artificial tissue integrated abutments widens the range of indications for fixed reconstructions. Risky long-span bridges as well as the preparation of intact teeth for bridge abutments may frequently be avoided. Never should the contours of the prosthesis interfere with the patient's performance of optimal plaque control. Furthermore, supportive periodontal therapy with regular maintenance visits must be provided to optimize a long-term prognosis of the dention as well as the tissue-integrated artificial abutments.

  4. Pediatric Dental Patients are Part of a Larger Picture: Detailing Population Realities.

    PubMed

    Waldman, H B; Perlman, S P

    2015-01-01

    The traditional setting of a dental practice may offer pediatric dentists a potentially isolated picture of the general health and use of health services by youngsters in their community. Results from the latest National Health Interview Survey are reviewed to provide broad dimensions to supplement and reinforce the general and specific information usually developed regarding individual patients.

  5. Coagulopathy in critically ill patients: part 2-soluble clotting factors and hemostatic testing.

    PubMed

    Wheeler, Arthur P; Rice, Todd W

    2010-01-01

    This manuscript provides an overview of how to interpret in vitro clotting studies and how to select studies to evaluate patients with bleeding disorders in the ICU. It provides a practical approach to understanding the complex subject of clotting factor abnormalities, including the most common problems of preanalytical error and anticoagulation therapy. Limitations and pitfalls of diagnostic testing are highlighted.

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

    PubMed

    Reitman, Nancy Clayton

    2010-05-01

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

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

    PubMed

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

    2015-09-01

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

  8. Pain measurement as part of primary healthcare of adult patients with sickle cell disease

    PubMed Central

    Signorelli, Andreza Aparecida Felix; Ribeiro, Sonia Beatriz Felix; Moraes-Souza, Helio; de Oliveira, Lucas Felix; Ribeiro, João Batista; da Silva, Sheron Hellen; de Oliveira, Daniel Fachinelli Felix; Ribeiro, Matheus Fernando Felix

    2013-01-01

    Objective The aim of this exploratory, cross-sectional study was to evaluate pain in sickle cell disease patients and aspects related to primary healthcare. Methods Data were obtained through home interviews. The assessment instruments (body diagram, Numerical Pain Scale, McGill Pain Questionnaire) collected information on the underlying disease and on pain. Data were analyzed using the Statistical Package for Social Sciences program for Windows. Associations between the subgroups of sickle cell disease patients (hemoglobin SS, hemoglobin SC, sickle β-thalassemia and others) and pain were analyzed using contingency tables and non-parametric tests of association (classic chi-square, Fisher's and Kruskal-Wallis) with a level of 5% (p-value < 0.05) being set for the rejection of the null hypothesis. Results Forty-seven over 18-year-old patients with sickle cell disease were evaluated. Most were black (78.7%) and female (59.6%) and the mean age was 30.1 years. The average number of bouts of pain annually was 7.02; pain was predominantly reported by individuals with sickle cell anemia (hemoglobin SS). The intensity of pain (Numeric Pain Scale) was 5.5 and the quantitative index (McGill) was 35.9. This study also shows that patients presented a high frequency of moderately painful crises in their own homes. Conclusion According to these facts, it is essential that pain related to sickle cell disease is properly identified, quantified, characterized and treated at the three levels of healthcare. In primary healthcare, accurate measurement of pain combined with better care may decrease acute painful episodes and consequently minimize tissue damage, thus improving the patient's overall health. PMID:24106446

  9. Part II: Biochemical changes after pituitary adenylate cyclase-activating polypeptide-38 infusion in migraine patients.

    PubMed

    Guo, Song; Vollesen, Anne Luise Haulund; Hansen, Young Bae Lee; Frandsen, Erik; Andersen, Malene Rohr; Amin, Faisal Mohammad; Fahrenkrug, Jan; Olesen, Jes; Ashina, Messoud

    2017-02-01

    Background Intravenous infusion of pituitary adenylate cyclase-activating polypeptide-38 (PACAP38) provokes migraine attacks in 65-70% of migraine without aura (MO) patients. We investigated whether PACAP38 infusion causes changes in the endogenous production of PACAP38, vasoactive intestinal polypeptide (VIP), calcitonin gene-related peptide (CGRP), tumour necrosis factor alpha (TNFα), S100 calcium binding protein B (S100B), neuron-specific enolase and pituitary hormones in migraine patients. Methods We allocated 32 previously genotyped MO patients to receive intravenous infusion PACAP38 (10 pmol/kg/minute) for 20 minutes and recorded migraine-like attacks. Sixteen of the patients were carriers of the risk allele rs2274316 ( MEF2D), which confers increased risk of MO and may regulate PACAP38 expression, and 16 were non-carriers. We collected blood samples at baseline and 20, 30, 40, 60 and 90 minutes after the start of the infusion. A control group of six healthy volunteers received intravenous saline. Results PACAP38 infusion caused significant changes in plasma concentrations of VIP ( p = 0.026), prolactin ( p = 0.011), S100B ( p < 0.001) and thyroid-stimulating hormone (TSH; p = 0.015), but not CGRP ( p = 0.642) and TNFα ( p = 0.535). We found no difference in measured biochemical variables after PACAP38 infusion in patients who later developed migraine-like attacks compared to those who did not ( p > 0.05). There was no difference in the changes of biochemical variables between patients with and without the MEF2D-associated gene variant ( p > 0.05). Conclusion PACAP38 infusion elevated the plasma levels of VIP, prolactin, S100B and TSH, but not CGRP and TNFα. Development of delayed migraine-like attacks or the presence of the MEF2D gene variant was not associated with pre-ictal changes in plasma levels of neuropeptides, TNFα and pituitary hormones.

  10. Mouth Cancer for Clinicians. Part 9: The Patient and Care Team.

    PubMed

    Kalavrezos, Nicholas; Scully, Crispian

    2016-04-01

    A MEDLINE search early in 2015 revealed more than 250,000 papers on head and neck cancer; over 100,000 on oral cancer; and over 60,000 on mouth cancer. Not all publications contain robust evidence. We endeavour to encapsulate the most important of the latest information and advances now employed in practice, in a form comprehensible to healthcare workers, patients and their carers. This series offers the primary care dental team in particular, an overview of the aetiopathogenesis, prevention, diagnosis and multidisciplinary care of mouth cancer, the functional and psychosocial implications, and minimization of the impact on the quality of life of patient and family. Clinical Relevance: This article offers the dental team an overview of the multidisciplinary team (MDT; or multi-speciality team) and its roles, and an overview of the implications of therapies that are discussed more fully in future articles in the series.

  11. Stalking by patients: doctors' experiences in a Canadian urban area (Part II)--physician responses.

    PubMed

    Abrams, Karen M; Robinson, Gail Erlick

    2013-07-01

    Stalking involves recurrent unwanted communication, harassment, and intrusive behaviors. The aim of this study was to examine physicians' experiences of being stalked by their patients, with particular attention to the emotional impact on the physicians and their actions taken. A questionnaire designed to study the nature and the impact of stalking experiences among physicians was sent to 3159 randomly chosen physicians in the Greater Toronto Area. Approximately 15% (14.9%) of the 1190 physicians who responded reported having been stalked. The physicians reported feeling angry, frustrated, anxious, frightened, lacking control, and helpless. The physicians coped in a number of ways including terminating the physician-patient relationship, but many just ignored the problem. Most had no previous knowledge about stalking. Physicians experience a range of emotions as a result of being a victim of stalking. In view of the prevalence and the impact, physicians may benefit from education to help prepare them for the possibility of being stalked.

  12. Evaluation of patients presenting with knee pain: Part II. Differential diagnosis.

    PubMed

    Calmbach, Walter L; Hutchens, Mark

    2003-09-01

    Knee pain is a common presenting complaint with many possible causes. An awareness of certain patterns can help the family physician identify the underlying cause more efficiently. Teenage girls and young women are more likely to have patellar tracking problems such as patellar subluxation and patellofemoral pain syndrome, whereas teenage boys and young men are more likely to have knee extensor mechanism problems such as tibial apophysitis (Osgood-Schlatter lesion) and patellar tendonitis. Referred pain resulting from hip joint pathology, such as slipped capital femoral epiphysis, also may cause knee pain. Active patients are more likely to have acute ligamentous sprains and overuse injuries such as pes anserine bursitis and medial plica syndrome. Trauma may result in acute ligamentous rupture or fracture, leading to acute knee joint swelling and hemarthrosis. Septic arthritis may develop in patients of any age, but crystal-induced inflammatory arthropathy is more likely in adults. Osteoarthritis of the knee joint is common in older adults.

  13. Retrieval medicine: a review and guide for UK practitioners. Part 2: safety in patient retrieval systems

    PubMed Central

    Hearns, S; Shirley, P J

    2006-01-01

    Retrieval and transfer of critically ill and injured patients is a high risk activity. Risk can be minimised with robust safety and clinical governance systems in place. This article describes the various governance systems that can be employed to optimise safety and efficiency in retrieval services. These include operating procedure development, equipment management, communications procedures, crew resource management, significant event analysis, audit and training. PMID:17130608

  14. Medication adherence and patient outcomes: part 2: interventions and resources to overcome low health literacy.

    PubMed

    Petty, Janet L

    2013-01-01

    This article explores the influence of health literacy on medication adherence. With health literacy skills nearly flat for over a decade and an aging population receiving multiple and complex medication regimens, literacy is becoming a more important factor in nursing assessment and intervention. Concrete tools are provided to help the clinical nurse specialist (CNS) assess literacy and evaluate written resources for patient education and to improve medication adherence.

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

    PubMed

    Lee, Kyoung-Hee

    2015-06-01

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

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

    PubMed Central

    Buch, Jatin; Kothari, Nitin; Shah, Nishal

    2016-01-01

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

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

    PubMed Central

    Ocloo, Josephine E.; Fulop, Naomi J.

    2011-01-01

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

  18. Moustache reconstruction in patients with cleft lip: (final aesthetic touches in clefts-part ii).

    PubMed

    Duskova, Marketa; Sosna, Bohuslav; Sukop, Andrej

    2006-09-01

    Men with clefts often have limited or even missing moustache growth in scar areas or in the upper lip prolabium. However the histological testing showed the absence or at least the inactive form of androgenic receptor in hair follicle of cleft site, transplantation of autologous grafts harvested from hair was successful in all six cases either into scars or the prolabium. A more natural effect was achieved by using micrografts. The positive reaction of patients proved there is a need for detailed treatment in highly outgoing individuals.

  19. Self-inflicted Cardiac Injury with Nail Gun Without Hemodynamic Compromise: A Case Report

    PubMed Central

    Ho, Simon; Feranec, Nicholas

    2017-01-01

    Pneumatically powered nail guns have been used in construction since 1959. Penetrating injuries to the heart with nail guns have a wide range of presentations from asymptomatic to cardiac tamponade and exsanguination. Mortality related to cardiac nail gun injuries is similar to knife injuries, estimated at 25%. Surgical exploration is the treatment of choice. We describe a case of self-inflicted nail gun injury to the chest without hemodynamic compromise in a 51-year-old man. Computed tomography (CT) imaging confirmed nail penetrating the right ventricle, with the tip adjacent to but not violating the abdominal aorta. The patient was successfully treated with thoracotomy and foreign body removal. PMID:28191375

  20. Esthetic Rehabilitation of a Severely Compromised Anterior Area: Combined Periodontal and Restorative Approach

    PubMed Central

    Censi, Rachele; Vavassori, Virna; Borgonovo, Andrea Enrico; Re, Dino

    2014-01-01

    The complete oral rehabilitation of patients demanding a beautiful and attractive smile involves a multidisciplinary approach that includes the change of both the morphological aspect of the teeth and the architecture of gum tissues. This clinical report describes a successful interdisciplinary approach for the treatment of an esthetically compromised dentition. In a first phase, the periodontal plastic surgery was performed for root coverage and, in particular, it was decided for the execution of a coronally advanced flap for the treatment of multiple recession defects. Once complete healing of soft tissues was obtained, six lithium disilicate veneers were placed over the anterior maxillary teeth. Lithium disilicate is a glass-based ceramic which presents excellent aesthetics and allows the passage of light without creating unnatural reflections. This feature has made it possible to recreate a natural aspect of teeth that in combination with the harmonic architecture of soft tissue has permitted obtaining a beautiful and pleasant smile. PMID:24715999

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

    PubMed

    Pizzorno, Joseph; Shippy, Ann

    2016-06-01

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

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

    SciTech Connect

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

    2012-01-01

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

  3. Tert-butylhydroquinone Compromises Survival in Murine Experimental Stroke

    PubMed Central

    Sun, Jiahong; Hu, Heng; Ren, Xuefang; Simpkins, James W.

    2016-01-01

    tert-butylhydroquinone (tBHQ), an Nrf2 signaling pathway inducer that is widely used as a food additive in the U.S., prevents oxidative stress-induced cytotoxicity in neurons. This study assesses the effects of tBHQ on ischemic stroke outcomes in mice. We measured infarct size, neurological deficits, and brain volume after tBHQ treatments in murine permanent middle cerebral artery occlusion (pMCAO) model in vivo. Further, we evaluated the regulation of tBHQ on mitochondrial function in cerebrovascular endothelial cells in vitro, which is critical to the blood–brain barrier (BBB) permeability. Our results demonstrated that tBHQ increased post-stroke mortality and worsened stroke outcomes. Mitochondrial function was suppressed by tBHQ treatment of cerebrovascular endothelial cells, and this suppression was potentiated by co-treatment with lipopolysaccharide (LPS), the bacterial mimic. These data indicate that tBHQ-exacerbated stroke damage might due to the compromised BBB permeability in permanent stroke. PMID:26827673

  4. Oviposition site selection in Cactoblastis cactorum (Lepidoptera): constraints and compromises.

    PubMed

    Robertson, H G

    1987-10-01

    Oviposition by Cactoblastis cactorum on Opuntia ficus-indica and O. aurantiaca was assessed from the positioning of egg sticks on plants in the field. The number of egg sticks laid on O. ficus-indica plants was affected by: (1) plant size; (2) moth emergence near the plant; (3) cladode condition; and (4) plant conspicuousness. These factors contributed towards the clumping of egg sticks on plants. There was no apparent oviposition preference for one of the two host plant species despite the fact that egg predation was higher and fecundity lower on O. aurantiaca. The selection of a site for oviposition on the host plants was influenced by: (1) cladode condition; (2) height above ground; and (3) shelter from wind during oviposition. Succulent cladodes were the favoured sites for oviposition. The evidence suggests that in C. cactorum, oviposition site selection is largely the net result of a compromise between oviposition behaviour selected for increasing the probability of juvenile survival and oviposition behaviour selected for increasing the probability of laying the full complement of eggs. In addition, environmental and physiological factors such as wind and wing-loading, are thought to place constraints on the range of sites available for oviposition.

  5. Compromise and Synergy in High-Efficiency Thermoelectric Materials.

    PubMed

    Zhu, Tiejun; Liu, Yintu; Fu, Chenguang; Heremans, Joseph P; Snyder, Jeffrey G; Zhao, Xinbing

    2017-03-06

    The past two decades have witnessed the rapid growth of thermoelectric (TE) research. Novel concepts and paradigms are described here that have emerged, targeting superior TE materials and higher TE performance. These superior aspects include band convergence, "phonon-glass electron-crystal", multiscale phonon scattering, resonant states, anharmonicity, etc. Based on these concepts, some new TE materials with distinct features have been identified, including solids with high band degeneracy, with cages in which atoms rattle, with nanostructures at various length scales, etc. In addition, the performance of classical materials has been improved remarkably. However, the figure of merit zT of most TE materials is still lower than 2.0, generally around 1.0, due to interrelated TE properties. In order to realize an "overall zT > 2.0," it is imperative that the interrelated properties are decoupled more thoroughly, or new degrees of freedom are added to the overall optimization problem. The electrical and thermal transport must be synergistically optimized. Here, a detailed discussion about the commonly adopted strategies to optimize individual TE properties is presented. Then, four main compromises between the TE properties are elaborated from the point of view of the underlying mechanisms and decoupling strategies. Finally, some representative systems of synergistic optimization are also presented, which can serve as references for other TE materials. In conclusion, some of the newest ideas for the future are discussed.

  6. Acute confusion and unreal experiences in intensive care patients in relation to the ICU syndrome. Part II.

    PubMed

    Granberg, A; Engberg, I B; Lundberg, D

    1999-02-01

    The intensive care unit syndrome (ICU syndrome) is defined as an altered emotional state occurring in a highly stressful environment, which may manifest itself in various forms such as delirium, confusion, crazy dreams or unreal experiences. The purpose of this part of a study of patients' experiences is to describe and illuminate patients' experiences of acute confusion, disorientation, wakefulness, dreams and nightmares during and after their stay in the ICU. The data were obtained from 19 ventilated patients, who were interviewed twice and had stayed at least 36 hours in the ICU, the first interview being about one week after discharge from the ICU, and the second 4-8 weeks later. The hermeneutic approach used when interpreting and analysing the text from the interviews revealed that patients' experiences of unreal experiences were often associated with intense fear. Intense or continuous unbearable fear seems to result in frightening unreal experiences, which further increase the level of fear. Care actions or caring relationships with relatives or nurses can reduce this fear, which can help to prevent the occurrence and/or duration and intensity of the unreal experiences. Trust and confidence in nurses or significant others and feelings of self-control or trust in self-control seemed to reduce the risk of unreal experiences so that adverse stimuli might only trigger a mild confusion.

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

    PubMed

    Robinson, G E; Stewart, D E

    1996-03-01

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

  8. [Surgical therapy and critical care medicine in severely burned patients - Part 1: the first 24 ours].

    PubMed

    Dembinski, Rolf; Kauczok, Jens; Deisz, Robert; Pallua, Norbert; Marx, Gernot

    2012-09-01

    Critical care medicine in severely burned patients should be adapted to the different pathophysiological phases. Accordingly, surgical and non-surgical therapy must be coordinated adequately. Initial wound care comprises topical treatment of less severely injured skin and surgical debridement of severely burned areas. The first 24 hours of intensive care are focused on calculated fluid delivery to provide stable hemodynamics and avoid progression of local edema formation. In the further course wound treatment with split-thickness skin grafts is the major aim of surgical therapy. Critical care is focused on the avoidance of complications like infections and ventilator associated lung injury. Therefore, lung-protective ventilation strategies, weaning and sedation protocols, and early enteral nutrition are important cornerstones of the treatment.

  9. False aneurysm on distal part of coarctation of the aorta in a parous Turner syndrome patient.

    PubMed

    Oi, Keiji; Yoshida, Tetsuya; Takeshita, Masashi; Tsuruta, Goro

    2013-09-01

    False aneurysm associated with untreated coarctation of the aorta (CoA) is an uncommon vascular complication. We present a 41-year-old woman with mosaic Turner syndrome who had CoA complicated with a small false aneurysm on descending aorta just distal to the coarctation. The patient had not been diagnosed with Turner syndrome despite several physical characteristics of the syndrome because she had histories of natural childbirth. The false aneurysm was resected with the coarctation through a thoracotomy and proximal aorta was directly anastomosed to distal aorta. Endovascular therapy has become preferred method in recent years in treatment for coarctation of the aorta. However, careful consideration should be given to the irregularities on the aorta with the coarctation for diagnosis of false aneurysm.

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

    PubMed Central

    Kapfhammer, Hans-Peter

    2014-01-01

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

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

    PubMed

    Kapfhammer, Hans-Peter

    2014-06-01

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

  12. ["Need-driven-dementia-compromised-behavior" model and "gentle care" as answer to Alzheimer's disease].

    PubMed

    Gallese, Giulia; Stobbione, Tiziana

    2013-01-01

    Alzheimer's disease is characterized by a progressive cognitive, behavioural and functional decline which determines ability loss. With the gradual aging of the population, Alzheimer's disease is becoming a major health and social problem which involves not only the individuals but also their whole family. The aim of this study is to identify the most important needs of patients and to suggest interventions to manage it at home, according to the pattern of Gentle Care. Care needs of Alzheimer's disease patients have been investigated, through the use of semi-structured interview of caregivers who take care of loved ones at home. The survey has been carried out through the use of a data collection tool proposed in the conceptual model of nursing "Need-driven Dementia-compromised Behaviour Model", validated and tested in the United States. Data highlights an high degree of patient dependence from their caregiver for numerous activities of daily living. Interviews show a poor level of information and lack of support from professionals who can help caregivers in their everyday life. On the basis of the data gathered, a number of care interventions, which seams as the most appropriate in order to best take care of patients, were identified. Moreover, main needs of family caregivers were also identified, they need more information and support with respect to caregiving responsibilities.

  13. Atypical extraspinal musculoskeletal tuberculosis in immunocompetent patients: part II, tuberculous myositis, tuberculous bursitis, and tuberculous tenosynovites.

    PubMed

    Abdelwahab, Ibrahim Fikry; Bianchi, Stefano; Martinoli, Carlo; Klein, Michael; Hermann, George

    2006-12-01

    Tuberculosis involving the soft tissue from adjacent bone or joint is well recognized. However, primary tuberculous pyomyositis, tuberculous bursitis, and tuberculous tenosynovitis are rare entities constituting 1% of skeletal tuberculosis. Tuberculous tenosynovitis involves most commonly the tendon sheaths of the hand and wrist, and tuberculous bursitis occurs most commonly around the hip. The greater trochanteric bursa and the greater trochanter are the most frequent sites of tuberculous bursitis. Cases of primary tuberculous pyomyositis and tenosynovitis of the tendons of the ankle and foot are seldom reported in the radiology literature. All imaging modalities-plain radiography, bone scan, computed tomography, and magnetic resonance imaging (MRI)--provide information that is helpful in determining therapy. MRI in particular, with its multiplanar capabilities and superb contrast of soft tissue, can demonstrate the extent of the soft tissue mass and access the adjacent bones and joints. However, MRI has no diagnostic specificity in regard to tuberculosis, and in nonendemic areas, biopsy is strongly recommended. All patients in this review were permanent residents of North America or Western Europe and were immunocompetent. Examples of atypical presentations of the above entities are demonstrated.

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

    PubMed

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

    2014-08-01

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

  15. Zinc reduces epithelial barrier compromise induced by human seminal plasma

    PubMed Central

    Mullin, James M.; Diguilio, Katherine M.; Valenzano, Mary C.; Deis, Rachael; Thomas, Sunil; Zurbach, E. Peter; Abdulhaqq, Shaheed; Montaner, Luis J.

    2017-01-01

    Human semen has the potential to modulate the epithelial mucosal tissues it contacts, as seminal plasma (SP) is recognized to contain both pro- and anti-barrier components, yet its effects on epithelial barrier function are largely unknown. We addressed the role of human SP when exposed to the basal-lateral epithelial surface, a situation that would occur clinically with prior mechanical or disease-related injury of the human epithelial mucosal cell layers in contact with semen. The action of SP on claudins-2, -4, -5, and -7 expression, as well as on a target epithelium whose basolateral surface has been made accessible to SP, showed upregulation of claudins-4 and -5 in CACO-2 human epithelial cell layers, despite broad variance in SP-induced modulation of transepithelial electrical resistance and mannitol permeability. Upregulation of claudin-2 by SP also exhibited such variance by SP sample. We characterize individual effects on CACO-2 barrier function of nine factors known to be present abundantly in seminal plasma (zinc, EGF, citrate, spermine, fructose, urea, TGF, histone, inflammatory cytokines) to establish that zinc, spermine and fructose had significant potential to raise CACO-2 transepithelial resistance, whereas inflammatory cytokines and EGF decreased this measure of barrier function. The role of zinc as a dominant factor in determining higher levels of transepithelial resistance and lower levels of paracellular leak were confirmed by zinc chelation and exogenous zinc addition. As expected, SP presentation to the basolateral cell surface also caused a very dramatic yet transient elevation of pErk levels. Results suggest that increased zinc content in SP can compete against the barrier-compromising effect of negative modulators in SP when SP gains access to that epithelium’s basolateral surface. Prophylactic elevation of zinc in an epithelial cell layer prior to contact by SP may help to protect an epithelial barrier from invasion by SP-containing STD

  16. The muscle-mechanical compromise framework: Implications for the scaling of gait and posture

    PubMed Central

    Usherwood, James Richard (Jim)

    2016-01-01

    Abstract Many aspects of animal and human gait and posture cannot be predicted from purely mechanical work minimization or entirely based on optimizing muscle efficiency. Here, the Muscle-Mechanical Compromise Framework is introduced as a conceptual paradigm for considering the interactions and compromises between these two objectives. Current assumptions in implementing the Framework are presented. Implications of the compromise are discussed and related to the scaling of running mechanics and animal posture. PMID:28149398

  17. ISPD Cardiovascular and Metabolic Guidelines in Adult Peritoneal Dialysis Patients Part I - Assessment and Management of Various Cardiovascular Risk Factors.

    PubMed

    Wang, Angela Yee Moon; Brimble, K Scott; Brunier, Gillian; Holt, Stephen G; Jha, Vivekanand; Johnson, David W; Kang, Shin-Wook; Kooman, Jeroen P; Lambie, Mark; McIntyre, Chris; Mehrotra, Rajnish; Pecoits-Filho, Roberto

    2015-01-01

    Cardiovascular disease contributes significantly to the adverse clinical outcomes of peritoneal dialysis (PD) patients. Numerous cardiovascular risk factors play important roles in the development of various cardiovascular complications. Of these, loss of residual renal function is regarded as one of the key cardiovascular risk factors and is associated with an increased mortality and cardiovascular death. It is also recognized that PD solutions may incur significant adverse metabolic effects in PD patients. The International Society for Peritoneal Dialysis (ISPD) commissioned a global workgroup in 2012 to formulate a series of recommendations regarding lifestyle modification, assessment and management of various cardiovascular risk factors, as well as management of the various cardiovascular complications including coronary artery disease, heart failure, arrhythmia (specifically atrial fibrillation), cerebrovascular disease, peripheral arterial disease and sudden cardiac death, to be published in 2 guideline documents. This publication forms the first part of the guideline documents and includes recommendations on assessment and management of various cardiovascular risk factors. The documents are intended to serve as a global clinical practice guideline for clinicians who look after PD patients. The ISPD workgroup also identifies areas where evidence is lacking and further research is needed.

  18. HIV Infection and Compromised Mucosal Immunity: Oral Manifestations and Systemic Inflammation

    PubMed Central

    Heron, Samantha E.; Elahi, Shokrollah

    2017-01-01

    Mucosal surfaces account for the vast majority of HIV transmission. In adults, HIV transmission occurs mainly by vaginal and rectal routes but rarely via oral route. By contrast, pediatric HIV infections could be as the result of oral route by breastfeeding. As such mucosal surfaces play a crucial role in HIV acquisition, and spread of the virus depends on its ability to cross a mucosal barrier. HIV selectively infects, depletes, and/or dysregulates multiple arms of the human immune system particularly at the mucosal sites and causes substantial irreversible damage to the mucosal barriers. This leads to microbial products translocation and subsequently hyper-immune activation. Although introduction of antiretroviral therapy (ART) has led to significant reduction in morbidity and mortality of HIV-infected patients, viral replication persists. As a result, antigen presence and immune activation are linked to “inflammaging” that attributes to a pro-inflammatory environment and the accelerated aging process in HIV patients. HIV infection is also associated with the prevalence of oral mucosal infections and dysregulation of oral microbiota, both of which may compromise the oral mucosal immunity of HIV-infected individuals. In addition, impaired oral immunity in HIV infection may predispose the patients to periodontal diseases that are associated with systemic inflammation and increased risk of cardiovascular diseases. The purpose of this review is to examine existing evidence regarding the role of innate and cellular components of the oral cavity in HIV infection and how HIV infection may drive systemic hyper-immune activation in these patients. We will also discuss current knowledge on HIV oral transmission, HIV immunosenescence in relation to the oral mucosal alterations during the course of HIV infection and periodontal disease. Finally, we discuss oral manifestations associated with HIV infection and how HIV infection and ART influence the oral microbiome

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

    PubMed

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

    2016-06-01

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

  20. EEG spectral analysis of NREM sleep in a large sample of patients with insomnia and good sleepers: effects of age, sex and part of the night.

    PubMed

    Svetnik, Vladimir; Snyder, Ellen S; Ma, Junshui; Tao, Peining; Lines, Christopher; Herring, William Joseph

    2017-02-01

    Previous studies of the differences between patients with insomnia and good sleepers with regard to quantitative electroencephalographic measures have mostly utilized small samples and consequently had limited ability to account for potentially important confounding factors of age, sex and part of the night. We conducted a power spectral analysis using a large database of sleep electroencephalographic recordings to evaluate differences between patients with insomnia (N = 803) and good sleepers (N = 811), while simultaneously accounting for these factors and their interaction. Comparisons of power as a function of age and part of the night were made between cohorts (patients with insomnia versus good sleepers) by sex. Absolute power in the delta, theta and sigma bands declined with age for both females and males. Females had significantly greater power than males at all ages, and for each band, cohort and part of the night. These sex differences were much greater than differences between patients with insomnia and good sleepers. Compared with good sleepers, patients with insomnia under age 40-45 years had reduced delta band power during Part 1 of the night. Females with insomnia over age 45 years had increased delta and theta band power in Parts 2 and 3 of the night, and males with insomnia under age 40 years had reduced theta power in Part 1. Females with insomnia had increased beta2 power in all parts of the night, and males with insomnia had reduced alpha power during all parts of the night. Relative power (the proportion that an individual frequency band contributes to the total power) decreased in the delta band and increased in all other bands with age for both cohorts, sexes and all parts of the night. This analysis provides a unique resource for quantitative information on the differences in power spectra between patients with insomnia and good sleepers accounting for age, sex and part of the night.

  1. Child mental health consultation with families of medically compromised infants.

    PubMed

    Mayes, Linda C

    2003-07-01

    behavioral and psychological interventions are integrated with the child's biomedical care. 5. Fostering a brief, or sometimes long-term, therapeutic relationship with the family or facilitating the family's finding such a relationship with another clinician. There will never be enough child and adolescent psychiatrists and psychologists to treat all families of medically compromised infants. Knowledge of normative responses has advanced to the point at which basic skills can be used by and transmitted to others who can provide basic services. There is much to be learned about the short- and long-term sequelae of such stressful situations on individuals and family systems with preexisting psychopathology. For such families, child mental health professionals are uniquely suited to play a further role in research and treatment.

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

    PubMed

    Schnabl, Dagmar

    2015-01-01

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

  3. White matter fiber compromise contributes differentially to attention and emotion processing impairment in alcoholism, HIV-infection, and their comorbidity.

    PubMed

    Schulte, T; Müller-Oehring, E M; Sullivan, E V; Pfefferbaum, A

    2012-10-01

    Alcoholism (ALC) and HIV-1 infection (HIV) each affects emotional and attentional processes and integrity of brain white matter fibers likely contributing to functional compromise. The highly prevalent ALC+HIV comorbidity may exacerbate compromise. We used diffusion tensor imaging (DTI) and an emotional Stroop Match-to-Sample task in 19 ALC, 16 HIV, 15 ALC+HIV, and 15 control participants to investigate whether disruption of fiber system integrity accounts for compromised attentional and emotional processing. The task required matching a cue color to that of an emotional word with faces appearing between the color cue and the Stroop word in half of the trials. Nonmatched cue-word color pairs assessed selective attention, and face-word pairs assessed emotion. Relative to controls, DTI-based fiber tracking revealed lower inferior longitudinal fasciculus (ilf) integrity in HIV and ALC+HIV and lower uncinate fasciculus (uf) integrity in all three patient groups. Controls exhibited Stroop effects to positive face-word emotion, and greater interference was related to greater callosal, cingulum and ilf integrity. By contrast, HIV showed greater interference from negative Stroop words during color-nonmatch trials, correlating with greater uf compromise. For face trials, ALC and ALC+HIV showed greater Stroop-word interference, correlating with lower cingulate and callosal integrity. Thus, in HIV, conflict resolution was diminished when challenging conditions usurped resources needed to manage interference from negative emotion and to disengage attention from wrongly cued colors (nonmatch). In ALC and ALC+HIV, poorer callosal integrity was related to enhanced emotional interference suggesting curtailed interhemispheric exchange needed between preferentially right-hemispheric emotion and left-hemispheric Stroop-word functions.

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

    PubMed

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

    2012-08-01

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

  5. Chronic opioid therapy for nonmalignant pain: the patient's perspective. Part I--life before and after opioid therapy.

    PubMed

    Vallerand, April; Nowak, Luann

    2009-09-01

    Prescription of opioid analgesics for managing chronic nonmalignant pain is a highly debated treatment modality. Although opioid therapy has been shown to decrease pain intensity, improve quality of life, and enhance functioning for adults with pain, opioids are rarely used as a long-term treatment option. Limited qualitative research exists that reflects patients' perspectives regarding life with chronic nonmalignant pain. This paper reports the results of a phenomenologic study that investigated the experience of 22 adults receiving opioid therapy for chronic nonmalignant pain. Themes that emerged regarding life before and after treatment with opioid therapy are discussed in part 1 of this two-part series. Life before treatment with opioids was characterized by desperation and inability to function. Life after treatment with opioids was characterized by balancing, living a secret life, fear of losing the pain management regimen, and thankfulness for a life regained. Overall, the data reflected the fact that these individuals trade the incapacitation of chronic pain for secrecy to regain their life and improve their functional capacity and ability to perform self-care. Awareness of the life-enhancing benefits of opioid therapy in adults with chronic nonmalignant pain will enable clinicians to intervene appropriately and to act as advocates on behalf of adults using chronic opioid therapy.

  6. International stem cell tourism and the need for effective regulation. Part II: Developing sound oversight measures and effective patient support.

    PubMed

    Cohen, Cynthia B; Cohen, Peter J

    2010-09-01

    Part I of this article, published in the March 2010 issue of the Kennedy Institute of Ethics Journal, traces and addresses the provision of unproven stem cell treatments in Russia and India, examines the concept of innovative treatment, and concludes that stronger regulations are needed to protect the health and informed choices of patients. The current paper, Part II, proposes that the regulatory frameworks for the development of safe and efficacious treatments in effect in the United States and the United Kingdom provide examples of strong oversight measures from which countries seeking to obtain international credibility for their biotechnological competence could draw when developing regulations for stem cell treatments. Major sources of information available to persons who consider receiving such unproven treatments are explored in order to understand and address their concerns. The paper concludes with proposed measures to inform those considering the pursuit of unproven stem cell treatments abroad more accurately about their efficacy and safety and provide them with improved medical and social support in their home countries.

  7. Orthodontic treatment for the TMJ patient following splint therapy to stabilize a displaced disk(s): a systemized approach. Part I, TMJ orthodontic diagnosis.

    PubMed

    Brenkert, Dennis R

    2010-07-01

    Orthodontic treatment for a patient who has had a displaced disk or disks and has been stabilized by anterior repositioning splint therapy presents the dentist with a difficult orthodontic problem. Frequently, there is a posterior open bite present, with the anterior teeth only occluding in the stabilized TMJ position upon removal of the splint. The current articles (Part I of II presented here) will present an organized TMJ/orthodontic diagnosis (Part I) and orthodontic treatment method (Part II, to be presented in the next journal) to properly treat these patients to a consistent stabilized occlusion compatible with the TMJ splint stabilized position.

  8. Orthodontic treatment for the TMJ patient following splint therapy to stabilize a displaced disk(s): a systemized approach. Part II.

    PubMed

    Brenkert, Dennis R

    2010-10-01

    Orthodontic treatment for a patient who has had a displaced disk or disks and has been stabilized by anterior repositioning splint therapy presents the dentist with a difficult orthodontic problem. Frequently, there is a posterior open bite present, with the anterior teeth only occluding in the stabilized TMJ position upon removal of the splint. The current articles (Part II of II presented here) will present an organized TMJ/orthodontic diagnosis [Part I, J Craniomandib Pract2010; 28(3):193-199] and orthodontic treatment method (Part II) to properly treat these patients to a consistent stabilized occlusion compatible with the TMJ splint stabilized position.

  9. 10 CFR 15.41 - When a claim may be compromised.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 10 Energy 1 2012-01-01 2012-01-01 false When a claim may be compromised. 15.41 Section 15.41 Energy NUCLEAR REGULATORY COMMISSION DEBT COLLECTION PROCEDURES Compromise of a Claim § 15.41 When a... principal balance of a debt, exclusive of interest, penalties, and administrative costs, exceeds $100,000...

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

    ERIC Educational Resources Information Center

    Creed, Peter A.; Blume, Kellie

    2013-01-01

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

  11. 20 CFR 340.14 - Factors due to be considered in a compromise.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 20 Employees' Benefits 1 2011-04-01 2011-04-01 false Factors due to be considered in a compromise. 340.14 Section 340.14 Employees' Benefits RAILROAD RETIREMENT BOARD REGULATIONS UNDER THE RAILROAD UNEMPLOYMENT INSURANCE ACT RECOVERY OF BENEFITS § 340.14 Factors due to be considered in a compromise....

  12. 28 CFR Appendix to Subpart Y of... - Redelegations of Authority To Compromise and Close Civil Claims

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    .... Environment and Natural Resources Division Redelegation Of Authority To Initiate And To Compromise Environment and Natural Resources Division Cases This directive supersedes Land and Natural Resources Memorandum... with, and to compromise, Environment and Natural Resources Division cases: Section I—Authority...

  13. 28 CFR Appendix to Subpart Y of... - Redelegations of Authority To Compromise and Close Civil Claims

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    .... Environment and Natural Resources Division Redelegation Of Authority To Initiate And To Compromise Environment and Natural Resources Division Cases This directive supersedes Land and Natural Resources Memorandum... with, and to compromise, Environment and Natural Resources Division cases: Section I—Authority...

  14. 28 CFR Appendix to Subpart Y of... - Redelegations of Authority To Compromise and Close Civil Claims

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    .... Environment and Natural Resources Division Redelegation Of Authority To Initiate And To Compromise Environment and Natural Resources Division Cases This directive supersedes Land and Natural Resources Memorandum... with, and to compromise, Environment and Natural Resources Division cases: Section I—Authority...

  15. 28 CFR Appendix to Subpart Y of... - Redelegations of Authority To Compromise and Close Civil Claims

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    .... Environment and Natural Resources Division Redelegation Of Authority To Initiate And To Compromise Environment and Natural Resources Division Cases This directive supersedes Land and Natural Resources Memorandum... with, and to compromise, Environment and Natural Resources Division cases: Section I—Authority...

  16. 22 CFR 304.7 - Authority to adjust, determine, compromise, and settle claims.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 22 Foreign Relations 2 2014-04-01 2014-04-01 false Authority to adjust, determine, compromise, and settle claims. 304.7 Section 304.7 Foreign Relations PEACE CORPS CLAIMS AGAINST GOVERNMENT UNDER FEDERAL... the Peace Corps retains authority to consider, ascertain, adjust, determine, compromise and...

  17. 22 CFR 304.7 - Authority to adjust, determine, compromise, and settle claims.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 22 Foreign Relations 2 2011-04-01 2009-04-01 true Authority to adjust, determine, compromise, and settle claims. 304.7 Section 304.7 Foreign Relations PEACE CORPS CLAIMS AGAINST GOVERNMENT UNDER FEDERAL... the Peace Corps retains authority to consider, ascertain, adjust, determine, compromise and...

  18. 22 CFR 304.7 - Authority to adjust, determine, compromise, and settle claims.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 22 Foreign Relations 2 2013-04-01 2009-04-01 true Authority to adjust, determine, compromise, and settle claims. 304.7 Section 304.7 Foreign Relations PEACE CORPS CLAIMS AGAINST GOVERNMENT UNDER FEDERAL... the Peace Corps retains authority to consider, ascertain, adjust, determine, compromise and...

  19. 22 CFR 304.7 - Authority to adjust, determine, compromise, and settle claims.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 22 Foreign Relations 2 2012-04-01 2009-04-01 true Authority to adjust, determine, compromise, and settle claims. 304.7 Section 304.7 Foreign Relations PEACE CORPS CLAIMS AGAINST GOVERNMENT UNDER FEDERAL... the Peace Corps retains authority to consider, ascertain, adjust, determine, compromise and...

  20. 22 CFR 304.7 - Authority to adjust, determine, compromise, and settle claims.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 22 Foreign Relations 2 2010-04-01 2010-04-01 true Authority to adjust, determine, compromise, and settle claims. 304.7 Section 304.7 Foreign Relations PEACE CORPS CLAIMS AGAINST GOVERNMENT UNDER FEDERAL... the Peace Corps retains authority to consider, ascertain, adjust, determine, compromise and...

  1. 48 CFR 239.7102-2 - Compromising emanations-TEMPEST or other standard.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... INFORMATION TECHNOLOGY Security and Privacy for Computer Systems 239.7102-2 Compromising emanations—TEMPEST or... 48 Federal Acquisition Regulations System 3 2010-10-01 2010-10-01 false Compromising emanations-TEMPEST or other standard. 239.7102-2 Section 239.7102-2 Federal Acquisition Regulations System...

  2. 32 CFR 2001.48 - Loss, possible compromise or unauthorized disclosure.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 32 National Defense 6 2012-07-01 2012-07-01 false Loss, possible compromise or unauthorized disclosure. 2001.48 Section 2001.48 National Defense Other Regulations Relating to National Defense... SECURITY INFORMATION Safeguarding § 2001.48 Loss, possible compromise or unauthorized disclosure....

  3. 32 CFR 2001.48 - Loss, possible compromise or unauthorized disclosure.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 32 National Defense 6 2013-07-01 2013-07-01 false Loss, possible compromise or unauthorized disclosure. 2001.48 Section 2001.48 National Defense Other Regulations Relating to National Defense... SECURITY INFORMATION Safeguarding § 2001.48 Loss, possible compromise or unauthorized disclosure....

  4. 32 CFR 2001.48 - Loss, possible compromise or unauthorized disclosure.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 32 National Defense 6 2014-07-01 2014-07-01 false Loss, possible compromise or unauthorized disclosure. 2001.48 Section 2001.48 National Defense Other Regulations Relating to National Defense... SECURITY INFORMATION Safeguarding § 2001.48 Loss, possible compromise or unauthorized disclosure....

  5. 27 CFR 70.484 - Offers in compromise of forfeiture liabilities.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... proponent is notified of the acceptance or rejection of the offer. If the offer is rejected, the sum... is notified and the case is closed. Acceptance of an offer in compromise of civil liabilities does not remit criminal liabilities, nor does acceptance of an offer in compromise of criminal...

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

    PubMed Central

    2010-01-01

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

  7. Clavicle fracture with thoracic penetration and hemopneumothorax but without neurovascular compromise.

    PubMed

    Tjoumakaris, Fotios P; Matzon, Jonas L; Williams, Gerald R

    2011-10-05

    Clavicle fractures are rarely associated with more severe neurologic or vascular injuries. When these associated injuries are encountered, prompt recognition and treatment are paramount to optimize outcome. The majority of fractures that result in neurovascular compromise are from high-energy trauma; however, a high index of suspicion should be present in all cases as low-energy trauma can also result in more catastrophic injury. This article describes a case of a low-energy clavicle fracture in a 28-year-old woman that resulted in intrathoracic penetration of the fracture fragment with hemopneumothorax. The patient underwent successful chest tube placement and open reduction and internal fixation of the fracture. A multidisciplinary team was used during surgery, including cardiothoracic, trauma, and orthopedic surgery. Two years postoperatively, the patient was back to normal activities with no neurologic, pulmonary, or vascular sequelae. This case highlights the importance of a comprehensive physical examination and inspection of all radiographs so that associated injuries are not missed.

  8. Contralateral Abdominal Pocketing in Salvation of Replanted Fingertips with Compromised Circulation

    PubMed Central

    Shim, Hyung-Sup; Kim, Dong-Hwi; Kwon, Ho; Jung, Sung-No

    2014-01-01

    Abdominal pocketing is one of the most useful methods in salvation of compromised replanted fingertips. Abdominal pocketing has generally been performed in the ipsilateral lower abdominal quadrant, but we have also performed contralateral pocketing at our institute. To determine which approach is more beneficial, a total of 40 patients underwent an abdominal pocketing procedure in either the ipsilateral or contralateral lower abdominal quadrant after fingertip replantation. Dates of abdominal pocketing after initial replantation, detachment after abdominal pocketing, range of motion (ROM) before abdominal pocketing, and sequential ROM after the detachment operation and date of full ROM recovery and Disabilities of Arm, Shoulder, and Hand questionnaire (DASH) score were recorded through medical chart review. Mean detachment date, mean abduction of shoulder after the detachment operation, and mean days to return to full ROM were not significantly different between the ipsilateral and contralateral pocketing groups. However, the mean DASH score was significantly lower in the contralateral group than the ipsilateral group. There were also fewer postoperative wound complications in the contralateral group than in the ipsilateral group. We, therefore, recommend contralateral abdominal pocketing rather than ipsilateral abdominal pocketing to increase patient comfort and reduce pain and complications. PMID:25379539

  9. Contralateral abdominal pocketing in salvation of replanted fingertips with compromised circulation.

    PubMed

    Shim, Hyung-Sup; Kim, Dong-Hwi; Kwon, Ho; Jung, Sung-No

    2014-01-01

    Abdominal pocketing is one of the most useful methods in salvation of compromised replanted fingertips. Abdominal pocketing has generally been performed in the ipsilateral lower abdominal quadrant, but we have also performed contralateral pocketing at our institute. To determine which approach is more beneficial, a total of 40 patients underwent an abdominal pocketing procedure in either the ipsilateral or contralateral lower abdominal quadrant after fingertip replantation. Dates of abdominal pocketing after initial replantation, detachment after abdominal pocketing, range of motion (ROM) before abdominal pocketing, and sequential ROM after the detachment operation and date of full ROM recovery and Disabilities of Arm, Shoulder, and Hand questionnaire (DASH) score were recorded through medical chart review. Mean detachment date, mean abduction of shoulder after the detachment operation, and mean days to return to full ROM were not significantly different between the ipsilateral and contralateral pocketing groups. However, the mean DASH score was significantly lower in the contralateral group than the ipsilateral group. There were also fewer postoperative wound complications in the contralateral group than in the ipsilateral group. We, therefore, recommend contralateral abdominal pocketing rather than ipsilateral abdominal pocketing to increase patient comfort and reduce pain and complications.

  10. Identification of hemodynamically compromised regions by means of cerebral blood volume mapping utilizing computed tomography perfusion imaging.

    PubMed

    Takahashi, Satoshi; Tanizaki, Yoshio; Akaji, Kazunori; Kimura, Hiroaki; Katano, Takehiro; Suzuki, Kentaro; Mochizuki, Yoichi; Shidoh, Satoka; Nakazawa, Masaki; Yoshida, Kazunari; Mihara, Ban

    2017-04-01

    The aim of the study was to evaluate the potential role of computed tomography perfusion (CTP) imaging in identifying hemodynamically compromised regions in patients with occlusive cerebrovascular disease. Twelve patients diagnosed with either occlusion or severe stenosis of the internal carotid artery or the M1 portion of the middle cerebral artery underwent CTP imaging. The data was analyzed by an automated ROI-determining software. Patients were classified into two subgroups: an asymptomatic group consisting of three patients in whom perfusion pressure distal to the site of occlusion/stenosis (PPdis) could be maintained in spite of the arterial occlusion/stenosis, and a symptomatic group consisting of nine patients in whom PPdis could not be maintained enough to avoid watershed infarction. Four CTP-related parameters were independently compared between the two groups. Significant differences were determined using a two-sample t-test. When statistically significant differences were identified, cut-off points were calculated using ROC curves. Analysis revealed statistically significant differences between the asymptomatic and symptomatic subgroups only in the measure of relCBV (p=0.028). Higher relCBV values were observed in the symptomatic subgroup. ROC curve analysis revealed 1.059 to be the optimal relCBV cut-off value for distinguishing between the asymptomatic and symptomatic subgroups. The data revealed that, in patients whose PPdis is maintained, relCBV remains around 1.00. Conversely, in patients whose PPdis decreased, relCBV increased. From these findings, we conclude that elevation of relCBV as observed using CTP imaging accurately reflects the extent of compensatory vasodilatation involvement and can identify hemodynamically compromised regions.

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

    PubMed Central

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

    2016-01-01

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

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

    PubMed

    Cochrane, Sally

    2014-09-01

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

  13. Estimating Treatment and Treatment Times for Special and Nonspecial Patients in Hospital Ambulatory Dental Clinics.

    ERIC Educational Resources Information Center

    Rosenberg, Dara J.; And Others

    1986-01-01

    A study compared the treatments and the amount of time needed for treatment of the dental needs of developmentally disabled, severely compromised, and moderately compromised patients with those of nondisabled patients in a hospital ambulatory dental clinic. (MSE)

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

    SciTech Connect

    Wang, Ruoxing; Guo, Yan-Lin

    2012-10-01

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

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

    PubMed Central

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

    2015-01-01

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

  16. Inflammation-induced desmoglein-2 ectodomain shedding compromises the mucosal barrier

    PubMed Central

    Kamekura, Ryuta; Nava, Porfirio; Feng, Mingli; Quiros, Miguel; Nishio, Hikaru; Weber, Dominique A.; Parkos, Charles A.; Nusrat, Asma

    2015-01-01

    Desmosomal cadherins mediate intercellular adhesion and control epithelial homeostasis. Recent studies show that proteinases play an important role in the pathobiology of cancer by targeting epithelial intercellular junction proteins such as cadherins. Here we describe the proinflammatory cytokine-induced activation of matrix metalloproteinase 9 and a disintegrin and metalloproteinase domain–containing protein 10, which promote the shedding of desmosomal cadherin desmoglein-2 (Dsg2) ectodomains in intestinal epithelial cells. Epithelial exposure to Dsg2 ectodomains compromises intercellular adhesion by promoting the relocalization of endogenous Dsg2 and E-cadherin from the plasma membrane while also promoting proliferation by activation of human epidermal growth factor receptor 2/3 signaling. Cadherin ectodomains were detected in the inflamed intestinal mucosa of mice with colitis and patients with ulcerative colitis. Taken together, our findings reveal a novel response pathway in which inflammation-induced modification of columnar epithelial cell cadherins decreases intercellular adhesion while enhancing cellular proliferation, which may serve as a compensatory mechanism to promote repair. PMID:26224314

  17. Generation of DNA single-strand displacement by compromised nucleotide excision repair

    PubMed Central

    Godon, Camille; Mourgues, Sophie; Nonnekens, Julie; Mourcet, Amandine; Coin, Fréderic; Vermeulen, Wim; Mari, Pierre-Olivier; Giglia-Mari, Giuseppina

    2012-01-01

    Nucleotide excision repair (NER) is a precisely coordinated process essential to avoid DNA damage-induced cellular malfunction and mutagenesis. Here, we investigate the mechanistic details and effects of the NER machinery when it is compromised by a pathologically significant mutation in a subunit of the repair/transcription factor TFIIH, namely XPD. In contrast to previous studies, we find that no single- or double-strand DNA breaks are produced at early time points after UV irradiation of cells bearing a specific XPD mutation, despite the presence of a clear histone H2AX phosphorylation (γH2AX) signal in the UV-exposed areas. We show that the observed γH2AX signal can be explained by the presence of longer single-strand gaps possibly generated by strand displacement. Our in vivo measurements also indicate a strongly reduced TFIIH-XPG binding that could promote single-strand displacement at the site of UV lesions. This finding not only highlights the crucial role of XPG's interactions with TFIIH for proper NER, but also sheds new light on how a faulty DNA repair process can induce extreme genomic instability in human patients. PMID:22863773

  18. Chronic Temporomandibular Disorder Is Not Necessarily Associated with a Compromised Endogenous Analgesic System

    PubMed Central

    Garrett, Pauline H.; Sarlani, Eleni; Grace, Edward G.; Greenspan, Joel D.

    2015-01-01

    Aims Our previous work demonstrated that women with temporomandibular disorder (TMD) exhibit enhanced temporal summation of pain upon repetitive mechanical stimulation of the fingers, compared to healthy controls, suggestive of widespread up regulated central nociceptive processing in this patient population. The current study asks whether TMD case-control differences in Conditioned Pain Modulation (CPM) exist, using a mechanically evoked Temporal Summation (TS) model. Methods A series of 10 repetitive, mildly noxious, mechanical stimuli were applied to the fingers of 30 TMD women and 30 age-matched healthy women. The subjects rated the pain intensity caused by the 1st, 5th and 10th stimulus in the train. To evaluate CPM, the same series of mechanical stimulations were applied with concomitant exposure of the other hand to a painfully cold water bath. Results Pain ratings increased significantly with stimulus repetition (p<0.01) and CPM significantly reduced TS of pain (p<0.01). Of particular note, both groups showed very similar degrees of CPM, with no significant group difference. Conclusion Painful TMD is not necessarily associated with a compromised ability to engage the endogenous analgesic system in an experimental setting. PMID:23630686

  19. Fatal systemic candidiasis of gastrointestinal origin: an experimental model in mice compromised by anti-cancer treatment.

    PubMed

    Sandovsky-Losica, H; Barr-Nea, L; Segal, E

    1992-01-01

    An experimental model of fatal systemic candidiasis originating from the gastrointestinal (GI) tract of compromised mice is presented. ICR female mice were compromised by a single anti-cancer treatment: irradiation (4 or 6 Greys i.e. 400-600 rads), methotrexate (MTX) (3 mg per mouse, intraperitoneally) or 5-fluorouracil (5FU) (200 mg kg-1, intravenously). Three days later, compromised and non-treated control mice were exposed to Candida albicans administered orally. Morbidity and mortality due to candidiasis were monitored for 30 days post-candidal inoculation. Increased and longer GI colonization was noted among the MTX and 5FU treated mice, or 6 Greys irradiated mice (up to 92.3% for over 30 days in anti-cancer treated mice). The stomach was found to be the major part of the GI tract involved in fungal colonization. A significant number (53.8-83.3%) of the anti-cancer treated mice developed systemic candidiasis originating from the GI tract, which was fatal in 30-80% of the infected animals. In systemically infected animals, candidal antigen was demonstrated in the serum, and fungal abscesses containing C. albicans were observed in the liver, kidneys and spleen. C. albicans was isolated from the infected organs. The severity of the infection, as reflected by the number of fungi in visceral organs, and by mortality during the 30 days post-candidal inoculation, indicated differences in the course and nature of the infection among the three treatment groups (i.e. MTX, 5FU, 6 Greys).(ABSTRACT TRUNCATED AT 250 WORDS)

  20. [Results of comprehensive management of patients with chronic lower limb ischaemia using gene-engineering technologies of angiogenesis stimulation (Part 1)].

    PubMed

    Gavrilenko, A V; Voronov, D A

    2015-01-01

    Presented herein are the results of clinical use of gene engineering methods of stimulating angiogenesis in patients with chronic lower limb ischaemia. An open prospective controlled clinical study included a total of 160 patients with chronic lower limb ischaemia. Gene engineering technologies of angiogenesis stimulation were used both as an independent method of treatment in comprehensive conservative therapy (80 patients) and as comprehensive treatment in combination with revascularizing operations (80 patients). Part One of the article deals with the results outcomes of using the above technologies in combination combined with surgical treatment. It was shown that gene-engineering technologies of angiogenesis stimulation increase efficiency of comprehensive management of patients with lower limb chronic ischaemia of any severity. Additional use of gene-engineering methods of inducing angiogenesis does not virtually change the immediate outcomes of surgical treatment but considerably increase their efficacy in the remote postoperative period and accordingly improves the long-term results of treatment for this cohort of patients.

  1. 7 CFR 1956.68 - Compromise or adjustment without debtor's signature.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... HOUSING SERVICE, RURAL BUSINESS-COOPERATIVE SERVICE, RURAL UTILITIES SERVICE, AND FARM SERVICE AGENCY... Loan Programs and Multi-Family Housing § 1956.68 Compromise or adjustment without debtor's...

  2. 32 CFR 2001.48 - Loss, possible compromise or unauthorized disclosure.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... governments normally will not be advised of any security system vulnerabilities that contributed to the... INFORMATION SECURITY OVERSIGHT OFFICE, NATIONAL ARCHIVES AND RECORDS ADMINISTRATION CLASSIFIED NATIONAL SECURITY INFORMATION Safeguarding § 2001.48 Loss, possible compromise or unauthorized disclosure....

  3. 45 CFR 608.2 - Collection, compromise, and use of consumer reporting agencies.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ...) NATIONAL SCIENCE FOUNDATION CLAIMS COLLECTION AND ADMINISTRATIVE OFFSET § 608.2 Collection, compromise, and... briefly describing the nature of the review performed and the conclusion reached shall be made....

  4. 45 CFR 608.2 - Collection, compromise, and use of consumer reporting agencies.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ...) NATIONAL SCIENCE FOUNDATION CLAIMS COLLECTION AND ADMINISTRATIVE OFFSET § 608.2 Collection, compromise, and... briefly describing the nature of the review performed and the conclusion reached shall be made....

  5. Neurostimulation for primary headache disorders: Part 2, review of central neurostimulators for primary headache, overall therapeutic efficacy, safety, cost, patient selection, and future research in headache neuromodulation.

    PubMed

    Jenkins, Brian; Tepper, Stewart J

    2011-10-01

    This article is the second of 2 articles reviewing neurostimulation for primary headaches. In Part 1, we described methods, pathophysiology and anatomy, and history of neuromodulation in the treatment of headache, as well as reviewing the literature on peripheral neuromodulation for primary headaches. Peripheral targets for stimulation include percutaneous nerves, transcranial holocephalic, occipital nerves, auriculotemporal nerves, supraorbital nerves, cervical epidural, and sphenopalatine ganglia. In Part 2, we describe available literature on central neuromodulation in primary headaches. Central stimulation targets include vagus nerve and deep brain structures. Part 2 also analyzes overall therapeutic efficacy, safety, cost, patient selection, and recommendations for further research of neurostimulation modalities based on available data.

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

    SciTech Connect

    Koukourakis, Michael I.

    2015-05-29

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

  7. Compromised trabecular microarchitecture and lower finite element estimates of radius and tibia bone strength in adults with turner syndrome: a cross-sectional study using high-resolution-pQCT.

    PubMed

    Hansen, Stinus; Brixen, Kim; Gravholt, Claus H

    2012-08-01

    Although bone mass appear ample for bone size in Turner syndrome (TS), epidemiological studies have reported an increased risk of fracture in TS. We used high-resolution peripheral quantitative computed tomography (HR-pQCT) to measure standard morphological parameters of bone geometry and microarchitecture, as well as estimated bone strength by finite element analysis (FEA) to assess bone characteristics beyond bone mineral density (BMD) that possibly contribute to the increased risk of fracture. Thirty-two TS patients (median age 35, range 20-61 years) and 32 healthy control subjects (median age 36, range 19-58 years) matched with the TS participants with respect to age and body-mass index were studied. A full region of interest (ROI) image analysis and a height-matched ROI analysis adjusting for differences in body height between groups were performed. Mean bone cross-sectional area was lower in TS patients in radius (-15%) and tibia (-13%) (both p < 0.01) whereas cortical thickness was higher in TS patients in radius (18%, p < 0.01) but not in tibia compared to controls. Cortical porosity was lower in TS patients at both sites (-32% in radius, -36% in tibia, both p < 0.0001). Trabecular integrity was compromised in TS patients with lower bone volume per tissue volume (BV/TV) (-27% in radius, -22% in tibia, both p < 0.0001), trabecular number (-27% in radius, -12% in tibia, both p < 0.05), and higher trabecular spacing (54% in radius, 23% in tibia, both p < 0.01). In the height-matched ROI analysis, differences remained significant apart from total area at both sites, cortical thickness in radius, and trabecular number in tibia. FEA estimated failure load was lower in TS patients in both radius (-11%) and tibia (-16%) (both p < 0.01) and remained significantly lower in the height-matched ROI analysis. Conclusively, TS patients had compromised trabecular microarchitecture and lower bone strength at both skeletal sites, which may partly

  8. Combating QR-Code-Based Compromised Accounts in Mobile Social Networks

    PubMed Central

    Guo, Dong; Cao, Jian; Wang, Xiaoqi; Fu, Qiang; Li, Qiang

    2016-01-01

    Cyber Physical Social Sensing makes mobile social networks (MSNs) popular with users. However, such attacks are rampant as malicious URLs are spread covertly through quick response (QR) codes to control compromised accounts in MSNs to propagate malicious messages. Currently, there are generally two types of methods to identify compromised accounts in MSNs: one type is to analyze the potential threats on wireless access points and the potential threats on handheld devices’ operation systems so as to stop compromised accounts from spreading malicious messages; the other type is to apply the method of detecting compromised accounts in online social networks to MSNs. The above types of methods above focus neither on the problems of MSNs themselves nor on the interaction of sensors’ messages, which leads to the restrictiveness of platforms and the simplification of methods. In order to stop the spreading of compromised accounts in MSNs effectively, the attacks have to be traced to their sources first. Through sensors, users exchange information in MSNs and acquire information by scanning QR codes. Therefore, analyzing the traces of sensor-related information helps to identify the compromised accounts in MSNs. This paper analyzes the diversity of information sending modes of compromised accounts and normal accounts, analyzes the regularity of GPS (Global Positioning System)-based location information, and introduces the concepts of entropy and conditional entropy so as to construct an entropy-based model based on machine learning strategies. To achieve the goal, about 500,000 accounts of Sina Weibo and about 100 million corresponding messages are collected. Through the validation, the accuracy rate of the model is proved to be as high as 87.6%, and the false positive rate is only 3.7%. Meanwhile, the comparative experiments of the feature sets prove that sensor-based location information can be applied to detect the compromised accounts in MSNs. PMID:27657071

  9. Combating QR-Code-Based Compromised Accounts in Mobile Social Networks.

    PubMed

    Guo, Dong; Cao, Jian; Wang, Xiaoqi; Fu, Qiang; Li, Qiang

    2016-09-20

    Cyber Physical Social Sensing makes mobile social networks (MSNs) popular with users. However, such attacks are rampant as malicious URLs are spread covertly through quick response (QR) codes to control compromised accounts in MSNs to propagate malicious messages. Currently, there are generally two types of methods to identify compromised accounts in MSNs: one type is to analyze the potential threats on wireless access points and the potential threats on handheld devices' operation systems so as to stop compromised accounts from spreading malicious messages; the other type is to apply the method of detecting compromised accounts in online social networks to MSNs. The above types of methods above focus neither on the problems of MSNs themselves nor on the interaction of sensors' messages, which leads to the restrictiveness of platforms and the simplification of methods. In order to stop the spreading of compromised accounts in MSNs effectively, the attacks have to be traced to their sources first. Through sensors, users exchange information in MSNs and acquire information by scanning QR codes. Therefore, analyzing the traces of sensor-related information helps to identify the compromised accounts in MSNs. This paper analyzes the diversity of information sending modes of compromised accounts and normal accounts, analyzes the regularity of GPS (Global Positioning System)-based location information, and introduces the concepts of entropy and conditional entropy so as to construct an entropy-based model based on machine learning strategies. To achieve the goal, about 500,000 accounts of Sina Weibo and about 100 million corresponding messages are collected. Through the validation, the accuracy rate of the model is proved to be as high as 87.6%, and the false positive rate is only 3.7%. Meanwhile, the comparative experiments of the feature sets prove that sensor-based location information can be applied to detect the compromised accounts in MSNs.

  10. Platelet Transfusion – the Art and Science of Compromise

    PubMed Central

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

    2013-01-01

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

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

    PubMed

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

    2014-06-01

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

  12. Postconcussional disorder and PTSD symptoms of military-related traumatic brain injury associated with compromised neurocircuitry.

    PubMed

    Yeh, Ping-Hong; Wang, Binquan; Oakes, Terrence R; French, Louis M; Pan, Hai; Graner, John; Liu, Wei; Riedy, Gerard

    2014-06-01

    Traumatic brain injury (TBI) is a common combat injury, often through explosive blast, and produces heterogeneous brain changes due to various mechanisms of injury. It is unclear whether the vulnerability of white matter differs between blast and impact injury, and the consequences of microstructural changes on neuropsychological function are poorly understood in military TBI patients. Diffusion tensor imaging (DTI) techniques were used to assess the neurocircuitry in 37 U.S. service members (29 mild, 7 moderate, 1 severe; 17 blast and 20 nonblast), who sustained a TBI while deployed, compared to 14 nondeployed, military controls. High-dimensional deformable registration of MRI diffusion tensor data was followed by fiber tracking and tract-specific analysis along with region-of-interest analysis. DTI results were examined in relation to post-concussion and post-traumatic stress disorder (PTSD) symptoms. The most prominent white matter microstructural injury for both blast and nonblast patients was in the frontal fibers within the fronto-striatal (corona radiata, internal capsule) and fronto-limbic circuits (fornix, cingulum), the fronto-parieto-occipital association fibers, in brainstem fibers, and in callosal fibers. Subcortical superior-inferiorly oriented tracts were more vulnerable to blast injury than nonblast injury, while direct impact force had more detrimental effects on anterior-posteriorly oriented tracts, which tended to cause heterogeneous left and right hemispheric asymmetries of white matter connectivity. The tractography using diffusion anisotropy deficits revealed the cortico-striatal-thalamic-cerebellar-cortical (CSTCC) networks, where increased post-concussion and PTSD symptoms were associated with low fractional anisotropy in the major nodes of compromised CSTCC neurocircuitry, and the consequences on cognitive function were explored as well.

  13. GGGGCC repeat expansion in C9orf72 compromises nucleocytoplasmic transport.

    PubMed

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

    2015-09-03

    The GGGGCC (G4C2) repeat expansion in a noncoding region of C9orf72 is the most common cause of sporadic and familial forms of amyotrophic lateral sclerosis and frontotemporal dementia. The basis for pathogenesis is unknown. To elucidate the consequences of G4C2 repeat expansion in a tractable genetic system, we generated transgenic fly lines expressing 8, 28 or 58 G4C2-repeat-containing transcripts that do not have a translation start site (AUG) but contain an open-reading frame for green fluorescent protein to detect repeat-associated non-AUG (RAN) translation. We show that these transgenic animals display dosage-dependent, repeat-length-dependent degeneration in neuronal tissues and RAN translation of dipeptide repeat (DPR) proteins, as observed in patients with C9orf72-related disease. This model was used in a large-scale, unbiased genetic screen, ultimately leading to the identification of 18 genetic modifiers that encode components of the nuclear pore complex (NPC), as well as the machinery that coordinates the export of nuclear RNA and the import of nuclear proteins. Consistent with these results, we found morphological abnormalities in the architecture of the nuclear envelope in cells expressing expanded G4C2 repeats in vitro and in vivo. Moreover, we identified a substantial defect in RNA export resulting in retention of RNA in the nuclei of Drosophila cells expressing expanded G4C2 repeats and also in mammalian cells, including aged induced pluripotent stem-cell-derived neurons from patients with C9orf72-related disease. These studies show that a primary consequence of G4C2 repeat expansion is the compromise of nucleocytoplasmic transport through the nuclear pore, revealing a novel mechanism of neurodegeneration.

  14. Sustained NMDA receptor hypofunction induces compromised neural systems integration and schizophrenia-like alterations in functional brain networks.

    PubMed

    Dawson, Neil; Xiao, Xiaolin; McDonald, Martin; Higham, Desmond J; Morris, Brian J; Pratt, Judith A

    2014-02-01

    Compromised functional integration between cerebral subsystems and dysfunctional brain network organization may underlie the neurocognitive deficits seen in psychiatric disorders. Applying topological measures from network science to brain imaging data allows the quantification of complex brain network connectivity. While this approach has recently been used to further elucidate the nature of brain dysfunction in schizophrenia, the value of applying this approach in preclinical models of psychiatric disease has not been recognized. For the first time, we apply both established and recently derived algorithms from network science (graph theory) to functional brain imaging data from rats treated subchronically with the N-methyl-D-aspartic acid (NMDA) receptor antagonist phencyclidine (PCP). We show that subchronic PCP treatment induces alterations in the global properties of functional brain networks akin to those reported in schizophrenia. Furthermore, we show that subchronic PCP treatment induces compromised functional integration between distributed neural systems, including between the prefrontal cortex and hippocampus, that have established roles in cognition through, in part, the promotion of thalamic dysconnectivity. We also show that subchronic PCP treatment promotes the functional disintegration of discrete cerebral subsystems and also alters the connectivity of neurotransmitter systems strongly implicated in schizophrenia. Therefore, we propose that sustained NMDA receptor hypofunction contributes to the pathophysiology of dysfunctional brain network organization in schizophrenia.

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

    PubMed

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

    2013-02-01

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

  16. Communication Tools for the Modern Doctor Bag. Physician Patient Communication Part 1: Beginning of a medical interview

    PubMed Central

    Kuehl, Sapna Patel

    2011-01-01

    Effective physician patient communication is essential to best practice in medicine. Good communication with patients is critical in making the right diagnosis, improving compliance and overall outcomes for our patients (as well as improving physician satisfaction.) Communication skills can be learned and need to be taught, practiced and given the same emphasis as other core competencies in medicine. The focus of this article is on the Calgary-Cambridge Model for physician patient communication in the context of a medical interview. The beginning of a patient encounter is discussed, with emphasis on appropriate introductions and attentive active listening. PMID:23882333

  17. Bedouin in Lebanon: Social discrimination, political exclusion, and compromised health care.

    PubMed

    Chatty, Dawn; Mansour, Nisrine; Yassin, Nasser

    2013-04-01

    Global inequalities in health have long been associated with disparities between rich and poor nations. The middle-income countries of the Levant (Lebanon, Syria and Jordan) have developed models of health care delivery that mirror the often complex make-up of their states. In Lebanon, which is characterized by political clientelism and sectarian structures, access to health care is more contingent on ethnicity and religious affiliation than on poverty. This case study of the Bedouin of the Middle Bekaa Valley of Lebanon is based on interviews with policymakers, health care providers and the Bedouin as part of a study funded by the European Commission between 2006 and 2010. The study explores the importance of considering social discrimination and political exclusion in understanding compromised health care. Three decades after the Declaration of Alma Ata (1978), which declared that an acceptable level of health care for all should be attained by the year 2000, the Bedouin community of Lebanon remains largely invisible to the government and, thus, invisible to national health care policy and practice. They experience significant social discrimination from health practitioners and policymakers alike. Their unfair treatment under the health system is generally disassociated from issues of wealth or poverty; it is manifested in issues of access and use, discrimination, and resistance and agency. Overcoming their political exclusion and recognizing the social discrimination they face are steps that can be taken to protect and promote equal access to basic reproductive and child health care. This case study of the Bedouin in Lebanon is also relevant to the health needs of other marginalized populations in remote and rural areas.

  18. Low self-esteem and psychiatric patients: Part II – The relationship between self-esteem and demographic factors and psychosocial stressors in psychiatric patients

    PubMed Central

    Salsali, Mahnaz; Silverstone, Peter H

    2003-01-01

    Background The objective of the present study was to identify the effects and relative importance of demographic factors and psychosocial stressors on self-esteem of psychiatric patients. Method The present study was carried out on a consecutive sample of 1,190 individuals attending an open-access psychiatric outpatient clinic. Patients were diagnosed according to DSM III-R diagnostic criteria following detailed assessments. At screening, patients and controls completed two self-esteem questionnaires, the Rosenberg self-esteem scale and the Janis and Field Social Adequacy scale. In addition, a large amount of demographic and psychosocial data was collected on all patients. Results Significantly increased self-esteem was observed with an increase in age, educational achievement and income. Employed patients showed significantly higher self-esteem compared to unemployed patients. Female patients had a significantly lower self-esteem compared to male patients. The self-esteem of psychiatric patients did not vary significantly with their marital status. No relationship was detected between acute stressors and the self-esteem of psychiatric patients, although severe enduring stressors were associated with lower self-esteem in psychiatric patients. Conclusion The results of this large study demonstrate that the self-esteem of adult psychiatric patients is affected by a number of demographic and psychosocial factors including age, sex, educational status, income, employment status, and enduring psychosocial stressors. PMID:12622872

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

    PubMed Central

    Srinath, Rashmi; Prakash, Shobha

    2016-01-01

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

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

    PubMed

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

    2016-04-01

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

  1. Choosing a particular oral anticoagulant and dose for stroke prevention in individual patients with non-valvular atrial fibrillation: part 1.

    PubMed

    Diener, Hans-Christoph; Aisenberg, James; Ansell, Jack; Atar, Dan; Breithardt, Günter; Eikelboom, John; Ezekowitz, Michael D; Granger, Christopher B; Halperin, Jonathan L; Hohnloser, Stefan H; Hylek, Elaine M; Kirchhof, Paulus; Lane, Deirdre A; Verheugt, Freek W A; Veltkamp, Roland; Lip, Gregory Y H

    2016-02-04

    Patients with atrial fibrillation (AF) have a high risk of stroke and mortality, which can be considerably reduced by oral anticoagulants (OAC). Recently, four non-vitamin-K oral anticoagulants (NOACs) were compared with warfarin in large randomized trials for the prevention of stroke and systemic embolism. Today's clinician is faced with the difficult task of selecting a suitable OAC for a patient with a particular clinical profile or a particular pattern of risk factors and concomitant diseases. We reviewed analyses of subgroups of patients from trials of vitamin K antagonists vs. NOACs for stroke prevention in AF with the aim to identify patient groups who might benefit from a particular OAC more than from another. In the first of a two-part review, we discuss the choice of NOAC for stroke prevention in the following subgroups of patients with AF: (i) stable coronary artery disease or peripheral artery disease, including percutaneous coronary intervention with stenting and triple therapy; (ii) cardioversion, ablation and anti-arrhythmic drug therapy; (iii) mechanical valves and rheumatic valve disease, (iv) patients with time in therapeutic range of >70% on warfarin; (v) patients with a single stroke risk factor (CHA2DS2VASc score of 1 in males, 2 in females); and (vi) patients with a single first episode of paroxysmal AF. Although there are no major differences in terms of efficacy and safety between the NOACs for some clinical scenarios, in others we are able to suggest that particular drugs and/or doses be prioritized for anticoagulation.

  2. Towards A Theory of Autonomous Reconstitution of Compromised Cyber-Systems

    SciTech Connect

    Ramuhalli, Pradeep; Halappanavar, Mahantesh; Coble, Jamie B.; Dixit, Mukul

    2013-11-12

    The ability to maintain mission-critical operations in cyber-systems in the face of disruptions is critical. Faults in cyber systems can come from accidental sources (e.g., natural failure of a component) or deliberate sources (e.g., an intelligent adversary). Natural and intentional manipulation of data, computing, or coordination are the most impactful ways that an attacker can prevent an infrastructure from realizing its mission goals. Under these conditions, the ability to reconstitute critical infrastructure becomes important. Specifically, the question is: Given an intelligent adversary, how can cyber systems respond to keep critical infrastructure operational? In cyber systems, the distributed nature of the system poses serious difficulties in maintaining operations, in part due to the fact that a centralized command and control apparatus is unlikely to provide a robust framework for resilience. Resilience in cyber-systems, in general, has several components, and requires the ability to anticipate and withstand attacks or faults, as well as recover from faults and evolve the system to improve future resilience. The recovery effort (and any subsequent evolution) may require significant reconfiguration of the system (at all levels – hardware, software, services, permissions, etc.) if the system is to be made resilient to further attack or faults. This is especially important in the case of ongoing attacks, where reconfiguration decisions must be taken with care to avoid further compromising the system while maintaining continuity of operations. Collectively, we will label this recovery and evolution process as “reconstitution”. Currently, reconstitution is performed manually, generally after-the-fact, and usually consists of either standing up redundant systems, check-points (rolling back the configuration to a “clean” state), or re-creating the system using “gold-standard” copies. For enterprise systems, such reconstitution may be performed

  3. Course of patients with juvenile spondyloarthritis during 4 years of observation, juvenile part of GESPIC

    PubMed Central

    Weiß, Anja; Minden, Kirsten; Listing, Joachim; Foeldvari, Ivan; Sieper, Joachim; Rudwaleit, Martin

    2017-01-01

    Objective To describe the course and the 4-year outcome of juvenile spondyloarthritis (jSpA). Methods Patients with a diagnosis of jSpA and an age at onset ≤16 years were included in the German Spondyloarthritis Inception cohort (GESPIC) and followed up prospectively for 4 years. Results 118 patients (73% men, 66% HLA-B27 positive, mean age 13.5 years, mean symptom duration 2.2 years) were enrolled in 2 study centres: 52% of patients with jSpA were captured by the enthesitis-related arthritis subgroup of the International League of Associations for Rheumatology classification criteria. At inclusion, the majority of patients had active peripheral arthritis (75.4%), followed by inflammatory back pain (IBP) (19.5%) and enthesitis (16.1%). There was a significant improvement in clinical manifestations and in patient-reported outcomes over time. During the 4-year follow-up, 85% of the patients had at least 1 period of remission on drug ≥6 months, and 46% of the patients achieved remission ≥12 months without medication, of whom 68% kept this status and 32% worsened. At the end of 4 years of observation, 23% of the patients were in remission without medication, but 57% still suffered from active disease. Patients with peripheral arthritis had a likelihood of 29% for having peripheral arthritis after 4 years, whereas the likelihood of IBP persistence was 53% for those with IBP at enrolment. Conclusions Although 1 quarter of patients with jSpA achieved remission off medication after 4 years, the likelihood of having recurrent or persistent disease into adulthood is substantial, particularly for jSpA with IBP. Trial registration number NCT 01277419.

  4. Compromise Approach-Based Genetic Algorithm for Constrained Multiobjective Portfolio Selection Model

    NASA Astrophysics Data System (ADS)

    Li, Jun

    In this paper, fuzzy set theory is incorporated into a multiobjective portfolio selection model for investors’ taking into three criteria: return, risk and liquidity. The cardinality constraint, the buy-in threshold constraint and the round-lots constraints are considered in the proposed model. To overcome the difficulty of evaluation a large set of efficient solutions and selection of the best one on non-dominated surface, a compromise approach-based genetic algorithm is presented to obtain a compromised solution for the proposed constrained multiobjective portfolio selection model.

  5. The issue of penal and legal protection of the intensive care unit physician within the context of patient's consent to treatment. Part II: unconscious patient.

    PubMed

    Siewiera, Jacek; Kübler, Andrzej; Filipowska, Monika; Trnka, Jakub; Zamaro-Michalska, Aleksandra

    2014-01-01

    Cultural changes in Western societies, as well as the rapid development of medical technology during the last quarter of a century, have led to many changes in the relationship between a physician and a patient. During this period, the patient's consent to treatment has proven to be an essential component of any decision relating to the patient's health. The patient's will component, as an essential element of the legality of the treatment process, is also reflected in the Polish legislation. The correct interpretation of the legal regulations and the role the patient's will plays in the therapeutic decision-making process within the Intensive Care Unit (ICU) requires the consideration of both the good of the patient and the physician's safety in terms of his criminal responsibility. Clinical experience indicates that the physicians' decisions result in the choice of the best treatment strategy for a patient only if they are based on current medical knowledge and an assessment of therapeutic opportunities. The good of the patient must be the sole objective of the physician's actions, and as a result of the current state of medical knowledge and the medical prognosis, all the conditions of the legal safety of a physician taking decisions must be met. In this paper, the authors have set out how to obtain consent (substantive consent) to treat an unconscious patient in the ICU in light of the current Polish law, as well as a physician's daily practice. The solutions proposed in the text of the publication are aimed at increasing the legal safety of the ICU physicians when making key decisions relating to the strategy of the treatment of ICU patients.

  6. Recent trends in survival of adult patients with acute leukemia: overall improvements, but persistent and partly increasing disparity in survival of patients from minority groups.

    PubMed

    Pulte, Dianne; Redaniel, Maria Theresa; Jansen, Lina; Brenner, Hermann; Jeffreys, Mona

    2013-02-01

    The survival of younger patients with acute leukemia has improved in the early 21(st) century, but it is unknown whether people of all ethnic and racial backgrounds have benefited equally. Using cancer registry data from the Surveillance, Epidemiology and End Results Program, we assessed trends in 5-year relative survival for patients aged 15 years or more with acute lymphoblastic leukemia and acute myeloblastic leukemia divided by racial and ethnic group, including non-Hispanic whites, African-Americans, Hispanics, and Asian-Pacific Islanders in the 1990s and the early 21(st) century. Modeled period analysis was used to obtain the most up-to-date estimates of survival. Overall, the 5-year survival increased from 31.6% in 1997-2002 to 39.0% in 2003-2008 for patients with acute lymphoblastic leukemia and from 15.5% in 1991-1996 to 22.5% in 2003-2008 for those with acute myeloblastic leukemia. Nevertheless, among patients with acute lymphoblastic leukemia, age-adjusted 5-year relative survival rates remained lower for African-Americans and Hispanics than for non-Hispanic whites. Among patients with acute myeloblastic leukemia, the increase in survival was greatest (from 32.6% in 1991-1996 to 47.1% in 2003-2008) for younger patients (15-54 years), and was more pronounced for non-Hispanic whites (+16.4% units) than for other patients (+10.8% units). Increases in survival are observed in all ethnic or racial groups. Nevertheless, among patients with acute leukemias, disparities in survival persist between non-Hispanic white people and people of other ethnic or racial groups. Disparities are increasing in younger patients with acute myeloblastic leukemia. Improvements in access to treatment, especially for minority patients, may improve outcomes.

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

    PubMed

    Dumaidi, Kamal; Al-Jawabreh, Amer

    2014-10-01

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

  8. Sleep disturbances in caregivers of patients with end-stage congestive heart failure: Part II--assess and intervene.

    PubMed

    Rausch, Sarah M; Baker, Kathy; Boonmee, Junyanee

    2007-01-01

    Sleep disturbances in caregivers of patients with congestive heart failure is common. The consequences of sleep disturbances are dire and have potential to seriously impact caregiver health and patient outcomes. Therefore, it is imperative that the health care team, especially nurses, assess and intervene. Basic assessment of caregiver sleep disturbance can be quick and simple and can be performed while assessing the congestive heart failure patient's health. If a more complex sleep disorder is suspected, other assessments can be conducted if time and money permit. The benefits to properly assessing sleep disturbance and subsequent treatment far outweigh the minimal time spent by the health care team or caregiver.

  9. Sleep disturbances in caregivers of patients with end-stage congestive heart failure: Part I--The problem.

    PubMed

    Rausch, Sarah M; Baker, Kathy; Boonmee, Junyanee

    2007-01-01

    Up to 90% of caregivers report sleep disturbances, particularly congestive heart failure (CHF) caregivers. Sleep disturbances have numerous consequences that can negatively impact a wide domain of outcomes in both the caregiver and the patient for whom they care. Ultimately, these disturbances can lead to caregiver morbidity and CHF patient morbidity, readmission, and mortality. Nurses play a central role in patient education, especially with caregivers. Therefore, nurses can help to educate caregivers on the consequences of stress-related sleep disturbances, which are very prevalent in CHF caregivers.

  10. Choosing a particular oral anticoagulant and dose for stroke prevention in individual patients with non-valvular atrial fibrillation: part 2.

    PubMed

    Diener, Hans-Christoph; Aisenberg, James; Ansell, Jack; Atar, Dan; Breithardt, Günter; Eikelboom, John; Ezekowitz, Michael D; Granger, Christopher B; Halperin, Jonathan L; Hohnloser, Stefan H; Hylek, Elaine M; Kirchhof, Paulus; Lane, Deirdre A; Verheugt, Freek W A; Veltkamp, Roland; Lip, Gregory Y H

    2016-02-04

    The choice of oral anticoagulant (OAC) for patients with atrial fibrillation (AF) may be influenced by individual clinical features or by patterns of risk factors and comorbidities. We reviewed analyses of subgroups of patients from trials of vitamin K antagonists vs. non-vitamin K oral anticoagulants (NOACs) for stroke prevention in AF with the aim to identify patient groups who might benefit from a particular OAC more than from another. In addition, we discuss the timing of initiation of anticoagulation. In the second of a two-part review, we discuss the use of NOAC for stroke prevention in the following subgroups of patients with AF: (vii) secondary stroke prevention in patients after stroke or transient ischaemic attack (TIA), (viii) patients with acute stroke requiring thrombolysis or thrombectomy, (ix) those initiating or restarting OAC treatment after stroke or TIA, (x) those with renal impairment on dialysis, (xi) the elderly, (xii) those at high risk of gastrointestinal bleeding, and (xiii) those with hypertension. In addition, we discuss adherence and compliance. Finally, we present a summary of treatment suggestions. In specific subgroups of patients with AF, evidence supports the use of particular NOACs and/or particular doses of anticoagulant. The appropriate choice of treatment for these subgroups will help to promote optimal clinical outcomes.

  11. California's nurse-to-patient ratios, Part 1: 8 years later, what do we know about nurse-level outcome?

    PubMed

    Serratt, Teresa

    2013-09-01

    California's nurse-to-patient ratios have been in place since 2004. The author reviews outcomes at the nurse level from a comprehensive literature review. Data suggest that increased levels of nurse staffing have resulted in greater job satisfaction.

  12. Patient Evaluation and Preparation in Vascular and Interventional Radiology: What Every Interventional Radiologist Should Know (Part 1: Patient Assessment and Laboratory Tests)

    SciTech Connect

    Taslakian, Bedros; Sebaaly, Mikhael Georges Al-Kutoubi, Aghiad

    2016-03-15

    Performing an interventional procedure imposes a commitment on interventional radiologists to conduct the initial patient assessment, determine the best course of therapy, and provide long-term care after the procedure is completed. After patient referral, contact with the referring physician and multidisciplinary team approach is vital. In addition, clinical history, physical examination, as well as full understanding of the pre-procedural laboratory results and imaging findings can guide the interventional radiologist to implement the most appropriate management plan, avoid unnecessary procedures, and prevent complications to achieve a successful outcome. We provide a comprehensive, methodical review of pre-procedural care and management in patients undergoing vascular and interventional radiology procedures.

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

    PubMed Central

    Sims, Shireen Madani; Lynch, James W.

    2016-01-01

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

  14. The Ontario Prehospital Advanced Life Support (OPALS) study Part II: Rationale and methodology for trauma and respiratory distress patients. OPALS Study Group.

    PubMed

    Stiell, I G; Wells, G A; Spaite, D W; Nichol, G; O'Brien, B; Munkley, D P; Field, B J; Lyver, M B; Luinstra, L G; Dagnone, E; Campeau, T; Ward, R; Anderson, S

    1999-08-01

    The Ontario Prehospital Advanced Life Support (OPALS) Study represents the largest prehospital study yet conducted, worldwide. This study will involve more than 25,000 cardiac arrest, trauma, and critically ill patients over an 8-year period (1994-2002). The current article, Part II, describes in detail the rationale and methodology for major trauma and respiratory distress patients and for an economic evaluation of Advanced Life Support (ALS) programs in the OPALS Study. The OPALS Study, using a rigorous controlled methodology and a large sample size, should clearly indicate the benefit in trauma and respiratory distress patient survival and morbidity that results from the widespread introduction of prehospital ALS programs to communities of many different sizes. [Stiell IG, Wells GA, Spaite DW, Nichol G, O'Brien B, Munkley DP, Field BJ, Lyver MB, Luinstra LG, Dagnone E, Campeau T, Ward R, Anderson S, for the OPALS Study Group: The Ontario Prehospital Advanced Life Support (OPALS) Study Part II: Rationale and methodology for trauma and respiratory distress patients.

  15. 15 CFR 19.7 - When will Commerce entities compromise a Commerce debt?

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 15 Commerce and Foreign Trade 1 2010-01-01 2010-01-01 false When will Commerce entities compromise a Commerce debt? 19.7 Section 19.7 Commerce and Foreign Trade Office of the Secretary of Commerce COMMERCE DEBT COLLECTION Procedures To Collect Commerce Debts § 19.7 When will Commerce entities...

  16. Inadequate satellite cell replication compromises muscle regrowth following postnatal nutrient restriction

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Perinatal growth impairment permanently compromises skeletal muscle mass. The present study assessed the contribution of muscle satellite cell replicative capacity to this deficit. Mouse dams were fed either a low protein (LP, n=7) or control (C, n=6) diet during lactation. Pups were weaned at 21 d ...

  17. Using Emergence Theory-Based Curriculum to Teach Compromise Skills to Students with Autistic Spectrum Disorders

    ERIC Educational Resources Information Center

    Fein, Lance; Jones, Don

    2015-01-01

    This study addresses the compromise skills that are taught to students diagnosed with autistic spectrum disorders (ASD) and related social and communication deficits. A private school in the southeastern United States implemented an emergence theory-based curriculum to address these skills, yet no formal analysis was conducted to determine its…

  18. 31 CFR 5.7 - When will Treasury entities compromise a Treasury debt?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 31 Money and Finance: Treasury 1 2010-07-01 2010-07-01 false When will Treasury entities compromise a Treasury debt? 5.7 Section 5.7 Money and Finance: Treasury Office of the Secretary of the Treasury TREASURY DEBT COLLECTION Procedures To Collect Treasury Debts § 5.7 When will Treasury...

  19. 7 CFR 1956.66 - Compromise and adjustment of nonjudgment debts.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ...'s essential family living expenses, and farm or business operation expenses necessary to continue... SERVICE, RURAL BUSINESS-COOPERATIVE SERVICE, RURAL UTILITIES SERVICE, AND FARM SERVICE AGENCY, DEPARTMENT... Programs and Multi-Family Housing § 1956.66 Compromise and adjustment of nonjudgment debts....

  20. 40 CFR 1620.6 - Authority to adjust, determine, compromise, and settle.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 40 Protection of Environment 32 2010-07-01 2010-07-01 false Authority to adjust, determine, compromise, and settle. 1620.6 Section 1620.6 Protection of Environment CHEMICAL SAFETY AND HAZARD INVESTIGATION BOARD ADMINISTRATIVE CLAIMS ARISING UNDER THE FEDERAL TORT CLAIMS ACT § 1620.6 Authority to...

  1. Comments on James Q. Wilson's Compromise on Affirmative Action in American Higher Education.

    ERIC Educational Resources Information Center

    Murray, Charles; And Others

    1997-01-01

    Provides responses from a small group of conservative scholars concerning the compromise proposed by Dr. James Q. Wilson indicating that the nation will allow some affirmative action in the form of race-based preferential admissions at the undergraduate level, but not in graduate programs. (GR)

  2. TEMPORAL ASSOCIATION BETWEEN PULMONARY AND SYSTEMIC EFFECTS OF PARTICULATE MATTER IN HEALTHY AND CARDIOVASCULAR COMPROMISED RATS

    EPA Science Inventory

    Temporal association between pulmonary and systemic effects of particulate matter in healthy and cardiovascular compromised rats

    Urmila P. Kodavanti, Mette C. Schladweiler, Allen D. Ledbetter, Russ Hauser*, David C. Christiani*, John McGee, Judy R. Richards, Daniel L. Co...

  3. Happenstance and Compromise: A Gendered Analysis of Students' Computing Degree Course Selection

    ERIC Educational Resources Information Center

    Lang, Catherine

    2010-01-01

    The number of students choosing to study computing at university continues to decline this century, with an even sharper decline in female students. This article presents the results of a series of interviews with university students studying computing courses in Australia that uncovered the influence of happenstance and compromise on course…

  4. 13 CFR 108.1710 - SBA authority to collect or compromise its claims.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 13 Business Credit and Assistance 1 2011-01-01 2011-01-01 false SBA authority to collect or compromise its claims. 108.1710 Section 108.1710 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION NEW MARKETS VENTURE CAPITAL (âNMVCâ) PROGRAM SBA Financial Assistance for NMVC Companies...

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

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 13 Business Credit and Assistance 1 2010-01-01 2010-01-01 false SBA authority to collect or compromise its claims. 108.1710 Section 108.1710 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION NEW MARKETS VENTURE CAPITAL (âNMVCâ) PROGRAM SBA Financial Assistance for NMVC Companies...

  6. 13 CFR 108.1710 - SBA authority to collect or compromise its claims.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 13 Business Credit and Assistance 1 2013-01-01 2013-01-01 false SBA authority to collect or compromise its claims. 108.1710 Section 108.1710 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION NEW MARKETS VENTURE CAPITAL (âNMVCâ) PROGRAM SBA Financial Assistance for NMVC Companies...

  7. 13 CFR 108.1710 - SBA authority to collect or compromise its claims.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 13 Business Credit and Assistance 1 2012-01-01 2012-01-01 false SBA authority to collect or compromise its claims. 108.1710 Section 108.1710 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION NEW MARKETS VENTURE CAPITAL (âNMVCâ) PROGRAM SBA Financial Assistance for NMVC Companies...

  8. 13 CFR 108.1710 - SBA authority to collect or compromise its claims.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 13 Business Credit and Assistance 1 2014-01-01 2014-01-01 false SBA authority to collect or compromise its claims. 108.1710 Section 108.1710 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION NEW MARKETS VENTURE CAPITAL (âNMVCâ) PROGRAM SBA Financial Assistance for NMVC Companies...

  9. 13 CFR 107.1710 - SBA authority to collect or compromise its claims.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 13 Business Credit and Assistance 1 2011-01-01 2011-01-01 false SBA authority to collect or compromise its claims. 107.1710 Section 107.1710 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION SMALL BUSINESS INVESTMENT COMPANIES SBA Financial Assistance for Licensees (Leverage)...

  10. 13 CFR 107.1710 - SBA authority to collect or compromise its claims.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 13 Business Credit and Assistance 1 2012-01-01 2012-01-01 false SBA authority to collect or compromise its claims. 107.1710 Section 107.1710 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION SMALL BUSINESS INVESTMENT COMPANIES SBA Financial Assistance for Licensees (Leverage)...

  11. 13 CFR 107.1710 - SBA authority to collect or compromise its claims.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 13 Business Credit and Assistance 1 2013-01-01 2013-01-01 false SBA authority to collect or compromise its claims. 107.1710 Section 107.1710 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION SMALL BUSINESS INVESTMENT COMPANIES SBA Financial Assistance for Licensees (Leverage)...

  12. 13 CFR 107.1710 - SBA authority to collect or compromise its claims.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 13 Business Credit and Assistance 1 2014-01-01 2014-01-01 false SBA authority to collect or compromise its claims. 107.1710 Section 107.1710 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION SMALL BUSINESS INVESTMENT COMPANIES SBA Financial Assistance for Licensees (Leverage)...

  13. 28 CFR 71.54 - Collection and compromise of liabilities imposed by Agency.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Collection and compromise of liabilities...) IMPLEMENTATION OF THE PROVISIONS OF THE PROGRAM FRAUD CIVIL REMEDIES ACT OF 1986 Assignment of Responsibilities... and civil penalties imposed under the Program Fraud Civil Remedies Act of 1986, and, subsequent to...

  14. State, Labor, Capital: Institutionalizing Democratic Class Compromise in the Southern Cone.

    DTIC Science & Technology

    1987-08-01

    at promoting, in limited fashion, the structural bases of class compromise. 36La Voz Argentina, V.7, N 70 (December 1985), p. 1. 37C. Pareja , "Las...fiscal crisis. This per force changes the orientation of concertation, and complicates its mission. On concertation in the Southern Cone, see C. Pareja

  15. Effects of Warmth of Interaction, Accuracy of Understanding, and the Proposal of Compromises on Listener's Behavior

    ERIC Educational Resources Information Center

    Johnson, David W.

    1971-01-01

    The results of this experiment demonstrate a causal relationship (a) between the expressed accuracy of understanding and the proposal of compromises and the induction of cooperation in a negotiation situation and (b) between the expressed warmth and degree of favorableness of interpersonal attitudes, thus giving support to the efficacy of Rogerian…

  16. 78 FR 53702 - User Fees for Processing Installment Agreements and Offers in Compromise

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-08-30

    ...). The public hearing will be held in the IRS Auditorium beginning at 10 a.m. at the Internal Revenue... proposed fees balance the need to recover costs with the goals of encouraging the use of installment... proposed fee balances the need to recover costs with the goal of encouraging offers in compromise. The...

  17. Adolescent Occupational Aspirations: Test of Gottfredson's Theory of Circumscription and Compromise

    ERIC Educational Resources Information Center

    Cochran, Daria B.; Wang, Eugene W.; Stevenson, Sarah J.; Johnson, Leah E.; Crews, Charles

    2011-01-01

    The authors investigated the relationship between adolescent occupational aspirations and midlife career success. The model for adolescent occupational aspirations was derived from Gottfredson's (1981) theory of circumscription and compromise. The authors hypothesized that parental socioeconomic status (SES), ability, and gender predict adolescent…

  18. 32 CFR 310.14 - Notification when information is lost, stolen, or compromised.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... purposes, such as identity theft, fraud, stalking, etc. The personal impact on the affected individual may... the Federal Trade Commission's public Web site on identity theft at http://www.consumer.gov/idtheft... the individual of any loss, theft, or compromise (See also, § 310.50 for reporting of the breach...

  19. 32 CFR 310.14 - Notification when information is lost, stolen, or compromised.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... purposes, such as identity theft, fraud, stalking, etc. The personal impact on the affected individual may... the Federal Trade Commission's public Web site on identity theft at http://www.consumer.gov/idtheft... the individual of any loss, theft, or compromise (See also, § 310.50 for reporting of the breach...

  20. 32 CFR 310.14 - Notification when information is lost, stolen, or compromised.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... purposes, such as identity theft, fraud, stalking, etc. The personal impact on the affected individual may... the Federal Trade Commission's public Web site on identity theft at http://www.consumer.gov/idtheft... the individual of any loss, theft, or compromise (See also, § 310.50 for reporting of the breach...

  1. 32 CFR 310.14 - Notification when information is lost, stolen, or compromised.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... purposes, such as identity theft, fraud, stalking, etc. The personal impact on the affected individual may... the Federal Trade Commission's public Web site on identity theft at http://www.consumer.gov/idtheft... the individual of any loss, theft, or compromise (See also, § 310.50 for reporting of the breach...

  2. 32 CFR 310.14 - Notification when information is lost, stolen, or compromised.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... purposes, such as identity theft, fraud, stalking, etc. The personal impact on the affected individual may... the Federal Trade Commission's public Web site on identity theft at http://www.consumer.gov/idtheft... the individual of any loss, theft, or compromise (See also, § 310.50 for reporting of the breach...

  3. 20 CFR 410.565 - Collection and compromise of claims for overpayment.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Collection and compromise of claims for overpayment. 410.565 Section 410.565 Employees' Benefits SOCIAL SECURITY ADMINISTRATION FEDERAL COAL MINE HEALTH AND SAFETY ACT OF 1969, TITLE IV-BLACK LUNG BENEFITS (1969- ) Payment of Benefits §...

  4. 20 CFR 410.565 - Collection and compromise of claims for overpayment.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 20 Employees' Benefits 2 2011-04-01 2011-04-01 false Collection and compromise of claims for overpayment. 410.565 Section 410.565 Employees' Benefits SOCIAL SECURITY ADMINISTRATION FEDERAL COAL MINE HEALTH AND SAFETY ACT OF 1969, TITLE IV-BLACK LUNG BENEFITS (1969- ) Payment of Benefits §...

  5. [Results of comprehensive management of patients with chronic lower limb ischaemia using gene-engineering technologies of angiogenesis stimulation (Part 2)].

    PubMed

    Gavrilenko, A V; Voronov, D A

    2015-01-01

    Presented herein are the results of clinical use of gene engineering methods of stimulating angiogenesis in patients with lower limb chronic ischaemia. An open prospective controlled clinical study included a total of 160 patients with lower limb chronic ischaemia. Gene engineering technologies of angiogenesis stimulation were used both as an independent method of treatment in comprehensive conservative therapy (80 patients) and as comprehensive treatment in combination with revascularizing operations (80 patients). Part Two of the article deals with the results of using the above technologies in the composition of comprehensive treatment. It was shown that gene-engineering technologies of angiogenesis stimulation may successfully be used in comprehensive conservative treatment in patients with stage IIB CLLI, as well as stage III. Clinically meaningful improvement is confirmed by objective factors, including better parameters of regional haemodynamics, perfusion, functional reserve of blood flow, etc. Gene-engineering methods of angiogenesis stimulation were found demonstrated were associated with good tolerance and an admissible rate of adverse events in patients with CLLI. All undesirable events turned out transitory during the immediate follow-up period.

  6. An epistemology of patient safety research: a framework for study design and interpretation. Part 3. End points and measurement.

    PubMed

    Brown, C; Hofer, T; Johal, A; Thomson, R; Nicholl, J; Franklin, B D; Lilford, R J

    2008-06-01

    This article builds on the previous two articles in this series, which focused on an evaluation framework and study designs for patient safety research. The current article focuses on what to measure as evidence of safety and how these measurements can be undertaken. It considers four different end points, highlighting their methodological advantages and disadvantages: patient outcomes, fidelity, intervening variables and clinical error. The choice of end point depends on the nature of the intervention being evaluated and the patient safety problem it has been designed to address. This paper also discusses the different methods of measuring error, reviewing best practice and paying particular attention to case note review. Two key issues with any method of data collection are ensuring construct validity and reliability. Since no end point or method of data collection is infallible, the present authors advocate the use of multiple end points and methods where feasible.

  7. Tragic Choices and Moral Compromise: The Ethics of Allocating Kidneys for Transplantation

    PubMed Central

    Hoffmaster, Barry; Hooker, Cliff

    2013-01-01

    Context For almost a decade, the Kidney Transplantation Committee of the United Network for Organ Sharing has been striving to revise its approach to allocating kidneys from deceased donors for transplantation. Two fundamental values, equality and efficiency, are central to distributing this scarce resource. The prevailing approach gives primacy to equality in the temporal form of first-come, first-served, whereas the motivation for a new approach is to redeem efficiency by increasing the length of survival of transplanted kidneys and their recipients. But decision making about a better way of allocating kidneys flounders because it is constrained by the amorphous notion of “balancing” values. Methods This article develops a more fitting, productive approach to resolving the conflict between equality and efficiency by embedding the notion of compromise in the analysis of a tragic choice provided by Guido Calabresi and Philip Bobbitt. For Calabresi and Bobbitt, the goals of public policy with respect to tragic choices are to limit tragedy and to deal with the irreducible minimum of tragedy in the least offensive way. Satisfying the value of efficiency limits tragedy, and satisfying the value of equality deals with the irreducible minimum of tragedy in the least offensive way. But both values cannot be completely satisfied simultaneously. Compromise is occasioned when not all the several obligations that exist in a situation can be met and when neglecting some obligations entirely in order to fulfill others entirely is improper. Compromise is amalgamated with the notion of a tragic choice and then used to assess proposals for revising the allocation of kidneys considered by the Kidney Transplantation Committee. Findings Compromise takes two forms in allocating kidneys: it occurs within particular approaches to allocating kidneys because neither equality nor efficiency can be fully satisfied, and it occurs over the course of sequential approaches to allocating

  8. What proportion of patients with psychosis is willing to take part in research? A mental health electronic case register analysis

    PubMed Central

    Oduola, Sherifat; Callard, Felicity; Wykes, Til; Broadbent, Matthew; Stewart, Robert; Craig, Thomas K J; McGuire, Philip

    2017-01-01

    Objective The proportion of people with mental health disorders who participate in clinical research studies is much smaller than for those with physical health disorders. It is sometimes assumed that this reflects an unwillingness to volunteer for mental health research studies. We examined this issue in a large sample of patients with psychosis. Design Cross-sectional study. Setting Anonymised electronic mental health record data from the South London and Maudsley NHS Foundation Trust (SLaM). Participants 5787 adults diagnosed with a psychotic disorder. Exposure Whether approached prior to 1 September 2014 for consent to be approached about research participation. Main outcome measures Number of days spent in a psychiatric hospital, whether admitted to hospital compulsorily, and total score on the Health of the Nation Outcome Scale (HoNOS) between 1 September 2014 and 28 February 2015 with patient factors (age, gender, ethnicity, marital status and diagnosis) and treating clinical service as covariates. Results 1187 patients (20.5% of the total sample) had been approached about research participation. Of those who were approached, 773 (65.1%) agreed to be contacted in future by researchers. Patients who had been approached had 2.3 fewer inpatient days (95% CI −4.4 to −0.3, p=0.03), were less likely to have had a compulsory admission (OR 0.65, 95% CI 0.50 to 0.84, p=0.001) and had a better HoNOS score (β coefficient −0.9, 95% CI −1.5 to −0.4, p=0.001) than those who had not. Among patients who were approached, there was no significant difference in clinical outcomes between those agreed to research contact and those who did not. Conclusions About two-thirds of patients with psychotic disorders were willing to be contacted about participation in research. The patients who were approached had better clinical outcomes than those who were not, suggesting that clinicians were more likely to approach patients who were less unwell. PMID:28279995

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

    SciTech Connect

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

    2013-02-15

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

  10. Influence of political opposition and compromise on conservation outcomes in the Tongass National Forest, Alaska.

    PubMed

    Beier, Colin M

    2008-12-01

    To understand how a highly contentious policy process influenced a major conservation effort, I examined the origins, compromises, and outcomes of the Alaska National Interest Lands Conservation Act of 1980 (ANILCA) for the Tongass National Forest. Tongass wilderness designation was among the most controversial issues in the ANILCA debate, and it faced strong opposition from influential lawmakers, land managers, and Alaska residents. To investigate the influence of this opposition on Tongass conservation outcomes, I conducted a gap analysis of Tongass reserves and a policy analysis of the ANILCA debate and traced the influence of specific interests through the amendments, negotiations, and resulting compromises needed to enact ANILCA. Overall, I found that Tongass reserves comprise a broadly representative cross-section of ecosystems and species habitats in southeastern Alaska. Redrawn reserve boundaries, industry subsidies, and special access regulations reflected compromises to minimize the impact of wilderness conservation on mining, timber, and local stakeholder interests, respectively. Fragmentation of the Admiralty Island National Monument-the most ecologically valuable and politically controversial reserve-resulted from compromises with Alaskan Native (indigenous peoples of Alaska) corporations and timber interests. Despite language to accommodate "reasonable access" to wilderness reserves, ongoing access limitations highlight the concerns of Alaska residents that opposed ANILCA several decades ago. More broadly, the Tongass case suggests that early and ambitious conservation action may offset strong political opposition; compromises needed to establish key reserves often exacerbate development impacts in unprotected areas; and efforts to minimize social conflicts are needed to safeguard the long-term viability of conservation measures.

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

    ERIC Educational Resources Information Center

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

    2016-01-01

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

  12. Aberrant functioning of the putamen links delusions, antipsychotic drug dose, and compromised connectivity in first episode psychosis--Preliminary fMRI findings.

    PubMed

    Raij, Tuukka T; Mäntylä, Teemu; Kieseppä, Tuula; Suvisaari, Jaana

    2015-08-30

    The dopamine theory proposes the relationship of delusions to aberrant signaling in striatal circuitries that can be normalized with dopamine D2 receptor-blocking drugs. Localization of such circuitries, as well as their upstream and downstream signaling, remains poorly known. We collected functional magnetic resonance images from first-episode psychosis patients and controls during an audiovisual movie. Final analyses included 20 patients and 20 controls; another sample of 10 patients and 10 controls was used to calculate a comparison signal-time course. We identified putamen circuitry in which the signal aberrance (poor correlation with the comparison signal time course) was predicted by the dopamine theory, being greater in patients than controls; correlating positively with delusion scores; and correlating negatively with antipsychotic-equivalent dosage. In Granger causality analysis, patients showed a compromised contribution of the cortical salience network to the putamen and compromised contribution of the putamen to the default mode network. Results were corrected for multiple comparisons at the cluster level with primary voxel-wise threshold p < 0.005 for the salience network contribution, but liberal primary threshold p < 0.05 was used in other group comparisons. If replicated in larger studies, these findings may help unify and extend current hypotheses on dopaminergic dysfunction, salience processing and pathogenesis of delusions.

  13. Management of the dental patient on anticoagulant medication: a review.

    PubMed

    Agarwal, Manoj; Mittal, Sankalp; Vijay, Sharmistha; Yadav, Pooja; Panwar, Vasim Raja; Gupta, Neha

    2014-01-01

    Patients taking anticoagulant medication pose a challenge for the clinician. Dentists are often required to manage bleeding as part of routine oral surgery or dental procedures, and altered hemostasis can lead to complications. Nevertheless, use of these medications is generally important for the patient's health and any alteration in the anticoagulant regimen may have untoward sequelae. In addition, several medications can affect the clotting mechanism, potentially compromising hemostasis. This article will review a variety of anticoagulant medications and the medical conditions that necessitate their use.

  14. A qualitative study of experiences with and perceptions regarding long-acting injectable antipsychotics: Part I-patient perspectives.

    PubMed

    Iyer, Srividya; Banks, Nicola; Roy, Marc-André; Tibbo, Phil; Williams, Richard; Manchanda, Rahul; Chue, Pierre; Malla, Ashok

    2013-05-01

    Objectif : Malgré le problème largement reconnu de la mauvaise observance des antipsychotiques (AP), les injectables à action prolongée (IAP) qui pourraient améliorer l’observance sont sous-utilisés au Canada. Les attitudes à l’égard des IAP chez les patients et les psychiatres peuvent contribuer à cette sous-utilisation. Notre objectif était d’enquêter sur les perceptions et les attitudes des patients à l’égard des IAP au Canada. Méthode : Des groupes de discussion ont été formés de 34 patients ayant reçu un diagnostic de psychose du spectre de la schizophrénie dans 4 provinces canadiennes. Les groupes de discussion portaient sur les expériences avec les AP IAP et les attitudes à leur égard. Les séances ont fait l’objet d’un enregistrement sonore et ont été transcrites textuellement, et ces transcriptions ont été codées à l’aide d’une combinaison de méthodes déductives et inductives. Résultats : Quatre thèmes se sont dégagés : conscience et connaissance des IAP; perceptions des IAP; considérations concernant le coût et la commodité; et les questions liées au contexte coercitif dans lequel les IAP sont souvent prescrits. Neuf patients n’avaient jamais entendu parler des IAP, et d’autres ont déclaré ne pas avoir compris lorsqu’on a discuté avec eux des IAP. Les patients avaient habituellement entendu parler des IAP dans un contexte soit de coercition, soit de non-observance des médicaments. Les patients avaient des perceptions positives et négatives à l’égard des IAP. Les perceptions positives étaient axées sur la prévention de la rechute et l’effort réduit pour maintenir l’observance, et les perceptions négatives portaient sur les coûts financiers et la complication des rendez-vous pour recevoir les injections. Conclusion : Afin d’accroître l’utilisation des IAP, il faut aborder certaines questions, notamment l’insuffisance de l’information donnée aux patients, l

  15. Nutritional and Pharmacological Modulation of the Metabolic Response of Severely Burned Patients: Review of the Literature (Part II)*.

    PubMed

    Atiyeh, B S; Gunn, S W A; Dibo, S A

    2008-09-30

    Severe burn patients are some of the most challenging critically ill patients, with an extreme state of physiological stress and an overwhelming systemic metabolic response. Increased energy expenditure to cope with this insult necessitates mobilization of large amounts of substrate from fat stores and active muscle for repair and fuel, leading to catabolism. The hypermetabolic response can last for as long as nine months to one year after injury and is associated with impaired wound healing, increased infection risks, erosion of lean body mass, hampered rehabilitation, and delayed reintegration of burn survivors into society. Reversal of the hypermetabolic response by manipulating the patient's physiological and biochemical environment through the administration of specific nutrients, growth factors, or other agents, often in pharmacological doses, is emerging as an essential component of the state of the art in severe burn management. Early enteral nutritional support, control of hyperglycaemia, blockade of catecholamine response, and use of anabolic steroids have all been proposed to attenuate hypermetabolism or to blunt catabolism associated with severe burn injury. The present study is a literature review of the proposed nutritional and metabolic therapeutic measures in order to determine evidence-based best practice. Unfortunately, the present state of our knowledge does not allow the formulation of clear-cut guidelines. Only general trends can be outlined which will certainly have some practical applications but above all will dictate future research in the field.

  16. Nutritional and pharmacological modulation of the metabolic response of severely burned patients: review of the literature (part 1).

    PubMed

    Atiyeh, B S; Gunn, S W A; Dibo, S A

    2008-06-30

    Severe burn patients are some of the most challenging critically ill patients, with an extreme state of physiological stress and an overwhelming systemic metabolic response. Increased energy expenditure to cope with this insult necessitates mobilization of large amounts of substrate from fat stores and active muscle for repair and fuel, leading to catabolism. The hypermetabolic response can last for as long as nine months to one year after injury and is associated with impaired wound healing, increased infection risks, erosion of lean body mass, hampered rehabilitation, and delayed reintegration of burn survivors into society. Reversal of the hypermetabolic response by manipulating the patient's physiological and biochemical environment through the administration of specific nutrients, growth factors, or other agents, often in pharmacological doses, is emerging as an essential component of the state of the art in severe burn management. Early enteral nutritional support, control of hyperglycaemia, blockade of catecholamine response, and use of anabolic steroids have all been proposed to attenuate hypermetabolism or to blunt catabolism associated with severe burn injury. The present study is a literature review of the proposed nutritional and metabolic therapeutic measures in order to determine evidence-based best practice. Unfortunately, the present state of our knowledge does not allow the formulation of clear-cut guidelines. Only general trends can be outlined which will certainly have some practical applications but above all will dictate future research in the field.

  17. Nutritional and Pharmacological Modulation of the Metabolic Response of Severely Burned Patients: Review of the Literature (Part III)*.

    PubMed

    Atiyeh, B S; Gunn, S W A; Dibo, S A

    2008-12-31

    Severe burn patients are some of the most challenging critically ill patients, with an extreme state of physiological stress and an overwhelming systemic metabolic response. Increased energy expenditure to cope with this insult necessitates mobilization of large amounts of substrate from fat stores and active muscle for repair and fuel, leading to catabolism. The hypermetabolic response can last for as long as nine months to one year after injury and is associated with impaired wound healing, increased infection risks, erosion of lean body mass, hampered rehabilitation, and delayed reintegration of burn survivors into society.Reversal of the hypermetabolic response by manipulating the patient's physiological and biochemical environment through the administration of specific nutrients, growth factors, or other agents, often in pharmacological doses, is emerging as an essential component of the state of the art in severe burn management. Early enteral nutritional support, control of hyperglycaemia, blockade of catecholamine response, and use of anabolic steroids have all been proposed to attenuate hypermetabolism or to blunt catabolism associated with severe burn injury. The present study is a literature review of the proposed nutritional and metabolic therapeutic measures in order to determine evidence-based best practice. Unfortunately, the present state of our knowledge does not allow the formulation of clear-cut guidelines. Only general trends can be outlined which will certainly have some practical applications but above all will dictate future research in the field.

  18. Spectrum and frequency of GJB2, GJB6 and SLC26A4 gene mutations among nonsyndromic hearing loss patients in eastern part of India.

    PubMed

    Adhikary, Bidisha; Ghosh, Sudakshina; Paul, Silpita; Bankura, Biswabandhu; Pattanayak, Arup Kumar; Biswas, Subhradev; Maity, Biswanath; Das, Madhusudan

    2015-12-01

    Genetically caused nonsyndromic hearing loss is highly heterogeneous. Inspite of this large heterogeneity, mutations in the genes GJB2, GJB6 and SLC26A4 are major contributors. The mutation spectrum of these genes varies among different ethnic groups. Only a handful of studies focused on the altered genetic signature of these genes in different demographic regions of India but never focused on the eastern part of the country. Our study for the first time aimed to characterize the mutation profile of these genes in hearing loss patients of West Bengal state, India. Mutations in GJB2, GJB6 and SLC26A4 genes were screened by bidirectional sequencing from 215 congenital nonsyndromic hearing loss patients. Radiological diagnosis was performed in patients with SLC26A4 mutations by temporal bone CT scan. The study revealed that 4.65% and 6.97% patients had monoallelic and biallelic GJB2 mutations respectively. Six mutations were identified, p.W24X being the most frequent one accounting for 71.05% of the mutated alleles. Mutations in GJB6 including the previously identified deletion mutation (GJB6-D13S1830) were not identified in our study. Further, no patients harbored biallelic mutations in the SLC26A4 gene or the common inner ear malformation Enlarged Vestibular Aqueduct (EVA). The mutation profile of GJB2 in our study is distinct from other parts of India, suggesting that the mutation spectrum of this gene varies with ethnicity and geographical origin. The absence of GJB6 mutations and low frequency of SLC26A4 mutations suggest that additional genetic factors may also contribute to this disease.

  19. Alveolar Soft Part Sarcoma-A Histological Surprise in a Male Patient who was Suspected to have Breast Cancer

    PubMed Central

    Varghese, Sunitha Susan; Sasidharan, Balukrishna; Kandasamy, Subramaniam; Manipadam, Marie Therese; Backianathan, Selvamani

    2013-01-01

    Alveolar Soft Part Sarcoma (ASPS) is a very rare type of soft tissue sarcoma. Its cell of origin is unclear. It usually presents in the second to fourth decade of life. The most common reported sites of ASPS are the lower extremities, the head and the neck. Because of the rarity of this disease, there is no standard treatment plan. Surgical excision with negative margins is considered as the treatment of choice. We are reporting a rare presentation of ASPS as a male breast lump. PMID:23730668

  20. Physician-industry relations. Part 1: individual physicians.

    PubMed

    Coyle, Susan L

    2002-03-05

    This is part 1 of a 2-part paper on ethics and physician-industry relationships. Part 1 offers advice to individual physicians; part 2 gives recommendations to medical education providers and medical professional societies. Physicians and industry have a shared interest in advancing medical knowledge. Nonetheless, the primary ethic of the physician is to promote the patient's best interests, while the primary ethic of industry is to promote profitability. Although partnerships between physicians and industry can result in impressive medical advances, they also create opportunities for bias and can result in unfavorable public perceptions. Many physicians and physicians-in-training think they are impervious to commercial influence. However, recent studies show that accepting industry hospitality and gifts, even drug samples, can compromise judgment about medical information and subsequent decisions about patient care. It is up to the physician to judge whether a gift is acceptable. A very general guideline is that it is ethical to accept modest gifts that advance medical practice. It is clearly unethical to accept gifts or services that obligate the physician to reciprocate. Conflicts of interest can arise from other financial ties between physicians and industry, whether to outside companies or self-owned businesses. Such ties include honorariums for speaking or writing about a company's product, payment for participating in clinic-based research, and referrals to medical resources. All of these relationships have the potential to influence a physician's attitudes and practices. This paper explores the ethical quandaries involved and offers guidelines for ethical business relationships.

  1. The issue of legal protection of the intensive care unit physician within the context of patient consent to treatment. Part I: conscious patient, refusing treatment.

    PubMed

    Siewiera, Jacek; Trnka, Jakub; Kübler, Andrzej

    2014-01-01

    In daily clinical practice, physicians working in intensive care units (ICUs) face situations when their professional duty to protect the patient's life is in conflict with the obligation to respect the will of the patient and to assess his or her chances of treatment. Although the mere fact of conflict between these fundamental values for the ICU physician is a natural and obvious element in the chosen specialisation, many 'non-medical' circumstances make the given conflict not only very difficult but also dangerous for the physician. So far, the ethical and legal aspects of dying have been commented upon by a large group of lawyers and experts involved in the interpretation of the Polish regulations. The authors believe that a detailed analysis of the regulations should be carried out by persons of legal education, possessing a genuine medical experience associated with the specificity of end of life care in ICUs. In this paper, the authors have compared the current regulations of legislative acts of the common law relating to medical activities at anaesthesiology and intensive care units as well as based on the judgements of the common court of law over the past ten years. In the act of dissuading an ICU doctor from a medical procedure, all factors influencing the doctor's responsibility should be taken into account in accordance with the criminal law. In the case of a patient's death due to a refusal of treatment with the patient's full awareness, and given proper notification as to the consequences of refusing treatment, the doctor's responsibility lies under article 150 of the Polish penal code.

  2. Chiari malformation Type I surgery in pediatric patients. Part 1: validation of an ICD-9-CM code search algorithm

    PubMed Central

    Ladner, Travis R.; Greenberg, Jacob K.; Guerrero, Nicole; Olsen, Margaret A.; Shannon, Chevis N.; Yarbrough, Chester K.; Piccirillo, Jay F.; Anderson, Richard C. E.; Feldstein, Neil A.; Wellons, John C.; Smyth, Matthew D.; Park, Tae Sung; Limbrick, David D.

    2016-01-01

    Objective Administrative billing data may facilitate large-scale assessments of treatment outcomes for pediatric Chiari malformation Type I (CM-I). Validated International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code algorithms for identifying CM-I surgery are critical prerequisites for such studies but are currently only available for adults. The objective of this study was to validate two ICD-9-CM code algorithms using hospital billing data to identify pediatric patients undergoing CM-I decompression surgery. Methods The authors retrospectively analyzed the validity of two ICD-9-CM code algorithms for identifying pediatric CM-I decompression surgery performed at 3 academic medical centers between 2001 and 2013. Algorithm 1 included any discharge diagnosis code of 348.4 (CM-I), as well as a procedure code of 01.24 (cranial decompression) or 03.09 (spinal decompression or laminectomy). Algorithm 2 restricted this group to the subset of patients with a primary discharge diagnosis of 348.4. The positive predictive value (PPV) and sensitivity of each algorithm were calculated. Results Among 625 first-time admissions identified by Algorithm 1, the overall PPV for CM-I decompression was 92%. Among the 581 admissions identified by Algorithm 2, the PPV was 97%. The PPV for Algorithm 1 was lower in one center (84%) compared with the other centers (93%–94%), whereas the PPV of Algorithm 2 remained high (96%–98%) across all subgroups. The sensitivity of Algorithms 1 (91%) and 2 (89%) was very good and remained so across subgroups (82%–97%). Conclusions An ICD-9-CM algorithm requiring a primary diagnosis of CM-I has excellent PPV and very good sensitivity for identifying CM-I decompression surgery in pediatric patients. These results establish a basis for utilizing administrative billing data to assess pediatric CM-I treatment outcomes. PMID:26799412

  3. Chiari malformation Type I surgery in pediatric patients. Part 1: validation of an ICD-9-CM code search algorithm.

    PubMed

    Ladner, Travis R; Greenberg, Jacob K; Guerrero, Nicole; Olsen, Margaret A; Shannon, Chevis N; Yarbrough, Chester K; Piccirillo, Jay F; Anderson, Richard C E; Feldstein, Neil A; Wellons, John C; Smyth, Matthew D; Park, Tae Sung; Limbrick, David D

    2016-05-01

    OBJECTIVE Administrative billing data may facilitate large-scale assessments of treatment outcomes for pediatric Chiari malformation Type I (CM-I). Validated International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code algorithms for identifying CM-I surgery are critical prerequisites for such studies but are currently only available for adults. The objective of this study was to validate two ICD-9-CM code algorithms using hospital billing data to identify pediatric patients undergoing CM-I decompression surgery. METHODS The authors retrospectively analyzed the validity of two ICD-9-CM code algorithms for identifying pediatric CM-I decompression surgery performed at 3 academic medical centers between 2001 and 2013. Algorithm 1 included any discharge diagnosis code of 348.4 (CM-I), as well as a procedure code of 01.24 (cranial decompression) or 03.09 (spinal decompression or laminectomy). Algorithm 2 restricted this group to the subset of patients with a primary discharge diagnosis of 348.4. The positive predictive value (PPV) and sensitivity of each algorithm were calculated. RESULTS Among 625 first-time admissions identified by Algorithm 1, the overall PPV for CM-I decompression was 92%. Among the 581 admissions identified by Algorithm 2, the PPV was 97%. The PPV for Algorithm 1 was lower in one center (84%) compared with the other centers (93%-94%), whereas the PPV of Algorithm 2 remained high (96%-98%) across all subgroups. The sensitivity of Algorithms 1 (91%) and 2 (89%) was very good and remained so across subgroups (82%-97%). CONCLUSIONS An ICD-9-CM algorithm requiring a primary diagnosis of CM-I has excellent PPV and very good sensitivity for identifying CM-I decompression surgery in pediatric patients. These results establish a basis for utilizing administrative billing data to assess pediatric CM-I treatment outcomes.

  4. Social cognition in schizophrenia, Part 2: 12-month stability and prediction of functional outcome in first-episode patients.

    PubMed

    Horan, William P; Green, Michael F; DeGroot, Michael; Fiske, Alan; Hellemann, Gerhard; Kee, Kimmy; Kern, Robert S; Lee, Junghee; Sergi, Mark J; Subotnik, Kenneth L; Sugar, Catherine A; Ventura, Joseph; Nuechterlein, Keith H

    2012-06-01

    This study evaluated the longitudinal stability and functional correlates of social cognition during the early course of schizophrenia. Fifty-five first-episode schizophrenia patients completed baseline and 12-month follow-up assessments of 3 key domains of social cognition (emotional processing, theory of mind, and social/relationship perception), as well as clinical ratings of real-world functioning and symptoms. Scores on all 3 social cognitive tests demonstrated good longitudinal stability with test-retest correlations exceeding .70. Higher baseline and 12-month social cognition scores were both robustly associated with significantly better work functioning, independent living, and social functioning at the 12-month follow-up assessment. Furthermore, cross-lagged panel analyses were consistent with a causal model in which baseline social cognition drove later functional outcome in the domain of work, above and beyond the contribution of symptoms. Social cognitive impairments are relatively stable, functionally relevant features of early schizophrenia. These results extend findings from a companion study, which showed stable impairments across patients in prodromal, first-episode, and chronic phases of illness on the same measures. Social cognitive impairments may serve as useful vulnerability indicators and early clinical intervention targets.

  5. Tissue banking in a regulated environment--does this help the patient? Part 1--Legislation, regulation and ethics in the UK.

    PubMed

    Clark, Brian J

    2007-01-01

    The difficulties with 'retained organs' in the UK have resulted in a new legislation relating to human organs, tissues, and bodies - the Human Tissue Act 2004 and the Human Tissue Act Scotland 2006 are now in place. The new laws apply to a wide range of activities including transplantation, education, clinical audit, the practice of autopsies, anatomical examination and others, including the use of human tissues in research. Pathobiology research that uses human tissues is now undertaken in a regulated environment in the UK. The details of these regulations are described and the consequences discussed. In the second part of the paper the patient's views and expectations in this new setting are forwarded.

  6. A widely displaced Galeazzi-equivalent lesion with median nerve compromise.

    PubMed

    Galanopoulos, Ilias; Fogg, Quentin; Ashwood, Neil; Fu, Katherine

    2012-08-18

    We present the case of a 14-year-old boy with a right distal radial fracture accompanied by a severely displaced complete distal ulnar physeal separation and associated median nerve compromise. This injury is known as Galeazzi-equivalent lesion in children and is an extremely rare injury associated with growth arrest. Recognition of the lesion can be difficult but wide displacement may be associated with other significant injuries such as neurovascular compromise. Prompt intervention reversed the neurological symptoms. At 10-month postoperation there was neither growth arrest nor loss of motion. Complete separation of the ulna physis remains often because of soft tissue interposition or capsule problems and prompt reduction is recommended in the literature as a priority.

  7. Genomic imprinting effects in a compromised in utero environment: implications for a healthy pregnancy.

    PubMed

    Lim, A L; Ferguson-Smith, A C

    2010-04-01

    Genomic imprinting in gametogenesis marks a subset of mammalian genes for parent-of-origin-dependent monoallelic expression in the offspring. In mice, the identification and manipulation of individual imprinted genes has shown that the diverse products of these genes are largely devoted to controlling pre- and postnatal growth. Human syndromes with parental origin effects have been characterized both at the phenotypic and genotypic levels, allowing further elucidation of the function and regulation of imprinted genes. Evidence suggests that a compromised in utero environment influences fetal growth through the modulation of epigenetic states. However it is not known whether imprinted genes, by their nature, might be more or less susceptible to such environmental influences. Here we review the progress made in addressing the influence of a compromised in utero environment on the behavior of imprinted genes. We also examine whether these environmental influences may have an impact on the later development of human disease.

  8. Human Milk for Ill and Medically Compromised Infants: Strategies and Ongoing Innovation.

    PubMed

    DiLauro, Sara; Unger, Sharon; Stone, Debbie; O'Connor, Deborah L

    2016-08-01

    The use of human milk (mother's own milk and/or donor milk) in ill or medically compromised infants frequently requires some adaptation to address medical diagnoses and/or altered nutrition requirements. This tutorial describes the nutrition and immunological benefits of breast milk as well as provides evidence for the use of donor milk when mother's own milk is unavailable. Several strategies used to modify human milk to meet the medical and nutrition needs of an ill or medically compromised infant are reviewed. These strategies include (1) the standard fortification of human milk to support adequate growth, (2) the novel concept of target fortification in preterm infants, (3) instructions on how to alter maternal diet to address cow's milk protein intolerance and/or allergy in breast milk-fed infants, and (4) the removal and modification of the fat in breast milk used in infants diagnosed with chylothorax.

  9. Transient vascular compromise of the lunate after fracture-dislocation or dislocation of the carpus.

    PubMed

    White, R E; Omer, G E

    1984-03-01

    Although classic avascular necrosis of the lunate is rare after fracture-dislocation or dislocation of the carpus, these severe carpal injuries can compromise the vascular supply of the lunate. The lunate thus develops a relative increase in radiodensity. Our finding of an incidence of 12.5%--three of 24 cases--suggests a relatively frequent occurrence. The clinical course was transient with resolution of abnormal radiodensity and subjective findings. Moreover, none of the three cases progressed to classic avascular necrosis of the lunate, Kienböck's disease. The clinician should not confuse this transient vascular compromise of the lunate with Kienböck's disease, but should be aware of the entity and its benign, self-limited course and should treat it expectantly.

  10. Early Visual Deprivation Severely Compromises the Auditory Sense of Space in Congenitally Blind Children

    PubMed Central

    Vercillo, Tiziana; Burr, David; Gori, Monica

    2016-01-01

    A recent study has shown that congenitally blind adults, who have never had visual experience, are impaired on an auditory spatial bisection task (Gori, Sandini, Martinoli, & Burr, 2014). In this study we investigated how thresholds for auditory spatial bisection and auditory discrimination develop with age in sighted and congenitally blind children (9 to 14 years old). Children performed 2 spatial tasks (minimum audible angle and space bisection) and 1 temporal task (temporal bisection). There was no impairment in the temporal task for blind children but, like adults, they showed severely compromised thresholds for spatial bisection. Interestingly, the blind children also showed lower precision in judging minimum audible angle. These results confirm the adult study and go on to suggest that even simpler auditory spatial tasks are compromised in children, and that this capacity recovers over time. PMID:27228448

  11. Rescue of a periodontally compromised tooth by non-surgical treatment: a case report

    PubMed Central

    2016-01-01

    Purpose This article describes a case of the successful non-surgical management of a periodontally compromised maxillary premolar. Methods A combination therapy, including root planing, occlusal adjustment, and tooth splinting, was applied. Clinical and radiographic examinations were performed during the 16-month follow-up period. Results All periodontal parameters were improved. There were dramatic decreases (3–6 mm) in the probing pocket depth, tooth mobility, and marginal bone loss. Interestingly, gradual resolution of the periapical radiolucency and alveolar bone regeneration were observed in the radiographs, and the periodontal condition was maintained during the follow-up period. Conclusions Within the limits of this study, these results demonstrate the importance of natural tooth preservation through proper periodontal treatment and occlusal adjustment of the periodontally compromised tooth, which is typically targeted for tooth extraction and dental implantation. PMID:27127693

  12. A widely displaced Galeazzi-equivalent lesion with median nerve compromise

    PubMed Central

    Galanopoulos, Ilias; Fogg, Quentin; Ashwood, Neil; Fu, Katherine

    2012-01-01

    We present the case of a 14-year-old boy with a right distal radial fracture accompanied by a severely displaced complete distal ulnar physeal separation and associated median nerve compromise. This injury is known as Galeazzi-equivalent lesion in children and is an extremely rare injury associated with growth arrest. Recognition of the lesion can be difficult but wide displacement may be associated with other significant injuries such as neurovascular compromise. Prompt intervention reversed the neurological symptoms. At 10-month postoperation there was neither growth arrest nor loss of motion. Complete separation of the ulna physis remains often because of soft tissue interposition or capsule problems and prompt reduction is recommended in the literature as a priority. PMID:22907852

  13. Corporate corruption of the environment: sustainability as a process of compromise.

    PubMed

    Nyberg, Daniel; Wright, Christopher

    2013-09-01

    A key response to environmental degradation, climate change and declining biodiversity has been the growing adoption of market principles in an effort to better value the social good of nature. Through concepts such as 'natural capitalism' and 'corporate environmentalism', nature is increasingly viewed as a domain of capitalist endeavour. In this article, we use convention theory and a pluralist understanding of social goods to investigate how the social good of the environment is usurped by the alternate social good of the market. Through analysis of interviews with sustainability managers and corporate documentation, we highlight how organizational actors employ compromise to temporally settle disputes between competing claims about environmental activities. Our findings contribute to an understanding of the processes of empirically grounded critique and the under-theorized concept of compromise between social goods. Rather than protecting the environment, the corporate promotion of sustainability facilitates the corruption of the social good of the environment and its conversion into a market commodity.

  14. Tail loss compromises immunity in the many-lined skink, Eutropis multifasciata

    NASA Astrophysics Data System (ADS)

    Kuo, Chi-Chien; Yao, Chiou-Ju; Lin, Te-En; Liu, Hsu-Che; Hsu, Yu-Cheng; Hsieh, Ming-Kun; Huang, Wen-San

    2013-04-01

    Tail autotomy incurs energetic costs, and thus, a trade-off in resource allocation may lead to compromised immunity in lizards. We tested the hypothesis that tailless lizards will favor constitutive innate immunity responses over an energetically costly inflammatory response. The influence of fasting and colorful ornamentation was also investigated. We experimentally induced tail autotomy in the lizard Eutropis multifasciata and found that inflammation was suppressed by tail loss, but not further affected by fasting; the suppressive effect of colorful ornamentation was manifested only in males, but not in females. Constitutive innate immunity was not affected by any of these factors. As expected, only costly inflammation was compromised, and a less expensive constitutive innate immunity might be favored as a competent first-line defense during energetically demanding periods. After considering conventional trade-offs among tail regeneration and reproduction, further extending these studies to incorporate disease risk and how this influences escape responses to predators and future reproduction would make worthwhile studies.

  15. Evidence for altered placental blood flow and vascularity in compromised pregnancies

    PubMed Central

    Reynolds, Lawrence P; Caton, Joel S; Redmer, Dale A; Grazul-Bilska, Anna T; Vonnahme, Kimberly A; Borowicz, Pawel P; Luther, Justin S; Wallace, Jacqueline M; Wu, Guoyao; Spencer, Thomas E

    2006-01-01

    The placenta is the organ that transports nutrients, respiratory gases, and wastes between the maternal and fetal systems. Consequently, placental blood flow and vascular development are essential components of normal placental function and are critical to fetal growth and development. Normal fetal growth and development are important to ensure optimum health of offspring throughout their subsequent life course. In numerous sheep models of compromised pregnancy, in which fetal or placental growth, or both, are impaired, utero-placental blood flows are reduced. In the models that have been evaluated, placental vascular development also is altered. Recent studies found that treatments designed to increase placental blood flow can ‘rescue’ fetal growth that was reduced due to low maternal dietary intake. Placental blood flow and vascular development are thus potential therapeutic targets in compromised pregnancies. PMID:16469783

  16. [Influence of antiplatelet drugs (AD) on the efectiveness of combined therapy in patients with small cell lung cancer. Part I. Influence of AD on the haemostatic system].

    PubMed

    Ochmański, Władysław

    2008-01-01

    In the last years, a sharp rise in the morbidity due to lung cancer is observed, especially in the male population. Despite the intensive, multidirectional development of oncology, early detection and effective treatment of lung cancer is still limited. Its detection is delayed because of the lack of characteristic early signs. Especially poor in prognosis are patients with small cell lung cancer (SCLC), who usually die in consequence of distant metastases. This may result due to coating of the surface of circulating neoplastic cells with thrombocytes and clots. Platelets aggregates on the surface of neoplastic cells may have a protective action in relation to cytostatic drugs. This is why neoplastic cells that persist through this phase, implant themselves into various organs giving rise to metastases. The aim of the 1st part of the paper was to evaluate the influence of antiplatelet drugs (AD) on the haemostatic system of patients with SCLC. There is data in literature indicating a ameliorating influence of AD on time of survival of patients with certain neoplasms. The study was performed in 87 male patients aged 35-73 years with SCLC, limited to half of the chest (limited disease). After 2 i.v. chemotherapy series in 3 week intervals (VAC scheme according Greco): --Adriamycin (ADR) 40 mg on 1sq.m of body surface; --Vincristin (VCR) 1 mg; on 1sq.m of body surface; --Cyclophosfamid (CTX) 1000 mg on 1sq.m of body surface; radiation was also applied--40 Gy during 20 days on the tumor and mediastinum. The described treatment was performed in 22 patients from controls (Group I). Patients from Group II (n = 22) received additionally Defibrotide, Group III (n = 22) Ticlide and Group IV (n = 21) Aspirin. To evaluate of the influence of AD on the haemostatic system--every 3 months during the consecutive 27 weeks, the following tests were performed: bleeding time, clotting time, platelet aggregation, platelets aggregation ratio, euglobulin clot lysis time (ECLT

  17. The administration of probiotics and synbiotics in immune compromised adults: is it safe?

    PubMed

    Van den Nieuwboer, M; Brummer, R J; Guarner, F; Morelli, L; Cabana, M; Claasen, E

    2015-03-01

    This study aimed to systematically evaluate safety of probiotics and synbiotics in immune compromised adults (≥18 years). Safety was analysed using the Common Terminology Clinical Adverse Events (CTCAE version 4.0) classification, thereby providing an update on previous reports using the most recent available clinical data (2008-2013). Safety aspects are represented and related to number of participants per probiotic strain/culture, study duration, dosage, clinical condition and selected afflictions. Analysis of 57 clinical studies indicates that probiotic and/or synbiotic administration in immune compromised adults is safe with regard to the current evaluated probiotic strains, dosages and duration. Individuals were considered immune compromised if HIV-infected, critically ill, underwent surgery or had an organ- or an autoimmune disease. There were no major safety concerns in the study, as none of the serious adverse events (AE)s were related, or suspected to be related, to the probiotic or synbiotic product and the study products were well tolerated. Overall, AEs occurred less frequent in immune compromised subjects receiving probiotics and/or synbiotics compared to the control group. In addition, the results demonstrated a flaw in precise reporting and classification of AE in most studies. Furthermore, generalisability of conclusions are greatly limited by the inconsistent, imprecise and potentially incomplete reporting as well as the variation in probiotic strains, dosages, administration regimes, study populations and reported outcomes. We argue that standardised reporting on adverse events (CTCAE) in 'food' studies should be obligatory, thereby improving reliability of data and re-enforcing the safety profile of probiotics.

  18. Two-phase treatment of patients with crossbite and tendency toward skeletal Class III malocclusion*

    PubMed Central

    Bayerl, Maria de Lourdes Machado

    2014-01-01

    Angle Class III malocclusion is characterized by an inadequate anteroposterior dental relationship which may or may not be accompanied by skeletal changes. In general, patients are distressed by a significantly compromised facial aspect which, when associated with a deficient middle third, encourages patients to seek treatment. This article reports a two-phase treatment carried out in a female patient aged six years and six months with a tendency towards a Class III skeletal pattern. This case was presented to the Brazilian Board of Orthodontics and Facial Orthopedics (BBO). It is representative of the Discrepancy Index (DI) category, and fulfills part of the requirements for obtaining BBO Diploma. PMID:25279531

  19. Further development of an in vitro model for studying the penetration of chemicals through compromised skin.

    PubMed

    Davies, Diane J; Heylings, Jon R; Gayes, Heather; McCarthy, Timothy J; Mack, M Catherine

    2017-02-01

    A new in vitro model based on the electrical resistance properties of the skin barrier has been established in this laboratory. The model utilises a tape stripping procedure in dermatomed pig skin that removes a specific proportion of the stratum corneum, mimicking impaired barrier function observed in humans with damaged skin. The skin penetration and distribution of chemicals with differing physicochemical properties, namely; Benzoic acid, 3-Aminophenol, Caffeine and Sucrose has been assessed in this model. Although, skin penetration over 24h differed for each chemical, compromising the skin did not alter the shape of the time course profile, although absorption into receptor fluid was higher for each chemical. Systemic exposure (receptor fluid, epidermis and dermis), was marginally higher in compromised skin following exposure to the fast penetrant, Benzoic acid, and the slow penetrant Sucrose. The systemically available dose of 3-Aminophenol increased to a greater extent and the absorption of Caffeine was more than double in compromised skin, suggesting that Molecular Weight and Log Pow, are not the only determinants for assessing systemic exposure under these conditions. Although further investigations are required, this in vitro model may be useful for prediction of dermal route exposure under conditions where skin barrier is impaired.

  20. Loss of GSNOR1 Function Leads to Compromised Auxin Signaling and Polar Auxin Transport.

    PubMed

    Shi, Ya-Fei; Wang, Da-Li; Wang, Chao; Culler, Angela Hendrickson; Kreiser, Molly A; Suresh, Jayanti; Cohen, Jerry D; Pan, Jianwei; Baker, Barbara; Liu, Jian-Zhong

    2015-09-01

    Cross talk between phytohormones, nitric oxide (NO), and auxin has been implicated in the control of plant growth and development. Two recent reports indicate that NO promoted auxin signaling but inhibited auxin transport probably through S-nitrosylation. However, genetic evidence for the effect of S-nitrosylation on auxin physiology has been lacking. In this study, we used a genetic approach to understand the broader role of S-nitrosylation in auxin physiology in Arabidopsis. We compared auxin signaling and transport in Col-0 and gsnor1-3, a loss-of-function GSNOR1 mutant defective in protein de-nitrosylation. Our results showed that auxin signaling was impaired in the gsnor1-3 mutant as revealed by significantly reduced DR5-GUS/DR5-GFP accumulation and compromised degradation of AXR3NT-GUS, a useful reporter in interrogating auxin-mediated degradation of Aux/IAA by auxin receptors. In addition, polar auxin transport was compromised in gsnor1-3, which was correlated with universally reduced levels of PIN or GFP-PIN proteins in the roots of the mutant in a manner independent of transcription and 26S proteasome degradation. Our results suggest that S-nitrosylation and GSNOR1-mediated de-nitrosylation contribute to auxin physiology, and impaired auxin signaling and compromised auxin transport are responsible for the auxin-related morphological phenotypes displayed by the gsnor1-3 mutant.

  1. Normal and Malignant Muscle Cell Transplantation into Immune Compromised Adult Zebrafish

    PubMed Central

    Moore, John C.; Langenau, David M.

    2014-01-01

    Zebrafish have become a powerful tool for assessing development, regeneration, and cancer. More recently, allograft cell transplantation protocols have been developed that permit engraftment of normal and malignant cells into irradiated, syngeneic, and immune compromised adult zebrafish. These models when coupled with optimized cell transplantation protocols allow for the rapid assessment of stem cell function, regeneration following injury, and cancer. Here, we present a method for cell transplantation of zebrafish adult skeletal muscle and embryonal rhabdomyosarcoma (ERMS), a pediatric sarcoma that shares features with embryonic muscle, into immune compromised adult rag2E450fs homozygous mutant zebrafish. Importantly, these animals lack T cells and have reduced B cell function, facilitating engraftment of a wide range of tissues from unrelated donor animals. Our optimized protocols show that fluorescently labeled muscle cell preparations from α-actin-RFP transgenic zebrafish engraft robustly when implanted into the dorsal musculature of rag2 homozygous mutant fish. We also demonstrate engraftment of fluorescent-transgenic ERMS where fluorescence is confined to cells based on differentiation status. Specifically, ERMS were created in AB-strain myf5-GFP; mylpfa-mCherry double transgenic animals and tumors injected into the peritoneum of adult immune compromised fish. The utility of these protocols extends to engraftment of a wide range of normal and malignant donor cells that can be implanted into dorsal musculature or peritoneum of adult zebrafish. PMID:25591079

  2. Mechanism-based management for mucositis: option for treating side effects without compromising the efficacy of cancer therapy

    PubMed Central

    Kwon, Youngjoo

    2016-01-01

    Mucositis is a major side effect induced by chemotherapy and radiotherapy. Although mucositis is a leading cause of morbidity and mortality in cancer patients, management is largely limited to controlling symptoms, and few therapeutic agents are available for treatment. Since mucositis could be inhibited by the modulation of radiotherapy- or chemotherapy-induced pathways independently of cancer treatment, there is an opportunity for the development of more targeted therapies and interventions. This article examined potential therapeutic agents that have been investigated for the prevention and/or inhibition of mucositis induced by conventional chemotherapy and radiotherapy. They can be classified according to their mechanisms of action: scavenging reactive oxygen species, inhibition of specific cytokine production or inflammation, and inhibition of apoptosis. These early events may be good target pathways for preventing the pathogenesis of mucositis. Considering that both cancer therapy and therapeutic agents for mucositis act on both normal and cancer cells, agents that inhibit mucositis should act through mechanisms that selectively protect normal cells without compromising cancer treatment. Therefore, mechanism-based guidance for the treatment of mucositis is critical to prevent risky treatments for cancer patients and to relieve detrimental side effects effectively from cancer therapy. PMID:27103826

  3. Cervical spondylotic myelopathy: Part II: clinical and imaging considerations *

    PubMed Central

    Burns, SH; O’Connor, SM; Mior, SA

    1991-01-01

    In this, the second of a two part series, we continue to review the recent literature pertaining to cervical spondylotic myelopathy (CSM). Caused by the compromise of the spinal canal resulting from the superimposition of spondylotic changes upon a congenitally narrowed canal, CSM has a predictable radiographic and clinical presentation. The clinical presentation frequently includes both upper and lower motor neuron signs and symptoms. Careful analysis of the plain film images usually reveals a spinal canal measuring 12 mm or less. Additional imaging modalities confirm the diagnosis. This paper presents the clinical and imaging characteristics underlying CSM and stresses the importance of including CSM in the differential diagnosis of patients complaining of neck and leg dysfunctions. ImagesFigure 1Figure 2Figure 3Figure 4

  4. The care and feeding of your high-profile patients.

    PubMed

    Baum, Neil

    2013-01-01

    Doctors and practices enjoy, for the most part, taking care of a high-profile patient. However, with the gratification and ego boost that come from being "chosen" to care for these individuals, there are potential risks and decision-making principles that must not be compromised. As a physician, a high-profile patient is a patient and an individual in need of care and expertise, and medically is no different than any other patient who seeks evaluation and treatment. As a practice, there is a need to understand how to interact and manage the expectations of the high-profile patient. This article will discuss the advantages, risks, and obstacles of and staff preparation for managing such patients.

  5. A curriculum on physician-patient sexual misconduct and teacher-learner mistreatment. Part 2: Teaching method.

    PubMed

    Robinson, G E; Stewart, D E

    1996-04-01

    Medical educators have become increasingly aware of the need for health care professionals to receive more training about the causes and consequences of physician-patient sexual misconduct and teacher-learner mistreatment and harassment. A curriculum in use at the University of Toronto includes a didactic component, consisting of lectures, and an experiential component, consisting of a workshop. This article concerns how, by discussing case vignettes designed to illustrate salient points, the participants have an opportunity to consider their responses in actual clinical and teaching situations. Evaluation of the course by 373 participants shows that the curriculum is considered acceptable and is likely to be of benefit. Of the course participants, 54% (15/28) of those attending the course for faculty and 39% (133/345) of those at subsequent courses stated that they would change their clinical and teaching practices in positive ways as a result of attending. A further 38% (130/345) stated that they already practised in a manner congruent with the model discussed.

  6. Military medical advances resulting from the conflict in Korea, Part I: Systems advances that enhanced patient survival.

    PubMed

    Baker, Michael S

    2012-04-01

    The Korean War started several years after the World War II had ended and no recognition of the threat or preparation was made for this possibility. The military and its medical service had been downsized after World War II and had to quickly ramp up to meet the surprise attack. The war provided the laboratory for trials and experimentation with the new technological developments of the era. The Korean conflict led to numerous advances in medical systems and patient care. The Mobile Army Surgical Hospital came of age, and was instrumental in saving many lives. Helicopters saw their first regular use as flying ambulances to take the injured to definitive care in a timely fashion. The national blood banking program was rapidly geared up and new techniques such as plastic bags for collection and delivery resulted. Body armor was developed that would allow mobility while offering protection and was widely used for the first time. Each of these systems improvements saved the lives of soldiers in combat and were soon to be used in the civilian sector to save and improve lives around the world.

  7. Polymorphisms in CaSR and CLDN14 Genes Associated with Increased Risk of Kidney Stone Disease in Patients from the Eastern Part of India.

    PubMed

    Guha, Manalee; Bankura, Biswabandhu; Ghosh, Sudakshina; Pattanayak, Arup Kumar; Ghosh, Saurabh; Pal, Dilip Kumar; Puri, Anurag; Kundu, Anup Kumar; Das, Madhusudan

    2015-01-01

    Kidney stone disease (KSD) is a major clinical problem imposing a large burden for both healthcare and economy globally. In India, the prevalence of kidney stone disease is rapidly increasing. This study aimed to evaluate the association between genetic defects in vitamin D receptor (VDR), calcium sensing receptor (CaSR) and claudin 14 (CLDN14) genes and kidney stone disease in patients from eastern India. We enrolled 200 consecutive kidney stone patients (age 18-60 years) (cases) and their corresponding sex and age matched 200 normal individuals (controls). To identify genetic variants responsible for KSD, we performed sequence analysis of VDR, CaSR and CLDN14 genes. Four non-synonymous (rs1801725, rs1042636, rs1801726 and rs2228570), one synonymous (rs219780) and three intronic single nucleotide polymorphisms (SNPs) (rs731236, rs219777 and rs219778) were identified. Genotype and allele frequency analysis of these SNPs revealed that, rs1801725 (Ala986Ser), rs1042636 (Arg990Gly) of CaSR gene and rs219778, rs219780 (Thr229Thr) of CLDN14 gene were significantly associated with KSD. Serum calcium levels were significantly higher in subjects carrying 986Ser allele and calcium excretion was higher in subjects bearing 990Gly allele. In conclusion, rs1801725, rs1042636, rs219778 and rs219780 SNPs were associated with kidney stone risk in patients from the eastern part of India.

  8. Helicobacter pylori does not play a part in the dyspeptic complaints of rheumatology patients receiving long term treatment with non-steroidal anti-inflammatory drugs

    PubMed Central

    Calvet, X; Gratacos, J; Font, J; Larrosa, M; Sanfeliu, I; Roque, M

    2002-01-01

    Objective: To determine the variables related to dyspepsia in rheumatology patients requiring NSAID treatment, assessing in particular the role of Helicobacter pylori infection. Methods: One hundred and eighty six consecutive patients with a rheumatological disorder requiring NSAID treatment (68 male, 118 female; mean (SD) age 55 (15) years) were included in a cross sectional study; dyspeptic symptoms were measured by a previously validated scale. Helicobacter pylori infection was determined by serology. Variables related to the severity of symptoms and the need for antisecretory drugs were determined by multivariate analysis. Results: No relation was found between Helicobacter pylori infection and dyspepsia or any of its surrogate markers (antisecretory drug use or NSAID intolerance). Female sex and treatment with antisecretory drugs were found to be independent predictors for the appearance and severity of dyspeptic symptoms. The only independent predictive variables of the requirement for antisecretory drugs were age, previous ulcer disease, taking NSAIDs with a medium or high anti-inflammatory potential, and the symptoms score. Conclusion: Helicobacter pylori infection does not seem to play any part in the gastric symptoms of patients treated long term with NSAIDs. PMID:12079909

  9. Poly(GR) in C9ORF72-Related ALS/FTD Compromises Mitochondrial Function and Increases Oxidative Stress and DNA Damage in iPSC-Derived Motor Neurons.

    PubMed

    Lopez-Gonzalez, Rodrigo; Lu, Yubing; Gendron, Tania F; Karydas, Anna; Tran, Helene; Yang, Dejun; Petrucelli, Leonard; Miller, Bruce L; Almeida, Sandra; Gao, Fen-Biao

    2016-10-19

    GGGGCC repeat expansions in C9ORF72 are the most common genetic cause of both ALS and FTD. To uncover underlying pathogenic mechanisms, we found that DNA damage was greater, in an age-dependent manner, in motor neurons differentiated from iPSCs of multiple C9ORF72 patients than control neurons. Ectopic expression of the dipeptide repeat (DPR) protein (GR)80 in iPSC-derived control neurons increased DNA damage, suggesting poly(GR) contributes to DNA damage in aged C9ORF72 neurons. Oxidative stress was also increased in C9ORF72 neurons in an age-dependent manner. Pharmacological or genetic reduction of oxidative stress partially rescued DNA damage in C9ORF72 neurons and control neurons expressing (GR)80 or (GR)80-induced cellular toxicity in flies. Moreover, interactome analysis revealed that (GR)80 preferentially bound to mitochondrial ribosomal proteins and caused mitochondrial dysfunction. Thus, poly(GR) in C9ORF72 neurons compromises mitochondrial function and causes DNA damage in part by increasing oxidative stress, revealing another pathogenic mechanism in C9ORF72-related ALS and FTD.

  10. Facial Reanimation: Basic Surgical Tools and Creation of an Effective Toolbox for Treating Patients with Facial Paralysis. Part A: Functional Muscle Transfers in the Long-Term Facial Palsy Patient.

    PubMed

    Rozen, Shai M

    2017-02-01

    The literature on facial paralysis is vast; however, detailed videos of the basic tools of dynamic reanimation within the context of patient scenarios accompanied by detailed narrative emphasizing both technique and thought processes are not common. Although not all scenarios of facial paralysis can be discussed in one setting, videographic visualization of basic surgical procedures, including facial marking, facial dissection, donor nerve preparation, cross-facial nerve graft, nerve transfers, and muscle harvest and inset, may provide a strong toolbox. Using these tools in various combinations depending on the unique case details enables the surgeon to treat a great majority of facial palsy patients. Part A, with the first of two videos, concentrates on free functional muscle transfer in the setting of longstanding facial paralysis. It includes preoperative markings, preparation of the patient in the operating room before incision, facial dissection including exposure of the masseter nerve, partial gracilis muscle harvest, and perhaps most importantly, the inset of the muscle on the paralyzed side. Part B (with the second video) concentrates on the cross-facial nerve graft and nerve transfers, used in the context of acute facial palsy, providing the short-term goal of mimetic musculature salvage in addition to longer term specific regional reinnervation by means of cross-facial nerve grafting. We hope that these videos provide a strong learning tool for enthusiastic novice medical students, residents, and fellows wishing to prepare for their cases, and faculty level physicians who wish to use them as a refresher before surgery.

  11. Melatonin attenuates (-)-epigallocatehin-3-gallate-triggered hepatotoxicity without compromising its downregulation of hepatic gluconeogenic and lipogenic genes in mice.

    PubMed

    Wang, Dongxu; Wei, Yaqing; Wang, Taotao; Wan, Xiaochun; Yang, Chung S; Reiter, Russel J; Zhang, Jinsong

    2015-11-01

    (-)-Epigallocatehin-3-gallate (EGCG), a major constituent of green tea, can ameliorate metabolic syndrome at least in part through reducing gluconeogenesis and lipogenesis. Green tea extracts, of which EGCG is a key constituent, have been used for weight loss in humans. A potential adverse effect of high-dose EGCG or green tea extracts is hepatotoxicity. Melatonin, an endogenous antioxidant with a high safety profile, is effective in preventing various types of tissue damage. The current study investigated the influence of melatonin on EGCG-triggered hepatotoxicity and EGCG-downregulated hepatic genes responsible for gluconeogenesis and lipogenesis in mice. We found that (i) melatonin extended survival time of mice intoxicated with lethal doses of EGCG; (ii) melatonin ameliorated acute liver damage and associated hepatic Nrf2 suppression caused by a nonlethal toxic dose of EGCG; (iii) melatonin reduced subacute liver injury and hepatic Nrf2 activation caused by lower toxic doses of EGCG; and (iv) melatonin did not compromise the action of pharmacological doses of EGCG in downregulating a battery of hepatic genes responsible for gluconeogenesis and lipogenesis, including G6Pc, PEPCK, FOXO1α, SCD1, Fasn, leptin, ACCα, ACCβ, GAPT, and Srebp-1. Taken together, these results suggest that the combination of EGCG and melatonin is an effective approach for preventing potential adverse effects of EGCG as a dietary supplement for metabolic syndrome alleviation and body weight reduction.

  12. Spatial landmarks regulate a Cdc42-dependent MAPK pathway to control differentiation and the response to positional compromise

    PubMed Central

    Basu, Sukanya; Vadaie, Nadia; Prabhakar, Aditi; Li, Boyang; Adhikari, Hema; Pitoniak, Andrew; Chow, Jacky; Chavel, Colin A.; Cullen, Paul J.

    2016-01-01

    A fundamental problem in cell biology is to understand how spatial information is recognized and integrated into morphogenetic responses. Budding yeast undergoes differentiation to filamentous growth, which involves changes in cell polarity through mechanisms that remain obscure. Here we define a regulatory input where spatial landmarks (bud-site–selection proteins) regulate the MAPK pathway that controls filamentous growth (fMAPK pathway). The bud-site GTPase Rsr1p regulated the fMAPK pathway through Cdc24p, the guanine nucleotide exchange factor for the polarity establishment GTPase Cdc42p. Positional landmarks that direct Rsr1p to bud sites conditionally regulated the fMAPK pathway, corresponding to their roles in regulating bud-site selection. Therefore, cell differentiation is achieved in part by the reorganization of polarity at bud sites. In line with this conclusion, dynamic changes in budding pattern during filamentous growth induced corresponding changes in fMAPK activity. Intrinsic compromise of bud-site selection also impacted fMAPK activity. Therefore, a surveillance mechanism monitors spatial position in response to extrinsic and intrinsic stress and modulates the response through a differentiation MAPK pathway. PMID:27001830

  13. Ablation of Dido3 compromises lineage commitment of stem cells in vitro and during early embryonic development

    PubMed Central

    Fütterer, A; Raya, Á; Llorente, M; Izpisúa-Belmonte, J C; de la Pompa, J L; Klatt, P; Martínez-A, C

    2012-01-01

    The death inducer obliterator (Dido) locus encodes three protein isoforms, of which Dido3 is the largest and most broadly expressed. Dido3 is a nuclear protein that forms part of the spindle assembly checkpoint (SAC) and is necessary for correct chromosome segregation in somatic and germ cells. Here we report that specific ablation of Dido3 function in mice causes lethal developmental defects at the onset of gastrulation. Although these defects are associated with centrosome amplification, spindle malformation and a DNA damage response, we provide evidence that embryonic lethality of the Dido3 mutation cannot be explained by its impact on chromosome segregation alone. We show that loss of Dido3 expression compromises differentiation of embryonic stem cells in vitro and of epiblast cells in vivo, resulting in early embryonic death at around day 8.5 of gestation. Close analysis of Dido3 mutant embryoid bodies indicates that ablation of Dido3, rather than producing a generalized differentiation blockade, delays the onset of lineage commitment at the primitive endoderm specification stage. The dual role of Dido3 in chromosome segregation and stem cell differentiation supports the implication of SAC components in stem cell fate decisions. PMID:21660050

  14. Live Attenuated S. Typhimurium Vaccine with Improved Safety in Immuno-Compromised Mice

    PubMed Central

    Periaswamy, Balamurugan; Maier, Lisa; Vishwakarma, Vikalp; Slack, Emma; Kremer, Marcus; Andrews-Polymenis, Helene L.; McClelland, Michael; Grant, Andrew J.; Suar, Mrutyunjay; Hardt, Wolf-Dietrich

    2012-01-01

    Live attenuated vaccines are of great value for preventing infectious diseases. They represent a delicate compromise between sufficient colonization-mediated adaptive immunity and minimizing the risk for infection by the vaccine strain itself. Immune defects can predispose to vaccine strain infections. It has remained unclear whether vaccine safety could be improved via mutations attenuating a vaccine in immune-deficient individuals without compromising the vaccine's performance in the normal host. We have addressed this hypothesis using a mouse model for Salmonella diarrhea and a live attenuated Salmonella Typhimurium strain (ssaV). Vaccination with this strain elicited protective immunity in wild type mice, but a fatal systemic infection in immune-deficient cybb−/−nos2−/− animals lacking NADPH oxidase and inducible NO synthase. In cybb−/−nos2−/− mice, we analyzed the attenuation of 35 ssaV strains carrying one additional mutation each. One strain, Z234 (ssaV SL1344_3093), was >1000-fold attenuated in cybb−/−nos2−/− mice and ≈100 fold attenuated in tnfr1−/− animals. However, in wt mice, Z234 was as efficient as ssaV with respect to host colonization and the elicitation of a protective, O-antigen specific mucosal secretory IgA (sIgA) response. These data suggest that it is possible to engineer live attenuated vaccines which are specifically attenuated in immuno-compromised hosts. This might help to improve vaccine safety. PMID:23029007

  15. Risky Driving, Mental Health, and Health-Compromising Behaviors: Risk Clustering in Late Adolescents and Adults

    PubMed Central

    Sommers, Marilyn S.; Fargo, Jamison D.

    2014-01-01

    Background Health-compromising behaviors in adolescents and adults co-occur. Because motor vehicle crashes are the leading cause of death and disability for these age groups, understanding the association between risky driving and other health compromising behaviors is critical. Methods We performed a secondary analysis of data from a randomized controlled trial of an intervention for participants who screened positive for risky driving and problem drinking. Using baseline data, we examined relationships among conduct behavior problems before and after age 15, depressive symptoms, sleep, problem drinking, and risky driving (hostile, reckless and drinking and driving) in late adolescents ages 18–24 (n= 110) and adults ages 25–44 (n= 202). We developed a measurement model for the entire sample using confirmatory factor analysis, which was then specified as a multi-group structural equation model. Results Late adolescents and adults had some similar associations for pathways through problem drinking to drinking and driving; depression to reckless driving; and conduct behavior problems after 15 to hostile driving. Late adolescents, however, had more complex relationships: depressive symptoms and conduct behavior problems before 15 were associated with more risky driving behaviors through multiple pathways and males reported more risky driving. Conclusions Risky driving is associated with other health-compromising behaviors and mental health factors. It is a multidimensional phenomenon more pronounced in late adolescence than adulthood. In order to promote safe driving, the findings support the need to consider behaviors that are a health threat in the late adolescent population during driving training and licensure. PMID:24814717

  16. Arsenic promotes centrosome abnormalities and cell colony formation in p53 compromised human lung cells

    SciTech Connect

    Liao Weiting; Lin Pinpin; Cheng, T.-S.; Yu, H.-S.; Chang, Louis W.

    2007-12-01

    Epidemiological evidence indicated that residents, especially cigarette smokers, in arseniasis areas had significantly higher lung cancer risk than those living in non-arseniasis areas. Thus, an interaction between arsenic and cigarette smoking in lung carcinogenesis was suspected. p53 dysfunction or mutation in lung epithelial cells was frequently observed in cigarette smokers. Our present study was to explore the differential effects by arsenic on H1355 cells (human lung adenocarcinoma cell line with mutation in p53), BEAS-2B (immortalized lung epithelial cell with functional p53) and pifithrin-{alpha}-treated BEAS-2B cells (p53-inhibited cells). These cells were treated with different doses of sodium arsenite (0, 0.1, 1, 5 and 10 {mu}M) for 48 h. A greater reduction in cell viability was observed in the BEAS-2B cells vs. p53 compromised cells (H1355 or p53-inhibited BEAS-2B). Similar observation was also made on 7-day cell survival (growth) study. TUNEL analysis confirmed that there was indeed a significantly reduced arsenite-induced apoptosis found in p53-compromised cells. Centrosomal abnormality has been attributed to eventual chromosomal missegregation, aneuploidy and tumorigenesis. In our present study, reduced p21 and Gadd45a expressions and increased centrosomal abnormality (atopic and multiple centrosomes) were observed in both arsenite-treated H1355 and p53-inhibited BEAS-2B cells as compared with similarly treated BEAS-2B cells. Increased anchorage-independent growth (colony formation) of BEAS-2B cells co-treated with pifithrin-{alpha} and 5 {mu}M sodium arsenite was also observed in soft agar. Our present investigation demonstrated that arsenic would act specifically on p53 compromised cells (either with p53 dysfunction or inhibited) to induce centrosomal abnormality and colony formation. These findings provided strong evidence on the carcinogenic promotional role of arsenic, especially under the condition of p53 dysfunction.

  17. Compromised Bone Microarchitecture and Estimated Bone Strength in Young Adults With Cystic Fibrosis

    PubMed Central

    Milliren, Carly E.; Derrico, Nicholas; Uluer, Ahmet; Sicilian, Leonard; Lapey, Allen; Sawicki, Gregory; Gordon, Catherine M.; Bouxsein, Mary L.; Finkelstein, Joel S.

    2014-01-01

    Context: Young adults with cystic fibrosis (CF) are at risk for low bone density and fractures, but the underlying alterations in bone microarchitecture that may contribute to their increased fracture risk are currently unknown. Objective: The main goal of this study was to use high-resolution peripheral quantitative computed tomography (HR-pQCT) to characterize the bone microarchitecture, volumetric bone mineral density (vBMD), and estimated strength of the radius and tibia in young adults with CF compared with healthy volunteers. Design and Setting: This was a cross-sectional study at an outpatient clinical research center within a tertiary academic medical center. Participants: Thirty young adults with CF, 18 to 40 years of age, were evaluated and compared with 60 healthy volunteers matched by age (±2 years), gender, and race. Main Outcome Measures: The primary outcomes were HR-pQCT–derived cortical and trabecular vBMD, bone microarchitecture, and estimates of bone strength. Results: At the radius and tibia, young adults with CF had smaller bone cross-sectional area and lower vBMD. Cortical and trabecular microarchitecture were compromised at both sites, most notably involving the trabecular bone of the tibia. These differences translated into lower estimated bone strength both at the radius and tibia. After accounting for body mass index differences, young adults with CF had lower bone area and estimated bone strength at the radius and had compromised trabecular microarchitecture and lower total and trabecular vBMD and estimated bone strength at the tibia. Alterations in trabecular bone density and microarchitecture and estimated strength measures of the tibia were also greater than expected based on dual-energy x-ray absorptiometry-derived areal BMD differences. Conclusions: Young adults with CF have compromised bone microarchitecture and lower estimated bone strength at both the radius and tibia, even after accounting for their smaller body size. These

  18. Compromise of Multiple Time-Resolved Transcriptomics Experiments Identifies Tightly Regulated Functions

    PubMed Central

    Klie, Sebastian; Caldana, Camila; Nikoloski, Zoran

    2012-01-01

    With the advent of high-throughput technologies for data acquisition from different components (i.e., genes, proteins, and metabolites) of a given biological system, generation of hypotheses, and biological interpretations based on multivariate data sets become increasingly important. These technologies allow for simultaneous gathering of data from the same biological components under different perturbations, including genotypic variation and/or changes in conditions, resulting in so-called multiple data tables. Moreover, these data tables are obtained over a well-chosen time domain to capture the dynamics of the response of the biological system to the perturbation. The computational problem we address in this study is twofold: (1) derive a single data table, referred to as a compromise, which captures information common to the investigated set of multiple tables and (2) identify biological components which contribute most to the determined compromise. Here we argue that recent extensions to principle component analysis called STATIS and dual-STATIS can be used to determine the compromise on which classical techniques for data analysis, such as clustering and term over-enrichment, can be subsequently applied. In addition, we illustrate that STATIS and dual-STATIS facilitate interpretations of a publically available transcriptomics data set capturing the time-resolved response of Arabidopsis thaliana to changing light and/or temperature conditions. We demonstrate that STATIS and dual-STATIS can be used not only to identify the components of a biological system whose behavior is similarly affected due to the perturbation (e.g., in time or condition), but also to specify the extent to which each dimension of the data tables reflect the perturbation. These findings ultimately provide insights in the components and pathways which could be under tight control in plant systems. PMID:23162561

  19. 12 CFR Appendix A to Part 363 - Guidelines and Interpretations

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ..., including the prevention or detection of management override or compromise of the internal control system.... Management's Reports on Internal Control over Financial Reporting under Part 363 and Section 404 of SOX 8B. Internal Control Reports and Part 363 Annual Reports for Acquired Businesses 8C. Management's Disclosure...

  20. Contribution of shot peening on carburized or carbonitrided parts

    NASA Astrophysics Data System (ADS)

    Renaud, P.; Bristiel, P.; Barrallier, L.; Desvignes, M.; Kubler, R.

    2011-01-01

    The main purpose of car manufacturers is to design parts which are light and at the same time very resistant to fatigue efforts. Surface treatments are effective means to deal with this compromise. They bring surface hardness and introduce compressive residual stresses. This experimental study focuses on the influence of shot peening on parts initially treated by carburizing or carbonitriding.

  1. Demographic corrections appear to compromise classification accuracy for severely skewed cognitive tests.

    PubMed

    O'Connell, Megan E; Tuokko, Holly; Kadlec, Helena

    2011-04-01

    Demographic corrections for cognitive tests should improve classification accuracy by reducing age or education biases, but empirical support has been equivocal. Using a simulation procedure, we show that creating moderate or extreme skewness in cognitive tests compromises the classification accuracy of demographic corrections, findings that appear replicated within clinical data for the few neuropsychological test scores with an extreme degree of skew. For most neuropsychological tests, the dementia classification accuracy of raw and demographically corrected scores was equivalent. These findings suggest that the dementia classification accuracy of demographic corrections is robust to slight degrees of skew (i.e., skewness <1.5).

  2. How to care for a patient's eyes in critical care settings.

    PubMed

    Marsden, Janet; Davies, Richard

    2016-12-14

    Rationale and key points Eye care is an important aspect of the nursing management of patients who are critically ill. All patients in acute care settings with absent or compromised eye defence mechanisms are at risk of eye complications and ocular surface disease. This article aims to assist nurses to care for the eyes of patients in critical care settings to enable early detection and routine management of ophthalmic issues, thereby avoiding visual compromise on patient discharge from critical care settings. » Corneal exposure is reported to occur in many patients who are critically ill. » Incomplete eyelid closure and lack of lubrication are the main mechanisms that underlie the development of corneal damage in patients who are critically ill. » Unconscious, sedated and/or paralysed patients and those with a reduced Glasgow Coma Scale score depend on healthcare professionals to maintain their ocular surface to prevent complications such as corneal abrasion, infection and ulceration, perforations and blindness. » Meticulous nursing care is required to prevent ophthalmic complications that can result from corneal exposure in this patient group. Regular, evidence-based eye care should be part of routine nursing practice for patients who are critically ill. Reflective activity 'How to' articles can help you update your practice and ensure it remains evidence-based. Apply this article to your practice. Reflect on and write a short account of: 1. How this article might change your practice? 2. How you could use this resource to educate your colleagues in eye care of the unconscious patient?

  3. Automated compromised right lung segmentation method using a robust atlas-based active volume model with sparse shape composition prior in CT.

    PubMed

    Zhou, Jinghao; Yan, Zhennan; Lasio, Giovanni; Huang, Junzhou; Zhang, Baoshe; Sharma, Navesh; Prado, Karl; D'Souza, Warren

    2015-12-01

    To resolve challenges in image segmentation in oncologic patients with severely compromised lung, we propose an automated right lung segmentation framework that uses a robust, atlas-based active volume model with a sparse shape composition prior. The robust atlas is achieved by combining the atlas with the output of sparse shape composition. Thoracic computed tomography images (n=38) from patients with lung tumors were collected. The right lung in each scan was manually segmented to build a reference training dataset against which the performance of the automated segmentation method was assessed. The quantitative results of this proposed segmentation method with sparse shape composition achieved mean Dice similarity coefficient (DSC) of (0.72, 0.81) with 95% CI, mean accuracy (ACC) of (0.97, 0.98) with 95% CI, and mean relative error (RE) of (0.46, 0.74) with 95% CI. Both qualitative and quantitative comparisons suggest that this proposed method can achieve better segmentation accuracy with less variance than other atlas-based segmentation methods in the compromised lung segmentation.

  4. Morphology and pathophysiology of target anatomical sites for ablation procedures in patients with atrial fibrillation: part II: pulmonary veins, caval veins, ganglionated plexi, and ligament of Marshall.

    PubMed

    Corradi, Domenico; Callegari, Sergio; Gelsomino, Sandro; Lorusso, Roberto; Macchi, Emilio

    2013-10-03

    The inadequate long-term efficacy of anti-arrhythmic therapy has been one of the main reasons for the development of non-pharmacological interventions for patients with atrial fibrillation such as catheter and surgical ablation. This has greatly increased interest in the functional morphology and electrophysiological properties of the atria and related anatomical structures. This article is the second of a two-part review that aims to provide anatomical and functional details concerning some of the principal anatomical sites commonly targeted by ablative procedures for treating atrial fibrillation, and covers pulmonary veins, ganglionated plexi, caval veins, and the ligament of Marshall. It also provides some general information about site-specific ablation procedures.

  5. Bioavailable transition metals in particulate matter mediate cardiopulmonary injury in healthy and compromised animal models.

    PubMed Central

    Costa, D L; Dreher, K L

    1997-01-01

    Many epidemiologic reports associate ambient levels of particulate matter (PM) with human mortality and morbidity, particularly in people with preexisting cardiopulmonary disease (e.g., chronic obstructive pulmonary disease, infection, asthma). Because much ambient PM is derived from combustion sources, we tested the hypothesis that the health effects of PM arise from anthropogenic PM that contains bioavailable transition metals. The PM samples studied derived from three emission sources (two oil and one coal fly ash) and four ambient airsheds (St. Louis, MO; Washington; Dusseldorf, Germany; and Ottawa, Canada). PM was administered to rats by intratracheal instillation in equimass or equimetal doses to address directly the influence of PM mass versus metal content on acute lung injury and inflammation. Our results indicated that the lung dose of bioavailable transition metal, not instilled PM mass, was the primary determinant of the acute inflammatory response for both the combustion source and ambient PM samples. Residual oil fly ash, a combustion PM rich in bioavailable metal, was evaluated in a rat model of cardiopulmonary disease (pulmonary vasculitis/hypertension) to ascertain whether the disease state augmented sensitivity to that PM. Significant mortality and enhanced airway responsiveness were observed. Analysis of the lavaged lung fluids suggested that the milieu of the inflamed lung amplified metal-mediated oxidant chemistry to jeopardize the compromised cardiopulmonary system. We propose that soluble metals from PM mediate the array of PM-associated injuries to the cardiopulmonary system of the healthy and at-risk compromised host. PMID:9400700

  6. Compromised Prefrontal Cognitive Control Over Emotional Interference in Adolescents with Internet Gaming Disorder.

    PubMed

    Lee, Junghan; Lee, Seojung; Chun, Ji Won; Cho, Hyun; Kim, Dai-jin; Jung, Young-Chul

    2015-11-01

    Increased reports of impulsivity and aggression in male adolescents with Internet gaming might reflect their dysfunction in emotion regulation, particularly in suppression of negative emotions, which should affect the various stages of Internet gaming disorder. This study tested the hypothesis that adolescents with Internet gaming disorder would be more disturbed by the emotional interference and demonstrate compromised dorsal anterior cingulate cortex (dACC) activation during a Stroop Match-to-Sample task. In addition, functional connectivity analysis was conducted to examine the interplays between neural correlates involved in emotional processing and how they were altered in adolescents with Internet gaming disorder. The Internet gaming disorder group demonstrated weaker dACC activation and stronger insular activations to interfering angry facial stimuli compared with the healthy control group. Negative functional connectivity between stronger insular activation and weaker dorsolateral prefrontal activation correlated with higher cognitive impulsivity in adolescents with Internet gaming disorder. These findings provide evidence of the compromised prefrontal cognitive control over emotional interference in adolescents with Internet gaming disorder.

  7. Tyrosine Hydroxylase Binding to Phospholipid Membranes Prompts Its Amyloid Aggregation and Compromises Bilayer Integrity

    PubMed Central

    Baumann, Anne; Jorge-Finnigan, Ana; Jung-KC, Kunwar; Sauter, Alexander; Horvath, Istvan; Morozova-Roche, Ludmilla A.; Martinez, Aurora

    2016-01-01

    Tyrosine hydroxylase (TH), a rate-limiting enzyme in the synthesis of catecholamine neurotransmitters and hormones, binds to negatively charged phospholipid membranes. Binding to both large and giant unilamellar vesicles causes membrane permeabilization, as observed by efflux and influx of fluorescence dyes. Whereas the initial protein-membrane interaction involves the N-terminal tail that constitutes an extension of the regulatory ACT-domain, prolonged membrane binding induces misfolding and self-oligomerization of TH over time as shown by circular dichroism and Thioflavin T fluorescence. The gradual amyloid-like aggregation likely occurs through cross-β interactions involving aggregation-prone motives in the catalytic domains, consistent with the formation of chain and ring-like protofilaments observed by atomic force microscopy in monolayer-bound TH. PC12 cells treated with the neurotoxin 6-hydroxydopamine displayed increased TH levels in the mitochondrial fraction, while incubation of isolated mitochondria with TH led to a decrease in the mitochondrial membrane potential. Furthermore, cell-substrate impedance and viability assays showed that supplementing the culture media with TH compromises cell viability over time. Our results revealed that the disruptive effect of TH on cell membranes may be a cytotoxic and pathogenic factor if the regulation and intracellular stability of TH is compromised. PMID:28004763

  8. Can Neglected Tropical Diseases Compromise Human Wellbeing in Sex-, Age-, and Trait-Specific Ways?

    PubMed Central

    Geary, David C.

    2016-01-01

    Traits that facilitate competition for reproductive resources or that influence mate choice have evolved to signal resilience to infectious disease and other stressors. As a result, the dynamics of competition and choice can, in theory, be used to generate predictions about sex-, age-, and trait-specific vulnerabilities for any sexually reproducing species, including humans. These dynamics and associated vulnerabilities are reviewed for nonhuman species, focusing on traits that are compromised by exposure to parasites. Using the same approach, sex-, age-, and trait-specific vulnerabilities to parasitic disease are illustrated for children’s and adolescent’s physical growth and fitness. Suggestions are then provided for widening the assessment of human vulnerabilities to include age-appropriate measures of behavioral (e.g., children’s play) and cognitive (e.g., language fluency) traits. These are traits that are likely to be compromised by infection in age- and sex-specific ways. Inclusion of these types of measures in studies of neglected tropic diseases has the potential to provide a more nuanced understanding of how these diseases undermine human wellbeing and may provide a useful means to study the efficacy of associated treatments. PMID:27077746

  9. Metabolic engineering of lipid catabolism increases microalgal lipid accumulation without compromising growth.

    PubMed

    Trentacoste, Emily M; Shrestha, Roshan P; Smith, Sarah R; Glé, Corine; Hartmann, Aaron C; Hildebrand, Mark; Gerwick, William H

    2013-12-03

    Biologically derived fuels are viable alternatives to traditional fossil fuels, and microalgae are a particularly promising source, but improvements are required throughout the production process to increase productivity and reduce cost. Metabolic engineering to increase yields of biofuel-relevant lipids in these organisms without compromising growth is an important aspect of advancing economic feasibility. We report that the targeted knockdown of a multifunctional lipase/phospholipase/acyltransferase increased lipid yields without affecting growth in the diatom Thalassiosira pseudonana. Antisense-expressing knockdown strains 1A6 and 1B1 exhibited wild-type-like growth and increased lipid content under both continuous light and alternating light/dark conditions. Strains 1A6 and 1B1, respectively, contained 2.4- and 3.3-fold higher lipid content than wild-type during exponential growth, and 4.1- and 3.2-fold higher lipid content than wild-type after 40 h of silicon starvation. Analyses of fatty acids, lipid classes, and membrane stability in the transgenic strains suggest a role for this enzyme in membrane lipid turnover and lipid homeostasis. These results demonstrate that targeted metabolic manipulations can be used to increase lipid accumulation in eukaryotic microalgae without compromising growth.

  10. 2-Sulfonylpyrimidines: Mild alkylating agents with anticancer activity toward p53-compromised cells

    PubMed Central

    Bauer, Matthias R.; Joerger, Andreas C.; Fersht, Alan R.

    2016-01-01

    The tumor suppressor p53 has the most frequently mutated gene in human cancers. Many of p53’s oncogenic mutants are just destabilized and rapidly aggregate, and are targets for stabilization by drugs. We found certain 2-sulfonylpyrimidines, including one named PK11007, to be mild thiol alkylators with anticancer activity in several cell lines, especially those with mutationally compromised p53. PK11007 acted by two routes: p53 dependent and p53 independent. PK11007 stabilized p53 in vitro via selective alkylation of two surface-exposed cysteines without compromising its DNA binding activity. Unstable p53 was reactivated by PK11007 in some cancer cell lines, leading to up-regulation of p53 target genes such as p21 and PUMA. More generally, there was cell death that was independent of p53 but dependent on glutathione depletion and associated with highly elevated levels of reactive oxygen species and induction of endoplasmic reticulum (ER) stress, as also found for the anticancer agent PRIMA-1MET(APR-246). PK11007 may be a lead for anticancer drugs that target cells with nonfunctional p53 or impaired reactive oxygen species (ROS) detoxification in a wide variety of mutant p53 cells. PMID:27551077

  11. Focal cartilage defect compromises fluid-pressure dependent load support in the knee joint.

    PubMed

    Dabiri, Yaghoub; Li, LePing

    2015-06-01

    A focal cartilage defect involves tissue loss or rupture. Altered mechanics in the affected joint may play an essential role in the onset and progression of osteoarthritis. The objective of the present study was to determine the compromised load support in the human knee joint during defect progression from the cartilage surface to the cartilage-bone interface. Ten normal and defect cases were simulated with a previously tested 3D finite element model of the knee. The focal defects were considered in both condyles within high load-bearing regions. Fluid pressurization, anisotropic fibril-reinforcement, and depth-dependent mechanical properties were considered for the articular cartilages and menisci. The results showed that a small cartilage defect could cause 25% reduction in the load support of the knee joint due to a reduced capacity of fluid pressurization in the defect cartilage. A partial-thickness defect could cause a fluid pressure decrease or increase in the remaining underlying cartilage depending on the defect depth. A cartilage defect also increased the shear strain at the cartilage-bone interface, which was more significant with a full-thickness defect. The effect of cartilage defect on the fluid pressurization also depended on the defect sites and contact conditions. In conclusion, a focal cartilage defect causes a fluid-pressure dependent load reallocation and a compromised load support in the joint, which depend on the defect depth, site, and contact condition.

  12. Compromised epidermal barrier stimulates Harderian gland activity and hypertrophy in ACBP−/− mice[S

    PubMed Central

    Bek, Signe; Neess, Ditte; Dixen, Karen; Bloksgaard, Maria; Marcher, Ann-Britt; Chemnitz, John; Færgeman, Nils J.; Mandrup, Susanne

    2015-01-01

    Acyl-CoA binding protein (ACBP) is a small, ubiquitously expressed intracellular protein that binds C14-C22 acyl-CoA esters with very high affinity and specificity. We have recently shown that targeted disruption of the Acbp gene leads to a compromised epidermal barrier and that this causes delayed adaptation to weaning, including the induction of the hepatic lipogenic and cholesterogenic gene programs. Here we show that ACBP is highly expressed in the Harderian gland, a gland that is located behind the eyeball of rodents and involved in the production of fur lipids and lipids used for lubrication of the eye lid. We show that disruption of the Acbp gene leads to a significant enlargement of this gland with hypertrophy of the acinar cells and increased de novo synthesis of monoalkyl diacylglycerol, the main lipid species produced by the gland. Mice with conditional targeting of the Acbp gene in the epidermis recapitulate this phenotype, whereas generation of an artificial epidermal barrier during gland development reverses the phenotype. Our findings indicate that the Harderian gland is activated by the compromised epidermal barrier as an adaptive and protective mechanism to overcome the barrier defect. PMID:26142722

  13. Compromised epidermal barrier stimulates Harderian gland activity and hypertrophy in ACBP-/- mice.

    PubMed

    Bek, Signe; Neess, Ditte; Dixen, Karen; Bloksgaard, Maria; Marcher, Ann-Britt; Chemnitz, John; Færgeman, Nils J; Mandrup, Susanne

    2015-09-01

    Acyl-CoA binding protein (ACBP) is a small, ubiquitously expressed intracellular protein that binds C14-C22 acyl-CoA esters with very high affinity and specificity. We have recently shown that targeted disruption of the Acbp gene leads to a compromised epidermal barrier and that this causes delayed adaptation to weaning, including the induction of the hepatic lipogenic and cholesterogenic gene programs. Here we show that ACBP is highly expressed in the Harderian gland, a gland that is located behind the eyeball of rodents and involved in the production of fur lipids and lipids used for lubrication of the eye lid. We show that disruption of the Acbp gene leads to a significant enlargement of this gland with hypertrophy of the acinar cells and increased de novo synthesis of monoalkyl diacylglycerol, the main lipid species produced by the gland. Mice with conditional targeting of the Acbp gene in the epidermis recapitulate this phenotype, whereas generation of an artificial epidermal barrier during gland development reverses the phenotype. Our findings indicate that the Harderian gland is activated by the compromised epidermal barrier as an adaptive and protective mechanism to overcome the barrier defect.

  14. Metabolic engineering of lipid catabolism increases microalgal lipid accumulation without compromising growth

    PubMed Central

    Trentacoste, Emily M.; Shrestha, Roshan P.; Smith, Sarah R.; Glé, Corine; Hartmann, Aaron C.; Hildebrand, Mark; Gerwick, William H.

    2013-01-01

    Biologically derived fuels are viable alternatives to traditional fossil fuels, and microalgae are a particularly promising source, but improvements are required throughout the production process to increase productivity and reduce cost. Metabolic engineering to increase yields of biofuel-relevant lipids in these organisms without compromising growth is an important aspect of advancing economic feasibility. We report that the targeted knockdown of a multifunctional lipase/phospholipase/acyltransferase increased lipid yields without affecting growth in the diatom Thalassiosira pseudonana. Antisense-expressing knockdown strains 1A6 and 1B1 exhibited wild-type–like growth and increased lipid content under both continuous light and alternating light/dark conditions. Strains 1A6 and 1B1, respectively, contained 2.4- and 3.3-fold higher lipid content than wild-type during exponential growth, and 4.1- and 3.2-fold higher lipid content than wild-type after 40 h of silicon starvation. Analyses of fatty acids, lipid classes, and membrane stability in the transgenic strains suggest a role for this enzyme in membrane lipid turnover and lipid homeostasis. These results demonstrate that targeted metabolic manipulations can be used to increase lipid accumulation in eukaryotic microalgae without compromising growth. PMID:24248374

  15. Can Neglected Tropical Diseases Compromise Human Wellbeing in Sex-, Age-, and Trait-Specific Ways?

    PubMed

    Geary, David C

    2016-04-01

    Traits that facilitate competition for reproductive resources or that influence mate choice have evolved to signal resilience to infectious disease and other stressors. As a result, the dynamics of competition and choice can, in theory, be used to generate predictions about sex-, age-, and trait-specific vulnerabilities for any sexually reproducing species, including humans. These dynamics and associated vulnerabilities are reviewed for nonhuman species, focusing on traits that are compromised by exposure to parasites. Using the same approach, sex-, age-, and trait-specific vulnerabilities to parasitic disease are illustrated for children's and adolescent's physical growth and fitness. Suggestions are then provided for widening the assessment of human vulnerabilities to include age-appropriate measures of behavioral (e.g., children's play) and cognitive (e.g., language fluency) traits. These are traits that are likely to be compromised by infection in age- and sex-specific ways. Inclusion of these types of measures in studies of neglected tropic diseases has the potential to provide a more nuanced understanding of how these diseases undermine human wellbeing and may provide a useful means to study the efficacy of associated treatments.

  16. DMP-1-mediated Ghr gene recombination compromises skeletal development and impairs skeletal response to intermittent PTH

    PubMed Central

    Liu, Zhongbo; Kennedy, Oran D.; Cardoso, Luis; Basta-Pljakic, Jelena; Partridge, Nicola C.; Schaffler, Mitchell B.; Rosen, Clifford J.; Yakar, Shoshana

    2016-01-01

    Bone minerals are acquired during growth and are key determinants of adult skeletal health. During puberty, the serum levels of growth hormone (GH) and its downstream effector IGF-1 increase and play critical roles in bone acquisition. The goal of the current study was to determine how bone cells integrate signals from the GH/IGF-1 to enhance skeletal mineralization and strength during pubertal growth. Osteocytes, the most abundant bone cells, were shown to orchestrate bone modeling during growth. We used dentin matrix protein (Dmp)-1-mediated Ghr knockout (DMP-GHRKO) mice to address the role of the GH/IGF axis in osteocytes. We found that DMP-GHRKO did not affect linear growth but compromised overall bone accrual. DMP-GHRKO mice exhibited reduced serum inorganic phosphate and parathyroid hormone (PTH) levels and decreased bone formation indices and were associated with an impaired response to intermittent PTH treatment. Using an osteocyte-like cell line along with in vivo studies, we found that PTH sensitized the response of bone to GH by increasing Janus kinase-2 and IGF-1R protein levels. We concluded that endogenously secreted PTH and GHR signaling in bone are necessary to establish radial bone growth and optimize mineral acquisition during growth.—Liu, Z., Kennedy, O. D., Cardoso, L., Basta-Pljakic, J., Partridge, N. C., Schaffler, M. B., Rosen, C. J., Yakar, S. DMP-1-mediated Ghr gene recombination compromises skeletal development and impairs skeletal response to intermittent PTH. PMID:26481310

  17. 2-Sulfonylpyrimidines: Mild alkylating agents with anticancer activity toward p53-compromised cells.

    PubMed

    Bauer, Matthias R; Joerger, Andreas C; Fersht, Alan R

    2016-09-06

    The tumor suppressor p53 has the most frequently mutated gene in human cancers. Many of p53's oncogenic mutants are just destabilized and rapidly aggregate, and are targets for stabilization by drugs. We found certain 2-sulfonylpyrimidines, including one named PK11007, to be mild thiol alkylators with anticancer activity in several cell lines, especially those with mutationally compromised p53. PK11007 acted by two routes: p53 dependent and p53 independent. PK11007 stabilized p53 in vitro via selective alkylation of two surface-exposed cysteines without compromising its DNA binding activity. Unstable p53 was reactivated by PK11007 in some cancer cell lines, leading to up-regulation of p53 target genes such as p21 and PUMA. More generally, there was cell death that was independent of p53 but dependent on glutathione depletion and associated with highly elevated levels of reactive oxygen species and induction of endoplasmic reticulum (ER) stress, as also found for the anticancer agent PRIMA-1(MET)(APR-246). PK11007 may be a lead for anticancer drugs that target cells with nonfunctional p53 or impaired reactive oxygen species (ROS) detoxification in a wide variety of mutant p53 cells.

  18. Changes of skin temperature of parts of the body and serum asymmetric dimethylarginine (ADMA) in type-2 diabetes mellitus Indian patients.

    PubMed

    Anburajan, M; Sivanandam, S; Bidyarasmi, S; Venkatraman, B; Menaka, M; Raj, Baldev

    2011-01-01

    In India, number of people with type 2 Diabetes Mellitus (DM) would be 87 million by the year 2030. DM disturbs autonomic regulation of skin micro-circulation, and causes decrease in resting blood flows through the skin. The skin blood flow has a major effect on its temperature. The aim of the study was to evaluate changes of skin temperature of all parts of the body and serum asymmetric dimethylarginine, ADMA (μmol/L) in type-2 DM Indian patients. Group-I: Normal (n = 17; M/F: 10/15, mean ± SD = 43.2 ± 9.4 years); Group-II: Type-2 DM without cardiovascular (CV) complications (n = 15; M/F: 10/7, mean ± SD = 46.3 ± 14.0 years); Thermograms of all parts of the body were acquired using a non-contact infrared (IR) thermography camera (ThermaCAM T400, FLIR Systems, Sweden). Blood parameters and thyroid hormone were measured biochemically. Indian diabetic risk score (IDRS) was calculated for each subject. In type-2 DM patients without CV group (n = 15), there was a statistically significant (p = 0.01) negative correlations between HbA(1c) and skin temperature of eye and nose (r = -0.57 and r = -0.55 respectively). ADMA was correlated significantly (p = 0.01) with HbA(1c) (r = 0.65) and estimated average glucose, eAG (r = 0.63). In normal subjects, mean minimum and maximum values of skin temperatures were observed at posterior side of sole (26.89 °C) and ear (36.85 °C) respectively. In type-2 DM without CV, mean values of skin temperature in different parts of the body from head to toe were lesser than those values in control group; but this decreases were statistically significant in nose (32.66 Vs 33.99 °C, p = 0.024) as well as in tibia (32.78 Vs 33.13 °C, p = 0.036) regions.

  19. From vulnerable plaque to vulnerable patient--Part III: Executive summary of the Screening for Heart Attack Prevention and Education (SHAPE) Task Force report.

    PubMed

    Naghavi, Morteza; Falk, Erling; Hecht, Harvey S; Jamieson, Michael J; Kaul, Sanjay; Berman, Daniel; Fayad, Zahi; Budoff, Matthew J; Rumberger, John; Naqvi, Tasneem Z; Shaw, Leslee J; Faergeman, Ole; Cohn, Jay; Bahr, Raymond; Koenig, Wolfgang; Demirovic, Jasenka; Arking, Dan; Herrera, Victoria L M; Badimon, Juan; Goldstein, James A; Rudy, Yoram; Airaksinen, Juhani; Schwartz, Robert S; Riley, Ward A; Mendes, Robert A; Douglas, Pamela; Shah, Prediman K

    2006-07-17

    Screening for early-stage asymptomatic cancers (eg, cancers of breast and colon) to prevent late-stage malignancies has been widely accepted. However, although atherosclerotic cardiovascular disease (eg, heart attack and stroke) accounts for more death and disability than all cancers combined, there are no national screening guidelines for asymptomatic (subclinical) atherosclerosis, and there is no government- or healthcare-sponsored reimbursement for atherosclerosis screening. Part I and Part II of this consensus statement elaborated on new discoveries in the field of atherosclerosis that led to the concept of the "vulnerable patient." These landmark discoveries, along with new diagnostic and therapeutic options, have set the stage for the next step: translation of this knowledge into a new practice of preventive cardiology. The identification and treatment of the vulnerable patient are the focuses of this consensus statement. In this report, the Screening for Heart Attack Prevention and Education (SHAPE) Task Force presents a new practice guideline for cardiovascular screening in the asymptomatic at-risk population. In summary, the SHAPE Guideline calls for noninvasive screening of all asymptomatic men 45-75 years of age and asymptomatic women 55-75 years of age (except those defined as very low risk) to detect and treat those with subclinical atherosclerosis. A variety of screening tests are available, and the cost-effectiveness of their use in a comprehensive strategy must be validated. Some of these screening tests, such as measurement of coronary artery calcification by computed tomography scanning and carotid artery intima-media thickness and plaque by ultrasonography, have been available longer than others and are capable of providing direct evidence for the presence and extent of atherosclerosis. Both of these imaging methods provide prognostic information of proven value regarding the future risk of heart attack and stroke. Careful and responsible

  20. De novo 13q deletions in two patients with mild anorectal malformations as part of VATER/VACTERL and VATER/VACTERL-like association and analysis of EFNB2 in patients with anorectal malformations.

    PubMed

    Dworschak, Gabriel C; Draaken, Markus; Marcelis, Carlo; de Blaauw, Ivo; Pfundt, Rolph; van Rooij, Iris A L M; Bartels, Enrika; Hilger, Alina; Jenetzky, Ekkehart; Schmiedeke, Eberhard; Grasshoff-Derr, Sabine; Schmidt, Dominik; Märzheuser, Stefanie; Hosie, Stuart; Weih, Sandra; Holland-Cunz, Stefan; Palta, Markus; Leonhardt, Johannes; Schäfer, Mattias; Kujath, Christina; Rissmann, Anke; Nöthen, Markus M; Zwink, Nadine; Ludwig, Michael; Reutter, Heiko

    2013-12-01

    Anorectal malformations (ARMs) comprise a broad spectrum of conditions ranging from mild anal anomalies to complex cloacal malformations. In 40-50% of cases, ARM occurs within the context of defined genetic syndromes or complex multiple congenital anomalies, such as VATER/VACTERL (vertebral defects [V], ARMs [A], cardiac defects [C], tracheoesophageal fistula with or without esophageal atresia [TE], renal malformations [R], and limb defects [L]) association. Here, we report the identification of deletions at chromosome 13q using single nucleotide polymorphism-based array analysis in two patients with mild ARM as part of VATER/VACTERL and VATER/VACTERL-like associations. Both deletions overlap the previously defined critical region for ARM. Heterozygous Efnb2 murine knockout models presenting with mild ARM suggest EFNB2 as an excellent candidate gene in this region. Our patients showed a mild ARM phenotype, closely resembling that of the mouse. We performed a comprehensive mutation analysis of the EFNB2 gene in 331 patients with isolated ARM, or ARM as part of VATER/VACTERL or VATER/VACTERL-like associations. However, we did not identify any disease-causing mutations. Given the convincing argument for EFNB2 as a candidate gene for ARM, analyses of larger samples and screening of functionally relevant non-coding regions of EFNB2 are warranted. In conclusion, our report underlines the association of chromosome 13q deletions with ARM, suggesting that routine molecular diagnostic workup should include the search for these deletions. Despite the negative results of our mutation screening, we still consider EFNB2 an excellent candidate gene for contributing to the development of ARM in humans.

  1. 36 CFR 1201.20 - What is the extent of the Archivist's authority to compromise debts owed to NARA, or to suspend...

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Archivist's authority to compromise debts owed to NARA, or to suspend or terminate collection action on such... Archivist's authority to compromise debts owed to NARA, or to suspend or terminate collection action on such debts? (a) The Archivist may compromise, suspend, or terminate collection action on those debts owed...

  2. 36 CFR 1201.20 - What is the extent of the Archivist's authority to compromise debts owed to NARA, or to suspend...

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... Archivist's authority to compromise debts owed to NARA, or to suspend or terminate collection action on such... Archivist's authority to compromise debts owed to NARA, or to suspend or terminate collection action on such debts? (a) The Archivist may compromise, suspend, or terminate collection action on those debts owed...

  3. Natural physical and biological processes compromise the long-term performance of compacted soil caps

    SciTech Connect

    Smith, E.D.

    1995-12-01

    Compacted soil barriers are components of essentially all caps placed on closed waste disposal sites. The intended functions of soil barriers in waste facility caps include restricting infiltration of water and release of gases and vapors, either independently or in combination with synthetic membrane barriers, and protecting other manmade or natural barrier components. Review of the performance of installed soil barriers and of natural processes affecting their performance indicates that compacted soil caps may function effectively for relatively short periods (years to decades), but natural physical and biological processes can be expected to cause them to fail in the long term (decades to centuries). This paper addresses natural physical and biological processes that compromise the performance of compacted soil caps and suggests measures that may reduce the adverse consequences of these natural failure mechanisms.

  4. Better innovate than compromise: a novel hepatic outflow reconstruction technique in pediatric living donor liver transplantation.

    PubMed

    Cherian, P Thomas; Mishra, Ashish K; Bangaari, Ashish; Kota, Venugopal; Sathyanarayanan, Mohan; Raya, Ravichandra; Rela, Mohamed

    2015-05-01

    Pediatric LDLT using donors with unfavorable vascular anatomy is challenging in terms of donor safety, and complexity of reconstruction in the recipient. We describe an innovative technique of hepatic venous outflow reconstruction involving the recipient RHV, in the presence of a rudimentary RHV in the donor. The postoperative course of the donor and recipient was uneventful with satisfactory venous outflow in both. This technique avoided the use of prosthetic material, an important consideration given the recipient age and requirement for growth. This shows that donors previously considered unsuitable for donation can be utilized safely as long as principles of vascular anastomosis are adhered to. Moreover, it highlights that innovation is sometimes necessary to avoid compromise in donor safety.

  5. Nothing is safe: Intolerance of uncertainty is associated with compromised fear extinction learning.

    PubMed

    Morriss, Jayne; Christakou, Anastasia; van Reekum, Carien M

    2016-12-01

    Extinction-resistant fear is considered to be a central feature of pathological anxiety. Here we sought to determine if individual differences in Intolerance of Uncertainty (IU), a potential risk factor for anxiety disorders, underlies compromised fear extinction. We tested this hypothesis by recording electrodermal activity in 38 healthy participants during fear acquisition and extinction. We assessed the temporality of fear extinction, by examining early and late extinction learning. During early extinction, low IU was associated with larger skin conductance responses to learned threat vs. safety cues, whereas high IU was associated with skin conductance responding to both threat and safety cues, but no cue discrimination. During late extinction, low IU showed no difference in skin conductance between learned threat and safety cues, whilst high IU predicted continued fear expression to learned threat, indexed by larger skin conductance to threat vs. safety cues. These findings suggest a critical role of uncertainty-based mechanisms in the maintenance of learned fear.

  6. Compromising the 19S proteasome complex protects cells from reduced flux through the proteasome.

    PubMed

    Tsvetkov, Peter; Mendillo, Marc L; Zhao, Jinghui; Carette, Jan E; Merrill, Parker H; Cikes, Domagoj; Varadarajan, Malini; van Diemen, Ferdy R; Penninger, Josef M; Goldberg, Alfred L; Brummelkamp, Thijn R; Santagata, Sandro; Lindquist, Susan

    2015-09-01

    Proteasomes are central regulators of protein homeostasis in eukaryotes. Proteasome function is vulnerable to environmental insults, cellular protein imbalance and targeted pharmaceuticals. Yet, mechanisms that cells deploy to counteract inhibition of this central regulator are little understood. To find such mechanisms, we reduced flux through the proteasome to the point of toxicity with specific inhibitors and performed genome-wide screens for mutations that allowed cells to survive. Counter to expectation, reducing expression of individual subunits of the proteasome's 19S regulatory complex increased survival. Strong 19S reduction was cytotoxic but modest reduction protected cells from inhibitors. Protection was accompanied by an increased ratio of 20S to 26S proteasomes, preservation of protein degradation capacity and reduced proteotoxic stress. While compromise of 19S function can have a fitness cost under basal conditions, it provided a powerful survival advantage when proteasome function was impaired. This means of rebalancing proteostasis is conserved from yeast to humans.

  7. A deletion in the bovine FANCI gene compromises fertility by causing fetal death and brachyspina.

    PubMed

    Charlier, Carole; Agerholm, Jorgen Steen; Coppieters, Wouter; Karlskov-Mortensen, Peter; Li, Wanbo; de Jong, Gerben; Fasquelle, Corinne; Karim, Latifa; Cirera, Susanna; Cambisano, Nadine; Ahariz, Naima; Mullaart, Erik; Georges, Michel; Fredholm, Merete

    2012-01-01

    Fertility is one of the most important traits in dairy cattle, and has been steadily declining over the last decades. We herein use state-of-the-art genomic tools, including high-throughput SNP genotyping and next-generation sequencing, to identify a 3.3 Kb deletion in the FANCI gene causing the brachyspina syndrome (BS), a rare recessive genetic defect in Holstein dairy cattle. We determine that despite the very low incidence of BS (<1/100,000), carrier frequency is as high as 7.4% in the Holstein breed. We demonstrate that this apparent discrepancy is likely due to the fact that a large proportion of homozygous mutant calves die during pregnancy. We postulate that several other embryonic lethals may segregate in livestock and significantly compromise fertility, and propose a genotype-driven screening strategy to detect the corresponding deleterious mutations.

  8. Induction of mitochondrial dysfunction as a strategy for targeting tumour cells in metabolically compromised microenvironments.

    PubMed

    Zhang, Xiaonan; Fryknäs, Mårten; Hernlund, Emma; Fayad, Walid; De Milito, Angelo; Olofsson, Maria Hägg; Gogvadze, Vladimir; Dang, Long; Påhlman, Sven; Schughart, Leoni A Kunz; Rickardson, Linda; D'Arcy, Padraig; Gullbo, Joachim; Nygren, Peter; Larsson, Rolf; Linder, Stig

    2014-01-01

    Abnormal vascularization of solid tumours results in the development of microenvironments deprived of oxygen and nutrients that harbour slowly growing and metabolically stressed cells. Such cells display enhanced resistance to standard chemotherapeutic agents and repopulate tumours after therapy. Here we identify the small molecule VLX600 as a drug that is preferentially active against quiescent cells in colon cancer 3-D microtissues. The anticancer activity is associated with reduced mitochondrial respiration, leading to bioenergetic catastrophe and tumour cell death. VLX600 shows enhanced cytotoxic activity under conditions of nutrient starvation. Importantly, VLX600 displays tumour growth inhibition in vivo. Our findings suggest that tumour cells in metabolically compromised microenvironments have a limited ability to respond to decreased mitochondrial function, and suggest a strategy for targeting the quiescent populations of tumour cells for improved cancer treatment.

  9. Compromised nutrition in gerbils infected by Cystoisospora felis detected through an animal performance analysis tool.

    PubMed

    Frazão-Teixeira, Edwards; de Oliveira, Francisco Carlos Rodrigues; Fiuza, Vagner Ricardo da Silva; Jiménez-Sanz, Amanda Lucía; Detmann, Edenio

    2011-01-01

    The impact of Cystoisospora felis infection on the nutritional efficiency of gerbils was studied. The variables weight gain and feed intake were measured during four weeks in 28 laboratory gerbils, of which 14 were inoculated with 3.5 × 10(5) sporulated oocysts of C. felis and the remaining 14 were controls. The animals from both groups were weighted, killed, eviscerated and had their carcasses and tissues weighted and compared. A modern tool designed for measuring nutritional performance of farm animals was applied. The results showed compromised nutritional efficiency of the infected animals within the first week after infection. The consequences of these results are discussed here, including the potential impact of infection on farm animals performance.

  10. Conflicts of interest in research: is clinical decision-making compromised? An opinion paper.

    PubMed

    Adibi, Shawn; Abidi, Shawn; Bebermeyer, Richard D

    2010-08-01

    Lack of transparency in funded research can compromise clinical decision-making in an evidence-based practice. Transparency can be defined as full disclosure of all financial assistance and support to authors and investigators. There is a perception that ethical principles are eroding and that research data can be biased due to conflicts of interest. These research outcomes biased or not, are used for clinical decision-making in the evidence-based practice. One suggested solution to this common ethical dilemma is to continue the dialogue on transparency in research and to create oversight bodies which include representatives from business and industry, private practice, academia, and research. There is increasing evidence of the need for more ethics education at all levels.

  11. Armc5 deletion causes developmental defects and compromises T-cell immune responses

    PubMed Central

    Hu, Yan; Lao, Linjiang; Mao, Jianning; Jin, Wei; Luo, Hongyu; Charpentier, Tania; Qi, Shijie; Peng, Junzheng; Hu, Bing; Marcinkiewicz, Mieczyslaw Martin; Lamarre, Alain; Wu, Jiangping

    2017-01-01

    Armadillo repeat containing 5 (ARMC5) is a cytosolic protein with no enzymatic activities. Little is known about its function and mechanisms of action, except that gene mutations are associated with risks of primary macronodular adrenal gland hyperplasia. Here we map Armc5 expression by in situ hybridization, and generate Armc5 knockout mice, which are small in body size. Armc5 knockout mice have compromised T-cell proliferation and differentiation into Th1 and Th17 cells, increased T-cell apoptosis, reduced severity of experimental autoimmune encephalitis, and defective immune responses to lymphocytic choriomeningitis virus infection. These mice also develop adrenal gland hyperplasia in old age. Yeast 2-hybrid assays identify 16 ARMC5-binding partners. Together these data indicate that ARMC5 is crucial in fetal development, T-cell function and adrenal gland growth homeostasis, and that the functions of ARMC5 probably depend on interaction with multiple signalling pathways. PMID:28169274

  12. Artemisinin mimics calorie restriction to trigger mitochondrial biogenesis and compromise telomere shortening in mice.

    PubMed

    Wang, Da-Ting; He, Jiang; Wu, Ming; Li, Si-Ming; Gao, Qian; Zeng, Qing-Ping

    2015-01-01

    Calorie restriction is known to extend lifespan among organisms by a debating mechanism underlying nitric oxide-driven mitochondrial biogenesis. We report here that nitric oxide generators including artemisinin, sodium nitroprusside, and L-arginine mimics calorie restriction and resembles hydrogen peroxide to initiate the nitric oxide signaling cascades and elicit the global antioxidative responses in mice. The large quantities of antioxidant enzymes are correlated with the low levels of reactive oxygen species, which allow the down-regulation of tumor suppressors and accessory DNA repair partners, eventually leading to the compromise of telomere shortening. Accompanying with the up-regulation of signal transducers and respiratory chain signatures, mitochondrial biogenesis occurs with the elevation of adenosine triphosphate levels upon exposure of mouse skeletal muscles to the mimetics of calorie restriction. In conclusion, calorie restriction-triggered nitric oxide provides antioxidative protection and alleviates telomere attrition via mitochondrial biogenesis, thereby maintaining chromosomal stability and integrity, which are the hallmarks of longevity.

  13. Audiologic Management of Older Adults With Hearing Loss and Compromised Cognitive/Psychoacoustic Auditory Processing Capabilities

    PubMed Central

    Kricos, Patricia B.

    2006-01-01

    The number and proportion of older adults in the United States population is increasing, and more clinical audiologists will be called upon to deliver hearing care to the approximately 35% to 50% of them who experience hearing difficulties. In recent years, the characteristics and sources of receptive communication difficulties in older individuals have been investigated by hearing scientists, cognitive psychologists, and audiologists. It is becoming increasingly apparent that cognitive compromises and psychoacoustic auditory processing disorders associated with aging may contribute to communication difficulties in this population. This paper presents an overview of best practices, based on our current knowledge base, for clinical management of older individuals with limitations in cognitive or psychoacoustic auditory processing capabilities, or both, that accompany aging. PMID:16528428

  14. Is conceptual understanding compromised by a problem-solving emphasis in an introductory physics course?

    NASA Astrophysics Data System (ADS)

    Ridenour, J.; Feldman, G.; Teodorescu, R.; Medsker, L.; Benmouna, N.

    2013-01-01

    Developing competency in problem solving and enhancing conceptual understanding are primary objectives in introductory physics, and many techniques and tools are available to help instructors achieve them. Pedagogically, we use an easy-to-implement intervention, the ACCESS protocol, to develop and assess problem-solving skills in our SCALE-UP classroom environment for algebra-based physics. Based on our research and teaching experience, an important question has emerged: while primarily targeting improvements in problem-solving and cognitive development, is it necessary that conceptual understanding be compromised? To address this question, we gathered and analyzed information about student abilities, backgrounds, and instructional preferences. We report on our progress and give insights into matching the instructional tools to student profiles in order to achieve optimal learning in group-based active learning. The ultimate goal of our work is to integrate individual student learning needs into a pedagogy that moves students closer to expert-like status in problem solving.

  15. Transitions into and out of daylight saving time compromise sleep and the rest-activity cycles

    PubMed Central

    Lahti, Tuuli A; Leppämäki, Sami; Lönnqvist, Jouko; Partonen, Timo

    2008-01-01

    Background The aim of this study was to analyze the effects of transition out of and into daylight saving time on the rest-activity cycles and sleep. Rest-activity cycles of nine healthy participants aged 20 to 40 years were measured around transitions out of and into daylight saving time on fall 2005 and spring 2006 respectively. Rest-activity cycles were measured using wrist-worn accelerometers. The participants filled in the Morningness-Eveningness and Seasonal Pattern Assessment Questionnaires before starting the study and kept a sleep diary during the study. Results Fall transition was more disturbing for the more morning type and spring transition for the more evening type of persons. Individuals having a higher global seasonality score suffered more from the transitions. Conclusion Transitions out of and into daylight saving time enhanced night-time restlessness and thereby compromised the quality of sleep. PMID:18269740

  16. Processing of visual information compromises the ability of older adults to control novel fine motor tasks.

    PubMed

    Baweja, Harsimran S; Kwon, MinHyuk; Onushko, Tanya; Wright, David L; Corcos, Daniel M; Christou, Evangelos A

    2015-12-01

    We performed two experiments to determine whether amplified motor output variability and compromised processing of visual information in older adults impair short-term adaptations when learning novel fine motor tasks. In Experiment 1, 12 young and 12 older adults underwent training to learn how to accurately trace a sinusoidal position target with abduction-adduction of their index finger. They performed 48 trials, which included 8 blocks of 6 trials (the last trial of each block was performed without visual feedback). Afterward, subjects received an interference task (watched a movie) for 60 min. We tested retention by asking subjects to perform the sinusoidal task (5 trials) with and without visual feedback. In Experiment 2, 12 young and 10 older adults traced the same sinusoidal position target with their index finger and ankle at three distinct visual angles (0.25°, 1° and 5.4°). In Experiment 1, the movement error and variability were greater for older adults during the visual feedback trials when compared with young adults. In contrast, during the no-vision trials, age-associated differences in movement error and variability were ameliorated. Short-term adaptations in learning the sinusoidal task were similar for young and older adults. In Experiment 2, lower amount of visual feedback minimized the age-associated differences in movement variability for both the index finger and ankle movements. We demonstrate that although short-term adaptations are similar for young and older adults, older adults do not process visual information as well as young adults and that compromises their ability to control novel fine motor tasks during acquisition, which could influence long-term retention and transfer.

  17. The Bacterial Virulence Factor Lymphostatin Compromises Intestinal Epithelial Barrier Function by Modulating Rho GTPases

    PubMed Central

    Babbin, Brian A.; Sasaki, Maiko; Gerner-Schmidt, Kirsten W.; Nusrat, Asma; Klapproth, Jan-Michael A.

    2009-01-01

    Lymphocyte inhibitory factor A (lifA) in Citrobacter rodentium encodes the large toxin lymphostatin, which contains two enzymatic motifs associated with bacterial pathogenesis, a glucosyltransferase and a protease. Our aim was to determine the effects of each lymphostatin motif on intestinal epithelial-barrier function. In-frame mutations of C. rodentium lifA glucosyltransferase (CrGlM21) and protease (CrPrM5) were generated by homologous recombination. Infection of both model intestinal epithelial monolayers and mice with C. rodentium wild type resulted in compromised epithelial barrier function and mislocalization of key intercellular junction proteins in the tight junction and adherens junction. In contrast, CrGlM21 was impaired in its ability to reduce barrier function and influenced the tight junction proteins ZO-1 and occludin. CrPrM5 demonstrated decreased effects on the adherens junction proteins β-catenin and E-cadherin. Analysis of the mechanisms revealed that C. rodentium wild type differentially influenced Rho GTPase activation, suppressed Cdc42 activation, and induced Rho GTPase activation. CrGlM21 lost its suppressive effects on Cdc42 activation, whereas CrPrM5 was unable to activate Rho signaling. Rescue experiments using constitutively active Cdc42 or C3 exotoxin to inhibit Rho GTPase supported a role of Rho GTPases in the epithelial barrier compromise induced by C. rodentium. Taken together, our results suggest that lymphostatin is a bacterial virulence factor that contributes to the disruption of intestinal epithelial-barrier function via the modulation of Rho GTPase activities. PMID:19286565

  18. Assessing relocation strategies of urban air quality monitoring stations by GA-based compromise programming.

    PubMed

    Tseng, C C; Chang, N B

    2001-06-01

    This paper presents a GA-based compromise programming technique for assessing the relocation strategy of urban air quality monitoring network with respect to the multi-objective and multi-pollutant design criteria. While the impact of conservative, quasi-stable, and reactive pollutants are considered in the design principles via a simulation analysis, cost, effectiveness, and efficiency characteristics are postulated in the optimization process. Therefore, technical coverage for illustrating the needs of siting air quality monitoring stations (AQMS) includes both the air quality simulation and optimization modeling analyses in a two-stage analytical framework simultaneously. It starts from determining the spatial interrelationship among those candidate sites using various types of air quality simulation models as an integrated means. And the outputs drawn from the simulation models can then be used as the required inputs in the compromise programming model in order to screen all those siting alternatives that may satisfy the planning goals subject to the essential constraints throughout the multi-objective optimization process. For the illustrating purposes, a series of technical settings for finding the optimal relocation scenarios of AQMS were examined in the case study for the city of Kaohsiung in South Taiwan where the long-term violations of official standards of ozone and particulates turn out to be critical. It not only expresses the ideas of relocation strategy but also indicates how to utilize those alternatives in the decision-making process for improving the functionality of air quality monitoring in the urban environment. Experience gained in this study clearly indicates that the more the number of pollutants and objectives considered simultaneously, the higher the number of candidate sites to be selected in the relocation strategy.

  19. Ionoregulatory Aspects of the Osmorespiratory Compromise during Acute Environmental Hypoxia in 12 Tropical and Temperate Teleosts.

    PubMed

    Robertson, Lisa M; Val, Adalberto Luis; Almeida-Val, Vera F; Wood, Chris M

    2015-01-01

    In the traditional osmorespiratory compromise, as seen in the hypoxia-intolerant freshwater rainbow trout (Oncorhynchus mykiss), the branchial modifications that occur to improve O2 uptake during hypoxia result in unfavorable increases in the fluxes of ions and water. However, at least one hypoxia-tolerant freshwater species, the Amazonian oscar (Astronotus ocellatus), shows exactly the opposite: decreased branchial flux rates of ions, water, and nitrogenous wastes during acute hypoxia. In order to find out whether the two strategies were widespread, we used a standard 2-h normoxia, 2-h hypoxia (20%-30% saturation), 2-h normoxic recovery protocol to survey 10 other phylogenetically diverse tropical and temperate species. Unidirectional influx and efflux rates of Na(+) and net flux rates of K(+), ammonia, and urea-N were measured. The flux reduction strategy was seen only in one additional species, the Amazonian tambaqui (Colossoma macropomum), which is similarly hypoxia tolerant and lives in the same ion-poor waters as the oscar. However, five other species exhibited evidence of the increased flux rates typical of the traditional osmorespiratory compromise in the trout: the rosaceu tetra (Hyphessobrycon bentosi rosaceus), the moenkhausia tetra (Moenkhausia diktyota), the bluegill sunfish (Lepomis macrochirus), the zebra fish (Danio rerio), and the goldfish (Carassius auratus). Four other species exhibited no marked flux changes during hypoxia: the cardinal tetra (Paracheirodon axelrodi), the hemigrammus tetra (Hemigrammus rhodostomus), the pumpkinseed sunfish (Lepomis gibbosus), and the Atlantic killifish (Fundulus heteroclitus). Overall, a diversity of strategies exist; we speculate that these may be linked to differences in habitat and/or lifestyle.

  20. Do low-income lone mothers compromise their nutrition to feed their children?

    PubMed Central

    McIntyre, Lynn; Glanville, N. Theresa; Raine, Kim D.; Dayle, Jutta B.; Anderson, Bonnie; Battaglia, Noreen

    2003-01-01

    Background Women who live in disadvantaged circumstances in Canada exhibit dietary intakes below recommended levels, but their children often do not. One reason for this difference may be that mothers modify their own food intake to spare their children nutritional deprivation. The objective of our study was to document whether or not low-income lone mothers compromise their own diets to feed their children. Methods We studied 141 low-income lone mothers with at least 2 children under the age of 14 years who lived in Atlantic Canada. Women were identified through community organizations using a variety of recruitment strategies. The women were asked weekly for 1 month to recall their food intake over the previous 24 hours; they also reported their children's (n = 333) food intake. Mothers also completed a questionnaire about “food insecurity,” that is, a lack of access to adequate, nutritious food through socially acceptable means, during each interview. Results Household food insecurity was reported by 78% of mothers during the study month. Mothers' dietary intakes and the adequacy of intake were consistently poorer than their children's intake overall and over the course of a month. The difference in adequacy of intake between mothers and children widened from Time 1, when the family had the most money to purchase food, to Time 4, when the family had the least money. The children experienced some improvement in nutritional intake at Time 3, which was possibly related to food purchases for them associated with receipt of the Child Tax Benefit Credit or the Goods and Services Tax Credit. Interpretation Our study demonstrates that low-income lone mothers compromise their own nutritional intake in order to preserve the adequacy of their children's diets. PMID:12642423