Seventeen years of Kasai portoenterostomy for biliary atresia in a single Southeast Asian paediatric centre.

PubMed

Chiang, Li Wei; Lee, Chuan Yaw; Krishnaswamy, Gita; Nah, Shireen Anne; Kader, Ajmal; Ong, Christina; Low, Yee; Phua, Kong Boo

2017-04-01

Biliary atresia (BA) has preponderance in Asian populations with Kasai portoenterostomy (KP) regarded as the first-line standard of care. Yet reports from Southeast Asia remain scant. This study reviews the demographics, short- and medium-term outcomes for our cohort, and evaluates prognostic factors for outcome. All patients diagnosed with BA between January 1997 and December 2013 were included. Clinical data were obtained from medical records. Jaundice clearance was defined as total bilirubin < 20 µmol/L within 6 months after KP. Two-year and 5-year native liver survival (NLS) were determined. Prognostic factors examined included gender, ethnicity, associated anomalies, age at KP, post-KP cholangitis and clearance of jaundice within 6 months. Of 58 patients studied, 31(53.4%) were male. Median age at time of KP was 53 days (range: 28-127). Ethnic distribution showed 32 (55.2%) Chinese, 16 (27.6%) Malays and 10 (17.2%) others. Twenty-one (36.2%) patients achieved jaundice clearance by 6 months. Two-year NLS rate was 36 out of 50 (72%), while 5-year NLS rate was 16 out of 35 (45.7%). Only clearance of jaundice within 6 months had a significant association with NLS (P = 0.006). All other factors showed no significant impact on outcome. Our short- and medium-term outcomes after KP for BA are comparable with those reported by most international centres. However, prognostic factors such as age at KP, cholangitis episodes and associated anomalies did not show significant correlation; only clearance of jaundice within 6 months was significantly predictive of NLS. © 2016 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).

Repeat liver resection for recurrent colorectal metastases: a single-centre, 13-year experience.

PubMed

Battula, Narendra; Tsapralis, Dimitrios; Mayer, David; Isaac, John; Muiesan, Paolo; Sutcliffe, Robert P; Bramhall, Simon; Mirza, Darius; Marudanayagam, Ravi

2014-02-01

Isolated intrahepatic recurrence is noted in up to 40% of patients following curative liver resection for colorectal liver metastases (CLM). The aims of this study were to analyse the outcomes of repeat hepatectomy for recurrent CLM and to identify factors predicting survival. Data for all liver resections for CLM carried out at one centre between 1998 and 2011 were analysed. A total of 1027 liver resections were performed for CLM. Of these, 58 were repeat liver resections performed in 53 patients. Median time intervals were 10.5 months between the primary resection and first hepatectomy, and 15.4 months between the first and repeat hepatectomies. The median tumour size was 3.0 cm and the median number of tumours was one. Six patients had a positive margin (R1) resection following first hepatectomy. There were no perioperative deaths. Significant complications included transient liver dysfunction in one and bile leak in two patients. Rates of 1-, 3- and 5-year overall survival following repeat liver resection were 85%, 61% and 52%, respectively, at a median follow-up of 23 months. R1 resection at first hepatectomy (P = 0.002), a shorter time interval between the first and second hepatectomies (P = 0.02) and the presence of extrahepatic disease (P = 0.02) were associated with significantly worse overall survival. Repeat resection of CLM is safe and can achieve longterm survival in carefully selected patients. A preoperative knowledge of poor prognostic factors helps to facilitate better patient selection. © 2013 International Hepato-Pancreato-Biliary Association.

A single-centre report on the characteristics of Tako-tsubo syndrome.

PubMed

Teh, Andrew W; New, Gishel; Cooke, Jennifer

2010-02-01

Tako-tsubo cardiomyopathy is an increasingly recognised phenomenon characterised by chest pain, ECG abnormalities, cardiac biomarker elevation and transient left ventricular dysfunction without significant coronary artery obstruction. To report the clinical and echocardiographic characteristics from a large single-centre Australian series of patients with Tako-tsubo syndrome. We prospectively collected data on 23 consecutive patients presenting between November 2005 and November 2007. Baseline demographics, ECG, echocardiography and coronary angiography were performed on nearly all patients. All patients presented with chest pain; 87% were female. Various stressors were noted and cardiac Troponin-T was elevated in 91% of patients. All patients had non-obstructive coronary disease at angiography. 19/23 patients had initial and subsequent echocardiography. Mean ejection fraction was 50% at baseline and 64% at follow-up (p<0.0001). Right ventricular dysfunction was present in eight, dynamic left ventricular outflow tract obstruction in two, diastolic dysfunction in seven and two patients had the mid-cavity variant. This large prospective single-centre Australian series of Tako-tsubo syndrome is in concert with previous published series. Complete recovery of left ventricular function on echocardiographic follow-up was typical. Although its pathogenesis remains unclear, early distinction from acute coronary syndromes is important and the prognosis is reassuringly good. Crown Copyright (c) 2009. Published by Elsevier B.V. All rights reserved.

Five years' experience at a single centre of craniocerebral injury from winnowing fan blades.

PubMed

Kumar, Apoorva; Shankar, Ravi; Pandey, Rajendra P; Keshri, Virendra; Singh, Kulwant; Sharma, Vivek

2010-02-01

India, an agriculture-based country, relies heavily on indigenous farm machinery. In our study we present 31 patients with winnowing fan blade head injury, operated on at our centre between 2004 and 2008. The mechanism and nature of the injuries, operative methods, outcome and methods of prevention are discussed with special reference to the occurrence of this type of injury in the pediatric population. Copyright 2009 Elsevier Ltd. All rights reserved.

A single-centre experience of Roux-en-Y enteric drainage for pancreas transplantation.

PubMed

Amin, Irum; Butler, Andrew J; Defries, Gail; Russell, Neil K; Harper, Simon J F; Jah, Asif; Saeb-Parsy, Kourosh; Pettigrew, Gavin J; Watson, Christopher J E

2017-04-01

Exocrine drainage following pancreas transplantation can be achieved by drainage into the bladder or bowel, the latter typically by direct duodeno-jejunostomy; the use of Roux-en-Y enteric drainage is uncommon. We report a retrospective analysis of a single-centre experience of Roux-en-Y enteric drainage following pancreas transplantation. Over a 14-year period (2001-2015), 204 consecutive adult pancreas transplants were performed (96.6% simultaneous pancreas and kidney transplants), of which 26.0% were from donors after circulatory death (DCD). During a median follow-up of 67 months (range 13-183 months), 14 (6.9%) recipients experienced complications related to their enteric drainage. Complications during follow-up included early enteric anastomotic haemorrhage (five patients), non-anastomotic enteric bleeding (one patient), small bowel obstruction (four patients) and graft duodenal perforation (two within 6 weeks, five beyond 12 months). No recipient lost their graft as a direct result of complications related to enteric drainage. Patient and pancreas graft survival at 1 year was 99.0% and 94.0% and at 5 years 91.3% and 84.9%, respectively. We conclude that Roux-en-Y enteric drainage following pancreas transplantation is a safe and effective procedure and facilitates graft salvage in the event of graft duodenal perforation. © 2017 Steunstichting ESOT.

Endovascular Management of Acute Embolic Occlusion of the Superior Mesenteric Artery: A 12-Year Single-Centre Experience

DOE Office of Scientific and Technical Information (OSTI.GOV)

Raupach, J., E-mail: janraupach@seznam.cz; Lojik, M., E-mail: miroslav.lojik@fnhk.cz; Chovanec, V., E-mail: chovanec.v@seznam.cz

2016-02-15

PurposeRetrospective evaluation of 12-year experience with endovascular management of acute mesenteric ischemia (AMI) due to embolic occlusion of the superior mesenteric artery (SMA).Materials and methodsFrom 2003 to 2014, we analysed the in-hospital mortality of 37 patients with acute mesenteric embolism who underwent primary endovascular therapy with subsequent on-demand laparotomy. Transcatheter embolus aspiration was used in all 37 patients (19 women, 18 men, median age 76 years) with embolic occlusion of the SMA. Adjunctive local thrombolysis (n = 2) and stenting (n = 2) were also utilised.ResultsWe achieved complete recanalization of the SMA stem in 91.9 %. One patient was successfully treated by surgical embolectomy due tomore » a failed endovascular approach. Subsequent exploratory laparotomy was performed in 73.0 % (n = 27), and necrotic bowel resection in 40.5 %. The total in-hospital mortality was 27.0 %.ConclusionPrimary endovascular therapy for acute embolic SMA occlusion with on-demand laparotomy is a recommended algorithm used in our centre to treat SMA occlusion. This combined approach for the treatment of AMI is associated with in-hospital mortality rate of 27.0 %.« less

Centre-based day care for children younger than five years of age in high-income countries.

PubMed

van Urk, Felix C; Brown, Taylor W; Waller, Rebecca; Mayo-Wilson, Evan

2014-09-23

A large proportion of children younger than five years of age in high-income countries experience significant non-parental care. Centre-based day care services may influence the development of children and the economic situation of parents. To assess the effects of centre-based day care without additional interventions (e.g. psychological or medical services, parent training) on the development and well-being of children and families in high-income countries (as defined by the World Bank 2011). In April 2014, we searched CENTRAL, Ovid MEDLINE, EMBASE, PsycINFO, the Education Resources Information Center (ERIC) and eight other databases. We also searched two trials registers and the reference lists of relevant studies. We included randomised and quasi-randomised controlled trials of centre-based day care for children younger than five years of age. We excluded studies that involved co-interventions not directed toward children (e.g. parent programmes, home visits, teacher training). We included the following outcomes: child cognitive development (primary outcome), child psychosocial development, maternal and family outcomes and child long-term outcomes. Two review authors independently assessed the risk of bias and extracted data from the single included study. We contacted investigators to obtain missing information. We included in the review one trial, involving 120 families and 143 children. Risk of bias was high because of contamination between groups, as 63% of control group participants accessed day care services separate from those offered within the intervention. No evidence suggested that centre-based day care, rather than no treatment (care at home), improved or worsened children's cognitive ability (Griffiths Mental Development Scale, standardised mean difference (SMD) 0.34, 95% confidence interval (CI) -0.01 to 0.69, 127 participants, 1 study, very low-quality evidence) or psychosocial development (parental report of abnormal development, risk ratio (RR

Paediatric ECMO at low-volume paediatric cardiac centres in the Nordic countries.

PubMed

Veien, M; Lindberg, L; Tynkkynen, P; Ravn, H B

2015-03-01

Extracorporeal membrane oxygenation (ECMO) is a life-saving resource-intensive technology for patients with respiratory and/or circulatory failure. We aimed to evaluate outcome data from three Nordic paediatric centres comparing with data from the International Registry of the Extracorporeal Life Support Organization (ELSO) and selected high-volume single-centre studies. One-hundred nineteen patients < 19 years from 2002 to 2012 were enrolled. Data on demographics and outcome were collected using a standardised registration form. Outcome data were compared with the ELSO registry and high-volume single-centre studies. Demographics, indications and diagnosis were similar to the ELSO register. Survival after ECMO was similar to outcome data from the ELSO register, apart from paediatric cardiac ECMO, where a significantly better survival to discharge was seen in the Nordic centres (68% vs. 49%; P = 0.03). Comparison with high-volume centres in the period after 2005 demonstrated a significantly better survival after cardiac ECMO in a single high-volume centre study, whereas four studies had significantly lower survival after cardiac ECMO. No significant difference was seen in children receiving respiratory ECMO in the Nordic centres and high-volume centres. Survival after ECMO in three low-volume Nordic centres demonstrated comparable outcome data with ELSO data and data from high-volume centres. We believe regular quality assurance surveys, as the present study, should be performed in order to maintain excellent therapy within the individual ECMO centres. © 2015 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

Causes of prolonged jaundice in infancy: 3-year experience in a tertiary paediatric centre.

PubMed

Andre, Margaret; Day, Andrew S

2016-01-29

Although prolonged jaundice (PJ) commonly occurs in infancy, there is not yet agreement as to the appropriate extent of investigations, particularly in otherwise well children. Significant pathologies may present with PJ in this age group and need to be considered. The aim of this retrospective study was to ascertain the causes of PJ in infants referred to a single tertiary paediatric centre. Infants referred with PJ over a 3-year period were identified. Clinical documentation, electronic notes and results of investigations performed prior to and after referral were reviewed. One hundred and sixty-seven infants with PJ were seen. Fifty-eight percent were over 28 days of age. Four patients had conjugated hyperbilirubinaemia. Eighteen percent of patients were found to have a specific medical diagnosis causing or contributing to PJ, almost half of whom had normal clinical examination. The single most common pathological cause for PJ was hypothyroidism found in six patients. This study demonstrates that normal clinical examination and exclusion of conjugated hyperbilirubinaemia are insufficient to exclude pathological causes of PJ. Overall, these children were referred late. Guidelines, in conjunction with education initiatives, are required to optimise the management of prolonged jaundice in infancy.

Recurrent Pneumonia in Children: A Reasoned Diagnostic Approach and a Single Centre Experience.

PubMed

Montella, Silvia; Corcione, Adele; Santamaria, Francesca

2017-01-29

Recurrent pneumonia (RP), i.e., at least two episodes of pneumonia in one year or three episodes ever with intercritical radiographic clearing of densities, occurs in 7.7%-9% of children with community-acquired pneumonia. In RP, the challenge is to discriminate between children with self-limiting or minor problems, that do not require a diagnostic work-up, and those with an underlying disease. The aim of the current review is to discuss a reasoned diagnostic approach to RP in childhood. Particular emphasis has been placed on which children should undergo a diagnostic work-up and which tests should be performed. A pediatric case series is also presented, in order to document a single centre experience of RP. A management algorithm for the approach to children with RP, based on the evidence from a literature review, is proposed. Like all algorithms, it is not meant to replace clinical judgment, but it should drive physicians to adopt a systematic approach to pediatric RP and provide a useful guide to the clinician.

Carotid endarterectomy: the change in practice over 11 years in a stroke centre.

PubMed

Tse, Gabrielle T W; Kilkenny, Monique F; Bladin, Chris; Grigg, Michael; Dewey, Helen M

2017-11-13

Recent research evidence has impacted the practice of carotid endarterectomy (CEA). We aim to characterize changes in the practice and outcome of CEA over time in a single large-volume stroke centre. All patients who underwent CEA from 2004 to 2014 and carotid angioplasty and stenting (CAS) from 2003 to 2008 at an Australian metropolitan tertiary stroke centre hospital were included. Clinical data were analysed to identify time trends in choice of intervention, patient selection, preoperative imaging utilization, surgical timing and outcome. There were 510 CEAs performed during 2004-2014 and 95 CASs during 2003-2008. The proportion of patients undergoing CEA compared to CAS increased from 60% to 90% from 2004 to 2008 (P < 0.001). CAS patients were more likely to have cardiac co-morbidities. From 2004 to 2014, the proportion of CEA patients aged ≥80 years increased (P = 0.001) and the proportion of asymptomatic patients decreased (P = 0.003) over time. Median time from symptom onset to surgery decreased from 52 days (Q1: 25, Q3: 74) in 2004 to 8 days (Q1: 5, Q3: 37) in 2014 (P < 0.001). Use of preoperative ultrasonography decreased whilst CT angiography and the number of imaging modalities applied to each patient increased over time (P < 0.001). Overall, 5.9% of CEAs were complicated by death, stroke or acute myocardial infarction with no significant change over time. The trends in CEA practice at our centre align with international trends and guidelines. This study provides a representative indicator of Australian hospital practice, and illustrates how evidence from research is translated into clinical care. © 2017 Royal Australasian College of Surgeons.

Gender and psychiatric diagnosis: a 5-year retrospective study in a Nigerian Federal Medical Centre.

PubMed

Agbir, T M; Oyigeya, M; Audu, M; Dapap, D D; Goar, S G

2010-01-01

The role of gender in psychiatry disorders is becoming increasingly important. This study is therefore, aimed at identifying gender pattern of admissions to a public mental health centre with regards to demographic characteristic, psychiatry diagnosis and length of stay on admission. In this retrospective study Hospital records of 388 patients admitted at the psychiatric section of the Federal Medical Centre (FMC) Makurdi, between January, 2004 and December, 2008 were studied for gender differences regarding demographic attributes, length of stay and psychiatry diagnoses. Findings revealed that more men than women were admitted overall. Most men (56%) were less than 30 years old whereas 60.6% of women were within 30-59 years aged bracket. For men the main diagnosis was schizophrenia (30.5%), followed by substance related disorders (16.5%) then depression (14.0%); for women the main diagnosis was also schizophrenia (30.3%), this was followed by depression (24.5%), only one woman was diagnosed with substance related disorder. A statistically significant association was also found between having a personality disorder and being a male (p = 0.009). Most female were single and belong to the lowest occupational group. There was no significant difference in the gender distribution of patients with respect to length of stay on admission (p = 0.161). The results revealed how psychiatry diagnosis is significantly influence by gender issues. We therefore recommend that; for a more effective psychiatry formulation, it is imperative to pay attention to gender issues that may affect the development of psychopathology.

Treating TTP/HUS with plasma exchange: a single centre's 25-year experience.

PubMed

Forzley, Brian R; Sontrop, Jessica M; Macnab, Jennifer J; Chen, Salina; Clark, William F

2008-10-01

Thrombotic thrombocytopenic purpura/Haemolytic uremic syndrome (TTP/HUS) is a thrombotic microangiopathy with a 6-month mortality rate of 16-29%. The present study described the clinical features, treatment regime and 6-month all-cause mortality rate of TTP/HUS patients at the London Health Sciences Centre (LHSC), Canada. Data for this retrospective cohort study were obtained from inpatient and outpatient records for all patients referred for plasma exchange therapy at LHSC, Canada between 1981 and 2006. Patients (n = 110) were categorized as: idiopathic primary (38%) or relapsed (16%), and secondary responsive (30%) or non-responsive (16%). Mortality data were available for all but three patients. The all-cause 6-month mortality rate was 19% overall and was 12% and 26% among idiopathic and secondary TTP/HUS patients, respectively. No mortality events occurred among the 17 idiopathic patients who relapsed. Relapsed patients had the least severe presenting characteristics, the fastest response time, and experienced significant improvement in the severity of clinical features between the first and final presentation. These findings suggest an excellent outcome for relapsed TTP/HUS patients. Patient education, surveillance, and aggressive plasma exchange therapy are hypothesized to improve the likelihood of survival: these hypotheses should be tested in a randomized controlled trial.

Hepatitis E in transfusion-dependent thalassaemia patients, in Greece: a single centre experience.

PubMed

Klonizakis, P; Gioula, G; Exindari, M; Apostolou, C; Kotsiafti, A; Vlachaki, E

2017-10-01

Hepatitis E is considered an emerging disease that may be a threat in both developing and industrialized countries all over the world. The risk of chronic hepatitis E virus infection is higher among immunocompromised patients. This study aimed to assess the status of hepatitis E infection in patients with transfusion-dependent thalassaemia from a single centre, in Greece. Our results suggest that the prevalence of hepatitis E infection in this group of patients is low. © 2017 International Society of Blood Transfusion.

Centre-based day care for children younger than five years of age in low- and middle-income countries.

PubMed

Brown, Taylor W; van Urk, Felix C; Waller, Rebecca; Mayo-Wilson, Evan

2014-09-25

version of the British Ability Scale-II (BAS-II) (standardised mean difference (SMD) 0.74, 95% confidence interval (CI) 0.48 to 1.00, 256 participants, 1 study, very low-quality evidence). This study did not measure other variables relevant to this review. The single study included in this review provides limited evidence on the effects of centre-based day care for children younger than five years of age in low- and middle-income countries. This study was at high risk of bias and may have limited generalisability to other low- and middle-income countries. Many of the studies excluded from this review paired day care attendance with co-interventions that are unlikely to be provided in normal day care centres. Effectiveness studies on centre-based day care without these co-interventions are few, and the need for such studies is significant. In future studies, comparisons might include home visits or alternative day care arrangements.

Re-operative thyroid surgery: a 20-year prospective cohort study at a tertiary referral centre.

PubMed

Hardman, John C; Smith, J A; Nankivell, P; Sharma, N; Watkinson, J C

2015-06-01

Re-operative thyroid surgery is a relatively uncommon procedure complicated by distorted anatomy and post-operative tissue changes. Surgery may follow initial benign or malignant pathology. Published outcomes vary widely in the literature. This study aims to report our outcomes from re-operative thyroid surgery. Patient demographics and complication rates for consecutive thyroidectomies performed by a single surgeon at a tertiary centre were collected between 1993 and 2013. Outcomes in re-operative surgery are analysed and compared with local and national data. Cases of re-operative surgery following benign disease are further analysed for histology, re-presenting symptoms and time between procedures. Our cohort comprised 1,657 cases including 164 re-operative procedures (101 malignant, 63 benign). Within our cohort re-operative cases were on average 4 years older (mean 49.9 vs 45.9 years, p = 0.001) and had a higher incidence of haematoma formation (4.3 vs 1.7 %, p = 0.033) and transient recurrent laryngeal nerve palsy (5.5 vs 2.5 %, p = 0.044) compared to primary surgery. Rates of permanent hypocalcaemia (2.4 vs 1.8 %, p = 0.540) and permanent RLN palsy (1.8 vs 0.4 %, p = 0.051) were higher in the re-operative group but did not reach significance. Comparison of complications following re-operation for benign and malignant disease revealed no significant differences. Mean interval to re-operation for benign cases was 17.4 years with 74.6 % found to have multinodular goitre at repeat procedure. Re-operative procedures comprised around 10 % of thyroid surgery at our centre. Re-operative cases experienced more complications than primary surgery but permanent rates were low. Re-operative surgery may therefore be safely considered in experienced hands.

Total aortic arch replacement with the elephant trunk technique: single-centre 30-year results.

PubMed

Shrestha, Malakh; Martens, Andreas; Krüger, Heike; Maeding, Illona; Ius, Fabio; Fleissner, Felix; Haverich, Axel

2014-02-01

The combined disease of the aortic arch and the descending aorta (aneurysms and dissection) remains a surgical challenge. Various approaches have been used to treat this complex pathology. In the two-stage operation, at the first-stage operation, the aortic arch is replaced through a median sternotomy. Later, at the second-stage operation, the descending thoracic aorta is replaced through a lateral thoracotomy. The elephant trunk (ET) technique was introduced by H.G. Borst at our centre in March 1982, greatly simplifying the second-phase operation. We present our 30-year experience. From March 1982 to March 2012, 179 patients (112 males, age 56.4±12.6 years) received an ET procedure for the combined disease of the aortic arch and the descending aorta (91 aneurysms, 88 dissections (47 acute)). Fifty-six of these patients had undergone previous cardiac operations. Concomitant procedures were performed if necessary. The cerebral protection was done either by deep (till 1999) or moderate hypothermic circulatory arrest and selective antegrade cerebral perfusion (SACP, after 1999). Cardiopulmonary bypass (CPB) and X-clamp times were 208.5±76.5 min and 123.7±54.8 min, respectively. The intraoperative mortality and 30-day mortality during the first-stage operation were 1.7% (3/179) and 17.3% (31/179, 15 with AADA), respectively. Perioperative stroke was 7.9% (n=14/176). Postoperative recurrent nerve palsy was present in 18.2% (32/176) and paraplegia in 5.6% (10/176). The second-stage completion operation was performed as early as possible. Fifty-seven second-stage completion procedures were performed, either surgically (n=50) or through interventional techniques (n=7). The intraoperative and 30-day mortality after the second-stage completion procedures were 5.2% (3/57) and 7.0% (4/57), respectively. The stroke, recurrent nerve palsy and paraplegia rates were 0, 0 and 7% (4/54), respectively. The ET technique has greatly facilitated the two-stage approach to the surgical

Three-dimensional printing in cardiac surgery and interventional cardiology: a single-centre experience.

PubMed

Schmauss, Daniel; Haeberle, Sandra; Hagl, Christian; Sodian, Ralf

2015-06-01

In individual cases, routine preoperative imaging might not be sufficient for optimal planning of cardiovascular procedures. Three-dimensional printing (3D), a widely used technique to build life-like replicas of anatomical structures that has proven value in different medical disciplines, might overcome these shortcomings. However, data on 3D printing in cardiovascular medicine are limited to single reports. This stimulated us to present our single-centre experience with 3D printing models in cardiac surgery and interventional cardiology. Between the years 2006 and 2013, we fabricated 3D printing models using preoperative computed tomography or magnetic resonance imaging data in paediatric and adult cardiac surgery, as well as interventional cardiology. We present the 8 most representative cases. The models were very helpful for perioperative planning and orientation, as well as simulation of procedures due to the exact and life-like illustration of the cardiovascular anatomy. The fabrication of 3D printing models is feasible for perioperative planning and simulation in a variety of complex cases in paediatric and adult cardiac surgery, as well as in interventional cardiology. Further studies including more patients and providing more data are expected to demonstrate that the use of 3D printing may decrease morbidity and mortality of complex, non-routine procedures in cardiovascular medicine. © The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Haematopoietic stem cell transplantation for primary immunodeficiency syndromes: A 5-year single-centre experience.

PubMed

Norman, Melissa; David, Clementine; Wainstein, Brynn; Ziegler, John B; Cohn, Richard; Mitchell, Richard; O'Brien, Tracey; Russell, Susan; Trahair, Toby; Trickett, Annette; Frith, Katie; Gray, Paul

2017-10-01

Haematopoietic stem cell transplantation (HSCT) is a central therapy in the treatment of primary immunodeficiency diseases (PIDs). Over the past 5 years, outcomes have been greatly improved due to earlier diagnosis, improved donor availability, advancements in graft manipulation and the use of less toxic preparative regimens. We present a 5-year audit of HSCT for PID at a single Australian tertiary hospital. Retrospective case note review identified diagnosis, pre-transplant medical morbidity, transplant protocol, engraftment, adverse events, post-transplant immune reconstitution and general health. A total of 22 patients with PID underwent 24 HSCTs at our institution between 2012 and 2016. The most common indications were severe combined immunodeficiency, chronic granulomatous disease and familial haemophagocytic lymphohistiocytosis, with a genetic diagnosis in all but two patients. Reduced intensity or reduced toxicity conditioning was used in 91% of cases, and 75% of the donors were unrelated. Transplant-related mortality at day +100 was 9.5%, and cumulative overall survival was 86%. There were three mortalities, all secondary to viral infection, one of which occurred in the context of graft failure. Two patients remained on immune support, with the remainder achieving adequate immune reconstitution. The outcomes for HSCT for PIDs performed at Sydney Children's Hospital were in line with the world's best practice. HSCT should be considered a potential therapeutic option for all Australian PID patients with a valid disease indication. © 2017 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).

Pembrolizumab in patients with thymic carcinoma: a single-arm, single-centre, phase 2 study.

PubMed

Giaccone, Giuseppe; Kim, Chul; Thompson, Jillian; McGuire, Colleen; Kallakury, Bhaskar; Chahine, Joeffrey J; Manning, Maria; Mogg, Robin; Blumenschein, Wendy M; Tan, Ming T; Subramaniam, Deepa S; Liu, Stephen V; Kaplan, Ian M; McCutcheon, Justine N

2018-03-01

Treatment options are limited for patients with thymic carcinoma. These aggressive tumours are not typically associated with paraneoplastic autoimmune disorders, and strong PD-L1 expression has been reported in thymic epithelial tumours. We aimed to assess the activity of pembrolizumab, a monoclonal antibody that targets PD-1, in patients with advanced thymic carcinoma. We completed a single-arm phase 2 study of pembrolizumab in patients with recurrent thymic carcinoma who had progressed after at least one line of chemotherapy. This was a single-centre study performed at Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA. Key inclusion criteria were an Eastern Cooperative Oncology Group performance status of 0-2, no history of autoimmune disease or other malignancy requiring treatment or laboratory abnormality, and adequate organ function. Patients received 200 mg of pembrolizumab every 3 weeks for up to 2 years. The primary objective of the study was the proportion of patients who had achieved a response assessed with Response Evaluation Criteria in Solid Tumors version 1.1. Analysis was per protocol, in all eligible patients. The study is registered with ClinicalTrials.gov, number NCT02364076, and is closed to accrual; we report the final analysis. 41 patients were enrolled from March 12, 2015, to Dec 16, 2016, of whom 40 were eligible and evaluable and one was excluded because of elevated liver enzymes at screening. The median follow-up was 20 months (IQR 14-26). The proportion of patients who achieved a response was 22·5% (95% CI 10·8-38·5); one (3%) patient achieved a complete response, eight (20%) patients achieved partial responses, and 21 (53%) patients achieved stable disease. The most common grade 3 or 4 adverse events were increased aspartate aminotransferase and alanine aminotransferase (five [13%] patients each). Six (15%) patients developed severe autoimmune toxicity, including two (5%) patients with myocarditis. There

Predictors of failure after single faecal microbiota transplantation in patients with recurrent Clostridium difficile infection: results from a 3-year, single-centre cohort study.

PubMed

Ianiro, G; Valerio, L; Masucci, L; Pecere, S; Bibbò, S; Quaranta, G; Posteraro, B; Currò, D; Sanguinetti, M; Gasbarrini, A; Cammarota, G

2017-05-01

Faecal microbiota transplantation (FMT) is an effective treatment for recurrent Clostridium difficile infection (CDI). Although a single faecal infusion is usually sufficient to eradicate CDI, a considerable number of patients need multiple infusions to be cured. The aim of this study was to identify predictors of failure after single faecal infusion in patients with recurrent CDI. We included patients with recurrent CDI prospectively treated with FMT by colonoscopy. By means of univariate and multivariate analysis, variables including female gender, age, number of CDI recurrences, severity of CDI, hospitalization, inadequate bowel preparation, unrelated donor, and use of frozen faeces, were assessed to predict failure after single faecal infusion. Sixty-four patients (39 women; mean age 74 years) were included. Of them, 44 (69%) were cured by a single faecal infusion, whereas 20 (31%) needed repeat infusions. Overall, FMT cured 62 of 64 (97%) patients. In the subgroup of patients with severe CDI, only eight of 26 (30%) were cured with a single infusion. At multivariate analysis, severe CDI (OR 24.66; 95% CI 4.44-242.08; p 0.001) and inadequate bowel preparation (OR 11.53; 95% CI 1.71-115.51; p 0.019) were found to be independent predictors of failure after single faecal infusion. Severe CDI and inadequate bowel preparation appear to be independent predictors of failure after single faecal infusion in patients treated with FMT by colonoscopy for recurrent CDI. Our results may help to optimize protocols and outcomes of FMT in patients with recurrent CDI. Copyright © 2016 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

Real world experience with lacosamide monotherapy- a single center 1-year follow-up study.

PubMed

Maloney, Eimer; McGinty, Ronan N; Costello, Daniel J

2018-05-01

Reporting of 'real-world' data on efficacy and tolerability of antiepileptic medications helps to inform physicians on how newer medications perform in the clinical setting, outside of the strict regimens of clinical trials. We report our experience of prescribing lacosamide monotherapy to a diverse range of patients at our epilepsy centre. We performed a single-centre, retrospective review of all patients who had been prescribed lacosamide monotherapy over the last 8 years. Efficacy is pragmatically reported based on reduction of seizure frequency and lacosamide retention rates. We identified 45 patients who were commenced on lacosamide monotherapy. Intent-to-treat analysis demonstrated a 51% (n = 23) 12 month retention rate. Forty percent (n = 18) achieved a greater than 50% reduction in seizure frequency and 35.5% (n = 16) became seizure free. We report real-world data showing a significant reduction in seizure frequency, a moderate rate of retention and an excellent side effect profile in our cohort of patients prescribed lacosamide monotherapy. Copyright © 2018 Elsevier B.V. All rights reserved.

Commercial renal transplantation: A risky venture? A single Canadian centre experience.

PubMed

Kapoor, Anil; Kwan, Kevin G; Whelan, J Paul

2011-10-01

Canada, akin to other developed nations, faces the growing challenges of end-stage renal disease (ESRD). Even with expanded donor criteria for renal transplantation (the treatment of choice for ESRD), the supply of kidneys is outpaced by the escalating demand. Remuneration for kidney donation is proscribed in Canada. Without an option of living-related transplantation (biological or emotional donors), patients often struggle with long waiting lists for deceased donor transplantation. Accordingly, many patients are now opting for more expedient avenues to obtaining a renal transplant. Through commercial organ retrieval programs, from living and deceased donors, patients are travelling outside Canada to have the procedure performed. Between September 2001 and July 2007, 10 patients (7 males, 3 females) underwent commercial renal transplantation outside Canada. We describe the clinical outcomes of these patients managed postoperatively at our single Canadian transplant centre. Six living unrelated and 4 deceased donor renal transplantations were performed on these 10 patients (mean age 49.5 years). All procedures were performed in developing countries and the postoperative complications were subsequently treated at our centre. The mean post-transplant serum creatinine was 142 μmol/L. The average follow-up time was 29.8 months (range: 3 to 73 months). One patient required a transplant nephrectomy secondary to fungemia and subsequently died. One patient had a failed transplant and has currently resumed hemodialysis. Acute rejection was seen in 5 patients with 3 of these patients requiring re-initiation of hemodialysis. Only 1 patient had an uncomplicated course after surgery. Despite the kidney trade being a milieu of corruption and commercialization, and the high risk of unconventional complications, patients returning to Canada after commercial renal transplantation are the new reality. Patients are often arriving without any documentation; therefore, timely, goal

Commercial renal transplantation: A risky venture? A single Canadian centre experience

PubMed Central

Kapoor, Anil; Kwan, Kevin G.; Whelan, J. Paul

2011-01-01

Background: Canada, akin to other developed nations, faces the growing challenges of end-stage renal disease (ESRD). Even with expanded donor criteria for renal transplantation (the treatment of choice for ESRD), the supply of kidneys is outpaced by the escalating demand. Remuneration for kidney donation is proscribed in Canada. Without an option of living-related transplantation (biological or emotional donors), patients often struggle with long waiting lists for deceased donor transplantation. Accordingly, many patients are now opting for more expedient avenues to obtaining a renal transplant. Through commercial organ retrieval programs, from living and deceased donors, patients are travelling outside Canada to have the procedure performed. Methods: Between September 2001 and July 2007, 10 patients (7 males, 3 females) underwent commercial renal transplantation outside Canada. We describe the clinical outcomes of these patients managed postoperatively at our single Canadian transplant centre. Results: Six living unrelated and 4 deceased donor renal transplantations were performed on these 10 patients (mean age 49.5 years). All procedures were performed in developing countries and the postoperative complications were subsequently treated at our centre. The mean post-transplant serum creatinine was 142 μmol/L. The average follow-up time was 29.8 months (range: 3 to 73 months). One patient required a transplant nephrectomy secondary to fungemia and subsequently died. One patient had a failed transplant and has currently resumed hemodialysis. Acute rejection was seen in 5 patients with 3 of these patients requiring re-initiation of hemodialysis. Only 1 patient had an uncomplicated course after surgery. Discussion: Despite the kidney trade being a milieu of corruption and commercialization, and the high risk of unconventional complications, patients returning to Canada after commercial renal transplantation are the new reality. Patients are often arriving without any

Post-operative outcomes in older patients: a single-centre observational study.

PubMed

Tang, Benjamin; Green, Cameron; Yeoh, Aun Chian; Husain, Faisal; Subramaniam, Ashwin

2018-05-01

Improved life-expectancies have seen increased rates of older patients undergoing surgery worldwide. These patients are at increased risk of post-operative complications. Australian evidence is limited regarding the association between age and post-operative outcomes, especially rapid response calls (RRCs) as indicators of adverse outcomes. The aim was to compare the post-operative outcomes of older patients (≥80 years) to younger patients. Specifically, 30-day in-hospital mortality; unplanned intensive care unit (ICU) admission; and RRC activation within 72 h post-operatively. Single-centre retrospective observational study conducted over 12 months in a metropolitan Australian hospital. All adult patients (≥16 years) undergoing surgical procedures were included, excluding cardiac and obstetric/gynaecological surgeries. Patient co-morbidities were quantified using Charlson co-morbidity index (CCI) and American Society of Anesthesiologists physical status classification. Seven thousand four hundred and seventy-nine patients met inclusion criteria, 14.5% (n = 1086) aged ≥80 years. Most procedures (65%) were elective; and general surgical procedures were most common (24.2%). Compared to younger patients, older patients had significantly higher 30-day mortality (2.3% versus 0.2%; P < 0.001), increased post-operative RRC rates (7.3% versus 1.2%; P < 0.001), and unplanned ICU admissions (3.2% versus 1.6%; P < 0.001). Increasing age was associated with increased risk of post-operative RRC, unplanned ICU admission, and in-hospital mortality (all P < 0.01), with associations remaining significant after controlling for surgery type and CCI. Older patients are at increased risk of adverse post-operative outcomes, including post-operative RRC, unplanned ICU admission, and mortality, especially if they underwent emergency procedures. This has implications for preoperative risk stratification and post-operative management. Incidence of post

Long-term prediction of functional outcome after stroke using single items of the Barthel Index at discharge from rehabilitation centre.

PubMed

De Wit, Liesbet; Putman, Koen; Devos, Hannes; Brinkmann, Nadine; Dejaeger, Eddy; De Weerdt, Willy; Jenni, Walter; Lincoln, Nadina; Schuback, Birgit; Schupp, Wilfried

2014-01-01

To determine the prognostic value of single items of the Barthel Index (BI) at discharge from rehabilitation, in predicting independence in personal activities of daily living (ADL) (BI score ≥ 95/100) at five years after stroke. People with stroke were recruited consecutively from four European rehabilitation centres. BI was assessed on discharge and at five years after stroke. Stepwise multivariate logistic regression analysis was used to determine independent predictors of BI score ≥ 95/100 at five years after stroke. Thereupon, percentage chance of reaching BI ≥ 95/100 at five years after stroke was calculated. Data were available for 153 patients. Independence in dressing (odds ratio (OR)=5.22, 95% confidence interval (CI)=1.85-14.76, p=0.002) and bathing (OR=8.10, 95% CI=3.40-19.32, p<0.0001) were independent predictors. Independence in both items resulted in 74.1% (57.6-85.8) chance of reaching BI ≥ 95/100 at five years after stroke. Dependence in both items resulted in 6.3% (5.1-7.9) chance. Independence in bathing, but dependence in dressing resulted in 35.4% (30.7-40.4) chance whereas the opposite resulted in 26.1% (20.7-32.3) chance. Simple assessment of dressing and bathing on discharge from rehabilitation enables therapeutic staff to predict prognosis for long-term independence in personal ADL. This method can be used for early identification of persons with stroke who need intensive follow-up. Implications for Rehabilitation (In)dependence for dressing and bathing at discharge from a rehabilitation centre are significant factors in the prediction of (in)dependence in personal ADL at five years after stroke. This predictive tool can be used for targeting inpatient stroke rehabilitation and early identification of those patients who need intensive follow-up.

Teleconsultation in vascular surgery: a 13 year single centre experience.

PubMed

Schmidt, Christian A P; Schmidt-Weitmann, Sabine H; Lachat, Mario L; Brockes, Christiane M

2014-01-01

The University Hospital of Zurich has provided an email-based medical consultation service for the general public since 1999. We examined the enquiries in a 13-year period to identify those related to vascular surgery (based on 22 ICD-10 codes specific for vascular surgery). There were 40,062 questions, of which 643 (2%) were selected by ICD-10 codes. After exclusion of diagnoses not relevant to vascular surgery, 139 questions remained, i.e. an average rate of about one per month. The mean age of the users was 43 years (range 19-88). Most users (61%) were women. The majority of users asked questions about their own health problems (79%) with varicose veins and spider veins accounting for 63% of all questions. Arterial diseases accounted for 30%. The patient's intention in contacting the service was to obtain advice on treatment options (37%), information about a diagnosis or symptoms (27%), or a second opinion (15%). The online service responded with detailed information and advice (87%) and suggested a referral to the family doctor or a specialist in 75%. Most patients (82%) rated the service overall as good or very good. It appears likely that telemedicine and in particular email teleconsultations will increase in vascular surgery in the future.

Epidemiology of coeliac disease in a single centre in Southern Derbyshire 1958–2014

PubMed Central

Holmes, Geoffrey K T; Muirhead, A

2017-01-01

Objective To determine trends in diagnosis of coeliac disease (CD) in patients attending a single centre 1958–2014 and provide figures for prevalence and incidence in those born in Derby city over 4 decades. To explore a link between deprivation and prevalence and characteristics of CD in Asians. Design An unselected, consecutive series of 2410 adult patients with CD diagnosed in the catchment area of the Derby hospitals was identified. 1077 born within Derby city identified by postcodes was used to determine changes in prevalence and incidence over 4 decades. 191 patients were Asian. Population numbers were obtained from National Census information. Results In the quinquennium 2010–2014, 20 times more patients were diagnosed than during 1975–1979. 27% were diagnosed at ≥60 years. A paucity of diagnoses in young men was observed. Women were diagnosed most often in age band ≥35<45, 15 years earlier than men. The largest increase in diagnosis rates occurred in young women and the elderly. In 2014, overall prevalence was 1:188; women 1:138. 4.6% of the variation was attributed to deprivation. Diagnosis rates in Asians increased markedly although only 5% were diagnosed at ≥60 years, much lower than for whites. Conclusions The dramatic increase in number of patients with CD presents challenges for follow-up and new models of care need to be explored. Healthcare workers should be alert to the diagnosis in young men and elderly Asians. A dedicated coeliac clinic is an excellent facility to increase diagnosis rates. PMID:28761688

[Five years of ROM in substance abuse treatment centres in the Netherlands].

PubMed

Oudejans, S C C; Schippers, G M; Spits, M E; Stollenga, M; van den Brink, W

2012-01-01

Three substance abuse treatment centres set up a benchmarking project for routine outcome management (ROM) of structured cognitive behavioral treatments for outpatients with a substance use disorder. To present the results of five years benchmarking. All patients were included at intake and the follow-up assessment was performed by a call-center nine months later. Twice a year aggregated data were fed back to management and treatment teams. Since 2005, clinical outcome data, including substance abuse data, have been collected for more than half of all 15.786 treated patients. At follow-up, nine months after intake, 23% was abstinent, 28% reported moderate substance use and 49% reported excessive substance use. The Dutch centres for the treatment of substance abuse were successful in setting up ROM projects to monitor and compare the development and the effects of outpatient addiction treatments. The clinical results are acceptable and correspond to the results of the American project called match. It is not yet clear whether the biannual feedback of aggregated outcomes to management and treatment teams has contributed to the creation of learning organisations, but it has provided transparency and has made it possible for teams to learn from the outcomes.

[Favourable outcome after fetoscopic laser surgery for twin-twin transfusion syndrome: experience of an emerging centre].

PubMed

Delabaere, A; Accoceberry, M; Niro, J; Velemir, L; Laurichesse-Delmas, H; Coste, K; Bœuf, B; Labbe, A; Storme, B; Lemery, D; Gallot, D

2011-09-01

Our objective was to report perinatal outcome during the first three years of an emerging centre for laser photocoagulation in twin-twin transfusion syndrome (TTTS) and to compare with outcome observed earlier in the same centre when management consisted in recurrent amniodrainage. We conducted a single centre retrospective study. We compared perinatal outcome of 19 consecutive cases of mid trimester TTTS managed by amniodrainage over a 10-year period with 49 cases of TTTS managed by laser photocoagulation over a 3-year period. Laser photocoagulation increased survival rate at birth (P=0.02) and at postnatal day 28 (P=0.01). Neurologic and cardiologic complications did not differ significantly (P=0.5 and P=0.3 respectively). We observed a significant increase in survival of the donor after laser coagulation at birth (P=0.04). Our study demonstrated better outcome after laser photocoagulation. Early results of an emerging centre appeared comparable to those of more experienced centres. Copyright © 2011 Elsevier Masson SAS. All rights reserved.

[Symptomatic extramedullary haematopoiesis in β-thalassemia: A retrospective single centre study].

PubMed

Maazoun, F; Gellen Dautremer, J; Boutekadjirt, A; Pissard, S; Habibi, A; Bachir, D; Rahmouni, A; Bartolucci, P; Debbache, K; Lagrange, J-L; Michel, M; Galacteros, F

2016-01-01

Symptomatic extramedullary hematopoiesis (EH) is a rare but potentially severe phenomenon which occurs in β-thalassemia. There are no treatment guidelines. Retrospective single centre study including the cases of symptomatic EH encountered between 1997 and 2014 in a unit specialised in red blood cell genetic disorders. Description of clinical, biological and radiological characteristics of the patients, treatments received, and outcomes. Among 182 β-thalassemia patients followed during the study period, 7 cases of symptomatic EH were diagnosed. They were 5 men and 2 women, and their mean age was 37 years. Four patients were splenectomised, two patients were regularly transfused, and four patients had already received erythropoietin. EH was localised in intravertebral areas and responsible for dorsal spinal cord compression in 5 patients, in paravertebral dorsal area in 1 patient, and in presacral area in 1 patient. The mean hemoglobin level at diagnosis was 7.9 g/dL. Treatment administered included: red cell transfusion in 6 cases, associated with hydroxyurea in 5 cases and/or radiotherapy in 3 patients. One patient was treated with surgery and HU. After a median follow-up of 41 months, clinical recovery was complete in 2 patients and partial in 5 patients. EH must be suspected in β-thalassemia in patients presenting clinical signs of organ compression, and a typical radiological aspect. The functional prognosis depends on the rapidity of treatment, which includes red blood cell transfusion, hydroxyurea, radiotherapy, and rarely surgery. Long-term outcome is uncertain. Copyright © 2015. Published by Elsevier SAS.

Infectious morbidity and resource use in children under 2 years old at childcare centres.

PubMed

Del Castillo-Aguas, Guadalupe; Gallego-Iborra, Ana; Gutiérrez-Olid, Mario; Pérez-González, Olga; Moreno-Muñoz, Ginesa; Ledesma-Albarrán, Juana M

2017-02-01

To analyse the associations between childcare centres and infectious morbidity and resource consumption. Cohort study from birth to 2 years. number and types of infections, drug consumption and medical visits. Exposure variable: attending or not attending a childcare centre. School age: 6-12, >12-18, >18-24 months. The initial cohort comprised 445 children, and the final cohort comprised 419 children. The mean number of recurrent infections and wheezing was higher in children attending childcare centres in all age groups with significant differences. Recurrent acute otitis media was observed in the 12- to 18-month group with an odds ratio of 6.04 (95% confidence interval, 1.3-27.6; P = 0.001) in the children attending childcare centres. In children older than 6 months, there was greater consumption of antibiotics, inhaled bronchodilators, oral and inhaled corticosteroids and montelukast. Attending a childcare is associated with an increased frequency of recurrent infections and wheezing, as well as the consumption of antibiotics, bronchodilators, corticosteroids and montelukast. © 2016 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).

Indications for permanent pacing and pacing mode prescription from 1989 to 2006. Experience of a single academic centre in Northern Greece.

PubMed

Styliadis, Ioannis H; Mantziari, Aggeliki P; Gouzoumas, Nikolaos I; Vassilikos, Vasilios P; Paraskevaidis, Stelios A; Mochlas, Sotirios T; Boufidou, Amalia I; Parcharidis, Georgios E

2008-01-01

Indications for pacing and pacing mode prescription have changed in the past decades following advances in pacemaker technology. The aim of the present study was to evaluate changes in indications for pacing and pacing modes during the years 1989-2006 in a single academic pacemaker centre in Northern Greece. Archives of permanent pacemaker implantation procedures were studied retrospectively and data from all implants, first or replacements, were retrieved. Data from 2078 procedures were found, 78.7% of which were first implantations. Patients were 54% male with mean age 72.5 years. Main indications for pacing were atrioventricular block (AVB, 45.7%), sick sinus syndrome (SSS, 32.8%), and atrial fibrillation (12.1%). Almost half (48.9%) of the AVB cases were complete AVB, while the most common types of SSS were tachy-brady syndrome (44.1%) and asystole (27.1%). Rare indications for pacing were carotid sinus syndrome (5.0%), heart failure (3.3%) and hypertrophic obstructive cardiomyopathy (1.0%). The two most frequently used pacing modes were VVI (38.5%) and DDD (25.8%). However, pacing modes have changed greatly over the years, with a marked increase in dual-chamber pacing after 1997 and a preference for rate responsive units after 2002. Biventricular systems were also used in selected patients with heart failure from 2002 on. Indications for pacing and pacing mode prescription in our centre are similar to other pacemaker registries and reflect the global trend in pacing for mimicking the physiological activity of the heart and for addressing problems other than symptomatic bradycardia.

Person-centred positive emotions, object-centred negative emotions: 2-year-olds generalize negative but not positive emotions across individuals.

PubMed

Vaish, Amrisha; Grossmann, Tobias; Woodward, Amanda

2015-09-01

Prior work suggests that young children do not generalize others' preferences to new individuals. We hypothesized (following Vaish et al., 2008, Psychol. Bull., 134, 383-403) that this may only hold for positive emotions, which inform the child about the person's attitude towards the object but not about the positivity of the object itself. It may not hold for negative emotions, which additionally inform the child about the negativity of the object itself. Two-year-old children saw one individual (the emoter) emoting positively or negatively towards one and neutrally towards a second novel object. When a second individual then requested an object, children generalized the emoter's negative but not her positive emotion to the second individual. Children thus draw different inferences from others' positive versus negative emotions: Whereas they view others' positive emotions as person centred, they may view others' negative emotions as object centred and thus generalizable across people. The results are discussed with relation to the functions and implications of the negativity bias. © 2015 The British Psychological Society.

A high capacity data centre network: simultaneous 4-PAM data at 20 Gbps and 2 GHz phase modulated RF clock signal over a single VCSEL carrier

NASA Astrophysics Data System (ADS)

Isoe, G. M.; Wassin, S.; Gamatham, R. R. G.; Leitch, A. W. R.; Gibbon, T. B.

2017-11-01

Optical fibre communication technologies are playing important roles in data centre networks (DCNs). Techniques for increasing capacity and flexibility for the inter-rack/pod communications in data centres have drawn remarkable attention in recent years. In this work, we propose a low complexity, reliable, alternative technique for increasing DCN capacity and flexibility through multi-signal modulation onto a single mode VCSEL carrier. A 20 Gbps 4-PAM data signal is directly modulated on a single mode 10 GHz bandwidth VCSEL carrier at 1310 nm, therefore, doubling the network bit rate. Carrier spectral efficiency is further maximized by modulating its phase attribute with a 2 GHz reference frequency (RF) clock signal. We, therefore, simultaneously transmit a 20 Gbps 4-PAM data signal and a phase modulated 2 GHz RF signal using a single mode 10 GHz bandwidth VCSEL carrier. It is the first time a single mode 10 GHz bandwidth VCSEL carrier is reported to simultaneously transmit a directly modulated 4-PAM data signal and a phase modulated RF clock signal. A receiver sensitivity of -10. 52 dBm was attained for a 20 Gbps 4-PAM VCSEL transmission. The 2 GHz phase modulated RF clock signal introduced a power budget penalty of 0.21 dB. Simultaneous distribution of both data and timing signals over shared infrastructure significantly increases the aggregated data rate at different optical network units within the DCN, without expensive optics investment. We further demonstrate on the design of a software-defined digital signal processing assisted receiver to efficiently recover the transmitted signal without employing costly receiver hardware.

Long term effects of an integrated care intervention on hospital utilization in patients with severe COPD: a single centre controlled study.

PubMed

Titova, Elena; Steinshamn, Sigurd; Indredavik, Bent; Henriksen, Anne Hildur

2015-02-03

Chronic obstructive pulmonary disease (COPD) is one of the main causes of morbidity and mortality globally. In Trondheim in 2008 an integrated care model (COPD-Home) consisting of an education program, self-management plan, home visits and a call centre for patient support and communication was developed. The objective was to determine the efficacy of an intervention according to the COPD-Home model in reducing hospital utilization among patients with COPD stage III and IV (GOLD 2007) discharged after hospitalization for acute exacerbations of COPD (AECOPD). A single centre, prospective, open, controlled clinical study comparing COPD-Home integrated care (IC) with usual care (UC). Ninety-one versus 81 patients mean age 73.4 ± 9.3 years (57% women) were included in the IC group (ICG) and the UC group (UCG) respectively, and after 2 years 51 and 49 patients were available for control in the respective groups. During the year prior to study start there were 71 hospital admissions (HA) in the ICG and 84 in the UCG. There was a 12.6% reduction in HA in the ICG during the first year of follow-up and a 46.5% reduction during the second year (p = 0.01) compared to an 8.3% increase during the first year and no change during the second year in the ICG. During the year prior to study start, the number of hospital days (HD) was 468 in the ICG and 479 in the UCG. In the IC group, the number of HD was reduced by 48.3% during the first year (p = 0.01), and remained low during the second year of follow-up (p=0.02). In the UC group, the number of HD remained unchanged during the follow-up period. There was a trend towards a shorter survival time among patients in the ICG compared to the UCG, hazard ratio 1.33 [95% CI 0.77 to 2.33]. Intervention according to the COPD-Home model reduced hospital utilization in patients with COPD III and IV with a persisting effect throughout the 2 years of follow-up. However, there was a trend towards a shorter survival time in the intervention

Biliary complications after right lobe living donor liver transplantation: a single-centre experience

PubMed Central

Yaprak, Onur; Dayangac, Murat; Akyildiz, Murat; Demirbas, Tolga; Guler, Necdet; Bulutcu, Fisun; Bassullu, Nuray; Akun, Elif; Yuzer, Yildiray; Tokat, Yaman

2012-01-01

Background Biliary complications that developed after right lobe liver transplantation from living donors were studied in a single centre. Methods From 2004 to 2010, 200 consecutive living donor right lobe liver transplantations were performed. The database was evaluated retrospectively. Biliary complications were diagnosed according to clinical, biochemical and radiological tests. The number of biliary ducts in the transplanted graft, the surgical techniques used for anastomosis, biliary strictures and bile leakage rates were analysed. Results Of a total of 200 grafts, 117 invloved a single bile duct, 77 had two bile ducts and in six grafts there were three bile ducts. In 166 transplants, the anastomosis was performed as a single duct to duct, in 21 transplants double duct to ducts, in one transplant, three duct to ducts and in 12 transplants as a Roux-en-Y reconstruction. In all, 40 bile leakages (20%) and 17 biliary strictures (8.5%) were observed in 49 patients resulting in a total of 57 biliary complications (28.5%). Seventeen patients were re-operated (12 as a result of bile leakages and five owing to biliary strictures). Conclusion Identification of more than one biliary orifice in the graft resulted in an increase in the complication rates. In grafts containing multiple orifices, performing multiple duct-to-duct (DD) or Roux-en-Y anastomoses led to a lower number of complications. PMID:22151451

The National Poisons Information Centre in Sri Lanka: the first ten years.

PubMed

Fernando, Ravindra

2002-01-01

Poisoning is a major health concern in Sri Lanka, which has a very high morbidity and mortality from pesticide poisoning. Poisoning, which continues to be in the first five leading causes of death, accounts for about 80,000 hospitalizations and over 3,000 deaths per year. The National Poisons Information Centre in Sri Lanka, thefirst such centre to be established in South Asia, completed 10 years service in 1997. The 4,070 calls received in thefirst 10 years are analyzed and compared with the national hospitalization pattern. The recorded data sheets of all enquiries received from 1988 to 1997 were analyzed retrospectively to study (1) purpose of enquiry, (2) category of enquirer, (3) circumstances of poisoning, (4) gender of victim, (5) age of victim, (6) type of poison, and (7) outcome. Items (6) and (7) were compared with the national hospital statistics for 1998. Of the 4,070 enquiries, 92% concerned specific patients and 6% were for information on poisons. Almost 90% of the enquiries were from medical or paramedical personnel, 5% from relatives or friends, and 3% from the victims. Nearly 38% of enquiries concerned pesticides compared to 27% of poisoning hospitalizations. Medicinal agents were the subject of 20% of enquiries compared to 13% of hospitalizations. The major discrepancy was for snake bites, accounting for only 6% of enquiries but 42% of hospitalizations. Sex distribution of enquiries showed more males than females. Thirty-seven percent of the victims were young adults-15-29years age group. Nearly 49% of the enquiries were for suicidal attempts. Seventy-one percent of the victims recovered. Although enquiries to the NPIC averaged only 0.5% of poisoning hospitalizations, they were sufficiently representative of the national pattern to predict that increasing utilization of the NPIC would offer a much needed service, both for

Factors predicting haematopoietic recovery in patients undergoing autologous transplantation: 11-year experience from a single centre.

PubMed

Bai, Lijun; Xia, Wei; Wong, Kelly; Reid, Cassandra; Ward, Christopher; Greenwood, Matthew

2014-10-01

Engraftment outcomes following autologous transplantation correlate poorly to infused stem cell number. We evaluated 446 consecutive patients who underwent autologous transplantation at our centre between 2001 and 2012. The impact of pre-transplant and collection factors together with CD34(+) dosing ranges on engraftment, hospital length of stay (LOS) and survival endpoints were assessed in order to identify factors which might be optimized to improve outcomes for patients undergoing autologous transplantation using haemopoietic progenitor cells-apheresis (HPC-A). Infused CD34(+) cell dose correlated to platelet but not neutrophil recovery. Time to platelet engraftment was significantly delayed in those receiving low versus medium or high CD34(+) doses. Non-remission status was associated with slower neutrophil and platelet recovery. Increasing neutrophil contamination of HPC-A was strongly associated with slower neutrophil recovery with infused neutrophil dose/kg recipient body weight ≥3 × 10(8)/kg having a significant impact on time to neutrophil engraftment (p = 0.001). Higher neutrophil doses/kg in HPC-A were associated with days of granulocyte colony stimulation factor (G-CSF) use, HPC-A volumes >500 ml and higher NCC in HPC-A. High infused neutrophil dose/kg and age >65 years were associated with longer hospital LOS (p = 0.002 and 0.011 respectively). Only age, disease and disease status predicted disease-free survival (DFS) and overall survival (OS) in our cohort (p < 0.005). Non-relapse mortality was not affected by low dose of CD34(+) (<2 × 10(6)/kg). In conclusion, our study shows that CD34(+) remains a useful and convenient marker for assessing haemotopoietic stem cell content and overall engraftment capacity post-transplant. Neutrophil contamination of HPC-A appears to be a key factor delaying neutrophil recovery. Steps to minimize the degree of neutrophil contamination in HPC-A product may be associated with more rapid neutrophil engraftment and

Safety of intravenous metoprolol use in unmonitored wards: a single-centre observational study.

PubMed

Kelly, D; Hawdon, G; Reeves, J; Morris, A; Cunningham, M; Barrett, J

2015-09-01

This study aims to examine and quantify the risks associated with the use of intravenous metoprolol on unmonitored wards. This study was a retrospective single-centre observational study from 1 January 2009 to 31 December 2013. The study hospital was a 415-bed, private hospital in Melbourne, Victoria. The study population was all patients who received intravenous metoprolol on an unmonitored ward. The primary outcome measure was the rate of serious adverse events (SAE), defined as a complication of intravenous metoprolol resulting in transfer to a critical-care environment, a medical emergency team call or death. Six hundred and nine patients received a total of 8260 doses of intravenous metoprolol. Seven cases were identified with a SAE deemed possibly related to beta-blocker use and there was one death. All SAE were hypotension, giving an overall rate of hypotension of 7/609 or 1.1% (95% confidence interval (CI), 0.5 to 2.4%) with a rate per dose delivered of 0.8/1000 doses (95% CI 0.3 to 1.7). The death occurred in a 94-year-old woman with abdominal sepsis. After case file review, consensus opinion deemed this to be unrelated to intravenous metoprolol. The use of intravenous metoprolol on unmonitored wards appears to be safe. The complication rate was low, suggesting that this may be a sensible approach to the management of in-hospital populations at risk of beta-blocker withdrawal. © 2015 Royal Australasian College of Physicians.

Survival following ruptured abdominal aortic aneurysm before and during the IMPROVE Trial: a single-centre series.

PubMed

Ambler, G K; Twine, C P; Shak, J; Rollins, K E; Varty, K; Coughlin, P A; Hayes, P D; Boyle, J R

2014-04-01

The first large-scale randomised trial (Immediate Management of the Patient with Rupture: Open Versus Endovascular repair [IMPROVE]) for endovascular repair of ruptured abdominal aortic aneurysm (rEVAR) has recently finished recruiting patients. The aim of this study was to examine the impact on survival after rEVAR when the IMPROVE protocol was initiated in a high volume abdominal aortic aneurysm (AAA) centre previously performing rEVAR. One hundred and sixty-nine patients requiring emergency infrarenal AAA repair from January 2006 to April 2013 were included. Eighty-four patients were treated before (38 rEVAR, 46 open) and 85 (31 rEVAR, 54 open) were treated during the trial period. A retrospective analysis was performed. Before the trial, there was a significant survival benefit for rEVAR over open repair (90-day mortality 13% vs. 30%, p = .04, difference remained significant up to 2 years postoperatively). This survival benefit was lost after starting randomisation (90-day mortality 35% vs. 33%, p = .93). There was an increase in overall 30-day mortality from 15% to 31% (p = .02), while there was no change for open repair (p = .438). There was a significant decrease in general anaesthetic use (p = .002) for patients treated during the trial. Randomised patients had shorter hospital and intensive treatment unit stays (p = .006 and p = .03 respectively). The change in survival seen during the IMROVE trial highlights the need for randomised rather than cohort data to eliminate selection bias. These results from a single centre reinforce those recently reported in IMPROVE. Copyright © 2014 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

Multi-port versus single-port cholecystectomy: results of a multi-centre, randomised controlled trial (MUSIC trial).

PubMed

Arezzo, Alberto; Passera, Roberto; Bullano, Alberto; Mintz, Yoav; Kedar, Asaf; Boni, Luigi; Cassinotti, Elisa; Rosati, Riccardo; Fumagalli Romario, Uberto; Sorrentino, Mario; Brizzolari, Marco; Di Lorenzo, Nicola; Gaspari, Achille Lucio; Andreone, Dario; De Stefani, Elena; Navarra, Giuseppe; Lazzara, Salvatore; Degiuli, Maurizio; Shishin, Kirill; Khatkov, Igor; Kazakov, Ivan; Schrittwieser, Rudolf; Carus, Thomas; Corradi, Alessio; Sitzman, Guenther; Lacy, Antonio; Uranues, Selman; Szold, Amir; Morino, Mario

2017-07-01

Single-port laparoscopic surgery as an alternative to conventional laparoscopic cholecystectomy for benign disease has not yet been accepted as a standard procedure. The aim of the multi-port versus single-port cholecystectomy trial was to compare morbidity rates after single-access (SPC) and standard laparoscopy (MPC). This non-inferiority phase 3 trial was conducted at 20 hospital surgical departments in six countries. At each centre, patients were randomly assigned to undergo either SPC or MPC. The primary outcome was overall morbidity within 60 days after surgery. Analysis was by intention to treat. The study was registered with ClinicalTrials.gov (NCT01104727). The study was conducted between April 2011 and May 2015. A total of 600 patients were randomly assigned to receive either SPC (n = 297) or MPC (n = 303) and were eligible for data analysis. Postsurgical complications within 60 days were recorded in 13 patients (4.7 %) in the SPC group and in 16 (6.1 %) in the MPC group (P = 0.468); however, single-access procedures took longer [70 min (range 25-265) vs. 55 min (range 22-185); P < 0.001]. There were no significant differences in hospital length of stay or pain VAS scores between the two groups. An incisional hernia developed within 1 year in six patients in the SPC group and in three in the MPC group (P = 0.331). Patients were more satisfied with aesthetic results after SPC, whereas surgeons rated the aesthetic results higher after MPC. No difference in quality of life scores, as measured by the gastrointestinal quality of life index at 60 days after surgery, was observed between the two groups. In selected patients undergoing cholecystectomy for benign gallbladder disease, SPC is non-inferior to MPC in terms of safety but it entails a longer operative time. Possible concerns about a higher risk of incisional hernia following SPC do not appear to be justified. Patient satisfaction with aesthetic results was greater after SPC than after

Ten years of the European Astronaut Centre (EAC).

PubMed

Messerschmid, E; Haignere, J P; Damian, K

2000-11-01

The European Astronaut Centre, the home base of ESA's Astronaut Corps, celebrated its 10th anniversary on 17 May 2000 with a media event highlighting the past, present and future of the Agency's manned space programme.

The changing spectrum of primary glomerular diseases within 15 years: a survey of 3331 patients in a single Chinese centre.

PubMed

Zhou, Fu-de; Zhao, Ming-hui; Zou, Wan-zhong; Liu, Gang; Wang, Haiyan

2009-03-01

Primary glomerular disease (PGD) is the leading cause of end-stage renal disease (ESRD) in China. With the development of socioeconomic status of Chinese people in the last two decades, PGD in ESRD is intent to decrease. However, whether this affects the spectrum of PGD is not clear. The aim of the current study is to investigate the changing spectrum of PGD in China. The records of 5398 consecutive native renal biopsies performed in adults (>or=14 years of age) in our centre between 1993 and 2007 were retrospectively analysed. The criteria for renal biopsy and pathologic diagnosis were kept unchanged. The patients were grouped according to a 5-year interval, 1993-97 (period 1), 1998-2002 (period 2) and 2003-07 (period 3). Then they were divided into four groups according to age for stratified analysis: 14-24 years, 25-44 years, 45-59 years and the elderly (>or=60 years). Three thousand, three hundred and thirty-one patients were diagnosed with PGD. PGD remained the most common renal disease, accounting for 65.9%, 57.7% and 63.2% in period 1, 2 and 3, respectively, without any significant difference. The proportion of elder patients increased significantly from 0% in 1993 to 9.1% in 2007 (P < 0.001). Within 1993-97, the leading PGD was IgA nephropathy (50.7%), followed by non-IgA MsPGN (19.9%), membranous nephropathy (MN) (13.3%) and minimal change disease (MCD) (6.3%), while within 2003-07, the most common PGD was still IgAN (58.2%), but followed by MN (14.3%), MCD (13.4%) and non-IgA MsPGN (7.0%). The age-adjusted frequency of IgAN and MCD increased significantly from period 1 to period 3 (P < 0.01 and P < 0.001, respectively), while that of non-IgA MsPGN, EnPGN and MPGN decreased significantly (P < 0.001, P < 0.01 and P < 0.05, respectively). There was no significant change in the age-adjusted frequency of FSGS, MN and CreGN during the study period. However, when patients were stratified by age, a sixfold increase in frequency of FSGS was identified in the 14

Birth centre confinement at the Queen Victoria Medical Centre. I. Obstetric and neonatal outcome.

PubMed

Campbell, J; Hudson, H; Lumley, J; Morris, N; Rao, J; Spensley, J

1981-10-03

A review of hte first 175 confinements at the Queen Victoria Medical Centre Birth Centre is presented. The design, structure and function of hte Birth Centre is described and the safety of the programme demonstrated. Seventy-four pregnancies (42%) accepted for Birth Centre confinement required transfer because of antepartum or intrapartum complications. There were satisfactory obstetric and neonatal outcomes in all pregnancies. The first year's experience has allowed a reassessment of the risk factors, which will permit greater use of the Birth Centre without any increases risk to mothers or babies.

Perceived, Expressed and Observed Prosociality among Four-Year-Old Girls and Boys in Childcare Centres

ERIC Educational Resources Information Center

Bouchard, Caroline; Coutu, Sylvain; Bigras, Nathalie; Lemay, Lise; Cantin, Gilles; Bouchard, Marie-Claire; Duval, Stéphanie

2015-01-01

This article examines the prosociality of four-year-old girls and boys in childcare centres. More specifically, it aims to measure gender differences in prosociality among children, based on three sources and methods of evaluation: (1) the early childhood educator's (ECE) perception (perceived prosociality), (2) the children's own responses to…

Cleft lip and palate treatment of 530 children over a decade in a single centre.

PubMed

Vlastos, I M; Koudoumnakis, E; Houlakis, M; Nasika, M; Griva, M; Stylogianni, E

2009-07-01

We sought to evaluate the process of care and the outcomes of cleft lip and palate operations carried by a multidisciplinary team at a centre of craniofacial anomalies with a high patients' volume. A retrospective review of all cleft lips and/or palates cases treated in the centre from 1995 to 2007 was performed. Direct and long term complication rates, clinical, audiologic, speech intelligibility and dental arch assessments were analyzed. A total of 530 children have been operated this period in the centre (64 isolated cleft lip closures). A detailed presentation of the outcomes is performed in relation to the various types of cleft lip and palates. The majority of parents (70%) reported very good or excellent results 2-5 years after the lip closure with the Millard technique, although those with bilateral clefts were significantly less satisfied (P<0.002). Forty-two percent of children with cleft palate and otitis media with effusion were self-improved 2-8 months after palate reconstruction and 83.3% of children treated with the two flaps palatoplasty technique had a rather high or very high intelligibility score. Muscles' retropositioning had a significant effect on intelligibility (P=0.04). Children with cleft lips and palates have a variety of conditions and functional limitations even after the surgical correction of their problem that need to be evaluated and treated by several specialists. The treatment protocol utilized by the multidisciplinary team of our centre is efficient with a relative low percentage of complications and unfavorable results.

Rate of employment after liver transplantation in France: a single-centre study.

PubMed

Rudler, Marika; Rousseau, Géraldine; Lebray, Pascal; Méténier, Océane; Vaillant, Jean-Christophe; Savier, Eric; Eyraud, Daniel; Poynard, Thierry; Thabut, Dominique

2016-02-01

A return to gainful employment is an important outcome parameter after liver transplantation (LT). A recent study in the USA has shown a very high rate of unemployment after LT (75%). To date, there are no available data in France, where the public health insurance programme guarantees financial protection for everyone. The aim of this study was to assess the employment rate after LT in a French LT centre and to determine factors associated with employment after LT. All patients who had undergone liver transplantation at our centre between January 2000 and April 2011 and who met the following criteria responded to a questionnaire: (i) between 18 and 65 years old at the time of LT, (ii) alive 1 year after LT, (iii) alive, not retired and released from the hospital at the time of survey, (iv) French residents who were affiliated with French national health insurance. A total of 345 LTs were performed in 314 patients during the study period. Of the patients, 109 were excluded from the study: 23 had died within the first year after LT, 28 had died at the time of the survey, three were still in the hospital, seven were living in a foreign country, 11 had retired and 37 were older than 65 years after LT. Two hundred five patients were included in the study. The response rate was 76.6% (157/205). Patients responded a mean 6.1 ± 0.9 years after LT, 77.7% were French nationals, 73.2% were men, and the mean age at LT was 48.8 ± 9.9 years. The aetiologies of liver disease were as follows: alcohol 32.5%, hepatitis C 26.1%, alcohol and hepatitis C 3.8%, hepatitis B 15.3%, biliary cirrhosis 5.1%, autoimmune 2.5% and other causes 14.7%. Two years after LT, 43.3% of patients were employed. The demographic variables associated with post-LT employment were male sex (P<0.001), age under 40 years at LT (P=0.02), a sedentary job (P=0.007), raising children under the age of 18 years at the time of LT (P=0.01), a high level of education (P=0.001), not being affiliated with the French

Initiation of non-invasive ventilation in amyotrophic lateral sclerosis and clinical practice guidelines: Single-centre, retrospective, descriptive study in a national reference centre.

PubMed

Georges, Marjolaine; Golmard, Jean-Louis; Llontop, Claudia; Shoukri, Amr; Salachas, François; Similowski, Thomas; Morelot-Panzini, Capucine; Gonzalez-Bermejo, Jésus

2017-02-01

In amyotrophic lateral sclerosis (ALS), respiratory muscle weakness leads to respiratory failure. Non-invasive ventilation (NIV) maintains adequate ventilation in ALS patients. NIV alleviates symptoms and improves survival. In 2006, French guidelines established criteria for NIV initiation based on limited evidence. Their impact on clinical practice remains unknown. Our objective was to describe NIV initiation practices of the main French ALS tertiary referral centre with respect to guidelines. In this retrospective descriptive study, 624 patients followed in a single national reference centre began NIV between 2005 and 2013. We analysed criteria used to initiate NIV, including symptoms, PaCO 2 , forced vital capacity, maximal inspiratory pressures and time spent with SpO 2 <90% at night. At NIV initiation, 90% of patients were symptomatic. Median PaCO 2 was 48 mmHg. The main criterion to initiate NIV was 'symptoms' followed by 'hypercapnia' in 42% and 34% of cases, respectively. NIV was initiated on functional parameters in only 5% of cases. Guidelines were followed in 81% of cases. In conclusion, despite compliance with French guidelines, the majority of patients are treated at the stage of symptomatic daytime hypoventilation, which suggests that NIV is initiated late in the course of ALS. Whether this practice could be improved by changing guidelines or increasing respiratory-dedicated resources remains to be determined.

Suicides in the Centre of Portugal: seven years analysis.

PubMed

Dias, Daniel; Mendonça, M Cristina; Real, Francisco Corte; Vieira, Duarte Nuno; Teixeira, Helena M

2014-01-01

As one of the more specific and distinctive problems of human beings, suicide has been investigated with increasing attention all over the world. Several risk factors have been described as well as limitations arising from their study. The World Health Organization estimates that this scourge affects one million people annually, which corresponds to one death every 40s worldwide. According to recent studies, Portugal, despite the good rates (10 suicide deaths per 100,000 inhabitants), had shown an increasing trend among younger people. This work aims to characterize the evolution of the suicidal profile autopsied at the Forensic Pathology Department of the Centre Branch of the National Institute of Legal Medicine and Forensic Sciences of Portugal, analyzing several variables: age, gender, marital status, employment status, suicidal methodology, toxicological analysis and some conditions/behaviors regarding personal history (alcoholism, suicidal ideation, suicide attempts, physical illness, psychiatric disorder). All the autopsies from the 1 January, 2003 to 31 December, 2009 were analyzed. The suicide profile achieved corresponded to a man (77%), aged between 65 and 74 years old (20.4%), married (54.5%), employed, who committed suicide by hanging, in September, May or February. Clinical records include an organic health problem or psychiatric one, in addition to risk behaviors such as alcoholism, suicidal thoughts or suicide attempts. The number of suicides autopsied at the Centre Branch has increased, resembling the profile to the result of many other authors. However, new medical and social developments place hanging as the favorite suicide method in our study. Many barriers remain to overthrow but several prevention programs begin to be designed and implemented. Future evaluations and interventions at the social and medical level, including the death certification process, will be fundamental to a better realistic understanding of this phenomenon. Copyright �

The oral food desensitization in the Italian allergy centres.

PubMed

Meglio, P; Caminiti, L; Pajno, G B; Dello Iacono, I; Tripodi, S; Verga, M C; Martelli, A

2015-05-01

Attempts aimed at inducing food tolerance through oral food desensitization (OFD) for the treatment of IgE-mediated food allergies are increasing. In Italy, a number of allergy centres offer this procedure. To collect information on how these centres are organized, how patients are selected, the methods used to administer OFD and how adverse reactions are managed. A questionnaire was e-mailed to all the Italian allergy centres offering OFD. The survey shows a high degree of variability between centres. A correct diagnosis of food allergy is crucial for selecting patients for OFD. In the Italian allergy centres, oral food challenges are mostly open label (84%), but in 16% of cases they are single-blind (8%) or double-blind (8%). A high proportion of allergy centres (83%) offer OFD to children presenting forms of anaphylaxis triggered by traces--or very low doses--of food allergen. The majority of allergy centres (76%) enroll patients over 3 years of age, with 44% enrolling patients above the age of 5. Not-controlled asthma, unreliability of parents in the management of OFD and/or risk of adverse events, are the main reasons for exclusion from the procedure. Although OFD may sometimes be successful and may be considered a valid alternative to an elimination diet, further randomized controlled trials are needed, in order to clarify some controversial points, such as the characteristics of the child undergoing OFD, and the methods of food preparation and administration. Moreover, further studies should further investigate OFD safety, efficacy and costs.

Single implants in the aesthetic region preceded by local ridge augmentation; a 10-year randomized controlled trial.

PubMed

Meijndert, Caroliene M; Raghoebar, Gerry M; Meijndert, Leo; Stellingsma, Kees; Vissink, Arjan; Meijer, Henny J A

2017-04-01

The aim of this randomized controlled trial was to assess the 10-year effects of three different augmentation techniques (augmentation with chin bone, augmentation with chin bone plus a membrane and augmentation with a bone substitute plus a membrane) for implant-supported restorations in the maxillary aesthetic region regarding clinical and radiographic parameters, and patient-centred outcomes. Ninety-three patients requesting single tooth replacement and presenting with a horizontal bone deficiency were included. After augmentation, 93 implants were placed. Clinical variables, standardized radiographs and photographs and patient questionnaires were analysed to assess the impact of the various augmentation techniques 1 month (T 1 ), 12 months (T 12 ) and 120 months (T 120 ) after final crown placement. 10-years implant survival was 95.7% and did not differ between the groups neither were significant differences observed in the other treatment outcomes assessed. Peri-implant bone loss was low, viz. 0.48 ± 1.19 mm (mesial) and 0.30 ± 1.24 mm (distal) at T 120 . Loss of midbuccal marginal gingival level at T 120 was 0.32 ± 0.83 mm. Mean overall satisfaction at T 120 was 8.6 with 98.6% of the patients satisfied. Clinical, radiographic, aesthetic and patient centred outcomes were very favourable after 10 years and did not differ between the groups with different bone augmentation techniques. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

The Child at the Centre: Self-Evaluation in the Early Years

ERIC Educational Resources Information Center

Her Majesty's Inspectorate of Education, 2007

2007-01-01

This revised edition of "The Child at the Centre" replaces all previous versions. Along with a revised edition of "How good is our school?," this document forms the third part of "How good is our school? The Journey to Excellence." Early education centres are now part of a wider partnership of professionals, all of…

Laser writing of coherent colour centres in diamond

NASA Astrophysics Data System (ADS)

Chen, Yu-Chen; Salter, Patrick S.; Knauer, Sebastian; Weng, Laiyi; Frangeskou, Angelo C.; Stephen, Colin J.; Ishmael, Shazeaa N.; Dolan, Philip R.; Johnson, Sam; Green, Ben L.; Morley, Gavin W.; Newton, Mark E.; Rarity, John G.; Booth, Martin J.; Smith, Jason M.

2017-02-01

Optically active point defects in crystals have gained widespread attention as photonic systems that could be applied in quantum information technologies. However, challenges remain in the placing of individual defects at desired locations, an essential element of device fabrication. Here we report the controlled generation of single negatively charged nitrogen-vacancy (NV-) centres in diamond using laser writing. Aberration correction in the writing optics allows precise positioning of the vacancies within the diamond crystal, and subsequent annealing produces single NV- centres with a probability of success of up to 45 ± 15%, located within about 200 nm of the desired position in the transverse plane. Selected NV- centres display stable, coherent optical transitions at cryogenic temperatures, a prerequisite for the creation of distributed quantum networks of solid-state qubits. The results illustrate the potential of laser writing as a new tool for defect engineering in quantum technologies, and extend laser processing to the single-defect domain.

UK Renal Registry 18th Annual Report: Chapter 11 2014 Multisite Dialysis Access Audit in England, Northern Ireland and Wales and 2013 PD One Year Follow-up: National and Centre-specific Analyses.

PubMed

Rao, Anirudh; Evans, Rebecca; Wilkie, Martin; Fluck, Richard; Kumwenda, Mick

2016-01-01

Data are presented from the third combined vascular and peritoneal dialysis access audit. In 2014, 53 centres in England, Wales and Northern Ireland (out of 62) returned data on first access from 4,339 incident haemodialysis (HD) patients and 1,090 incident peritoneal dialysis (PD) patients. Of the 5,429 incident patients, 20.1% started dialysis on PD, 27.8% started with an arteriovenous fistula (AVF), 1.0% with an arteriovenous graft (AVG), 27.1% on a tunnelled line (TL) and 24.0% on a non-tunnelled line (NTL). Older patients (565 years) were more likely to start haemodialysis using AVF compared to their younger counterparts (36.2% vs. 32.8%). Thirteen of the nineteen centres (68%) using the physician led percutaneous insertion technique had over 20% of their incident patients starting on PD when compared to only seven out of fourteen centres (50%) which used single technique (open surgical or laparoscopic) for their PD catheter insertion. Wide variations were apparent between centres for use of AVF as the first haemodialysis access ranging from 10–54%. Eight of the 49 centres were achieving close to the 65% target for AV fistula in their incident patients. Length of time known to nephrology services and likelihood of commencing dialysis using either an AVF or a PD catheter are strongly associated. Patients who were known to a nephrologist for over one year were more likely to start dialysis with AVF, as compared to those who were referred between 90–365 days (39.2% vs. 24.6%). Similarly, patients who were known to a nephrologist between 90 days and one year were more likely to start on PD when compared to patients who were referred <90 days prior to dialysis start (26.9% vs. 9.1%). By comparison, amongst the late presenters, only 3.5% had first access documented as an AVF and 87.3% started dialysis on either a tunnelled line or a non-tunnelled line. Initial surgical assessment was a key determinant of the likelihood of AVF formation. Of the incident patients

Clinical characteristics of bladder cancer in patients with spinal cord injury: the experience from a single centre.

PubMed

Böthig, Ralf; Kurze, Ines; Fiebag, Kai; Kaufmann, Albert; Schöps, Wolfgang; Kadhum, Thura; Zellner, Michael; Golka, Klaus

2017-06-01

Life expectancy for people with spinal cord injury has shown a marked increase due to modern advances in treatment methods and in neuro-urology. However, since life expectancy of people with paralysis increases, the risk of developing of urinary bladder cancer is gaining importance. Single-centre retrospective evaluation of patient data with spinal cord injuries and proven urinary bladder cancer and summary of the literature. Between 1998 and 2014, 24 (3 female, 21 male) out of a total of 6599 patients with spinal cord injury were diagnosed with bladder cancer. The average age at bladder cancer diagnosis was 57.67 years, which is well below the average for bladder cancer cases in the general population (male: 73, female: 77). All but one patient had a latency period between the onset of the spinal paralysis and tumour diagnosis of more than 10 years. The median latency was 29.83 years. The median survival for these patients was 11.5 months. Of the 24 patients, 19 (79%) had muscle invasive bladder cancer at ≥T2 at the time of diagnosis. The type of neurogenic bladder (neurogenic detrusor overactivity or acontractility) and the form of bladder drainage do not appear to influence the risk. Long-term indwelling catheter drainage played only a minor role in the investigated patients. The significantly younger age at onset and the frequency of invasive tumours at diagnosis indicate that spinal cord injury influences bladder cancer risk and prognosis as well. Early detection of bladder cancer in patients with spinal cord injury remains a challenge.

General practice--reflection on five years of multidisciplinary training at Medical Centre Gütersloh.

PubMed

van den Heuvel, H G J

2011-12-01

Medical Centre Gütersloh is a primary care setting which provides the full range of general practice care for British Forces Germany Health Service (BFG HS). The aim of this article is to evaluate the multidisciplinary training organised by the author there, to exchange information and to provide suggestions for improvement and development. Description of the training scheme and analysis of routinely collected management data. The training scheme is based on adult education principles with a focus on interactive learning. Over the period November 2005-July 2010 a total of 1201 members of staff from various disciplines participated in 86 documented training sessions. The majority of the attending staff considered the training to be relevant, interesting and well presented. A substantial proportion indicated that they would change their practice as a result of the training. These views remained stable over time. The majority of facilitators consisted of medical centre employees. This article provides an overview onfive years of multidisciplinary training in a general practice setting. Overall feedback from staff suggests that the training has been highly valued over those years. However, it is recognised that this evaluation has its limitations and suggestions are made regarding how these types of training schemes can be improved and developed further.

Cryostorage duration does not affect pregnancy and neonatal outcomes: a retrospective single-centre cohort study of vitrified-warmed blastocysts.

PubMed

Ueno, Satoshi; Uchiyama, Kazuo; Kuroda, Tomoko; Yabuuchi, Akiko; Ezoe, Kenji; Okimura, Tadashi; Okuno, Takashi; Kobayashi, Tamotsu; Kato, Keiichi

2018-06-01

A retrospective cohort study of 8736 autologous single vitrified-warmed blastocyst transfer cycles was conducted in a single centre to investigate the effect of cryostorage on clinical and neonatal outcomes. Cryostorage duration was classified into three groups: (A) 0-2 months (n = 4702); (B) 2-13 months (n = 2853) and (C) 13-97 months (n = 1181). Blastocysts were vitrified using the Cryotop method. No significant differences were observed in live birth rates: (A) 37.3%; (B) 34.9%; (C) (35.2%). Gestational period was significantly shorter in group C: (A) 38.7 ± 1.8; (B) 38.6 ± 1.6; (C) 38.1 ± 1.7; P < 0.05. This was clinically unimportant as the average gestational age was more than 38 weeks. No significant differences between groups were observed in birth weight: (A) 3060 ± 455 g; (B) 3052 ± 449 g; (C) 2992 ± 445 g, or congenital malformation rates: (A) 2.2%; (B) 1.9%; (C) 1.8%. The limitation of this study was that maximum storage duration was 8 years; most blastocysts were in cryostorage for much shorter periods. Long-term storage of blastocysts that are vitrified using an open device vitrification system has no negative effect on pregnancy and neonatal outcomes. Copyright © 2018 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

Low Rates of Major Complications for Radiofrequency Ablation of Atrial Fibrillation Maintained Over 14 Years: A Single Centre Experience of 2750 Consecutive Cases.

PubMed

Voskoboinik, Aleksandr; Sparks, Paul B; Morton, Joseph B; Lee, Geoffrey; Joseph, Stephen A; Hawson, Joshua J; Kistler, Peter M; Kalman, Jonathan M

2018-02-03

Despite technological advances, studies continue to report high complication rates for atrial fibrillation (AF) ablation. We sought to review complication rates for AF ablation at a high-volume centre over a 14-year period and identify predictors of complications. We reviewed prospectively collected data from 2750 consecutive AF ablation procedures at our institution using radiofrequency energy (RF) between January 2004 and May 2017. All cases were performed under general anaesthetic with transoesophageal echocardiography (TEE), 3D-mapping and an irrigated ablation catheter. Double transseptal puncture was performed under TEE guidance. All patients underwent wide antral circumferential isolation of the pulmonary veins (30W anteriorly, 25W posteriorly) with substrate modification at operator discretion. Of 2255 initial and 495 redo procedures, ablation strategies were: pulmonary vein isolation (PVI) only 2097 (76.3%), PVI+lines 368 (13.4%), PVI+posterior wall 191 (6.9%), PVI+cavotricuspid isthmus 277 (10.1%). There were 23 major (0.84%) and 20 minor (0.73%) complications. Cardiac tamponade (five cases - 0.18%) and phrenic nerve palsy (one case - 0.04%) rates were very low. Major vascular complications necessitating surgery or blood transfusion occurred in five patients (0.18%). There were no cases of death, permanent disability, atrio-oesophageal fistulae or symptomatic pulmonary vein (PV) stenosis, although there were five TEE probe-related complications (0.18%). Female gender (OR 2.14; 95% CI 1.07-4.26) but not age >70 (OR 1.01) was the only multivariate predictor of complications. Atrial fibrillation ablation performed at a high-volume centre using RF can be achieved with a low major complication rate in a representative AF population over a sustained period of time. Copyright © 2018 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights

Oncologic Outcomes After Robot-assisted Radical Prostatectomy: A Large European Single-centre Cohort with Median 10-Year Follow-up.

PubMed

Rajan, Prabhakar; Hagman, Anna; Sooriakumaran, Prasanna; Nyberg, Tommy; Wallerstedt, Anna; Adding, Christofer; Akre, Olof; Carlsson, Stefan; Hosseini, Abolfazl; Olsson, Mats; Egevad, Lars; Wiklund, Fredrik; Steineck, Gunnar; Wiklund, N Peter

2016-11-02

Robot-assisted radical prostatectomy (RARP) for prostate cancer (PCa) treatment has been widely adopted with limited evidence for long-term (>5 yr) oncologic efficacy. To evaluate long-term oncologic outcomes following RARP. Prospective cohort study of 885 patients who underwent RARP as monotherapy for PCa between 2002 and 2006 in a single European centre and followed up until 2016. RARP as monotherapy. Biochemical recurrence (BCR)-free survival (BCRFS), salvage therapy (ST)-free survival (STFS), prostate cancer-specific survival (CSS), and overall survival (OS) were estimated using the Kaplan-Meier method, and event-time distributions were compared using the log-rank test. Variables predictive of BCR and ST were identified using Cox proportional hazards models. We identified 167 BCRs, 110 STs, 16 PCa-related deaths, and 51 deaths from other/unknown causes. BCRFS, STFS, CSS, and OS rates were 81.8%, 87.5%, 98.5%, and 93.0%, respectively, at median follow-up of 10.5 yr. On multivariable analysis, the strongest independent predictors of both BCR and ST were preoperative Gleason score, pathological T stage, positive surgical margins (PSMs), and preoperative prostate-specific antigen. PSM >3mm/multifocal but not ≤3mm independently affected the risk of both BCR and ST. Study limitations include a lack of centralised histopathologic reporting, lymph node and post-operative tumour volume data in a historical cohort, and patient-reported outcomes. RARP appears to confer effective long-term oncologic efficacy. The risk of BCR or ST is unaffected by ≤3mm PSM, but further follow-up is required to determine any impact on CSS. Robot-assisted surgery for prostate cancer is effective 10 yr after treatment. Very small (<3mm) amounts of cancer at the cut edge of the prostate do not appear to impact on recurrence risk and the need for additional treatment, but it is not yet known whether this affects the risk of death from prostate cancer. Copyright © 2016 European Association

A single-centre 10-year experience with Candida bloodstream infections

PubMed Central

Labbé, Annie-Claude; Pépin, Jacques; Patiño, Carlos; Castonguay, Stéphanie; Restieri, Christiane; Laverdiere, Michel

2009-01-01

OBJECTIVE: To describe the clinical and microbiological features associated with Candida bloodstream infections observed at Hôpital Maisonneuve-Rosemont (Montreal, Quebec) between August 1996 and July 2006. METHODS: Episodes were retrieved from the microbiology laboratory. Different patient episodes and different isolate episodes in the same patient were selected. Antifungal susceptibility was determined by the Clinical and Laboratory Standards Institute’s (USA) M27A2 method. RESULTS: A total of 190 different episodes of candidemia in 185 patients were identified. Eleven (6%) episodes occurred in outpatients. Candida albicans was identified in the majority of episodes (57%). Its frequency remained stable over the years. The proportion of Candida krusei candidemia episodes increased between 2003 and 2006, but this was not statistically significant. A central venous indwelling catheter or a peripherally inserted central catheter line was present in the majority of patients (167 [88%]). Of the indwelling catheters removed at the time of diagnosis, 39% were positive for Candida species on culture. Overall, voriconazole was the most active agent (the minimum inhibitory concentration required to inhibit the growth of 90% of organisms was 0.5 mg/L). Resistance to fluconazole was observed in 26 (14%) isolates (C albicans, 4%; versus non-albicans Candida species, 27%; P<0.001). Being on the hematology-oncology unit at the time of diagnosis (adjusted OR 7.8; 95% CI 2.3 to 27.1; P=0.001) and having received fluconazole or itraconazole within the past three months (adjusted OR 8.3; 95% CI 2.8 to 24.4; P<0.001) were significantly associated with resistance to fluconazole in multivariate analysis. CONCLUSIONS: At Hôpital Maisonneuve-Rosemont, the frequency and species distribution of blood isolates of Candida remained stable over the past decade. In vitro resistance of C albicans to fluconazole and itraconazole remained minimal; resistance of non-albicans Candida species to

Teaching and Learning Centres: Towards Maturation

ERIC Educational Resources Information Center

Challis, Di; Holt, Dale; Palmer, Stuart

2009-01-01

Approximately 70% of Australian Teaching and Learning Centres have been restructured and/or have undergone leadership changes in the last three years. The volatility of this environment reflects the number of significant challenges faced by Teaching and Learning Centres. In determining what makes Centres successful, the issues that are likely to…

The Impact of the Mathematics Support Centre on the Grades of First Year Students at the National University of Ireland Maynooth

ERIC Educational Resources Information Center

Mac an Bhaird, Ciaran; Morgan, Tadhg; O'Shea, Ann

2009-01-01

In this article, we consider the mathematics grades of first year students at the National University of Ireland Maynooth and the influence that the Mathematics Support Centre (MSC) has on these grades. We will consider the evidence to suggest that the MSC has a positive effect on the grades of the students who attend the centre. It seems to be…

1 to 3-Year-Old Children in Day Care Centres in Finland: An Overview of Eight Doctoral Dissertations

ERIC Educational Resources Information Center

Hannikainen, Maritta

2010-01-01

This article gives a general picture of the policy and main structural features of early childhood education services for the younger children in Finland. It also provides an overview of the research on 1 to 3-year-old children in day care centres carried out in Finland during the last 15 years, the focus being on a review of all the eight…

Factors associated with anxiety and depression among type 2 diabetes outpatients in Malaysia: a descriptive cross-sectional single-centre study.

PubMed

Ganasegeran, Kurubaran; Renganathan, Pukunan; Manaf, Rizal Abdul; Al-Dubai, Sami Abdo Radman

2014-04-23

To determine the prevalence and factors associated with anxiety and depression among type 2 diabetes outpatients in Malaysia. Descriptive, cross-sectional single-centre study with universal sampling of all patients with type 2 diabetes. Endocrinology clinic of medical outpatient department in a Malaysian public hospital. All 169 patients with type 2 diabetes (men, n=99; women, n=70) aged between 18 and 90 years who acquired follow-up treatment from the endocrinology clinic in the month of September 2013. The validated Hospital Anxiety and Depression Scale (HADS), sociodemographic characteristics and clinical health information from patient records. Of the total 169 patients surveyed, anxiety and depression were found in 53 (31.4%) and 68 (40.3%), respectively. In multivariate analysis, age, ethnicity and ischaemic heart disease were significantly associated with anxiety, while age, ethnicity and monthly household income were significantly associated with depression. Sociodemographics and clinical health factors were important correlates of anxiety and depression among patients with diabetes. Integrated psychological and medical care to boost self-determination and confidence in the management of diabetes would catalyse optimal health outcomes among patients with diabetes.

The last 10 years in a burn centre in Ankara, Turkey: an analysis of 5264 cases.

PubMed

Türegün, M; Sengezer, M; Selmanpakoglu, N; Celiköz, B; Nişanci, M

1997-01-01

This is a retrospective study analysing 5264 patients treated in the burn centre at Gülhane Military Medical Academy from 1 January 1986 to 31 December 1995. Our burn centre is not only the first, but one of the best established and supported in Turkey. Our present study has the largest patient group of other previously published studies from Turkey. Of the total patients studied, 4464 patients had minor burns and were treated on an outpatient basis and 800 patients had moderate to major burns. Although our centre is in a military area in Ankara, only 1047 (20 per cent) patients were military personnel and the military-related burn causes comprised only 6 per cent of the total. The remaining 4217 (80 per cent of the total patients) were civilians. Flame injuries were also more frequent in military patients than civilians. Minor burns were most common in the age group 0-10 years old (40 per cent) and moderate to major burns in the age group 21-30 years (54 per cent). Scalds were the main cause of paediatric burns. Male patients were dominant. The overall mortality among inpatients was 18.2 per cent and mean total body surface area (TBSA) was 57.6 per cent in patients who died. 134 patients demonstrated inhalation injury and 82 per cent of these patients died. The epidemiological pattern of our patients is similar to that in other studies from developed countries, although some ethnic causative factors could be found. Our study indicates that emergency measures should be taken to prevent flame injuries at military barracks and industrial workplaces and scalding accidents to children at home and throughout the country.

Application of an incident taxonomy for radiation therapy: Analysis of five years of data from three integrated cancer centres.

PubMed

Greenham, Stuart; Manley, Stephen; Turnbull, Kirsty; Hoffmann, Matthew; Fonseca, Amara; Westhuyzen, Justin; Last, Andrew; Aherne, Noel J; Shakespeare, Thomas P

2018-01-01

To develop and apply a clinical incident taxonomy for radiation therapy. Capturing clinical incident information that focuses on near-miss events is critical for achieving higher levels of safety and reliability. A clinical incident taxonomy for radiation therapy was established; coding categories were prescription, consent, simulation, voluming, dosimetry, treatment, bolus, shielding, imaging, quality assurance and coordination of care. The taxonomy was applied to all clinical incidents occurring at three integrated cancer centres for the years 2011-2015. Incidents were managed locally, audited and feedback disseminated to all centres. Across the five years the total incident rate (per 100 courses) was 8.54; the radiotherapy-specific coded rate was 6.71. The rate of true adverse events (unintended treatment and potential patient harm) was 1.06. Adverse events, where no harm was identified, occurred at a rate of 2.76 per 100 courses. Despite workload increases, overall and actual rates both exhibited downward trends over the 5-year period. The taxonomy captured previously unidentified quality assurance failures; centre-specific issues that contributed to variations in incident trends were also identified. The application of a taxonomy developed for radiation therapy enhances incident investigation and facilitates strategic interventions. The practice appears to be effective in our institution and contributes to the safety culture. The ratio of near miss to actual incidents could serve as a possible measure of incident reporting culture and could be incorporated into large scale incident reporting systems.

Laparoscopic Complete Mesocolic Excision versus Open Complete Mesocolic Excision for Transverse Colon Cancer: Long-Term Survival Results of a Prospective Single Centre Non-Randomized Study.

PubMed

Storli, Kristian Eeg; Eide, Geir Egil

2016-01-01

Laparoscopic complete mesocolic excision (CME) used in the treatment of transverse colon cancer has been questioned on the basis of the technical challenges. The aim of this study was to evaluate the medium- and long-term clinical and survival outcomes after laparoscopic and open CME for transverse colon cancer and to compare the 2 approaches. This study was a retrospective non-randomized study of patients with prospectively registered data on open and laparoscopic CME for transverse colon cancer tumour-node-metastasis stages I-III operated on between 2007 and 2014. This was a single-centre study in a community teaching hospital. A total of 56 patients with transverse colon cancer were included, excluding those with tumours in the colonic flexures. The outcome aims were 4-year time to recurrence (TTR) and cancer-specific survival (CSS). Morbidity was also measured. The 4-year TTR was 93.9% in the laparoscopic group and 91.3% in the open group (p = 0.71). The 4-year CSS was 97.0% in the laparoscopic group and 91.3% in the open group (p = 0.42). This was a prospective single-institution study with a small sample size. Results of the study suggest that the laparoscopic CME approach might be the preferred approach for transverse colon cancer, especially regarding its benefits in terms of short-term morbidity, length of stay and oncological outcome. © 2016 S. Karger AG, Basel.

'Stepping in' or 'stepping back': how first year nursing students begin to learn about person-centred care.

PubMed

Currie, Kay; Bannerman, Samantha; Howatson, Val; MacLeod, Fiona; Mayne, Wendy; Organ, Christine; Renton, Sarah; Scott, Janine

2015-01-01

The concept of person-centred care has gained international recognition over the last decade and forms one of the key concepts of our Nursing Quality Improvement Curricular Framework. This study aimed to investigate nursing students' learning about person-centred care during the first-year of their programme. Qualitative thematic analysis of a section of placement learning documents from two consecutive cohorts of students from all fields of nursing (n=405), supplemented by three focus group discussions. Two conceptual categories of student approaches to learning emerged. Firstly, 'stepping back', or learning from a distance about how nurses provide care, often through reading case notes and care plans; second, 'stepping in', learning about the patient as a person by direct interaction with service users. Evidence of reflection on the patient's experience of care was limited. These results have resonance with existing pedagogical theories around preferences for active or passive styles of learning. The potential for clinical mentors to build student confidence and encourage direct engagement with patients was highlighted. Students are aware of the concepts, principles and professional values of person-centred care from early in their programme; however, the majority tend to be preoccupied by learning about what nurses 'do', rather than 'how patients experience care'. Development towards a more person-centred approach may require targeted support from mentors to help students gain confidence and begin reflecting on how patients experience care. Copyright © 2014 Elsevier Ltd. All rights reserved.

Total aortic arch replacement with the frozen elephant trunk technique: 10-year follow-up single-centre experience.

PubMed

Ius, Fabio; Fleissner, Felix; Pichlmaier, Maximilian; Karck, Matthias; Martens, Andreas; Haverich, Axel; Shrestha, Malakh

2013-11-01

Since August 2001, the frozen elephant trunk (FET) technique has been used at our institution to treat degenerative or dissecting aneurysms involving the aortic arch and descending aorta as a potential 'single-stage' procedure. The aim of this study was to review our FET experience and to present the 10-year results. Between August 2001 and January 2012, 131 patients underwent FET implant with three different prostheses: the custom-made Chavan-Haverich (n = 66), the Jotec E-vita (n = 30) and the Vascutek Thoraflex (n = 35) prostheses. Concomitant procedures included aortic valve-sparing operations (David, n = 17) and aortic root replacement (Bentall, n = 25). Patient records and the first postoperative and last available computer tomography (CT) were retrospectively reviewed. Incidence of rethoracotomy for bleeding, stroke, spinal cord injury, prolonged ventilatory support (>96 h) and acute renal failure requiring dialysis were 18, 11, 1, 41 and 16%, respectively. In-hospital mortality was 15%. The mean follow-up was 42 ± 37 (range 1-134 months). At 1, 5 and 10 years, survivals were 82 ± 3, 72 ± 5 and 58 ± 8%, respectively. Freedoms from distal aortic operation were 81 ± 4, 67 ± 5 and 43 ± 13%, respectively. Thirty-six patients underwent 40 distal aortic operations, either open surgical (n = 22, 55%) or endovascular (n = 18, 45%). Chronic aortic dissection was identified as an independent risk factor for distal aortic operation (odds ratio = 3.8; 95% confidence interval 1.5-9.3; P = 0.004). At last CT control, false-lumen thrombosis rates up to 93% were achieved around the stent graft. An FET concept adds to the armament of the surgeon in the treatment of complex and diverse aortic arch pathologies. The preoperative patient risk profile explains the postoperative morbidity and in-hospital mortality. The FET can potentially be still a 'one-stage' procedure in selected patients. However, the extension of FET to patients with extensive aortic aneurysms has led

A 10 year epidemiological study of paediatric burns at the Welsh Centre for burns and plastic surgery.

PubMed

Sanyaolu, Leigh; Javed, Muhammad Umair; Eales, Micheal; Hemington-Gorse, Sarah

2017-05-01

Paediatric burns make up a significant proportion of burn injured patients seen within the hospital setting and worldwide account for a significant proportion of unintentional deaths. Currently there is limited data on severe paediatric burns requiring intensive care support. Our study aimed primarily to describe the epidemiology of severe burns admitted to the intensive care unit at our centre receiving fluid resuscitation over a 10 year period. A secondary aim was to describe the referrals patterns in general over the same time period. A retrospective analysis was performed for paediatric patients referred to our centre receiving fluid resuscitation and intensive care support from 2003 to 2013. We also analysed the patterns of referrals, admissions and need for surgical intervention over the same time period retrospectively. Children less than 5 years old made up 65% of admissions to intensive care and scald injuries (56%) were the commonest aetiology. Both total length of stay (25 days in 2003 to 10 days in 2013) and intensive care length of stay (7.2 days in 2003 to 3 days in 2013) decreased during the study and less patients underwent operative intervention. Referrals to our centre increased from 261 in 2003 to 366 in 2013, however admission rates declined from 145 to 85 during that time period. Currently there is limited data on severe burns within the paediatric population. Our study provides epidemiological data in this area, an important step for developing future prevention strategies. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

Primary vesicoureteral reflux: A 26-year experience in a single centre.

PubMed

Vachvanichsanong, Prayong; Dissaneewate, Pornsak; McNeil, Edward

2016-04-01

To determine the nature of primary vesicoureteral reflux (VUR) and the association of VUR with hydronephrosis and renal damage. The medical records of children ≤ 15 years diagnosed with VUR, attending the Department of Pediatrics, Prince of Songkla University, Thailand between 1987 and 2013 were reviewed. Renal ultrasound and technetium-99m dimercaptosuccinic acid renal scan (DMSA) results were examined to determine the severity of hydronephrosis and renal damage, respectively. There were 177 boys and 211 girls. 350 (90.2%) were diagnosed following urinary tract infection (UTI). The median (IQR) age at diagnosis of first VUR was 7.6 (4.3-12.2) months in boys and 18.6 (9.0-46.6) months in girls (P < 0.001). Renal ultrasound was performed in 340 patients. Hydronephrosis was found in 105 patients and 135 kidneys and 22.5% VUR kidneys and 11.0% non-VUR kidneys (P = 0.01). The severity of hydronephrosis was associated with VUR grade (44.2% of grades IV and V VUR had hydronephrosis vs 11.9% of grades I-III VUR, P < 0.001). DMSA was performed in 332 patients. Abnormalities were found in 30.1% VUR kidneys and 4.1% non-VUR kidneys (P < 0.001). Abnormal DMSA results were strongly associated with VUR grade (17.8% for VUR grades I-III vs 60.5% for VUR grades IV and V, P < 0.001). Primary VUR in this group was most commonly diagnosed following investigation of UTI and detected during infancy, earlier in boys. Hydronephrosis and renal damage were associated with severity of VUR. © 2015 Asian Pacific Society of Nephrology.

A single-blinded, single-centre, controlled study in healthy adult smokers to identify the effects of a reduced toxicant prototype cigarette on biomarkers of exposure and of biological effect versus commercial cigarettes.

PubMed

Shepperd, Christopher J; Newland, Nik; Eldridge, Alison; Graff, Don; Meyer, Ingo

2013-07-29

Despite universal acceptance that smoking is harmful, a substantial number of adults continue to smoke. The development of potential reduced exposure products (more recently termed modified risk tobacco products) has been suggested as a way to reduce the risks of tobacco smoking. This trial is designed to investigate whether changes in toxicant exposure after switching from a commercial to reduced toxicant prototype (RTP) cigarette (7 mg International Organisation for Standardisation (ISO) tar yield) can be assessed by measurement of biomarkers and other factors. The primary objective is to descriptively assess changes in selected biomarkers of exposure (BoE) and biomarkers of biological effect (BoBE) within participants and within and between groups after switching. Secondary objectives are to assess similarly changes in other biomarkers, quality of life, smoking behaviours, physiological measures, mouth-level exposure to toxicants and sensory perception. This trial will assess current smokers, ex-smokers and never-smokers in a single-centre single-blind, controlled clinical trial with a forced-switching design and in-clinic (residential) and ambulatory (non-residential) periods. Smokers will be aged 23-55 years (minimum legal smoking age plus 5 years) and non-smokers 28-55 years (minimum legal smoking age plus 5 years, plus minimum 5 years since last smoked). Smokers will be allowed to smoke freely at all times. We will assess changes in selected BoE and BoBE and effective dose in urine and blood after switching. Creatinine concentrations in serum, creatinine clearance in urine, cotinine concentration in saliva, diaries and collection of spent cigarette filters will be used to assess compliance with the study protocol. Mouth-level exposure to toxins will be assessed by filter analysis. Data from this study are expected to improve scientific understanding of the effects of RTP cigarettes on BoE and BoBE, and give insights into study design for clinical

A single-blinded, single-centre, controlled study in healthy adult smokers to identify the effects of a reduced toxicant prototype cigarette on biomarkers of exposure and of biological effect versus commercial cigarettes

PubMed Central

2013-01-01

Background Despite universal acceptance that smoking is harmful, a substantial number of adults continue to smoke. The development of potential reduced exposure products (more recently termed modified risk tobacco products) has been suggested as a way to reduce the risks of tobacco smoking. This trial is designed to investigate whether changes in toxicant exposure after switching from a commercial to reduced toxicant prototype (RTP) cigarette (7 mg International Organisation for Standardisation (ISO) tar yield) can be assessed by measurement of biomarkers and other factors. The primary objective is to descriptively assess changes in selected biomarkers of exposure (BoE) and biomarkers of biological effect (BoBE) within participants and within and between groups after switching. Secondary objectives are to assess similarly changes in other biomarkers, quality of life, smoking behaviours, physiological measures, mouth-level exposure to toxicants and sensory perception. Methods/design This trial will assess current smokers, ex-smokers and never-smokers in a single-centre single-blind, controlled clinical trial with a forced-switching design and in-clinic (residential) and ambulatory (non-residential) periods. Smokers will be aged 23–55 years (minimum legal smoking age plus 5 years) and non-smokers 28–55 years (minimum legal smoking age plus 5 years, plus minimum 5 years since last smoked). Smokers will be allowed to smoke freely at all times. We will assess changes in selected BoE and BoBE and effective dose in urine and blood after switching. Creatinine concentrations in serum, creatinine clearance in urine, cotinine concentration in saliva, diaries and collection of spent cigarette filters will be used to assess compliance with the study protocol. Mouth-level exposure to toxins will be assessed by filter analysis. Discussion Data from this study are expected to improve scientific understanding of the effects of RTP cigarettes on BoE and BoBE, and

Comparison of Environmental Attitudes and Experiences of Five-Year-Old Children Receiving Preschool Education in the Village and City Centre

ERIC Educational Resources Information Center

Durkan, Nazmi; Güngör, Hande; Fetihi, Leyla; Erol, Ahmet; Gülay Ogelman, Hülya

2016-01-01

The purpose of the study is to compare environmental attitudes and experiences of five-year-old children receiving preschool education in the village and city centre. The first group comprised 54 five-year-old children who received preschool education and attended kindergartens of two primary schools in the Karateke and Kocabas villages of Honaz…

Incidence and root causes of delays in emergency orthopaedic procedures: a single-centre experience of 36,017 consecutive cases over seven years.

PubMed

Caesar, Ulla; Karlsson, Jon; Hansson, Elisabeth

2018-01-01

Emergency surgery is unplanned by definition and patients are scheduled for surgery with minimal preparation. Some patients who have sustained emergency orthopaedic trauma or other conditions must be operated on immediately or within a few hours, while others can wait until the hospital's resources permit and/or the patients' health status has been optimised as needed. This may affect the prioritisation procedures for both emergency and elective surgery and might result in waiting lists, not only for planned procedures but also for emergencies. The main purpose of this retrospective, observational, single-centre study was to evaluate and describe for the number and reasons of delays, as well as waiting times in emergency orthopaedic surgery using data derived from the hospital's records and registers. All the emergency patients scheduled for emergency surgery whose procedures were rescheduled and delayed between 1 January 2007 and 31 December 2013 were studied. We found that 24% (8474) of the 36,017 patients scheduled for emergency surgeries were delayed and rescheduled at least once, some several times. Eighty per cent of these delays were due to organisational causes. Twenty-one per cent of all the delayed patients had surgery within 24 h, whilst 41% waited for more than 24 h, up to 3 days. A large number of the clinic's emergency orthopaedic procedures were rescheduled and delayed and the majority of the delays were related to organisational reasons. The results can be interpreted in two ways; first, organisational reasons are avoidable and the potential for improvement is great and, secondly and most importantly, the delays might negatively affect patient outcomes.

Evaluation of orchiopexy practice patterns in patients with cryptorchidism: a single-centre study.

PubMed

Moslemi, Mohammad Kazem

2014-04-01

A retrospective study was conducted to determine the age at which orchiopexy was performed, and the laterality and anatomic location of undescended testes (UDTs) or non-palpable testes (NPTs). All documented orchiopexies performed in a large referral centre of Qom province, Qom, Iran during a 5 year period were evaluated. A total of 324 patients admitted for surgical correction of cryptorchidism from 2005 to 2009 were eligible for inclusion in our study. The patients were divided into two groups: group A paediatric orchiopexy, and group B adult orchiopexy. There were 252 paediatric patients (78%), with a mean age of 4.44 years, and 72 adult patients (22%). Forty-three patients (17%) were under 2 years of age and 59 patients (23.5%) were between 2 and 3 years. Right-side involvement was seen in 126 patients (50%), left-side in 91 patients (36%), and bilateral involvement in 35 patients (14%). Unilateral cryptorchidism was seen in 217 patients (85%). Regarding the anatomical location of the testes in unilateral cryptorchidism, superficial inguinal testis was seen in 117 patients (54%). The higher age of orchiopexies determined from this study compared with the recommended age for surgery, indicates that active interventions are necessary with public health education programs for patients, parents, midwives and general practitioners. Copyright © 2013 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

Single-stage revision for fungal peri-prosthetic joint infection: a single-centre experience.

PubMed

Klatte, T O; Kendoff, D; Kamath, A F; Jonen, V; Rueger, J M; Frommelt, L; Gebauer, M; Gehrke, T

2014-04-01

Fungal peri-prosthetic infections of the knee and hip are rare but likely to result in devastating complications. In this study we evaluated the results of their management using a single-stage exchange technique. Between 2001 and 2011, 14 patients (ten hips, four knees) were treated for a peri-prosthetic fungal infection. One patient was excluded because revision surgery was not possible owing to a large acetabular defect. One patient developed a further infection two months post-operatively and was excluded from the analysis. Two patients died of unrelated causes. After a mean of seven years (3 to 11) a total of ten patients were available for follow-up. One patient, undergoing revision replacement of the hip, had a post-operative dislocation. Another patient, undergoing revision replacement of the knee, developed a wound infection and required revision 29 months post-operatively following a peri-prosthetic femoral fracture. The mean Harris hip score increased to 74 points (63 to 84; p < 0.02) in those undergoing revision replacement of the hip, and the mean Hospital for Special Surgery knee score increased to 75 points (70 to 80; p < 0.01) in those undergoing revision replacement of the knee. A single-stage revision following fungal peri-prosthetic infection is feasible, with an acceptable rate of a satisfactory outcome.

Persons with Haemophilia in Sweden- Experiences and Strategies in Everyday Life. A Single Centre Study

PubMed Central

2015-01-01

Introduction/Aim Haemophilia is caused by deficiency in coagulation factor VIII or IX. Treatment with the missing coagulation factors has been available in most developed countries for several decades. The aim was to explore the experiences of adults living with severe or moderate haemophilia and their coping strategies at a single centre in Sweden. Method The interview study had a qualitative empirical approach and was analyzed on the basis of the method empirical phenomenological psychology. The sample included 14 participants, mean age 42 (19–80 y), who met the inclusion criteria and to saturation of information. Results: General characteristics were; All were satisfied with and grateful for access to medication. An acceptance of the disorder and willingness to live a normal life was identified among all participants. They were all content with the care provided by Haemophilia Treatment Centre (HTC) and felt supported by its multidisciplinary team. Four typologies were identified; Protective adults and assertive children during up-bringing, finding a role in social context, symptoms and treatments, fear of limited resources in the future. Task-, emotional- and avoidance coping strategies were seen in the interviews. The most prominent coping strategy was task oriented. Conclusion This interview study with Swedish PWH shows that they strive for normality and adaptation in social activities throughout life finding their own niche. The PWH expressed the importance of knowledge and support from the comprehensive medical team at HTC and therefore it seems important to continue comprehensive medical care at HTC in order to follow-up the haemophilia persons regularly. PMID:26431432

Ten-year surveillance of nosocomial bloodstream infections: trends of aetiology and antimicrobial resistance in a comprehensive cancer centre.

PubMed

Passerini, R; Ghezzi, Tl; Sandri, Mt; Radice, D; Biffi, R

2011-01-01

Bloodstream infections (BSIs) are one of the major life-threatening infectious conditions in cancer patients and are responsible for prolonged hospital stays, high healthcare costs and significant mortality. Several clinical trials have reported an improved survival in patients treated with appropriate empirical broad-spectrum antibiotic therapy. Early detection of pathogens and determination of their susceptibility are essential for the optimization of treatment. Variability between hospitals is substantial and requires the individual analysis of local trends. The aim of this study is to assess the local epidemiology of BSI in a single cancer centre over a 10-year period. Retrospective microbiological surveillance of all febrile/infective episodes occurring in oncological and surgical patients in a high-volume cancer centre between January 1999 and December 2008 were considered. Patients' data were collected, processed and analyzed using the epidemiological resource of the Virtuoso Plus software (Metafora Informatica Srl, Milano, Italy). Spearman's rank correlation coefficient, including the two-tailed test of significance, was used to investigate trends of incidence and rate of antibiotic resistance over the 10-year period. A total of 13,058 blood cultures (BCs) were performed in 2,976 patients. BCs were positive in 2,447 tests, representing 740 infective/febrile episodes: 358 (48%) in medical oncology and 382 (52%) in surgical wards. Gram-positives were responsible for the majority of episodes in oncological and surgical divisions (about 63% and 55%, respectively). Gram-positives were also the most common organism in non-catheter-related BSIs (CRBSIs) both in medical oncology (75%) and in surgical divisions (50%). Enterococci showed an increased resistance to levofloxacin, from 5.6% to 25.7% (p = 0.02) and to erythromycin, from 41.7% to 61.4%, (p = 0.05). Similarly, coagulase negative staphylococci (CoNS) developed resistance to levofloxacin and ciprofloxacin

Student-Centred and Teacher-Centred Learning Environment in Pre-Vocational Secondary Education: Psychological Needs, and Motivation

ERIC Educational Resources Information Center

Smit, Karin; de Brabander, Cornelis J.; Martens, Rob L.

2014-01-01

In this study the perception of psychological needs and motivation in a student-centred and a teacher-centred learning environment are compared, using Self Determination Theory as a framework. The self-report Intrinsic Motivation Inventory was completed by 230 students (mean age 16.1 years) in pre-vocational secondary education. School records on…

Proton Therapy for Craniopharyngioma - An Early Report from a Single European Centre.

PubMed

Ajithkumar, T; Mazhari, A-L; Stickan-Verfürth, M; Kramer, P-H; Fuentes, C-S; Lambert, J; Thomas, H; Müller, H; Fleischhack, G; Timmermann, B

2018-05-01

Proton beam therapy (PBT) is being increasingly used for craniopharyngioma. We describe our early outcome of patients treated with PBT. Between August 2013 and July 2016, 18 patients with craniopharyngiomas were treated with 54 Cobalt Gray Equivalent (CGE) in 30 fractions over 6 weeks at our centre. The early outcome of 16 patients included in a registry study was analysed. Radiological response was assessed by RECIST criteria and the disease- and treatment-related toxicities were scored according to the CTCAE 4.0. All patients are alive at a median follow-up of 32.6 months (range 9.2-70.6 months) from initial diagnosis. The median age at PBT was 10.2 years (range 5.4-46.9 years). One patient progressed 8.7 months after PBT and subsequently had complete resection of the tumour. At a median follow-up of 18.4 months after PBT, five patients remained in complete remission, four in partial remission and seven with stable disease. The most common adverse effects during PBT were grade 1 (cutaneous in seven patients and fatigue in six patients). There were no treatment-related grade 3 toxicities. Our early results are encouraging and comparable with the limited literature on PBT for craniopharyngioma. Copyright © 2018. Published by Elsevier Ltd.

Multiple sclerosis and pregnancy: a single-centre prospective comparative study.

PubMed

Cuello, J P; Martínez Ginés, M L; Martin Barriga, M L; de Andrés, C

2017-03-01

Multiple sclerosis (MS) is a autoimmune disorder which preferentially affects young women of childbearing age. During pregnancy, the annualized relapse rate (AAR) is modified, but pregnancy has no harm effect on the long-term course of the disease. We aimed to study the clinical course of our MS patients during pregnancy, and compare their obstetrics outcomes with a control group of non-MS patients. A single centre prospective observational study was conducted. We assessed the reproductive history, MS history, pregnancy course and new-born outcome of a cohort of MS patients who had had a pregnancy between january 2007 and july 2012. We compared the global outcomes with a control cohort of 58 age-matched healthy pregnancies. Complete data from 35 consecutive women were analyzed, 40 deliveries. Control groups: 58 patients, 60 deliveries. EDSS at pregnancy 0,7. ARR before pregnancy 0,5. During pregnancy 0,3, after pregnancy 0,4. Twelve patients were on disease-modifying drugs (DMD) before pregnancy, 4 prenatal exposure occurs. The comparison between relapse rate and EDSS before, during and after delivery showed no statistically significant difference. In addition, compared to control group, there were also no differences in the obstetric outcomes. In MS cohort, we found a higher incidence of assisted reproductive treatments and lower breastfeeding rate, both statistically significant. Our series confirms that pregnancy has no negative long term impact on the progression of MS and also suggest that there is no additional morbidity in the pregnancy, comparing to the rest of the population. Copyright © 2014 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

Review of Kinemax total knee replacements performed at the NHS treatment centre, Weston-Super-Mare: five-year results.

PubMed

Hickey, B A; Kempshall, P J; Metcalfe, A J; Forster, M C

2012-04-01

As part of the national initiative to reduce waiting times for joint replacement surgery in Wales, the Cardiff and Vale NHS Trust referred 224 patients to the NHS Treatment Centre in Weston-Super-Mare for total knee replacement (TKR). A total of 258 Kinemax TKRs were performed between November 2004 and August 2006. Of these, a total of 199 patients (232 TKRs, 90%) have been followed up for five years. This cohort was compared with 258 consecutive TKRs in 250 patients, performed at Cardiff and Vale Orthopaedic Centre (CAVOC) over a similar time period. The five year cumulative survival rate was 80.6% (95% confidence interval (CI) 74.0 to 86.0) in the Weston-Super-Mare cohort and 95.0% (95% CI 90.2 to 98.2) in the CAVOC cohort with revision for any reason as the endpoint. The relative risk for revision at Weston-Super-Mare compared with CAVOC was 3.88 (p < 0.001). For implants surviving five years, the mean Oxford knee scores (OKS) and mean EuroQol (EQ-5D) scores were similar (OKS: Weston-Super-Mare 29 (2 to 47) vs CAVOC 29.8 (3 to 48), p = 0.61; EQ-5D: Weston-Super-Mare 0.53 (-0.38 to 1.00) vs CAVOC 0.55 (-0.32 to 1.00), p = 0.79). Patients with revised TKRs had significantly lower Oxford knee and EQ-5D scores (p < 0.001). The results show a higher revision rate for patients operated at Weston-Super-Mare Treatment Centre, with a reduction in functional outcome and quality of life after revision. This further confirms that patients moved from one area to another for joint replacement surgery fare poorly.

Robotic-assisted coronary artery bypass surgery: an 18-year single-centre experience.

PubMed

Giambruno, Vincenzo; Chu, Michael W; Fox, Stephanie; Swinamer, Stuart A; Rayman, Reiza; Markova, Zarina; Barnfield, Rebecca; Cooper, Mitchell; Boyd, Douglas W; Menkis, Alan; Kiaii, Bob

2018-06-01

Minimally invasive robot-assisted direct coronary artery bypass (RADCAB) has emerged as a feasible minimally invasive surgical technique for revascularization that might offer several potential advantages over conventional approaches. We present our 18-year experience in RADCAB. Between February 1998 and February 2016, 605 patients underwent RADCAB. Patients underwent post-procedural selective graft patency assessment using cardiac catheterization. The mortality rate was 0.3%. The rate of conversion to sternotomy for any cause was reduced from 16.0% of the first 200 cases to 6.9% of the last 405 patients. The patency rate of the LITA-to-LAD anastomosis was 97.4%. Surgical re-exploration for bleeding occurred in 1.8% of patients, and the transfusion rate was 9.2%. Average ICU stay was 1.2 ± 1.4 days, and average hospital stay was 4.8 ± 2.9 days. Robot-assisted coronary artery bypass grafting is safe, feasible and it seems to represent an effective alternative to traditional coronary artery bypass grafting in selected patients. Copyright © 2018 John Wiley & Sons, Ltd.

Apixaban versus enoxaparin in the prevention of venous thromboembolism following total knee arthroplasty: a single-centre, single-surgeon, retrospective analysis.

PubMed

King, D A L; Pow, R E; Dickison, D M; Vale, P R

2016-09-01

There is a high risk of developing venous thromboembolism (VTE) following total knee arthroplasty (TKA). Conventional thromboprophylactic agents have limitations, such as route of administration, the need for monitoring, narrow therapeutic windows and interactions. Apixaban is a new oral anticoagulant with the potential to overcome these limitations. To report the efficacy and safety of apixaban and low-molecular-weight heparin, enoxaparin, in VTE prophylaxis following TKA. This single-centre, single-surgeon, retrospective analysis included 506 consecutive patients who underwent TKA between 2009 and 2015 and received enoxaparin or apixaban as thromboprophylaxis. Baseline characteristics of patients, in-hospital rates of VTE, total DVT, proximal or distal DVT, pulmonary embolism, bleeding outcomes and mortality were compared between the two groups. In-hospital VTE occurred in 22 (8.9%) patients in the enoxaparin group and 11 (4.5%) patients in the apixaban group (P = 0.049). Nine (3.6%) patients in the enoxaparin group and one (0.4%) in the apixaban group experienced a postoperative drop in haemoglobin ≥20 g/L that either necessitated transfusion of ≥2 units blood, caused haemodynamic instability or both (P = 0.020). Thirty-five patients experienced other bleeding events, with 25 (9.9%) in the enoxaparin group and 10 (4.0%) in the apixaban group (P = 0.009). There were no statistically significant differences in rates of total DVT, proximal or distal DVT, pulmonary embolism or mortality between the groups. Compared with enoxaparin, thromboprophylaxis with apixaban resulted in a lower VTE incidence and fewer haemorrhagic complications. © 2016 Royal Australasian College of Physicians.

The outcome of pregnancies in women with cystic fibrosis--single centre experience 1998-2011.

PubMed

Thorpe-Beeston, J G; Madge, S; Gyi, K; Hodson, M; Bilton, D

2013-02-01

To describe the maternal and fetal outcomes of pregnancies in women with cystic fibrosis. Retrospective study. Single obstetric hospital and adult cystic fibrosis centre. Retrospective case-note review of pregnant women with cystic fibrosis referred for antenatal care and delivery. Maternal and fetal outcomes, mode of delivery, lung function and pregnancy complications. Forty-eight pregnancies were studied in 41 women. There were two miscarriages, 44 singleton pregnancies and two sets of twins. All babies were liveborn and survived. The mean gestational age at delivery was 35.9 ± 3.3 weeks. There were no fetal abnormalities or terminations of pregnancy. The median birthweight centile was 31.9 (interquartile range 14.9-55.6). Twenty-five (52.1%) of the women had pancreatic insufficiency and 17 (35.4%) required insulin. There was a positive correlation between booking predicted forced expiratory volume in 1 second (FEV(1) ) and gestational age at delivery (P < 0.01). Women with FEV(1) ≤60% were more likely to deliver earlier and by caesarean section compared with women with FEV(1) >60% (35.0 ± 3.2 weeks versus 37.1 ± 3.0 weeks; P = 0.02 and 75.0% versus 25.0%; P = 0.01). Three of the seven women with an FEV(1) <40% died within 18 months of delivery. Four of the eight women with FEV(1) 40-50% died between 2 and 8 years after delivery. Pregnancy for women with cystic fibrosis is possible and results in favourable maternal and fetal outcomes, but the incidence of preterm delivery and caesarean section is increased. Women with pre-existing poor lung function should be counselled antenatally to ensure that they understand the implications of their shortened life-expectancy and parenthood. © 2012 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2012 RCOG.

Management of Cushing syndrome in children and adolescents: experience of a single tertiary centre.

PubMed

Güemes, Maria; Murray, Philip G; Brain, Caroline E; Spoudeas, Helen A; Peters, Catherine J; Hindmarsh, Peter C; Dattani, Mehul T

2016-07-01

The diagnosis and management of paediatric Cushing syndrome (CS) is highly challenging. This study aims to characterise its presentation, diagnosis, management and outcome by a retrospective case review of 30 patients (14 females) followed at a single tertiary paediatric endocrinology centre over a 30-year period. At presentation, median age was 8.9 years (0.2-15.5) and the commonest manifestations were weight gain (23/30), hirsutism (17/30), acne (15/30) and hypertension (15/30). Growth retardation was present in 11/30. Median body mass index (BMI) was +2.1 standard deviation score (SDS) (-6.5 to +4.6). Urinary free cortisol (UFC) was abnormal in 17/18 (94 %), midnight cortisol in 27/27 (100 %) and low-dose dexamethasone suppression (LDDS) test in 20/20 (100 %). High-dose dexamethasone suppression (HDDS) test was abnormal in 6/6 (100 %) of adrenal tumours, 1/10 (10 %) of Cushing disease (CD) and 1/2 (50 %) of ectopic tumours. Bilateral inferior petrosal sinus sampling (IPSS) identified five CD cases and one ectopic tumour. All patients underwent surgery and subsequently required cortisol replacement. Final diagnoses were 16 CD, 11 adrenal disease, 2 ectopic ACTH-secreting lesions and 1 case of unidentified aetiology. One year post-diagnosis, median BMI was 0.5 SDS (-2.5 to +3.7), hypertension was present in 4/14 (28 %), and 43 % (12/30) of individuals were off hydrocortisone. The prevalence of the clinical manifestations differs from that reported in other series. Screening tests were highly sensitive, with UFC, midnight cortisol and LDDS performing well. One year post-treatment, BMI and BP normalised in the majority of patients and almost half of them were able to discontinue replacement hydrocortisone. •Cushing syndrome is an extremely rare entity in the paediatric and adolescent age groups, so not many cohort studies have been published in this population. •Several tests can be employed to firstly diagnose hypercortisolaemia and secondly identify

Incisional hernia in pediatric surgery - experience at a single UK tertiary centre.

PubMed

Mullassery, Dhanya; Pedersen, Ami; Robb, Andrew; Smith, Nicola

2016-11-01

Incisional hernia (IH) is a recognized complication of open and laparoscopic visceral surgery, with reported rates of 10-50% in adult surgical literature. There is a paucity of data relating to incisional hernias in children. The aim of our study was to analyze the incidence and treatment of IH in children. Retrospective review of all patients admitted for incisional hernia repair at a tertiary pediatric surgical centre in the UK more than a 7-year period was performed. Data collected included age at initial surgery, time to IH repair, and type of IH repair and postoperative complications. Twenty one patients (14 male) underwent IH repair during the study period. The incidence of IH among children who had primary abdominal surgery in our institution less than the age of 6months was 2.3%. Median age at repair was 7.9months (range: 18days-5years). Median time from primary surgery to diagnosis of IH was 2months (range 0day-3years), with 81% (17/21) diagnosed within 1year of the preceding abdominal procedure. The most common pathology necessitating the primary operative procedure was necrotising enterocolitis (n=9) in babies of gestational age less than 30weeks. The highest rates of IH were noted in infants following closure of stoma (7.5%) and pyloromyotomy (2.52%). Primary closure was undertaken in all cases. Two children had recurrence of IH, one of which underwent surgical repair. Incidence of IH in children is low but significant. IH was most commonly diagnosed following closure of stoma for NEC in this study. Copyright © 2016. Published by Elsevier Inc.

Factors influencing long-term quality of life and depression in German liver transplant recipients: a single-centre cross-sectional study.

PubMed

Zahn, Alexandra; Seubert, Lisa; Jünger, Jana; Schellberg, Dieter; Weiss, Karl Heinz; Schemmer, Peter; Stremmel, Wolfgang; Sauer, Peter; Gotthardt, Daniel Nils

2013-06-26

Health-related quality of life (HRQOL) following orthotopic liver transplantation (OLT) has become increasingly important. Therefore, we aimed to identify factors affecting HRQOL after OLT. This cross-sectional, single-centre study surveyed 281 OLT patients. Survey tools included the Short Form (SF-36) Health Survey, the Patient Health Questionnaire 9 (PHQ9), and a self-designed employment questionnaire. Patient medical records were reviewed. Participants included 187 men (mean age at OLT: 50 [± 11; 13-69] years). Primary indications for OLT were viral hepatitis (28%), alcoholic liver disease (35%), cholestatic liver disease (11%), and others (26%). Follow-up ranged from 2 to 136 months. Clinical factors associated with improved HRQOL were age ≤ 45 years at OLT and current MELD score <=≤ 13. Time after OLT and indication for transplantation affected SF-36 HRQOL. SF-36 physical component summary scales plateaued at 3-years post-OLT and then stabilized. For the SF-36 HRQOL, scores were the lowest in all domains for OLT recipients transplanted for chronic viral hepatitis and for unemployed patients, whereas sex and number of transplantations showed no significant differences. The PHQ9 results showed that depression was significantly more frequent among patients with current MELD score ≥ 13 or impaired liver function and those transplanted for chronic viral hepatitis or unemployed patients. Age and sex did not influence PHQ9 results. Medical and psychosocial support is crucial for long-term HRQOL after OLT. Developing multidisciplinary interventions to address issues such as employment, age, MELD score, and liver function may improve long-term HRQOL in these patients.

Factors associated with anxiety and depression among type 2 diabetes outpatients in Malaysia: a descriptive cross-sectional single-centre study

PubMed Central

Ganasegeran, Kurubaran; Renganathan, Pukunan; Manaf, Rizal Abdul; Al-Dubai, Sami Abdo Radman

2014-01-01

Objective To determine the prevalence and factors associated with anxiety and depression among type 2 diabetes outpatients in Malaysia. Design Descriptive, cross-sectional single-centre study with universal sampling of all patients with type 2 diabetes. Setting Endocrinology clinic of medical outpatient department in a Malaysian public hospital. Participants All 169 patients with type 2 diabetes (men, n=99; women, n=70) aged between 18 and 90 years who acquired follow-up treatment from the endocrinology clinic in the month of September 2013. Main outcome measures The validated Hospital Anxiety and Depression Scale (HADS), sociodemographic characteristics and clinical health information from patient records. Results Of the total 169 patients surveyed, anxiety and depression were found in 53 (31.4%) and 68 (40.3%), respectively. In multivariate analysis, age, ethnicity and ischaemic heart disease were significantly associated with anxiety, while age, ethnicity and monthly household income were significantly associated with depression. Conclusions Sociodemographics and clinical health factors were important correlates of anxiety and depression among patients with diabetes. Integrated psychological and medical care to boost self-determination and confidence in the management of diabetes would catalyse optimal health outcomes among patients with diabetes. PMID:24760351

Girls' Groups and Boys' Groups at a Municipal Technology Centre

ERIC Educational Resources Information Center

Salminen-Karlsson, Minna

2007-01-01

This article describes the Swedish initiative of municipal technology centres from a gender point of view. These centres provide after-school technology education for children aged 6-16. By means of an ethnographic study, the effects of the use of single-sex groups in increasing the interest of girls and boys in technical activities have been…

Changing characteristics of a Psychiatric Emergency Care Centre. An eight year follow-up study.

PubMed

Seymour, Joanne; Chapman, Tristan; Starcevic, Vladan; Viswasam, Kirupamani; Brakoulias, Vlasios

2018-05-01

The objective of this study was to report changes in characteristics of admissions to an established Psychiatric Emergency Care Centre (PECC) eight years after its opening. Key clinical characteristics of admissions to the PECC were documented for 327 patients in 2015 and compared with the 477 patients in 2007, which is when the centre first opened. The characteristics of admission were evaluated using an audit of medical records from June to December in both 2007 and 2015. Statistically significant differences ( p<0.05) between 2007 and 2015 were: a reduction in the numbers of patients admitted with depression; a reduction in the numbers of patients diagnosed with adjustment disorder; an increase in the numbers of patients diagnosed with borderline personality disorder; a reduction in pro re nata (prn) use, including a reduction in the need for chemical restraint with midazolam and a decrease in the length of admission in the PECC. The significant reduction in aggression, the use of prn medication and the number of people with longer stays within the PECC support the usefulness of PECCs in relation to patient satisfaction and adherence to admission criteria policy. These factors may be considered as indicators of the efficiency of a PECC.

Clinical Profile and Early Complications after Single and Dual Chamber Permanent Pacemaker Implantation at Manmohan Cardiothoracic Vascular and Transplant Centre, Kathmandu, Nepal.

PubMed

Khanal, J; Poudyal, R R; Devkota, S; Thapa, S; Dhungana, R R

2015-01-01

Permanent pacemaker implantation is a minimally invasive surgical procedure in the management of patients with cardiac problems. However, complications during and after implantation are not uncommon. There is lack of evidences in rate of complications with the selection of pacemakers in Nepal. Therefore, this study was performed to compare the frequency of implantation and complication rate between single chamber and dual chamber pacemaker. The present study is based on all consecutive pacemaker implantations in a single centre between April 2014 and May 2015. A total of 116 patients were categorized into two cohorts according to the type of pacemaker implanted- single chamber or dual chamber. All patients had regular 2-weeks follow-up intervals with standardized documentation of all relevant patient data till 6-week after implantation. Data were presented as means ± standard deviation (SD) for continuous variables and as proportions for categorical variables. Comparison of continuous variables between the groups was made with independent Student's t-test. For discrete variables distribution between groups were compared with Chi-square test. The mean age (±SD) of total population at implant was 64.08 (± 15.09) years. Dual chamber units were implanted in 44 (37.93%) of patients, single chamber in 72 (62.06%). Only 14 women (31.81%) received dual chamber compared with 42 women (58.33%) who received single chamber (Chi-square=18, DF=1, P = 0.0084). Complete atrioventricular block was the commonest (56.03%) indication for permanent pacemaker insertion followed by sick sinus syndrome (33.62%), symptomatic high-grade AV block (11.20%). Hypertension (dual chamber 21.55%, single chamber 40.51%) was the most common comorbidity in both cohorts. Complications occurred in 11 (9.48%) patients. More proportion of complication occurred in single chamber group (9 patients, 12.50%) than in dual chamber (2 patients, 4.54%). Complications occurring in dual chamber group include

Single-Centre Experience with Percutaneous Cryoablation of Breast Cancer in 23 Consecutive Non-surgical Patients

DOE Office of Scientific and Technical Information (OSTI.GOV)

Cazzato, Roberto Luigi, E-mail: r.cazzato@unicampus.it; Lara, Christine Tunon de, E-mail: c.tunondelara@bordeaux.unicancer.fr; Buy, Xavier, E-mail: x.buy@bordeaux.unicancer.fr

AimTo present our single-centre prospective experience on the use of cryoablation (CA) applied to treat primary breast cancer (BC) in a cohort of patients unsuitable for surgical treatment.Materials and MethodsTwenty-three consecutive post-menopausal female patients (median age 85 years; range 56–96) underwent percutaneous CA of unifocal, biopsy-proven BC, under ultrasound/computed tomography (US/CT) guidance. Clinical and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) follow-ups were systematically scheduled at 3, 12, 18 and 24 months. Local tumour control was assessed by comparing baseline and follow-up DCE-MRI.ResultsTwenty-three BC (median size 14 mm) were treated under local anaesthesia (78.3 %) or local anaesthesia and conscious sedation (21.7 %). Median number ofmore » cryo-probes applied per session was 2.0. A “dual-freezing” protocol was applied for the first ten patients and a more aggressive “triple-freezing” protocol for the remaining 13. Median follow-up was 14.6 months. Five patients recurred during follow-up and two were successfully re-treated with CA. Five patients presented immediate CA-related complications: four hematomas evolved uneventfully at 3-month follow-up and one skin burn resulted in skin inflammation and skin retraction at 3 and 12 months, respectively.ConclusionsPercutaneous CA is safe and well tolerated for non-resected elderly BC patients. Procedures can be proposed under local anaesthesia only. Given the insulation properties of the breast gland, aggressive CA protocols are required. Prospective studies are needed to better understand the potential role of CA in the local treatment of early BC.« less

Laparoscopic surgery for complicated diverticular disease: a single-centre experience.

PubMed

Royds, J; O'Riordan, J M; Eguare, E; O'Riordan, D; Neary, P C

2012-10-01

The role of laparoscopic surgery in the management of patients with diverticular disease is still not universally accepted. The aim of our study was to evaluate the results of laparoscopic surgery for diverticular disease in a centre with a specialist interest in minimally invasive surgery. All diverticular resections carried out between 2006 and 2010 were reviewed. Data recorded included baseline demographics, indication for surgery, operative details, length of hospital stay and complications. Complicated diverticular disease was defined as diverticulitis with associated abscess, phlegmon, fistula, stricture, obstruction, bleeding or perforation. One hundred and two patients (58 men) who had surgery for diverticular disease were identified (median age 59 years, range 49-70 years). Sixty-four patients (64%) had surgery for complicated diverticular disease. The indications were recurrent acute diverticulitis (37%), colovesical fistula (21%), stricture formation (17%) and colonic perforation (16%). Sixty-nine cases (88%) were completed by elective laparoscopy. Postoperative mortality was 0%. For elective cases there was no difference in morbidity rates between patients with complicated and uncomplicated diverticular disease. The overall anastomotic leakage rate was 1% and the wound infection rate 7%. There was a nonsignificant trend to higher conversion to open surgery in the elective group in complicated (11.4%) compared with uncomplicated patients (5.2%) (P=0.67). Electively, the rate of stoma formation was higher in the complicated (31.6%) than the uncomplicated group (5.2%) (P<0.02). Laparoscopic surgery for both complicated and uncomplicated diverticular disease is associated with low rates of postoperative morbidity and relatively low conversion rates. Laparoscopic surgery is now the standard of care for complicated and uncomplicated diverticular disease in our institution. © 2011 The Authors. Colorectal Disease © 2011 The Association of Coloproctology of

Early and mid-term outcome of the arterial switch operation in 114 consecutive patients : A single centre experience.

PubMed

Prandstetter, C; Hofer, A; Lechner, E; Mair, R; Sames-Dolzer, E; Tulzer, G

2007-10-01

The arterial switch operation (ASO) has become the treatment of choice in patients with simple or complex transposition of the great arteries (TGA). The purpose of this study was to assess early and mid-term outcome after ASO in a single centre. Between 1995 and December 2005, 114 consecutive patients underwent an ASO at our institution, performed by one single surgeon. Patients charts, surgical reports and echocardiograms were retrospectively reviewed. Patients were analyzed in 3 different groups: Group I consisted of 77 neonates with TGA and intact ventricular septum, group II of 13 patients with TGA and ventricular septal defect which had to be closed surgically and group III of 24 patients with various forms of TGA in a complex setting. The patient's median weight was 3.23 kg (1.65-8.30). Twenty-five neonates were born preterm, 18 were diagnosed prenatally. Median follow-up time was 20.7 months (0.3-128.6). The thirty day mortality was 1.75% (2/114), late mortality 0.88% (1/112) accounting for an overall mortality of 2.63%. There was only one early coronary event and so far no late events. Ten of 111 survivors required reoperation, all but 1 from group III. Prevalence of supravalvular pulmonary stenosis was 4.7%. Freedom from reoperation at 5 years of follow-up time was 87.5%. One patient required permanent pacing, no other late arrhythmias occurred. In our series the only risk factor for increased mortality and morbidity was a body weight of less than 2500 g at the time of operation. No better outcome could be demonstrated in the prenatally diagnosed patients. The ASO can be performed safely and with low mortality and morbidity even in patients with complex TGA. Follow-up of these patients is required to detect residual problems like supravalvular pulmonary stenosis, coronary problems, arrhythmias and aortic valve dysfunction.

Centre of the Cell: Science Comes to Life.

PubMed

Balkwill, Frances; Chambers, Katie

2015-01-01

Centre of the Cell is a unique biomedical science education centre, a widening participation and outreach project in London's East End. This article describes Centre of the Cell's first five years of operation, the evolution of the project in response to audience demand, and the impact of siting a major public engagement project within a research laboratory.

[Human Single Drug Exposures to Non-opioid Analgesics Reported to the Poisons Information Centre Erfurt from 2003 to 2012].

PubMed

Hentschel, H; Prasa, D; Bergmann, I; Enden, G; Plenert, B; Frimlova, G; Just, S; Liebetrau, G; Stürzebecher, A; Deters, M

2016-01-01

Because of their frequency, non-opioid analgesics (NOA) single drug exposures registered by Poisons Information Centre (PIC) Erfurt have been studied over a decade. A retrospective analysis of frequencies, circumstances of exposure, symptom severity, and age groups in NOA single drug exposures received by the PIC Erfurt from the beginning of 2003 to the end of 2012 was undertaken. Of all 4749 NOA single drug exposures, the 10 most frequent were caused by paracetamol (n=1 686), ibuprofen (n=1 439), acetylsalicylic acid (n=456), dipyrone (n=274), diclofenac (n=267), flupirtine (n=138), naproxen (n=41), etoricoxib (n=36), indomethacin (n=24), and dexketoprofen (n=19). Paracetamol single drug exposures increased from 158 in 2003 to 216 in 2007 and fell afterwards to 133 in 2012. Ibuprofen single drug exposures continously rose from 57 in 2003 to 258 in 2012. Adults were more often involved in NOA (53.8%) and all single drug exposures (54.1%) than children (45.9% and 45.6%, respectively). Suicidal attempts were more frequent in NOA (43.1%) than in all single drug exposures (34.2%), whereas accidental exposures or exposures in abuse were less often (33.4 and 0.2%, 46.0 and 0.9% respectively). NOA single drug exposures resulted mostly in none to minor symptoms (77.0%) and rarely in moderate (2.1%) or severe symptoms (1.0%). One adult was found dead after probable ingestion of 32 g of acetylsalicylic acid in suicidal intention. Because many NOA are over-the-counter drugs, it is difficult to obtain data on their use. PIC data could provide information on the NOA use in the population. © Georg Thieme Verlag KG Stuttgart · New York.

The digital eczema centre utrecht.

PubMed

van Os-Medendorp, Harmieke; van Veelen, Carien; Hover, Maaike; Eland-de Kok, Petra; Bruijnzeel-Koomen, Carla; Sonnevelt, Gert-Jan; Mensing, Geert; Pasmans, Suzanne

2010-01-01

The University Medical Centre Utrecht (UMC Utrecht) has developed an eczema portal that combines e-consulting, monitoring and self-management training by a dermatology nurse online for patients and parents of young children with atopic dermatitis (AD). Patient satisfaction with the portal was high. It could be extended to become a Digital Eczema Centre for multidisciplinary collaboration between health-care providers from different locations and the patient. Before starting the construction of the Digital Eczema Centre, the feasibility was examined by carrying out a business case analysis. The purposes, strength and weaknesses showed that the Digital Eczema Centre offered opportunities to improve care for patients with AD. The financial analysis resulted in a medium/best case scenario with a positive result of euro50-240,000 over a period of five years. We expect that the Digital Eczema Centre will increase the accessibility and quality of care. The web-based patient record and the digital chain-of-care promote the involvement of patients, parents and multidisciplinary teams as well as the continuity and coordination of care.

[Centre of the state sanitary and epidemiological surveillance of Black Sea Fleet celebrates 75 years].

PubMed

Goncharov, G V; Brashkov, A A

2010-08-01

The history of the Centre of the state sanitary and epidemiological surveillance of Black Sea Fleet begun in the 1 April 1935 when the sanitary-epidemiological laboratory was founded. The article is concerned with the different stages of vivid development of this institute during 75 years. During this period organization, establishment and the name were changed many times. Since 2002 it got the current name and represents the scientific-methods institution which can solve the issues of sanitary-hygienic and antiepidemic supply of military personnel of the navy. Special attention is given to the high-readiness force.

Implant-supported single-tooth restorations. A 12-year prospective study.

PubMed

Donati, Mauro; Ekestubbe, Annika; Lindhe, Jan; Wennström, Jan L

2016-10-01

The aim of this study was to evaluate prospectively the 12-year outcome of implant-supported single-tooth restorations. Originally 45 self-tapping Astra Tech TiOblast ® ST-implants were installed by a two-stage protocol in 40 subjects requiring single-tooth prosthetic replacement for a missing tooth. Clinical and radiologic examinations were performed at completion of the prosthetic treatment 4-7 months after implant installation surgery and after 5 and 12 years in function. At 12 years 31 patients and 35 implants were available for evaluation. The overall failure rate after 12 years was 10.3% on the subject level and 9.1% on the implant level. The mean bone loss amounted to 0.67 mm (SD 2.20) on a subject level and 0.47 mm (1.72) on an implant level. Three subjects (10%) and three implants (8.6%) were diagnosed with peri-implantitis. Five subjects had experienced technical complications; three incidences of loosening of the abutment retention screw during the first 5 years and two minor porcelain fracture of the crown (two patients) between 5- and 12-years of follow-up. The findings reported in this 12-year prospective case series suggest that the use of the Astra Tech dental implants may be a valid treatment alternative for single-tooth replacement prostheses. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Cleavage of hydrogen by activation at a single non-metal centre - towards new hydrogen storage materials.

PubMed

Grabowski, Sławomir J

2015-05-28

Molecular surfaces of non-metal species are often characterized by both positive and negative regions of electrostatic potential (EP) at a non-metal centre. This centre may activate molecular hydrogen which further leads to the addition reaction. The positive EP regions at the non-metal centres correspond to σ-holes; the latter sites are enhanced by electronegative substituents. This is why the following simple moieties; PFH2, SFH, AsFH2, SeFH, BrF3, PF(CH3)2 and AsF(CH3)2, were chosen here to analyze the H2 activation and its subsequent splitting at the P, As, S, Se and Br centres. Also the reverse H-H bond reforming process is analyzed. MP2/aug-cc-pVTZ calculations were performed for systems corresponding to different stages of these processes. The sulphur centre in the SFH moiety is analyzed in detail since the potential barrier height for the addition reaction for this species is the lowest of the moieties analyzed here. The results of calculations show that the SFH + H2 → SFH3 reaction in the gas phase is endothermic but it is exothermic in polar solvents.

Outcomes of HeartWare Ventricular Assist System support in 141 patients: a single-centre experience.

PubMed

Wu, Long; Weng, Yu-Guo; Dong, Nian-Guo; Krabatsch, Thomas; Stepanenko, Alexander; Hennig, Ewald; Hetzer, Roland

2013-07-01

A third-generation ventricular assist device, the HeartWare Ventricular Assist System, has demonstrated its reliability and durability in animal models and clinical experience. However, studies of a large series of applications are still lacking. We evaluate the safety and efficacy of the HeartWare pump in 141 patients with end-stage heart failure at a single centre. A total of 141 patients (116 men and 25 women with a mean age of 52 years) in New York Heart Association (NYHA) Class IV received implantation of the HeartWare Ventricular Assist System between August 2009 and April 2011 at the Deutsches Herzzentrum Berlin. The outcomes were measured in terms of laboratory data, adverse events, NYHA functional class and survival during device support. The HeartWare system provided an adequate haemodynamic support for patients both inside and outside the hospital. NYHA class improved to I-II. Organ function and pulmonary vascular resistance improved significantly. In this cohort of patients, 14 patients underwent heart transplantation, one had had the device explanted following myocardial recovery, one had changed to another assist device, 81 were on ongoing support and 44 died. The overall actuarial survival rates at 6 and 12 months were 70 and 67%, respectively, and the 3-, 6- and 12-month survival rates on a left ventricular assist device (LVAD) support for bridge to transplantation patients were 82, 81 and 79%, respectively. Infection and bleeding were the main adverse events. Four patients underwent an LVAD exchange for pump thrombosis. The HeartWare system provides a safe and effective circulatory support in a population with a wide range of body surface areas, with a satisfactory actuarial survival time and an improved quality of life. It can be used for univentricular or biventricular support, being implanted into the pericardial space with simplified surgical techniques.

Utilisation patterns and cost of hospital care for people living with HIV in Ireland in 2012: a single-centre study.

PubMed

Brennan, Aline; Horgan, Mary; Jackson, Arthur; Browne, John P; Bergin, Colm J

2017-03-01

Data on the pattern and cost of health service use by HIV patients are required for evaluations of the cost-effectiveness of new drugs and technologies as well as being essential for service planning. The aim of this study was to identify the utilisation patterns and cost of hospital care for HIV patients in a single centre in Ireland in 2012. Data on the frequency and non-drug costs of all hospital resources used by HIV patients were extracted from a hospital activity-based costing system. Cost data were analysed using a generalised linear model. A total of 328 patients, 3672 patient months, were included in this study. Patients had a mean of 4.4 scheduled infectious disease outpatient appointments per patient year; 37% of patients also used another outpatient service, 15% in-patient services, 4% day-case service and 18% emergency department services in 2012. Patients with very advanced HIV disease continue to incur a disproportionate amount of the total cost of providing care. This study provides baseline utilisation and cost data for use of both infectious-disease and non-infectious disease hospital services and will be useful for service planning in light of the likely increases in resource demands.

Management of febrile children under five years in hospitals and health centres of rural Ghana.

PubMed

Webster, Jayne; Baiden, Frank; Bawah, Justina; Bruce, Jane; Tivura, Mathilda; Delmini, Rupert; Amenga-Etego, Seeba; Chandramohan, Daniel; Owusu-Agyei, Seth

2014-07-09

The case management of febrile children in hospitals' and health centres' pre-roll out of the new WHO policy on parasitological diagnosis was assessed. The delivery of artemisinin combination therapy (ACT) at these two levels of the health system was compared. Structured observations and exit interviews of 1,222 febrile children attending five hospitals and 861 attending ten health centres were conducted in six districts of the Brong Ahafo Region of Ghana. Effectiveness of delivery of case management of malaria was assessed. Proportions of children receiving ACT, anti-malarial monotherapy and antibiotics were described. Predictors of: a febrile child being given an ACT, a febrile child being given an antibiotic and of carers knowing how to correctly administer the ACT were assessed using logistic regression models stratified by hospitals and health centres. The system's effectiveness of delivering an ACT to febrile children diagnosed with malaria (parasitologically or clinically) was 31.4 and 42.4% in hospitals and health centres, respectively. The most ineffective process was that of ensuring that carers knew how to correctly administer the ACT. Overall 278 children who were not given an ACT were treated with anti-malarial monotherapy other than quinine. The majority of these children, 232/278 were given amodiaquine, 139 of these were children attending hospitals and 93 attending health centres. The cadre of health staff conducting consultation was a common predictor of the outcomes of interest. Presenting symptoms and examinations conducted were predictive of being given an ACT in hospitals and antibiotic in hospitals and health centres but not of being given an ACT in health centres. Treatment-seeking factors were predictive of being given an ACT if it was more than seven days since the fever began and an antibiotic in hospitals but not in health centres. Interventions to improve adherence to negative parasitological tests are needed, together with guidance on

Self Assessment and Student-Centred Learning

ERIC Educational Resources Information Center

McDonald, Betty

2012-01-01

This paper seeks to show how self assessment facilitates student-centred learning (SCL) and fills a gap in the literature. Two groups of students were selected from a single class in a tertiary educational institution. The control group of 25 was selected randomly by the tossing of an unbiased coin (heads = control group). They were trained in the…

Centre d'Observacio de l'Univers: first year of activities

NASA Astrophysics Data System (ADS)

Ribas, S. J.

2011-11-01

The Centre d'Observacio de l'Univers is one of the parts of the Parc Astronomic Montsec (PAM). PAM is an initiative of the Catalan government, through the Consorci del Montsec (Montsec Consortium), to take advantage of the capabilities and potential of the Montsec region to develop scientific research, training, and outreach activities, particularly in the field of astronomy. The choice of the Montsec mountains to install the PAM was motivated by the magnificent conditions for observing the sky at night; the sky above Montsec is the best (natural sky free of light pollution) in Catalonia for astronomical observations. The PAM has two main parts: the Observatori Astronomic del Montsec (OAdM) and the Centre d'Observacio del'Univers (COU). The OAdM is a professional observatory with an 80 cm catadioptric telescope (Joan Oro Telescope). The COU is a large multipurpose center which is intended to become an educational benchmark for teaching and communicate astronomy and other sciences in Catalonia. Since the opening more than 50000 visitors went to this center to enjoy science with Montsec dark skies and an special natural environment.

Folliculitis decalvans--a retrospective study in a tertiary referred centre, over five years.

PubMed

Chandrawansa, P H; Giam, Y C

2003-02-01

Folliculitis decalvans is a rare condition affecting mainly the scalp leading to scarring alopecia. Aetiology of the condition is still unknown, abnormal host response to Staphylococcus aureus has been postulated. We present a retrospective analysis of six cases of folliculitis decalvans presented to National Skin Centre (NSC), Singapore for the past five years, 1995-2000. The mean age of presentation was 39 years and ages ranged from 17 to 62 years. There were five male patients and one female patient. Duration of symptoms at presentation varied from six months to seven years. Occipital and vertex areas of the scalp were the only regions involved. Staphylococcus aureus was isolated in three patients; in one patient culture yielded negative results and no culture was done in the other two patients. All our patients were treated with several separate courses of systemic antibiotics which include doxycycline, erythromycin, minocycline, co-trimoxazole, cloxacillin, erythromycin, rifampicin and clindamycin. In addition one patient was treated with fucidic acid and zinc sulphate. The disease ran a protracted course with temporary improvement while on antibiotic and flare up of disease when antibiotics were stopped. The effectiveness of early treatment with rifampicin has been highlighted in some case reports in the past. We did use rifampicin in one of our patients. Our concern over emergence of antibiotic resistance, if used widely, may not permit us to use rifampicin on a wide scale.

Preoperative anaemia is associated with increased allogeneic pack red cell transfusion in revision hip and knee joint arthroplasty: a retrospective analysis of 5387 patients over a 10-year period at a single high volume centre.

PubMed

Kasivisvanathan, R; Ramesh, V; Rao Baikady, R; Nadaraja, S

2016-08-01

To estimate the prevalence of preoperative World Health Organization (WHO) defined anaemia in patients presenting for revision hip and knee arthroplasty and its association with transfusion of allogeneic packed red blood cells (PRBC). Studies have mainly investigated the prevalence of preoperative anaemia in primary and not revision hip and knee joint arthroplasty. An analysis of a prospectively collected patient data for 5387 patients having revision hip or knee arthroplasty over a 10-year period at a single high volume centre was conducted. Logistic regression was used to assess whether the presence of WHO defined preoperative anaemia as well as other risk factors were associated with inpatient allogeneic PRBC transfusion. There were 5387 patients assessed of which 3021 (56·01%) patients had revision total hip replacements and 2366 (43·09%) had revision total knee arthroplasty. Of these patients 1956 (36·03%) had preoperative WHO defined anaemia. A total of 2034 (37·08%) patients received at least one unit of allogeneic PRBC during their primary hospital admission. In the final model preoperative WHO defined anaemia was independently associated with allogeneic PRBC transfusion in hip and knee revision surgery OR 4·042 (4·012-4·072 95% CI) CONCLUSIONS: Preoperative anaemia is common in patients presenting for revision hip and knee arthroplasty and independently associated with transfusion of allogeneic PRBC. © 2016 British Blood Transfusion Society.

Clinical and laboratory characteristics of 19 patients with Churg-Strauss syndrome from a single South Australian centre.

PubMed

Whyte, A F; Smith, W B; Sinkar, S N; Kette, F E; Hissaria, P

2013-07-01

Churg-Strauss syndrome (CSS) is a rare, idiopathic systemic vasculitis. There is emerging evidence of an association between the presence or absence of antineutrophil cytoplasmic antibodies (ANCA) and clinical phenotype. Thromboembolism is an increasingly recognised complication of the disease. Given the paucity of Australian data, the aim of this study was to examine the clinical and laboratory features of CSS in a single Australian centre. We performed a retrospective review of all patients who fulfilled the American College of Rheumatology classification criteria for CSS managed at the Department of Immunology, Royal Adelaide Hospital between 2002 and 2008. Nineteen patients were included. All patients had asthma and most had upper airway involvement. Peripheral nerve, musculoskeletal, gastrointestinal and cutaneous involvement was common. Renal and cardiac involvement was uncommon in this series. Histological confirmation was obtained in 15 patients (78.9%). Ten patients (52.6%) were ANCA+, and these were more likely to have musculoskeletal involvement, such as arthralgia or myalgia (odds ratio 57, P = 0.005). Thrombosis was a feature at diagnosis in six patients (31.6%); two of these recurred with relapse. Sixteen patients (84.2%) were followed up; five died, and mean survival was 8.9 years. This is the first Australian study to focus on CSS. Our results demonstrate similar presentation and prognosis of CSS to previous descriptions; however, we noted that musculoskeletal involvement was more common in ANCA+ patients. In our series, thrombosis was a significant complication and we suggest that thromboprophylaxis may be warranted. © 2013 The Authors; Internal Medicine Journal © 2013 Royal Australasian College of Physicians.

Participant-centred active surveillance of adverse events following immunisation: a narrative review

PubMed Central

Cashman, Patrick; Macartney, Kristine; Khandaker, Gulam; King, Catherine; Gold, Michael; Durrheim, David N.

2017-01-01

Abstract The importance of active, participant-centred monitoring of adverse events following immunisation (AEFI) is increasingly recognised as a valuable adjunct to traditional passive AEFI surveillance. The databases OVID Medline and OVID Embase were searched to identify all published articles referring to AEFI. Only studies which sought participant response after vaccination were included. A total of 6060 articles published since the year 2000 were identified. After the application of screening inclusion and exclusion criteria, 25 articles describing 23 post-marketing AEFI systems were identified. Most countries had a single system: Ghana, Japan, China, Korea, Netherlands, Singapore, Brazil, Cambodia, Sri Lanka, Turkey and Cameroon except the USA (2), Canada (4) and Australia (6). Data were collected from participants with and without AEFI in all studies reviewed with denominator data enabling AEFI rate calculations. All studies considered either a single vaccine or specified vaccines or were time limited except one Australian system, which provides continuous automated participant-centred active surveillance of all vaccines. Post-marketing surveillance systems using solicited patient feedback are emerging as a novel AEFI monitoring tool. A number of exploratory systems utilising e-technology have been developed and their potential for scaling up and application in low and middle income countries deserves further investigation. PMID:28582563

Fungal infections in children in the early postoperative period after cardiac surgery for congenital heart disease: a single-centre experience.

PubMed

Jaworski, Radoslaw; Haponiuk, Ireneusz; Irga-Jaworska, Ninela; Chojnicki, Maciej; Steffens, Mariusz; Paczkowski, Konrad; Zielinski, Jacek

2016-09-01

Postoperative infections are still an important problem in cardiac surgery, especially in the paediatric population, and may influence the final outcome of congenital heart disease treatment. Postoperative infections with fungi are uncommon. The aetiology is poorly understood, and the proper diagnosis and treatment is unclear. In this single-centre study, the frequency of invasive fungal disease in children who underwent surgical management of congenital heart diseases was determined along with the risk factors for infection, treatment options and outcomes. All consecutive paediatric patients (<18 years of age) who underwent cardiac surgery for congenital heart disease between September 2008 and December 2015 in a paediatric cardiac centre in Poland were identified. Those who developed invasive fungal disease in the early postoperative period (30 days) were identified. Of the 1540 cardiosurgical procedures for congenital heart disease, 6 were complicated by fungal infection (0.39%). One patient had a high probability of fungal infection, but the diagnosis was unproved. Nevertheless, the patient was successfully treated with antifungal treatment. Five had proven invasive fungal disease. Of these, 3 were diagnosed with candidaemia. All had undergone cardiopulmonary bypass. Of the remaining 2 patients, 1 was a preterm newborn with complete atrioventricular septal defect who developed rib fungal invasion. The remaining patient had pulmonary atresia with ventricular septal defect and developed Fournier's gangrene after surgery. None of the patients died due to infection in the early postoperative period. However, the child with rib fungal invasion died 39 days after surgery as a result of multiorgan failure. Fungal infections in paediatric patients after cardiac surgery may markedly influence morbidity and mortality. Fungal infection prophylaxis in this specific group of children may reduce morbidity, whereas early empirical treatment followed by a targeted approach may

Bright optical centre in diamond with narrow, highly polarised and nearly phonon-free fluorescence at room temperature

NASA Astrophysics Data System (ADS)

John, Roger; Lehnert, Jan; Mensing, Michael; Spemann, Daniel; Pezzagna, Sébastien; Meijer, Jan

2017-05-01

Using shallow implantation of ions and molecules with masses centred at 27 atomic mass units (amu) in diamond, a new artificial optical centre with unique properties has been created. The centre shows a linearly polarised fluorescence with a main narrow emission line mostly found at 582 nm, together with a weak vibronic sideband at room temperature. The fluorescence lifetime is ∼2 ns and the brightest centres are more than three times brighter than the nitrogen-vacancy centres. A majority of the centres shows stable fluorescence whereas some others present a blinking behaviour, at faster or slower rates. Furthermore, a second kind of optical centre has been simultaneously created in the same diamond sample, within the same ion implantation run. This centre has a narrow zero-phonon line (ZPL) at ∼546 nm and a broad phonon sideband at room temperature. Interestingly, optically detected magnetic resonance (ODMR) has been measured on several single 546 nm centres and two resonance peaks are found at 0.99 and 1.27 GHz. In view of their very similar ODMR and optical spectra, the 546 nm centre is likely to coincide with the ST1 centre, reported once (with a ZPL at 550 nm), but of still unknown nature. These new kinds of centres are promising for quantum information processing, sub-diffraction optical imaging or use as single-photon sources.

Family-centred care for hospitalised children aged 0-12 Years: A systematic review of quasi-experimental studies.

PubMed

Shields, Linda; Zhou, Huaqiong; Taylor, Marjory; Hunter, Judith; Munns, Ailsa; Watts, Robin

Family-centred care is an approach to the planning, delivery, and evaluation of health care that is grounded in mutually beneficial partnerships among health care providers, patients, and families. It is a widely used model in paediatrics, and is felt instinctively to be the best way to provide care to children in hospital. However, its effectiveness has not been established. The objective of this review was to identify the effectiveness of family-centred models of care for children (excluding premature neonates) when compared to standard models of care. The review considered quasi-experimental studies of children aged 0-12 years, their families and/or attending health professionals. Interventions for inclusion were family-centred polices, family support, communication, educational and environmental. Outcomes of interest covered three categories: the child, parent and staff. These included psychological, behavioural, physical, developmental, knowledge, satisfaction and attitudinal outcomes. The degree of family-centredness for eligible studies was scored using a modified rating scale based on that developed by Trivette.This review considered studies that included hospitalised children aged 0-12 years (excluding premature neonates), their family and/or health care professionals.The review considered studies that evaluated the effectiveness of family-centred models of care for hospitalised children when compared to standard models of care.The review considered quasi-experimental studies for inclusion to enable the identification of current best evidence regarding the effectiveness of family-centred models of care on child, family and health service outcomes. Quasi-experimental design includes experimental studies in which participants are not randomly assigned to treatment conditions.This review considered studies that included the following outcome measures: SEARCH STRATEGY: The search strategy identified published and unpublished studies dated from 2004 to December

The evolving role of data scientist during 20 years of the British Atmospheric Data Centre (Invited)

NASA Astrophysics Data System (ADS)

Pascoe, S.; Parton, G.; Pascoe, C.; Guillory, A.; da Costa, E. D.

2013-12-01

In 2014 The British Atmospheric Data Centre (BADC), now part of the Centre of Environmental Data Archival (CEDA), will celebrate its 20th anniversary. During its lifetime, most BADC staff have defined themselves as data scientists by virtue of being scientists by background and "data workers" by practice. However, the definition of data scientist has been ill defined until recently. As the term has become popularised in the world of business and general information technology, we ask ourselves to what extent the popular definition fits our profession. We observe that data science, as practised at CEDA, encompasses several roles which overlap and compliment each other as we strive to be enablers of data exploitation. For us a data scientist's skills include elements of data curation, software engineering, data infrastructure management and data-intensive research. As data science has evolved the balance between these roles has shifted in response to changes in technology, demands of the research community and funding drivers. We have had to balance our role as enablers of data exploitation, by providing services and infrastructure to the geo-science community, with our role as pioneers of data exploitation itself. By telling the story of how these roles have evolved during the 20 year history of the BADC, we aim to explore the maturing role of data scientist as practised within the geo-sciences and contrast that role with its recently popularised usage. Looking forward we will address questions about how centres of expertise, such as CEDA, can best increase the data capabilities of geo-science research as a whole in order to facilitate the transition to data-intensive science.

Addiction research centres and the nurturing of creativity: The Centre for Addictions Research of British Columbia, Canada

PubMed Central

Stockwell, Tim; Reist, Dan; Macdonald, Scott; Benoit, Cecilia; Jansson, Mikael

2015-01-01

The Centre for Addictions Research of British Columbia (CARBC) was established as a multi-campus and multi-disciplinary research centre administered by the University of Victoria (UVic) in late 2003. Its core funding is provided from interest payments on an endowment of CAD$10.55 million. It is supported by a commitment to seven faculty appointments in various departments at UVic. The Centre has two offices, an administration and research office in Victoria and a knowledge exchange unit in Vancouver. The two offices are collaborating on the implementation of CARBC’s first 5-year plan which seeks to build capacity in British Columbia for integrated multi-disciplinary research and knowledge exchange in the areas substance use, addictions and harm reduction. Present challenges include losses to the endowment caused by the 2008/2009 economic crisis and difficulties negotiating faculty positions with the university administration. Despite these hurdles, to date each year has seen increased capacity for the Centre in terms of affiliated scientists, funding and staffing as well as output in terms of published reports, electronic resources and impacts on policy and practice. Areas of special research interest include: drug testing in the work-place, epidemiological monitoring, substance use and injury, pricing and taxation policies, privatization of liquor monopolies, poly-substance use, health determinants of indigenous peoples, street-involved youth and other vulnerable populations at risk of substance use problems. Further information about the Centre and its activities can be found on http://www.carbc.ca. PMID:20078479

Improved long-term survival after intra-operative single high-dose ATG-Fresenius induction in renal transplantation: a single centre experience.

PubMed

Kaden, Jürgen; May, Gottfried; Völp, Andreas; Wesslau, Claus

2009-01-01

In organ grafts donor-specific sensitization is initiated immediately after revascularization. Therefore, in 1990 we introduced the intra-operative single high-dose ATG-Fresenius (ATG-F) induction in addition to standard triple drug therapy (TDT) consisting of steroids, azathioprine and cyclosporin. A total of 778 first renal transplantations from deceased donors, performed between 1987 and 1998, were included in this evaluation. This retrospective analysis of clinic records and electronic databases presents data of all recipients of first kidney grafts who received two different ATG-F inductions (1(st) group: 9 mg/kg body weight as single high-dose intra-operatively, n=484; 2(nd) group: 3 mg/kg body weight on 7 or 8 consecutive days as multiple-dose starting also intra-operatively, n=78) and standard TDT alone (3(rd) group: TDT alone, n=216). The 10-year patient survival rates were 72.6+/-2.6% (TDT + ATG-F single high-dose), 79.5+/-5.1% (TDT + ATG-F multiple-dose) and 67.2+/-3.7%% (TDT alone; Kaplan-Meier estimates with standard errors; ATG-F vs TDT alone, p=0.001). The 10-year graft survival rates with censoring of patients that died with a functioning graft were 73.8+/-2.4%, 57.7+/-5.8% and 58.4+/-3.6% (Kaplan-Meier estimates with standard errors; 1(st) vs 2(nd )and 3(rd) group, respectively, p<0.001) and the 10-year graft survival rates with patient death counted as graft failure were 58.3+/-2.7%, 55.7+/-5.8% and 48.2+/-3.5% (Kaplan-Meier estimates with standard errors; ATG-F single high-dose vs TDT, p=0.023). In pre-sensitized recipients there were also significant differences in favour of ATG-F, more notably in the single high-dose ATG-F induction. A total of 69% of the patients in the two cohorts receiving ATG-F did not experience any transplant rejections compared to 56% in patients undergoing TDT alone (p=0.018). The incidence of infectious complications was comparable across all groups. According to evidence obtained from the routine documentation of 778

Most ornamental plants on sale in garden centres are unattractive to flower-visiting insects.

PubMed

Garbuzov, Mihail; Alton, Karin; Ratnieks, Francis L W

2017-01-01

variation there was a substantial number of both poor varieties that had a recommendation and good varieties that did not. Median attractiveness of multi-year plants was 1.6× that of single-year plants, with a similar overlap in distributions. Our study demonstrates the practicality of carrying out plant surveys in garden centres. Garden centres display large numbers of varieties for sale, most of which are in bloom. Furthermore, data gathered in garden centres appear to correlate well with data gathered in two previous studies in Sussex for plants established in gardens. Although it is unclear whether the varieties being sold in garden centres are a fair representation of varieties that are actually grown by gardeners, our results suggest that there might be considerable scope for making parks and gardens considerably more insect-friendly through judicious variety choices.

Most ornamental plants on sale in garden centres are unattractive to flower-visiting insects

PubMed Central

Alton, Karin; Ratnieks, Francis L.W.

2017-01-01

varieties without. But, due to the large variation there was a substantial number of both poor varieties that had a recommendation and good varieties that did not. Median attractiveness of multi-year plants was 1.6× that of single-year plants, with a similar overlap in distributions. Discussion Our study demonstrates the practicality of carrying out plant surveys in garden centres. Garden centres display large numbers of varieties for sale, most of which are in bloom. Furthermore, data gathered in garden centres appear to correlate well with data gathered in two previous studies in Sussex for plants established in gardens. Although it is unclear whether the varieties being sold in garden centres are a fair representation of varieties that are actually grown by gardeners, our results suggest that there might be considerable scope for making parks and gardens considerably more insect-friendly through judicious variety choices. PMID:28286716

Non-intrusive tunable resonant microwave cavity for optical detected magnetic resonance of NV centres in nanodiamonds

NASA Astrophysics Data System (ADS)

Le Floch, Jean-Michel; Bradac, Carlo; Volz, Thomas; Tobar, Michael E.; Castelletto, Stefania

2013-12-01

Optically detected magnetic resonance (ODMR) in nanodiamond nitrogen-vacancy (NV) centres is usually achieved by applying a microwave field delivered by micron-size wires, strips or antennas directly positioned in very close proximity (~ μm) of the nanodiamond crystals. The microwave field couples evanescently with the ground state spin transition of the NV centre (2.87 GHz at zero magnetic field), which results in a reduction of the centre photoluminescence. We propose an alternative approach based on the construction of a dielectric resonator. We show that such a resonator allows for the efficient detection of NV spins in nanodiamonds without the constraints associated to the laborious positioning of the microwave antenna next to the nanodiamonds, providing therefore improved flexibility. The resonator is based on a tunable Transverse Electric Mode in a dielectric-loaded cavity, and we demonstrate that the resonator can detect single NV centre spins in nanodiamonds using less microwave power than alternative techniques in a non-intrusive manner. This method can achieve higher precision measurement of ODMR of paramagnetic defects spin transition in the micro to millimetre-wave frequency domain. Our approach would permit the tracking of NV centres in biological solutions rather than simply on the surface, which is desirable in light of the recently proposed applications of using nanodiamonds containing NV centres for spin labelling in biological systems with single spin and single particle resolution.

Single-port laparoscopy in gynecologic oncology: seven years of experience at a single institution.

PubMed

Moulton, Laura; Jernigan, Amelia M; Carr, Caitlin; Freeman, Lindsey; Escobar, Pedro F; Michener, Chad M

2017-11-01

Single-port laparoscopy has gained popularity within minimally invasive gynecologic surgery for its feasibility, cosmetic outcomes, and safety. However, within gynecologic oncology, there are limited data regarding short-term adverse outcomes and long-term hernia risk in patients undergoing single-port laparoscopic surgery. The objective of the study was to describe short-term outcomes and hernia rates in patients after single-port laparoscopy in a gynecologic oncology practice. A retrospective, single-institution study was performed for patients who underwent single-port laparoscopy from 2009 to 2015. A univariate analysis was performed with χ 2 tests and Student t tests; Kaplan-Meier and Cox proportional hazards determined time to hernia development. A total of 898 patients underwent 908 surgeries with a median follow-up of 37.2 months. The mean age and body mass index were 55.7 years and 29.6 kg/m 2 , respectively. The majority were white (87.9%) and American Society of Anesthesiologists class II/III (95.5%). The majority of patients underwent surgery for adnexal masses (36.9%) and endometrial hyperplasia/cancer (37.3%). Most women underwent hysterectomy (62.7%) and removal of 1 or both fallopian tubes and/or ovaries (86%). Rate of adverse outcomes within 30 days, including reoperation (0.1%), intraoperative injury (1.4%), intensive care unit admission (0.4%), venous thromboembolism (0.3%), and blood transfusion, were low (0.8%). The rate of urinary tract infection was 2.8%; higher body mass index (P = .02), longer operative time (P = .02), smoking (P = .01), hysterectomy (P = .01), and cystoscopy (P = .02) increased the risk. The rate of incisional cellulitis was 3.5%. Increased estimated blood loss (P = .03) and endometrial cancer (P = .02) were independent predictors of incisional cellulitis. The rate for surgical readmissions was 3.4%; higher estimated blood loss (P = .03), longer operative time (P = .02), chemotherapy alone (P = .03), and

Colour centre recovery in yttria-stabilised zirconia: photo-induced versus thermal processes

NASA Astrophysics Data System (ADS)

Costantini, Jean-Marc; Touati, Nadia; Binet, Laurent; Lelong, Gérald; Guillaumet, Maxime; Beuneu, François

2018-05-01

The photo-annealing of colour centres in yttria-stabilised zirconia (YSZ) was studied by electron paramagnetic resonance spectroscopy upon UV-ray or laser light illumination, and compared to thermal annealing. Stable hole centres (HCs) were produced in as-grown YSZ single crystals by UV-ray irradiation at room temperature (RT). The HCs produced by 200-MeV Au ion irradiation, as well as the F+-type centres (? centres involving oxygen vacancies) were left unchanged upon UV illumination. In contrast, a significant photo-annealing of the latter point defects was achieved in 1.4-MeV electron-irradiated YSZ by 553-nm laser light irradiation at RT. Almost complete photo-bleaching was achieved by laser irradiation inside the absorption band of ? centres centred at a wavelength 550 nm. Thermal annealing of these colour centres was also followed by UV-visible absorption spectroscopy showing full bleaching at 523 K. Colour-centre evolutions by photo-induced and thermally activated processes are discussed on the basis of charge exchange processes between point defects.

Trends in Pulmonary Hypertension Over a Period of 30 Years: Experience From a Single Referral Centre.

PubMed

Quezada Loaiza, Carlos Andrés; Velázquez Martín, María Teresa; Jiménez López-Guarch, Carmen; Ruiz Cano, María José; Navas Tejedor, Paula; Carreira, Patricia Esmeralda; Flox Camacho, Ángela; de Pablo Gafas, Alicia; Delgado Jiménez, Juan Francisco; Gómez Sánchez, Miguel Ángel; Escribano Subías, Pilar

2017-11-01

Pulmonary arterial hypertension (PAH) is characterized by increased pulmonary vascular resistance, right ventricular dysfunction and death. Despite scientific advances, is still associated with high morbidity and mortality. The aim is to describe the clinical approach and determine the prognostic factors of patients with PAH treated in a national reference center over 30 years. Three hundred and seventy nine consecutive patients with PAH (January 1984 to December 2014) were studied. Were divided into 3 periods of time: before 2004, 2004-2009 and 2010-2014. Prognostic factors (multivariate analysis) were analyzed for clinical deterioration. Median age was 44 years (68.6% women), functional class III-IV: 72%. An increase was observed in more complex etiologies in the last period of time: Pulmonary venooclusive disease and portopulmonary hypertension. Upfront combination therapy significantly increased (5% before 2004 vs 27% after 2010; P < .05). Multivariate analysis showed prognostic significance in age, sex, etiology and combined clinical variables as they are independent predictors of clinical deterioration (P < .05). Survival free from death or transplantation for the 1st, 3rd and 5th year was 92.2%, 80.6% and 68.5% respectively. The median survival was 9 years (95% confidence interval, 7.532-11.959) CONCLUSIONS: The PAH is a heterogeneous and complex disease, the median survival free from death or transplantation in our series is 9 years after diagnosis. The structure of a multidisciplinary unit PAH must adapt quickly to changes that occur over time incorporating new diagnostic and therapeutic techniques. Copyright © 2017 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

The nitrogen-vacancy colour centre in diamond

NASA Astrophysics Data System (ADS)

Doherty, Marcus W.; Manson, Neil B.; Delaney, Paul; Jelezko, Fedor; Wrachtrup, Jörg; Hollenberg, Lloyd C. L.

2013-07-01

The nitrogen-vacancy (NV) colour centre in diamond is an important physical system for emergent quantum technologies, including quantum metrology, information processing and communications, as well as for various nanotechnologies, such as biological and sub-diffraction limit imaging, and for tests of entanglement in quantum mechanics. Given this array of existing and potential applications and the almost 50 years of NV research, one would expect that the physics of the centre is well understood, however, the study of the NV centre has proved challenging, with many early assertions now believed false and many remaining issues yet to be resolved. This review represents the first time that the key empirical and ab initio results have been extracted from the extensive NV literature and assembled into one consistent picture of the current understanding of the centre. As a result, the key unresolved issues concerning the NV centre are identified and the possible avenues for their resolution are examined.

A time series analysis performed on a 25-year period of kidney transplantation activity in a single center.

PubMed

Santori, G; Fontana, I; Bertocchi, M; Gasloli, G; Valente, U

2010-05-01

Following the example of many Western countries, where a "minimum volume rule" policy has been adopted as a quality parameter for complex surgical procedures, the Italian National Transplant Centre set the minimum number of kidney transplantation procedures/y at 30/center. The number of procedures performed in a single center over a large period may be treated as a time series to evaluate trends, seasonal cycles, and nonsystematic fluctuations. Between January 1, 1983, and December 31, 2007, we performed 1376 procedures in adult or pediatric recipients from living or cadaveric donors. The greatest numbers of cases/y were performed in 1998 (n = 86) followed by 2004 (n = 82), 1996 (n = 75), and 2003 (n = 73). A time series analysis performed using R Statistical Software (Foundation for Statistical Computing, Vienna, Austria), a free software environment for statistical computing and graphics, showed a whole incremental trend after exponential smoothing as well as after seasonal decomposition. However, starting from 2005, we observed a decreased trend in the series. The number of kidney transplants expected to be performed for 2008 by using the Holt-Winters exponential smoothing applied to the period 1983 to 2007 suggested 58 procedures, while in that year there were 52. The time series approach may be helpful to establish a minimum volume/y at a single-center level. Copyright (c) 2010 Elsevier Inc. All rights reserved.

Tinnitus and psychiatric comorbidities in liaison psychiatry analysis of three years in an audiophonology centre.

PubMed

Jacques, Denis; Nozeret, Yves; Zdanowicz, Nicolas; Reynaert, Christine; Garin, Pierre; Gilain, Chantal

2013-09-01

Patients who are suffering from tinnitus are rarely directly referred to an audiophonology centre. Often, they have tried several medications and met with several doctors. Sometimes, they are also referred too quickly to a psychiatrist without a complete ENT assessment. Nevertheless, they frequently develop psychiatric comorbidities in regard to the tinnitus. On the basis of structured interviews with the "Mini International Neuropsychiatric Interview" and on a review of records, we assessed the associated psychiatric diagnoses in patients who consulted for tinnitus as their main complaint at the audiophonology centre from the University Hospital Centre of Mont-Godinne-Dinant between 2009 and 2012. Of the 80 patients who consulted for tinnitus, 28% suffered from a major depressive disorder, 27.5% from a somatoform disorder, 23.7% from sleep disorder, 22.5% from an anxiety disorder and 16% from alcoholic dependence. On the basis of these results, we developed clinical considerations concerning the treatment approach and options for patients suffering from tinnitus with psychiatric comorbidities. The interdisciplinary approach (ENT and liaison psychiatry) in an audiophonology centre seems to be a factor for better treatment adherence for patients with severe and chronic tinnitus.

Single-pulse observations of the Galactic centre magnetar PSR J1745-2900 at 3.1 GHz

NASA Astrophysics Data System (ADS)

Yan, W. M.; Wang, N.; Manchester, R. N.; Wen, Z. G.; Yuan, J. P.

2018-05-01

We report on single-pulse observations of the Galactic centre magnetar PSR J1745-2900 that were made using the Parkes 64-m radio telescope with a central frequency of 3.1 GHz at five observing epochs between 2013 July and August. The shape of the integrated pulse profiles was relatively stable across the five observations, indicating that the pulsar was in a stable state between MJDs 56475 and 56514. This extends the known stable state of this pulsar to 6.8 months. Short-term pulse shape variations were also detected. It is shown that this pulsar switches between two emission modes frequently and that the typical duration of each mode is about 10 min. No giant pulses or subpulse drifting were observed. Apparent nulls in the pulse emission were detected on MJD 56500. Although there are many differences between the radio emissions of magnetars and normal radio pulsars, they also share some properties. The detection of mode changing and pulse nulling in PSR J1745-2900 suggests that the basic radio emission process for magnetars and normal pulsars is the same.

Abdominal Emergencies in Patients with Stage IV Melanoma: The Role of Surgery: A Single-centre Experience.

PubMed

Mantas, Dimitrios; Damaskos, Christos; Garmpis, Nikolaos; Dimitroulis, Dimitrios; Garmpi, Anna; Gogas, Helen

2018-06-01

Metastatic melanoma is an aggressive disease with poor prognosis. Melanoma can potentially involve any organ. In this article, we report on a single-centre experience in emergency surgery for M1c melanoma. Twenty-eight consecutive patients with M1c melanoma underwent surgical exploration due to abdominal emergencies. Pre-operative computed tomography confirmed the diagnosis and the location of the affected site. Pre-operative lactate dehydrogenase serum levels and post-operative histopathology findings were recorded. Intestinal obstruction was the most frequent intraoperative finding (75%). The ileum was most frequently affected (28.6%). Multifocal disease and extra-gastrointestinal tract metastases were present in 25% of cases each. Lactate dehydrogenase serum level was increased in 75% of the patients. Most patients underwent an enterectomy. Curative surgery for stage IV melanoma remains debatable, but surgery for patients presenting with abdominal emergencies appears to improve both survival rate and prognosis. Combined novel therapies and surgical resection is currently being studied with promising results. Copyright© 2018, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.

Percutaneous nephrostomy for symptomatic hypermobile kidney: a single centre experience.

PubMed

Starownik, Radosław; Golabek, Tomasz; Bar, Krzysztof; Muc, Kamil; Płaza, Paweł; Chlosta, Piotr

2014-12-01

Symptomatic hypermobile kidney is treated with nephropexy, a surgical procedure through which the floating kidney is fixed to the retroperitoneum. Although both open and endoscopic procedures have a high success rate, they can be associated with risk of complications, relatively long hospital stay and high cost. We describe our percutaneous technique for fixing a hypermobile kidney and evaluate the efficacy of the percutaneous nephrostomy insertion in management of symptomatic nephroptosis. Between January 2005 and December 2011, 11 patients diagnosed with a symptomatic right nephroptosis of at least 1 year duration were treated with a single point percutaneous nephrostomy technique. All data were retrieved from patients' medical records and then retrospectively analysed. Nephropexy through a single point percutaneous nephrostomy technique was successfully accomplished in 11 women. The mean operative time was 20 min. The intraoperative estimated blood loss was minimal in all cases. No major or minor intraoperative complications were noted. The average postoperative hospital stay was 2 days. Women returned to their usual activities 14 days following the surgery. Nine women had complete resolution of their pain, and 2 patients continued to complain of discomfort in their lumbar area. One patient was re-operated upon with satisfactory subjective and objective outcomes achieved. One patient refused re-operation. Percutaneous nephropexy is simple, inexpensive and effective for treatment of symptomatic hypermobile kidney. It remains a valuable alternative to open, laparoscopic, and robotic methods for fixing a floating kidney.

A star in a 15.2-year orbit around the supermassive black hole at the centre of the Milky Way.

PubMed

Schödel, R; Ott, T; Genzel, R; Hofmann, R; Lehnert, M; Eckart, A; Mouawad, N; Alexander, T; Reid, M J; Lenzen, R; Hartung, M; Lacombe, F; Rouan, D; Gendron, E; Rousset, G; Lagrange, A-M; Brandner, W; Ageorges, N; Lidman, C; Moorwood, A F M; Spyromilio, J; Hubin, N; Menten, K M

2002-10-17

Many galaxies are thought to have supermassive black holes at their centres-more than a million times the mass of the Sun. Measurements of stellar velocities and the discovery of variable X-ray emission have provided strong evidence in favour of such a black hole at the centre of the Milky Way, but have hitherto been unable to rule out conclusively the presence of alternative concentrations of mass. Here we report ten years of high-resolution astrometric imaging that allows us to trace two-thirds of the orbit of the star currently closest to the compact radio source (and massive black-hole candidate) Sagittarius A*. The observations, which include both pericentre and apocentre passages, show that the star is on a bound, highly elliptical keplerian orbit around Sgr A*, with an orbital period of 15.2 years and a pericentre distance of only 17 light hours. The orbit with the best fit to the observations requires a central point mass of (3.7 +/- 1.5) x 10(6) solar masses (M(*)). The data no longer allow for a central mass composed of a dense cluster of dark stellar objects or a ball of massive, degenerate fermions.

Implementation of enhanced recovery programme after pancreatoduodenectomy: a single-centre UK pilot study.

PubMed

Abu Hilal, Mohammed; Di Fabio, Francesco; Badran, Abdallah; Alsaati, Hani; Clarke, Hannah; Fecher, Imogen; Armstrong, Thomas H; Johnson, Colin D; Pearce, Neil W

2013-01-01

Data on enhanced recovery programmes after pancreatoduodenectomy (ERP-PD) is limited. The aim of this pilot study was to evaluate the feasibility, safety and clinical outcomes of ERP-PD when implemented at a high-volume UK university referral centre. This was an observational single-surgeon case-control study (before-and-after pathway). A total of 20 consecutive patients were prospectively enrolled for the ERP-PD and compared with 24 consecutive patients previously treated during an equal time frame. Patients in the ERP-PD group had a significant shorter time to remove naso-gastric tube (median of 5 vs. 7 days, p = 0.0001), start liquid diet (median of 2 vs. 5 days, p < 0.0001), start solid food (median of 4 vs. 9 days, p < 0.0001), pass stools (median of 6 vs. 7 days, p = 0.002), and had shorter length of stay (median of 8.5 days vs. 13 days, p = 0.015) compared to the pre-pathway group. Postoperative complications were overall less frequent but not significantly different in the ERP-PD group (p = 0.077). No difference in mortality and readmission rates was found. Our findings support the feasibility and safety of ERP-PD. Improved patients' outcomes, significant bed day savings and increase National Health Service productivity are anticipated with implementation of ERP-PD on a larger scale. Copyright © 2012 IAP and EPC. Published by Elsevier B.V. All rights reserved.

[Study of polymedicated patients over 65 years-old in an urban primary care centre].

PubMed

Garrido-Garrido, E M; García-Garrido, I; García-López-Durán, J C; García-Jiménez, F; Ortega-López, I; Bueno-Cavanillas, A

2011-01-01

To identify and characterise the polymedicated population over 65 years-old; and to determine the prevalence of drugs and the diseases in this population subgroup. Cross-sectional study. A primary care centre Zaidín-Centro in Granada. Andalusian Public Health Service. A total of 305 patients over 65 years-old taking polypharmacy (defined as use of five or more drugs, during a period equal to or greater than six months by any route) selected by stratified sampling by sex, age and number of drugs consumed. The analysed variables were sex, age, number of diseases, number of drugs and medical doctor. The prevalence of polypharmacy in patients over 65 years-old was 33.77%. These patients were using an average number of drugs of 8.7±2.5 and had an average number of diseases of 5.56±1.89. The prevalence of polypharmacy was greater among women, but differences decreased in people more than 85 years old. The antihypertensive pharmacological group was the most commonly used, in accordance with the most frequent disease, arterial hypertension. We found a strong relationship between the number of drugs and the number of diseases (p=0.05). Chronic use of drugs in the elderly is of considerable magnitude, affecting one out of every three. Polypharmacy in the elderly is a common and serious problem that needs to be reviewed and evaluated continuously. Copyright © 2010 SECA. Published by Elsevier Espana. All rights reserved.

Characteristics of clients to a suicide prevention centre--an epidemiological analysis of the users over a 10-year period.

PubMed

Qin, Ping; Madsen, Bente Hjorth; Mortensen, Preben Bo

2009-06-01

Suicide prevention centres play an important role on suicide prevention in communities. A better understanding of clients to these centres is essential and informative to suicide prevention. This study aimed to document the referral pattern of clients to a suicide prevention centre over a 10-year period and to capture their characteristics. All suicidal clients during 1996 to 2005 were included and compared with the regional population. Data were retrieved from longitudinal registers. There were in total 4274 contacts from 3505 individuals because of suicide attempt (38%) or suicide ideation (62%). Source of referral included self-initiation or family (25.4%), psychiatric hospitals (23.5%), general practitioners (21.7%), and somatic hospitals (15.1%). The clients were more likely females and persons at young ages. Compared with regional sex-age-matched counterparts, suicidal clients significantly more often had a history of psychiatric contact, were born by young parents, had no recorded link to a mother or father, had lost a parent, and had a parental psychiatric history. Also, they were often frequent movers and residents with a foreign citizenship. This study provided insights about the referral pattern of suicidal clients as well as client characteristics on selected variables at the birth and during upbringing, which may be informative to suicide intervention targeting at this group of population.

The Imperial College Thermophysical Properties Data Centre

NASA Astrophysics Data System (ADS)

Angus, S.; Cole, W. A.; Craven, R.; de Reuck, K. M.; Trengove, R. D.; Wakeham, W. A.

1986-07-01

The IUPAC Thermodynamic Tables Project Centre in London has at its disposal considerable expertise on the production and utilization of high-accuracy equations of state which represent the thermodynamic properties of substances. For some years they have been content to propagate this information by the traditional method of book production, but the increasing use of the computer in industry for process design has shown that an additional method was needed. The setting up of the IUPAC Transport Properties Project Centre, also at Imperial College, whose products would also be in demand by industry, afforded the occasion for a new look at the problem. The solution has been to set up the Imperial College Thermophysical Properties Data Centre, which embraces the two IUPAC Project Centres, and for it to establish a link with the existing Physical Properties Data Service of the Institution of Chemical Engineers, thus providing for the dissemination of the available information without involving the Centres in problems such as those of marketing and advertising. This paper outlines the activities of the Centres and discusses the problems in bringing their products to the attention of industry in suitable form.

Forty years of referrals and outcomes to a UK Child Development Centre (CDC): Has demand plateaued?

PubMed

Williams, A N; Mold, B; Kilbey, L; Naganna, P

2018-05-01

To explore 40 years of Child Development Centre (CDC) activity and outcomes at Northampton General Hospital 1974-2014. The study comprises 3 data sets: a published report from 1974 to 1999, an internal audit from 2001 to 2004, and more recent data collected from 2005 to 2014. The medical notes of all children who were assessed by the CDC in 2014 were reviewed, along with referral data collected by the CDC manager from this year and the preceding 10 years. From January 1, 1974 to December 31, 2014, 3,786 children were assessed. The male to female ratio is 2.8:1 from 2005 to 2014. Referrals for behavioural difficulties increased from 10% (10/100 referrals) in 1999-2004 to 17.8% (18/101 referrals) in 2014. Similarly, referrals for social and communication problems, "interaction" increased two and a half fold from 10% (10/100 referrals) in 1999-2004 to 26.7% (27/101 referrals) in 2014. Between 2004 and 2014, numbers of referrals for "developmental delay" halved (22.2% to 12%). We are aware of no other comparable extant UK CDC database. Services should plan for a referral rate of 6.5 per 1,000 preschool children. Between 1974 and 2014, there has clearly been a change in recorded assessment outcomes. From the mid-1980s, this reflects the change to a preschool assessment role and a shift away from purely educational outcome to include medical conditions. Covering 1974-2014, we demonstrate a clear increase in the number of referrals together with an increasing demand for assessments for social interaction and behavioural difficulties. This reflects the increased awareness of these neurodevelopmental difficulties and the changing diagnostic criteria which will now more likely result in an Autistic Spectrum Disorder diagnosis than previously. Together, these two features are most likely to have considerable implications for service development within Child Development Centres (CDCs) and Child Development Teams (CDTs). © 2018 John Wiley & Sons Ltd.

Participant-centred active surveillance of adverse events following immunisation: a narrative review.

PubMed

Cashman, Patrick; Macartney, Kristine; Khandaker, Gulam; King, Catherine; Gold, Michael; Durrheim, David N

2017-05-01

The importance of active, participant-centred monitoring of adverse events following immunisation (AEFI) is increasingly recognised as a valuable adjunct to traditional passive AEFI surveillance. The databases OVID Medline and OVID Embase were searched to identify all published articles referring to AEFI. Only studies which sought participant response after vaccination were included. A total of 6060 articles published since the year 2000 were identified. After the application of screening inclusion and exclusion criteria, 25 articles describing 23 post-marketing AEFI systems were identified. Most countries had a single system: Ghana, Japan, China, Korea, Netherlands, Singapore, Brazil, Cambodia, Sri Lanka, Turkey and Cameroon except the USA (2), Canada (4) and Australia (6). Data were collected from participants with and without AEFI in all studies reviewed with denominator data enabling AEFI rate calculations. All studies considered either a single vaccine or specified vaccines or were time limited except one Australian system, which provides continuous automated participant-centred active surveillance of all vaccines. Post-marketing surveillance systems using solicited patient feedback are emerging as a novel AEFI monitoring tool. A number of exploratory systems utilising e-technology have been developed and their potential for scaling up and application in low and middle income countries deserves further investigation. © The Author 2017. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene.

Ovarian tissue cryopreservation in girls undergoing haematopoietic stem cell transplant: experience of a single centre.

PubMed

Biasin, E; Salvagno, F; Berger, M; Nesi, F; Quarello, P; Vassallo, E; Evangelista, F; Marchino, G L; Revelli, A; Benedetto, C; Fagioli, F

2015-09-01

Fertility after childhood haemopoietic stem cell transplant (HSCT) is a major concern. Conditioning regimens before HSCT present a high risk (>80%) of ovarian failure. Since 2000, we have proposed cryopreservation of ovarian tissue to female patients undergoing HSCT at our centre, to preserve future fertility. After clinical and haematological evaluation, the patients underwent ovarian tissue collection by laparoscopy. The tissue was analysed by histologic examination to detect any tumour contamination and then frozen following the slow freezing procedure and cryopreserved in liquid nitrogen. From August 2000 to September 2013, 47 patients planned to receive HSCT, underwent ovarian tissue cryopreservation. The median age at diagnosis was 11.1 years and at the time of procedure it was 13 years, respectively. Twenty-four patients were not pubertal at the time of storage, whereas 23 patients had already experienced menarche. The median time between laparoscopy and HSCT was 25 days. Twenty-six out of 28 evaluable patients (93%) developed hypergonadotropic hypogonadism at a median time of 23.3 months after HSCT. One patient required autologous orthotopic transplantation that resulted in one live birth. Results show a very high rate of iatrogenic hypergonadotropic hypogonadism, highlighting the need for fertility preservation in these patients.

Evaluating the Promise of Single-Track Year-Round Schools.

ERIC Educational Resources Information Center

Haenn, Joseph F.

1996-01-01

Describes two single-track year-round elementary schools in Durham, North Carolina, established in discrete attendance zones. Remediation and enrichment activities were provided during intersession. Low-SES students were overrepresented in remediation sessions. Student outcomes data (end-of-grade reading and math test scores) suggest that…

Single-centre study of the diagnostic performance of plasma metanephrines with seated sampling for the diagnosis of phaeochromocytoma/paraganglioma.

PubMed

Boot, Christopher; Toole, Barry; Johnson, Sarah J; Ball, Stephen; Neely, Dermot

2017-01-01

Background Measurement of plasma metanephrines is regarded as one of the best screening tests for phaeochromocytoma/paraganglioma. Current guidelines recommend that samples are ideally collected in the supine position after 30 min rest and interpreted using supine reference ranges, in order to optimize the diagnostic performance of the test. Current practice in our centre is to collect samples for plasma metanephrines from seated patients. The aim of the study was to determine, if seated sampling for plasma metanephrines provides acceptable diagnostic performance in our centre. Methods Clinical and laboratory data of 113 patients, gathered over a four-year period 2010-2014, were reviewed. All had undergone preoperative plasma metanephrines measurement and had postoperative histopathology confirmation or exclusion of phaeochromocytoma/paraganglioma. Results Of 113 patients included in the study, 40 had a histological diagnosis of phaeochromocytoma/paraganglioma. The remaining 73 patients had an alternative adrenal pathology. The diagnostic sensitivity of normetanephrine or metanephrine above the upper limit of our in-house seated reference range was 93%. However, excluding three cases of paraganglioma determined clinically and biochemically to be non-functional raised the sensitivity to 100%. Diagnostic specificity was 90%. Applying published supine reference ranges made no difference to diagnostic sensitivity in this group of patients but decreased diagnostic specificity to 75%. Conclusions While these data are derived from a relatively small study population, they demonstrate acceptable diagnostic performance for seated plasma metanephrines as a screening test for phaeochromocytoma/paraganglioma. These data highlight a high diagnostic sensitivity for plasma metanephrines with seated sampling in our centre.

Metabolism, distribution and elimination of lisdexamfetamine dimesylate: open-label, single-centre, phase I study in healthy adult volunteers.

PubMed

Krishnan, Suma M; Pennick, Michael; Stark, Jeffrey G

2008-01-01

Attention-deficit/hyperactivity disorder (ADHD) in children often persists into adulthood and is potentially associated with significant social and occupational impairments. It is important to understand the effects of pharmacological treatments of ADHD in adults. This study aimed to assess the absorption, metabolism and elimination of lisdexamfetamine dimesylate in normal, healthy adult subjects following a single oral dose. A secondary objective was to assess the safety and tolerability of treatment. In an open-label, single-centre study, six healthy adult volunteers aged 22-52 years received a single oral 70 mg dose of (14)C-radiolabelled lisdexamfetamine dimesylate in solution following a 10-hour fast. Blood samples drawn pre-dose and at time points up to 120 hours post-dose were used for plasma pharmacokinetic analysis of the active d-amphetamine and the intact parent compound lisdexamfetamine dimesylate. Recovery of radioactivity was determined by liquid scintillation counting of blood samples (whole blood and plasma), urine samples and faecal samples collected pre-dose and at designated time points up to 120 hours post-dose. Urine samples were also analysed for the presence of amphetamine-derived metabolites. Safety was assessed by adverse event reporting, changes in physical findings, vital sign measurements, ECG measurements, and clinical laboratory test results. For intact lisdexamfetamine dimesylate, the median time to reach maximum plasma drug concentration (t(max)) was 1.00 hour, and the mean maximum plasma drug concentration (C(max)) was 58.2 +/- 28.1 ng/mL. Intact lisdexamfetamine dimesylate exhibited modest systemic exposure (area under the drug concentration-time curve from time 0 to infinity [AUC(infinity)] 67.04 +/- 18.94 ng . h/mL), and rapid elimination (mean apparent terminal elimination half-life [t((1/2)beta)] 0.47 hours). For d-amphetamine, the median t(max) was 3.00 hours, and the mean C(max) was 80.3 +/- 11.8 ng/mL. The AUC(infinity) of d

Ethical issues: the multi-centre low-risk ethics/governance review process and AMOSS.

PubMed

Vaughan, Geraldine; Pollock, Wendy; Peek, Michael J; Knight, Marian; Ellwood, David; Homer, Caroline S; Pulver, Lisa Jackson; McLintock, Claire; Ho, Maria T; Sullivan, Elizabeth A

2012-04-01

The Australasian Maternity Outcomes Surveillance System (AMOSS) conducts surveillance and research of rare and serious conditions in pregnancy. This multi-centre population health study is considered low risk with minimal ethical impact. To describe the ethics/governance review pathway undertaken by AMOSS. Prospective, descriptive study during 2009-2011 of the governance/ethical review processes required to gain approval for Australian and New Zealand (ANZ) maternity units with more than 50 births per year (n = 303) to participate in AMOSS. Review processes ranged from a single application for 24 NZ sites, a single application for eligible hospitals in two Australian states, full Health Research Ethics Committee (HREC) applications for individual hospitals, through simple letters of support. As of September 2011, 46 full/expedited ethics applications, 131 site governance applications and 136 letters of support requests were made over 33 months, involving an estimated 3261 hours by AMOSS staff/investigators, and an associated resource burden by participating sites, to obtain approval to receive nonidentifiable data from 291 hospitals. The AMOSS research system provides an important resource to enhance knowledge of conditions that cause rare and serious maternal morbidity. Yet the highly variable ethical approval processes required to implement this study have been excessively repetitive and burdensome. This process jeopardises timely, efficient research project implementation, without corresponding benefits to research participants. The resource burden to establish research governance for AMOSS confirms the urgent need for the Harmonisation of Multi-centre Ethical Review (HoMER) to further streamline ethics/governance review processes for multi-centre research. © 2011 The Authors. Australian and New Zealand Journal of Obstetrics and Gynaecology © 2011 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

Acquisition and retention of laparoscopic skills is different comparing conventional laparoscopic and single-incision laparoscopic surgery: a single-centre, prospective randomized study.

PubMed

Ellis, Scott Michael; Varley, Martin; Howell, Stuart; Trochsler, Markus; Maddern, Guy; Hewett, Peter; Runge, Tina; Mees, Soeren Torge

2016-08-01

Training in laparoscopic surgery is important not only to acquire and improve skills but also avoid the loss of acquired abilities. The aim of this single-centre, prospective randomized study was to assess skill acquisition of different laparoscopic techniques and identify the point in time when acquired skills deteriorate and training is needed to maintain these skills. Sixty surgical novices underwent laparoscopic surgery (LS) and single-incision laparoscopic surgery (SILS) baseline training (BT) performing two validated tasks (peg transfer, precision cutting). The novices were randomized into three groups and skills retention testing (RT) followed after 8 (group A), 10 (group B) or 12 (group C) weeks accordingly. Task performance was measured in time with time penalties for insufficient task completion. 92 % of the participants completed the BT and managed to complete the task in the required time frame of proficiency. Univariate and multivariate analyses revealed that SILS (P < 0.0001) and precision cutting (P < 0.0001) were significantly more difficult. Males performed significantly better than females (P < 0.005). For LS, a deterioration of skills (comparison of BT vs RT) was not identified; however, for SILS a significant deterioration of skills (adjustment of BT and RT values) was demonstrated for all groups (A-C) (P < 0.05). Our data reveal that complex laparoscopic tasks (cutting) and techniques (SILS) are more difficult to learn and acquired skills more difficult to maintain. Acquired LS skills were maintained for the whole observation period of 12 weeks but SILS skills had begun to deteriorate at 8 weeks. These data show that maintenance of LS and SILS skills is divergent and training curricula need to take these specifics into account.

Changing trend of viral hepatitis--"A twenty one year report from Pakistan Medical Research Council Research Centre, Jinnah Postgraduate Medical Centre, Karachi".

PubMed

Ahmed, Waquaruddin; Qureshi, Huma; Arif, Ambreen; Alam, Syed Ejaz

2010-02-01

To determine the frequency and pattern of Hepatitis B and C over the past twenty one years, in a liver research unit of Karachi. Retrospective analysis of the records of PMRC, Research Centre, Jinnah Postgraduate Medical Centre, Karachi, from 1987 to 2007 were reviewed. A special flow sheet was made where information of all patients with viral liver disease was entered. Patients having complete information of viral markers were included in the analysis. Cases with HBsAg, Anti HBc IgM positive and raised ALT were considered as acute Hepatitis B. HBs Ag/Anti HBc IgG positive were considered as chronic Hepatitis B. Delta antibody positive with or without HBsAg were considered as Delta Hepatitis. Anti HCV positive and raised ALT more than ten times for less than 6 months were considered as acute Hepatitis C, whereas Anti HCV and HCV-RNA positive with or without raised ALT for more than six months were considered as chronic Hepatitis C. Anti HEV IgM and Anti HAV IgM positive were considered as acute Hepatitis E and A respectively. A total of 5193 cases fulfilling all criteria of viral hepatitis were seen in the past 21 years. Of the total 3247 (62.5%) were males and 1946 (37.5%) females giving a male to female ratio of 1.7 : 1. Hepatitis C was the most common infection seen in 2896 cases (55.8%), followed by Hepatitis B in 1691 cases (32.6%). Seventy five percent cases of Hepatitis B were males and 25% females while 55% Hepatitis C cases were males and 45% females. Hepatitis B was seen a decade earlier in different age groups than hepatitis C. Overall, out of the total 5193 cases, 2294 (44.2%) were of chronic hepatitis, 1430 (27.5%) cirrhosis, 1083 (20.8%) carriers and 346 (6.7%) had acute hepatitis (hepatitis B; 214 (61.8%), hepatitis C; 21 (6.0%). While hepatitis B and hepatitis C both were present in 3 (1.3%). Hepatitis E was 70 (20.2%), hepatitis A 12 (3.5%) and all markers were negative in 26 (7.5%) cases). Forty cases (0.8%) were of Hepatocellular carcinoma. Year

Six essential roles of health promotion research centres: the Atlantic Canada experience

PubMed Central

Langille, Lynn L.; Crowell, Sandra J.; Lyons, Renée F.

2009-01-01

SUMMARY Over the past 20 years, the federal government and universities across Canada have directed resources towards the development of university-based health promotion research centres. Researchers at health promotion research centres in Canada have produced peer-reviewed papers and policy documents based on their work, but no publications have emerged that focus on the specific roles of the health promotion research centres themselves. The purpose of this paper is to propose a framework, based on an in-depth examination of one centre, to help identify the unique roles of health promotion research centres and to clarify the value they add to promoting health and advancing university goals. Considering the shifting federal discourse on health promotion over time and the vulnerability of social and health sciences to changes in research funding priorities, health promotion research centres in Canada and elsewhere may need to articulate their unique roles and contributions in order to maintain a critical focus on health promotion research. The authors briefly describe the Atlantic Health Promotion Research Centre (AHPRC), propose a framework that illustrates six essential roles of health promotion research centres and describe the policy contexts and challenges of health promotion research centres. The analysis of research and knowledge translation activities over 15 years at AHPRC sheds light on the roles that health promotion research centres play in applied research. The conclusion raises questions regarding the value of university-based research centres and challenges to their sustainability. PMID:19171668

Byurakan Astrophysical Observatory as Cultural Centre

NASA Astrophysics Data System (ADS)

Mickaelian, A. M.; Farmanyan, S. V.

2016-12-01

NAS RA V. Ambartsumian Byurakan Astrophysical Observatory is presented as a cultural centre for Armenia and the Armenian nation in general. Besides being scientific and educational centre, the Observatory is famous for its unique architectural ensemble, rich botanical garden and world of birds, as well as it is one of the most frequently visited sightseeing of Armenia. In recent years, the Observatory has also taken the initiative of the coordination of the Cultural Astronomy in Armenia and in this field, unites the astronomers, historians, archaeologists, ethnographers, culturologists, literary critics, linguists, art historians and other experts.

Exploring the wide range of terminology used to describe care that is patient-centred.

PubMed

Goodrich, Joanna

During the planning phase of The King's Fund's The Point of Care programme, we undertook a literature review, starting with the term 'patient-centred care'. We soon discovered the term not only had different meanings for different people but also that there were many related phrases with specific connotations in various professional contexts. When looking at the terminology that policymakers use, it seems that different terms--variations on 'patient-centred care'--have been favoured over the years. We decided to carry out our own research to investigate what language staff working in hospitals preferred to use when describing their care of patients. We collected data using focus groups and paired and single in-depth interviews. It seemed that the language hospital workers preferred to use was different, and that staff (some groups more than others) did not like much of the language that academics and policymakers use. It is important when working in a hospital context to use language that staffprefer.

Factors Affecting Academic Achievement in Single Mothers Attending Public Two-Year Institutions

ERIC Educational Resources Information Center

Young, Shakebra L.

2012-01-01

This quantitative, cross-sectional, correlation research study explored the relationships between self-efficacy, social support, and academic achievement among single mothers aged 18 and older attending Mississippi public two-year institutions. A total of 82 single mothers provided data for this study by completing the following research…

Ten years single-centre experience with intra-aortic balloon pump.

PubMed

Vandenplas, Guy; Bové, Thierry; Caes, Frank; Van Belleghem, Yves; François, Katrien; De Somer, Filip; Taeymans, Yves; Van Nooten, Guido

2011-12-01

The objective of this study was to investigate the patient characteristics and outcomes in 1406 patients undergoing intra-aortic balloon pump (IABP) counterpulsation. Between 1998 and 2008, 1406 consecutive patients were recorded in a prospective database. Based on the main clinical indication for IABP use, we defined 3 groups: group A, 630 cases of coronary ischaemia or infarction without serious left ventricular (LV) dysfunction; group B, 466 patients with left ventricular failure or cardiogenic shock; group C, 310 patients where IABP was used for miscellaneous procedures such as weaning from cardiopulmonary bypass or during high-risk angioplasty or surgery. Global mortality was 28% (n = 390), with a significant difference between group A (15%, n = 95) and group B (41%, n = 191) (P < 0.001). Mortality in group C was 34% (n = 104). Most insertions were done in the catheterization laboratory (n = 943) with subsequent mortality of 23% whereas 199 balloons were inserted in the operation room with 34% mortality. 170 balloons inserted in the intensive care unit resulted in 46% mortality (P < 0.001). Major IABP-induced complications were 6.8% with no statistical differences between the three groups. Advanced age, left ventricular failure and low BMI were identified as prognostic risk factors for early mortality. IABP deployed at an early clinical stage yields the best results, especially for acute coronary patients with preserved LV function whereas LV failure and late insertion result in worse outcome.

A Brief History of the J.P. Das Developmental Disabilities Centre

ERIC Educational Resources Information Center

Sobsey, Dick

2008-01-01

The J.P. Das Developmental Disabilities Centre celebrated its 40th anniversary on September 1, 2007, followed by The University of Alberta's 100th anniversary in 2008. The year 2008 also brought the appointment of a new Director for the Centre. As the immediate past Director of the Centre, the author recounts some of the history of the J.P. Das…

Kidney and liver transplants from donors after cardiac death: initial experience at the London Health Sciences Centre.

PubMed

Hernandez-Alejandro, Roberto; Caumartin, Yves; Chent, Cameron; Levstik, Mark A; Quan, Douglas; Muirhead, Norman; House, Andrew A; McAlister, Vivian; Jevnikar, Anthony M; Luke, Patrick P W; Wall, William

2010-04-01

The disparity between the number of patients waiting for an organ transplant and availability of donor organs increases each year in Canada. Donation after cardiac death (DCD), following withdrawal of life support in patients with hopeless prognoses, is a means of addressing the shortage with the potential to increase the number of transplantable organs. We conducted a retrospective, single-centre chart review of organs donated after cardiac death to the Multi-Organ Transplant Program at the London Health Sciences Centre between July 2006 and December 2007. In total, 34 solid organs (24 kidneys and 10 livers) were procured from 12 DCD donors. The mean age of the donors was 38 (range 18-59) years. The causes of death were craniocerebral trauma (n = 7), cerebrovascular accident (n = 4) and cerebral hypoxia (n = 1). All 10 livers were transplanted at our centre, as were 14 of the 24 kidneys; 10 kidneys were transplanted at other centres. The mean renal cold ischemia time was 6 (range 3-9.5) hours. Twelve of the 14 kidney recipients (86%) experienced delayed graft function, but all kidneys regained function. After 1-year follow-up, kidney function was good, with a mean serum creatinine level of 145 (range 107-220) micromol/L and a mean estimated creatinine clearance of 64 (range 41-96) mL/min. The mean liver cold ischemia time was 5.8 (range 5.5-8) hours. There was 1 case of primary nonfunction requiring retransplantation. The remaining 9 livers functioned well. One patient developed a biliary anastomotic stricture that resolved after endoscopic stenting. All liver recipients were alive after a mean follow-up of 11 (range 3-20) months. Since the inception of this DCD program, the number of donors referred to our centre has increased by 14%. Our initial results compare favourably with those from the transplantation of organs procured from donors after brain death. Donation after cardiac death can be an important means of increasing the number of organs available for

[177Lu]-PSMA-617 radionuclide treatment in patients with metastatic castration-resistant prostate cancer (LuPSMA trial): a single-centre, single-arm, phase 2 study.

PubMed

Hofman, Michael S; Violet, John; Hicks, Rodney J; Ferdinandus, Justin; Thang, Sue Ping; Akhurst, Tim; Iravani, Amir; Kong, Grace; Ravi Kumar, Aravind; Murphy, Declan G; Eu, Peter; Jackson, Price; Scalzo, Mark; Williams, Scott G; Sandhu, Shahneen

2018-06-01

Progressive metastatic castration-resistant prostate cancer is a highly lethal disorder and new effective therapeutic agents that improve patient outcomes are urgently needed. Lutetium-177 [ 177 Lu]-PSMA-617, a radiolabelled small molecule, binds with high affinity to prostate-specific membrane antigen (PSMA) enabling beta particle therapy targeted to metastatic castration-resistant prostate cancer. We aimed to investigate the safety, efficacy, and effect on quality of life of [ 177 Lu]-PSMA-617 in men with metastatic castration-resistant prostate cancer who progressed after standard treatments. In this single-arm, single-centre, phase 2 trial, we recruited men (aged 18 years and older) with metastatic castration-resistant prostate cancer and progressive disease after standard treatments, including taxane-based chemotherapy and second-generation anti-androgens, from the Peter MacCallum Cancer Centre, Melbourne, VIC, Australia. Patients underwent a screening PSMA and FDG-PET/CT to confirm high PSMA-expression. Eligible patients had progressive disease defined by imaging (according to Response Evaluation Criteria In Solid Tumours [RECIST] or bone scan) or new pain in an area of radiographically evident disease, and were required to have an Eastern Cooperative Oncology Group (ECOG) performance status score of 2 or lower. Eligible patients received up to four cycles of intravenous [ 177 Lu]-PSMA-617, at six weekly intervals. The primary endpoint was PSA response according to Prostate Cancer Clinical Trial Working Group criteria defined as a greater than 50% PSA decline from baseline and toxicity according to CTCAE. Additional primary endpoints were imaging responses (as measured by bone scan, CT, PSMA, and FDG PET/CT) and quality of life (assessed with the EORTC-Q30 and Brief Pain Inventory-Short Form questionnaires), all measured up to 3 months post completion of treatment. This trial is registered with the Australian New Zealand Clinical Trials Registry, number

Practice-based clinical evaluation of ceramic single crowns after at least five years.

PubMed

Dhima, Matilda; Paulusova, Vladimira; Carr, Alan B; Rieck, Kevin L; Lohse, Christine; Salinas, Thomas J

2014-02-01

Long-term practice-based clinical evaluations of various contemporary ceramic crown restorations from multiple practitioners are limited. The aims of this study were to evaluate the clinical performance of ceramic single crowns and to identify factors that influence their clinical performance. Ceramic single crowns that had been placed at the Mayo Clinic and in function since 2005 were identified and included in the study. The restorations were examined clinically, radiographically, and with photographs. Modified United States Public Health Services criteria were used for the clinical evaluation. The ceramic systems evaluated were bilayer and monolayer. Fifty-nine patients (41 women, 18 men) with 226 single teeth and implants restored with single ceramic crowns were identified. The mean duration from insertion date to study examination date was 6.1 years. Thirteen restorations (6%) were replaced at a mean 3.3 years after insertion date (range, 0.1-6.1 years). Estimated replacement-free survival rates (95% confidence interval [CI]; number of teeth/implants still at risk) at 5 years after insertion date were 95.1% (95% CI, 92.2-98.1; 153) and at 10 years were 92.8% (95% CI, 89.1-96.8; 8). The most common reason for replacement was fracture to the core of posterior layered ceramic crowns. The most commonly used luting agent was resin-modified ionomer cement. Most restorations exhibited clinically acceptable marginal integrity, shade, no caries recurrence, and no periapical pathology. The clinical performance of ceramic single crowns at 5 and 10 years supports their application in all areas of the mouth. With the majority of fractures to the core occurring early in the lifetime of layered ceramic posterior crowns, consideration of other monolithic ceramic systems for posterior crowns is advised. Copyright © 2014 Editorial Council for the Journal of Prosthetic Dentistry. Published by Mosby, Inc. All rights reserved.

Screening for infectious diseases among asylum seekers newly arrived in Germany in 2015: a systematic single-centre analysis.

PubMed

Kortas, A Z; Polenz, J; von Hayek, J; Rüdiger, S; Rottbauer, W; Storr, U; Wibmer, T

2017-12-01

During the migrant crisis in 2015, Germany was the largest single recipient of new asylum seekers in Europe. The German asylum law requires a screening examination for certain infectious diseases in asylum seekers upon arrival. The aim of this work was to analyse the rate of certain infectious diseases among asylum seekers screened at a reception centre in Southern Germany. Retrospective medical record review. Medical records of 2602 asylum seekers screened by a local public health authority in Germany in 2015 were systematically analysed. The majority of screened subjects came from Afghanistan and Syria. The mean age was 22.1 (±12.0) years. The majority of subjects were male (75.4%). Most individuals were of normal weight or overweight, more subjects were obese than underweight. A total of 78 (3.9%) individuals were infected with hepatitis B and eight (0.4%) with HIV. In 31 cases, chest radiographs suggested active tuberculosis (1.6%), which was confirmed in four cases (0.2%). The physical examination uncovered 44 (1.7%) cases of scabies, nine (0.3%) cases of lice, eight (0.3%) of upper respiratory tract infections, two (0.1%) of varicella and 13 (0.5%) of other skin infections. In the majority of subjects none of the screened infectious diseases were found. No evidence was found that the overall prevalence of certain infectious diseases screened for in the present analysis was considerably higher than in previous migration studies. Copyright © 2017 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Single vs dual (en bloc) kidney transplants from donors ≤ 5 years of age: A single center experience

PubMed Central

Al-Shraideh, Yousef; Farooq, Umar; El-Hennawy, Hany; Farney, Alan C; Palanisamy, Amudha; Rogers, Jeffrey; Orlando, Giuseppe; Khan, Muhammad; Reeves-Daniel, Amber; Doares, William; Kaczmorski, Scott; Gautreaux, Michael D; Iskandar, Samy S; Hairston, Gloria; Brim, Elizabeth; Mangus, Margaret; Stratta, Robert J

2016-01-01

AIM: To compare outcomes between single and dual en bloc (EB) kidney transplants (KT) from small pediatric donors. METHODS: Monocentric nonprospective review of KTs from pediatric donors ≤ 5 years of age. Dual EB KT was defined as keeping both donor kidneys attached to the inferior vena cava and aorta, which were then used as venous and arterial conduits for the subsequent transplant into a single recipient. Donor age was less useful than either donor weight or kidney size in decision-making for kidney utilization as kidneys from donors < 8 kg or kidneys < 6 cm in length were not transplanted. Post-transplant management strategies were standardized in all patients. RESULTS: From 2002-2015, 59 KTs were performed including 34 dual EB and 25 single KTs. Mean age of donors (17 mo vs 38 mo, P < 0.001), mean weight (11.0 kg vs 17.4 kg, P = 0.046) and male donors (50% vs 84%, P = 0.01) were lower in the dual EB compared to the single KT group, respectively. Mean cold ischemia time (21 h), kidney donor profile index (KDPI; 73% vs 62%) and levels of serum creatinine (SCr, 0.37 mg/dL vs 0.49 mg/dL, all P = NS) were comparable in the dual EB and single KT groups, respectively. Actuarial graft and patient survival rates at 5-years follow-up were comparable. There was one case of thrombosis resulting in graft loss in each group. Delayed graft function incidence (12% dual EB vs 20% single KT, P = NS) was slightly lower in dual EB KT recipients. Initial duration of hospital stay (mean 5.4 d vs 5.6 d) and the one-year incidences of acute rejection (6% vs 16%), operative complications (3% vs 4%), and major infection were comparable in the dual EB and single KT groups, respectively (all P = NS). Mean 12 mo SCr and abbreviated MDRD levels were 1.17 mg/dL vs 1.35 mg/dL and 72.5 mL/min per 1.73 m2 vs 60.5 mL/min per 1.73 m2 (both P = NS) in the dual EB and single KT groups, respectively. CONCLUSION: By transplanting kidneys from young pediatric donors into adult recipients, one can

Studies Using Single-Subject Designs in Sport Psychology: 30 Years of Research

ERIC Educational Resources Information Center

Martin, G. L.; Thompson, K.; Regehr, K.

2004-01-01

A prominent feature of behavior-analytic research has been the use of single-subject designs. We examined sport psychology journals and behavioral journals published during the past 30 years, and located 40 studies using single-subject designs to assess interventions for enhancing the performance of athletes and coaches. In this paper, we…

Effect of trimetazidine on recurrent angina pectoris and left ventricular structure in elderly multivessel coronary heart disease patients with diabetes mellitus after drug-eluting stent implantation: a single-centre, prospective, randomized, double-blind study at 2-year follow-up.

PubMed

Xu, Xiaohan; Zhang, Weijun; Zhou, Yujie; Zhao, Yingxin; Liu, Yuyang; Shi, Dongmei; Zhou, Zhiming; Ma, Hanying; Wang, Zhijian; Yu, Miao; Ma, Qian; Gao, Fei; Shen, Hua; Zhang, Jianwei

2014-04-01

Trimetazidine has been shown to improve angina pectoris and left ventricular (LV) function in diabetic patients with ischaemic cardiomyopathy. The objective of this study was to evaluate the effects of trimetazidine on recurrent angina pectoris and LV structure after drug-eluting stent (DES) implantation in elderly multivessel coronary heart disease (CHD) patients with diabetes mellitus (DM) and a left ventricular ejection fraction (LVEF) of ≥ 50 %. This was a single-centre, prospective, randomized, double-blind evaluation study. Between January 2010 and September 2010, 700 CHD patients with DM who were aged ≥ 65 years and undergoing coronary angiography at An Zhen Hospital (Beijing, China) were recruited and prospectively randomized to receive trimetazidine (20 mg three times daily) or placebo after DES implantation as an addition to conventional CHD treatment. The primary end points were the incidence of recurrent angina pectoris and measures of various echocardiographic parameters, which included LVEF. At 2-year follow-up, patients in the trimetazidine group (n = 255) showed significant improvements in the incidence (P = 0.024) and severity of angina pectoris, compared with the control group, as well as silent myocardial ischaemia (P = 0.009) and angina pectoris-free survival (P = 0.011). LV function and structure in trimetazidine-treated patients were relatively stable at 2-year follow-up, while they deteriorated in the control group (n = 255) with a significant difference between groups (all P < 0.01). The E peak to A peak (E/A) ratio in trimetazidine-treated patients and in the control group decreased after 2 years; the E/A ratio in trimetazidine-treated patients was slightly better than that in the control group, without a significant difference (P = 0.170). There was no significant difference in event-free survival for the composite end point including death, myocardial infarction, cerebrovascular accident (P = 0.422) and subsequent revascularization (P

Ancient deuterostome origins of vertebrate brain signalling centres.

PubMed

Pani, Ariel M; Mullarkey, Erin E; Aronowicz, Jochanan; Assimacopoulos, Stavroula; Grove, Elizabeth A; Lowe, Christopher J

2012-03-14

Neuroectodermal signalling centres induce and pattern many novel vertebrate brain structures but are absent, or divergent, in invertebrate chordates. This has led to the idea that signalling-centre genetic programs were first assembled in stem vertebrates and potentially drove morphological innovations of the brain. However, this scenario presumes that extant cephalochordates accurately represent ancestral chordate characters, which has not been tested using close chordate outgroups. Here we report that genetic programs homologous to three vertebrate signalling centres-the anterior neural ridge, zona limitans intrathalamica and isthmic organizer-are present in the hemichordate Saccoglossus kowalevskii. Fgf8/17/18 (a single gene homologous to vertebrate Fgf8, Fgf17 and Fgf18), sfrp1/5, hh and wnt1 are expressed in vertebrate-like arrangements in hemichordate ectoderm, and homologous genetic mechanisms regulate ectodermal patterning in both animals. We propose that these genetic programs were components of an unexpectedly complex, ancient genetic regulatory scaffold for deuterostome body patterning that degenerated in amphioxus and ascidians, but was retained to pattern divergent structures in hemichordates and vertebrates. © 2012 Macmillan Publishers Limited. All rights reserved

[Definition of endometriosis expert centres].

PubMed

Chanavaz-Lacheray, I; Darai, E; Descamps, P; Agostini, A; Poilblanc, M; Rousset, P; Bolze, P-A; Panel, P; Collinet, P; Hebert, T; Graesslin, O; Martigny, H; Brun, J-L; Dechaud, H; Mezan De Malartic, C; Piechon, L; Wattiez, A; Chapron, C; Golfier, F

2018-03-01

The Collège national des gynécologues obstétriciens français (CNGOF), in agreement with the Société de chirurgie gynécologique et pelvienne (SCGP), has set up a commission in 2017 to define endometriosis expert centres, with the aim of optimizing endometriosis care in France. The committee included members from university and general hospitals as well as private facilities, representing medical, surgical and radiological aspects of endometriosis care. Opinion of endometriosis patients' associations was obtained prior to writing this work. The final text was presented and unanimously validated by the members of the CNGOF Board of Directors at its meeting of October 13, 2017. Based on analysis of current management of endometriosis and the last ten years opportunities in France, the committee has been able to define the contours of endometriosis expert centres. The objectives, production specifications, mode of operation, missions and funding for these centres were described. The following missions have been specifically defined: territorial organization, global and referral care, communication and teaching as well as research and evaluation. Because of its daily impact for women and its economic burden in France, endometriosis justifies launching of expert centres throughout the country with formal accreditation by health authorities, ideally as part of the National Health Plan. Copyright © 2018 Elsevier Masson SAS. All rights reserved.

[Establishing an Ambulatory Health-Care Centre (AHCC) at a University Hospital].

PubMed

Krüll, A; Debatin, J F

2013-02-01

Since January 2004 hospitals have the opportunity to establish an ambulatory health-care centre (Medizinisches Versorgungszentrum - MVZ) as a result of the introduction of the Health-care Modernisation Act (Gesetz zur Modernisierung der gesetzlichen Krankenversicherung - GMG). After about a half-year preparatory phase, the UKE, in September 2004, began operation of the "Ambulanzzentrum des UKE GmbH" (a limited liability company) as the first MVZ at a university hospital in Germany. We report here on the establishment of the MVZ and the experience made. In the initial phase, only the medical fields of radiation therapy and nuclear medicine were represented. Both disciplines, especially radiation therapy, were existentially threatened by the extensive loss of ambulatory patients. The central motive for the establishment of the ambulatory health-care centre was to secure the survival of both disciplines and to preserve existing jobs. After it was put into operation, the referrals from practice-based colleagues to both radiation therapy and nuclear medicine increased quickly. The positive developments caused other departments of the UKE to express their interest in supplementing their outpatient activities with facilities in the MVZ. Over the following years, the ambulance centre grew steadily. Now 24 departments are represented in the MVZ, and the centre has a total of 49 positions for physicians contracted by and registered within the German public health insurance system. The number of salaried doctors has risen to 85, although many of these only work part time in the MVZ. Also more than 83 non-medical staff members were hired over the years. These were mostly physiotherapists, radiographers, and medical assistants. With the growing number of departments in the MVZ, the number of treated cases grew steadily. Currently approximately 20 000 cases are treated in each quarter of a year. The experience made while establishing an ambulatory health-care centre is very

Thermal Properties of the ESR Centres in Speleothem Samples

NASA Astrophysics Data System (ADS)

Ulusoy, Ü.; Anbar, Gül

2007-04-01

The paramagnetic centres used for ESR (Electron Spin Resonance) dating method should be thermally stable which is the main factor limiting the range of this method. In this work, thermal stabilities of the ESR centres in the cave deposites from the Aladaǧlar Massive and Alanya in Turkey has been investigated. The life times of the dating signal were calculated as about 4.0 and 3.7 years for G06 and G08 samples at the 10 °C depositing temperature. The activation energies of the centres are obtained the same, 0.7eV for both samples.

Wilson's Disease: a challenge of diagnosis. The 5-year experience of a tertiary centre.

PubMed

Gheorghe, Liana; Popescu, Irinel; Iacob, Speranta; Gheorghe, Cristian; Vaidan, Roxana; Constantinescu, Alexandra; Iacob, Razvan; Becheanu, Gabriel; Angelescu, Corina; Diculescu, Mircea

2004-09-01

Because molecular diagnosis is considered impractical and no patognomonic features have been described, diagnosis of Wilson's disease (WD) using clinical and biochemical findings is still challenging. We analysed predictive factors for the diagnosis in 55 patients with WD diagnosed in our centre between 1st January 1999 and 1st April 2004. All patients presented predominant liver disease classified as: 1) asymptomatic, found incidentally, 2) chronic hepatitis or cirrhosis, or 3) fulminant hepatic failure. Diagnosis was considered as classic (two out of the three following criteria: 1) serum ceruloplasmin < 20 mg/dl, 2) the presence of Kayser-Fleischer rings and/or 3) hepatic copper > 250 mg/g dry weight liver tissue), and non-classic (clinical manifestations plus laboratory parameters suggesting impaired copper metabolism). The association between the predictive factors and non-classic diagnosis was assessed based on the level of statistical significance (p value<0.05) associated with the chi-squared test in contingency tables. Multivariate analysis was performed by logistic regression using SPSS 10. There were 31 males (56.3%) and 24 females (43.7%) with the mean age at diagnosis of 20.92 +/- 9.97 years (4-52 years); 51 patients (92.7%) were younger than 40 years. Asymptomatic WD was diagnosed in 14 patients (25.4%), chronic liver disease due to WD in 29 patients (52.8%) and fulminant hepatic failure in 12 patients (21.8%). The classic diagnosis was made in 32 patients (58.18%). In the univariate analysis the non-classic diagnosis was associated with: age>18 years (p=0.03), increased copper excretion (p<0.0001), Coombs-negative hemolysis (p=0.03), absence of neurological manifestations (p<0.0001). Multivariate analysis identified age over 18 years, increased urinary copper, and isolated hepatic involvement as independent predictors. In clinical practice, WD should be considered also in patients who do not fulfil classic criteria. Independent factors associated

Multi-criteria correlation of tephra deposits to source centres applied in the Auckland Volcanic Field, New Zealand

NASA Astrophysics Data System (ADS)

Hopkins, Jenni L.; Wilson, Colin J. N.; Millet, Marc-Alban; Leonard, Graham S.; Timm, Christian; McGee, Lucy E.; Smith, Ian E. M.; Smith, Euan G. C.

2017-07-01

Linking tephras back to their source centre(s) in volcanic fields is crucial not only to reconstruct the eruptive history of the volcanic field but also to understand tephra dispersal patterns and thus the potential hazards posed by a future eruption. Here we present a multi-disciplinary approach to correlate distal basaltic tephra deposits from the Auckland Volcanic Field (AVF) to their source centres using proximal whole-rock geochemical signatures. In order to achieve these correlations, major and trace element tephra-derived glass compositions are compared with published and newly obtained whole-rock geochemical data for the entire field. The results show that incompatible trace element ratios (e.g. (Gd/Yb)N, (La/Yb)N, (Zr/Yb)N) vary widely across the AVF (e.g. (La/Yb)N = 5 to 40) but show a more restricted range within samples from a single volcanic centre (e.g. (La/Yb)N = 5 to 10). These ratios are also the least affected by fractional crystallisation and are therefore the most appropriate geochemical tools for correlation between tephra and whole-rock samples. However, findings for the AVF suggest that each volcanic centre does not have a unique geochemical signature in the field as a whole, thus preventing unambiguous correlation of tephras to source centre using geochemistry alone. A number of additional criteria are therefore combined to further constrain the source centres of the distal tephras including age, eruption scale, and location (of centres, and sites where tephra were sampled). The combination of tephrostratigraphy, 40Ar/39Ar dating and morphostratigraphic constraints allow, for the first time, the relative and absolute ordering of 48 of 53 volcanic centres of the Auckland Volcanic Field to be resolved. Eruption frequencies are shown to vary between 0.13 and 1.5 eruptions/kyr and repose periods between individual eruptions vary from <0.1 to 13 kyr, with 23 of the 48 centres shown to have pre-eruptive repose periods of <1000 years. No spatial

Sinonasal papillomas in a private referral otorhinolaryngology centre: Review of 22 years experience.

PubMed

de Sousa Fontes, Aderito; Sandrea Jiménez, Minaret; Urdaneta Lafée, Nelson; Abreu Durán, Perfecto A; Quintana Páez, Liwven E; de Sousa de Abreu, Andreina Carmina

To evaluate the clinical presentation, treatment outcome and follow-up of all patients managed with sinonasal papillomas (SP), at a tertiary private otorhinolaryngology centre in Caracas (Venezuela). We reviewed 94 patients with SP that were treated at our otolaryngology center, from July 1st 1993 to June 31st 2015. The demographic data, clinical features, radiological findings, anatomical origin, disease extension into the adjacent structures, surgical approaches performed, histopathology outcomes, recurrent risk, malignant transformation rate and coadjuvant therapies were assessed. Sixty-five patients (69.1%) were male and 29 (30.9%) female with an average age of 44.5 years (range 9-80 years). All patients underwent endoscopic sinus surgery. The most commont histologic subtypes of SP were inverted papilloma (58 patients; 61.7%), fungiform papilloma (35 patients; 37.2%) and oncocytic papilloma (one patient; 1.1%). SP was associated in 2 patients with undifferentiated squamous cell carcinoma. Twelve patients (12.8%) had disease with extension beyond the sinus without associated malignancy. All these patients received adjuvant treatment with advanced techniques of radiotherapy. The mean duration of the follow-up period was 9 years and 2 months. Eighteen patients (19.1%) had recurrent disease during the entire course of follow-up. Complete endoscopic surgical removal of SP is the treatment of choice. In less endoscopically accessible tumours, with peripheral extension or incompletely resected, Intensity Modulated Radiotherapy and Volumetric Modulated Arc Therapy may be indicated. Timely post-operative endoscopic follow-up with biopsy of suspected lesions is important for early detection of recurrences and associated malignancy. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello. All rights reserved.

Five-Year Outcomes of High-Dose Single-Fraction Spinal Stereotactic Radiosurgery

DOE Office of Scientific and Technical Information (OSTI.GOV)

Moussazadeh, Nelson; Department of Neurological Surgery, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York; Lis, Eric

Purpose: To characterize local tumor control and toxicity risk in very long-term survivors (>5 years) after high-dose spinal image guided, intensity modulated radiation therapy delivered as single-dose stereotactic radiosurgery (SRS). Previously published spinal SRS outcome analyses have included a heterogeneous population of cancer patients, mostly with short survival. This is the first study reporting the long-term tumor control and toxicity profiles after high-dose single-fraction spinal SRS. Methods and Materials: The study population included all patients treated from June 2004 to July 2009 with single-fraction spinal SRS (dose 24 Gy) who had survived at least 5 years after treatment. The endpoints examined included diseasemore » progression, surgical or radiation retreatment, in-field fracture development, and radiation-associated toxicity, scored using the Radiation Therapy Oncology Group radiation morbidity scoring criteria and the Common Terminology Criteria for Adverse Events, version 4.0. Local control and fracture development were assessed using Kaplan-Meier analysis. Results: Of 278 patients, 31 (11.1%), with 36 segments treated for spinal tumors, survived at least 5 years after treatment and were followed up radiographically and clinically for a median of 6.1 years (maximum 102 months). The histopathologic findings for the 5-year survivors included radiation-resistant metastases in 58%, radiation-sensitive metastases in 22%, and primary bone tumors in 19%. In this selected cohort, 3 treatment failures occurred at a median of 48.6 months, including 2 recurrences in the radiation field and 1 patient with demonstrated progression at the treatment margins. Ten lesions (27.8%) were associated with acute grade 1 cutaneous or gastrointestinal toxicity. Delayed toxicity ≥3 months after treatment included 8 cases (22.2%) of mild neuropathy, 2 (5.6%) of gastrointestinal discomfort, 8 (22.2%) of dermatitides, and 3 (8.3%) of myalgias

Head and neck mucosal melanoma: clinicopathological analysis of 51 cases treated in a single cancer centre and review of the literature.

PubMed

Francisco, A L N; Furlan, M V; Peresi, P M; Nishimoto, I N; Lourenço, S V; Pinto, C A L; Kowalski, L P; Ikeda, M K

2016-02-01

Head and neck mucosal melanoma (HNMM) is a rare and aggressive malignancy. The objective of this study was to describe the outcomes of patients with HNMM. Clinical and pathological data from 51 patients with primary HNMM were reviewed. All patients were treated at a single cancer centre between 1954 and 2012. Most tumours involved the nasal cavity (35.3%) and upper gingiva (29.4%). The majority of lesions were ulcerated (54.9%) and pigmented (84.3%). Forty-three patients underwent surgical treatment and 21 (41.2%) underwent adjuvant chemotherapy and/or radiotherapy. Eight patients (15.7%) received palliative treatment. The median follow-up period was 21 months. During this period, 30 (58.8%) patients had tumour recurrences. At the last clinical evaluation, only seven (13.7%) patients were alive with no evidence of disease and three (5.9%) were alive with HNMM. There were significant differences in overall survival probability according to the presence of ulceration (P=0.004), metastatic lymph nodes (P=0.003), and treatment including a radical surgical procedure (P<0.001). On multivariate analysis, ulceration was the only variable associated with an increased risk of death. Despite the poor prognosis, there was significant improvement in overall survival in the most recent years in this sample, mainly due to advances in diagnosis and reconstruction techniques. Copyright © 2015 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Acute coronary syndrome in young adults from a Malaysian tertiary care centre

PubMed Central

Hoo, Fan Kee; Foo, Yoke Loong; Lim, Sazlyna Mohd Sazlly; Ching, Siew Mooi; Boo, Yang Liang

2016-01-01

Background and Objective: Acute coronary syndrome (ACS) is one of the leading cause of morbidity and mortality worldwide. It is relatively uncommon in young adults as compared to the older population. Our objective was to assess the prevalence, demographic distribution, and risk factors for acute coronary syndrome (ACS) in patients less than 45 years of age admitted to a Malaysian tertiary care centre. Methods: This is a cross-sectional, retrospective, and single centre study with random sampling of the patients admitted for ACS to hospital from January 2005 to December 2013. Data were collected and analyzed. Patients less than 45 years of age were compared with patients more than 45 years of age. Result: A total of 628 patients were included in the study and with the prevalence of young ACS was 6.1% and mean age of 39±6 years. All the young ACS patients were diagnosed with unstable angina and non-ST elevation myocardial infarction (NSTEMI). Tobacco smoking and family history of coronary artery disease (CAD) were more frequent in young ACS. 59.5% of the young ACS patients were smokers, while 37.8% and 51.4% of them were found to suffer from diabetes mellitus and hypertension respectively. Tobacco smoking, diabetes mellitus, and hypertension had shown significant association with the onset of young ACS (p ≤ 0.05). Conclusion: Three leading risk factors (tobacco smoking, diabetes mellitus, and hypertension) had been shown to be significantly associated with the onset of young ACS. Thus, it is important to identify this cohort and implement aggressive measures in tackling the risk factors in order to prevent or halt the development of coronary artery disease. PMID:27648025

Acute coronary syndrome in young adults from a Malaysian tertiary care centre.

PubMed

Hoo, Fan Kee; Foo, Yoke Loong; Lim, Sazlyna Mohd Sazlly; Ching, Siew Mooi; Boo, Yang Liang

2016-01-01

Acute coronary syndrome (ACS) is one of the leading cause of morbidity and mortality worldwide. It is relatively uncommon in young adults as compared to the older population. Our objective was to assess the prevalence, demographic distribution, and risk factors for acute coronary syndrome (ACS) in patients less than 45 years of age admitted to a Malaysian tertiary care centre. This is a cross-sectional, retrospective, and single centre study with random sampling of the patients admitted for ACS to hospital from January 2005 to December 2013. Data were collected and analyzed. Patients less than 45 years of age were compared with patients more than 45 years of age. A total of 628 patients were included in the study and with the prevalence of young ACS was 6.1% and mean age of 39±6 years. All the young ACS patients were diagnosed with unstable angina and non-ST elevation myocardial infarction (NSTEMI). Tobacco smoking and family history of coronary artery disease (CAD) were more frequent in young ACS. 59.5% of the young ACS patients were smokers, while 37.8% and 51.4% of them were found to suffer from diabetes mellitus and hypertension respectively. Tobacco smoking, diabetes mellitus, and hypertension had shown significant association with the onset of young ACS (p ≤ 0.05). Three leading risk factors (tobacco smoking, diabetes mellitus, and hypertension) had been shown to be significantly associated with the onset of young ACS. Thus, it is important to identify this cohort and implement aggressive measures in tackling the risk factors in order to prevent or halt the development of coronary artery disease.

The effect of different unstable footwear constructions on centre of pressure motion during standing.

PubMed

Plom, W; Strike, S C; Taylor, M J D

2014-06-01

The aim of this study was to test the effect different unstable footwear constructions have on centre of pressure motion when standing. Sixteen young female volunteers were tested in five conditions, three unstable footwear (Reebok Easy-Tone, FitFlop and Skechers Shape-Ups), a standard shoe and barefoot in a randomised order. Double and single leg balance on a force plate was assessed via centre of pressure excursions and displacements in each condition. For double leg and single leg standing centre of pressure excursions in the anterior-posterior direction were significantly increased wearing Skechers Shape-Ups compared to barefoot and the standard shoe. For the Reebok Easy Tone during single leg standing excursions in the anterior-posterior direction were significantly greater compared to the barefoot condition. Cumulative displacement of the centre of pressure in medial-lateral direction increased significantly during single leg standing when wearing Skechers Shape-Ups compared to barefoot and standard shoe as well as for Reebok Easy Tone vs. barefoot. It would appear from these quiet standing results that the manner of the construction of instability shoes effects the CoP movement which is associated with induced instability. Greater CoP excursion occurred in the A-P direction while the cumulative displacements were greater in the M-L direction for those shoes with the rounded sole and soft foam and those with airpods. The shoe construction with altered density foam did not induce any change in the CoP movement, during quite standing, which tends to suggest that it is not effective at inducing balance. Not all instability shoes are effective in altering the overall instability of the wearer. Copyright © 2014 Elsevier B.V. All rights reserved.

Byurakan Astrophysical Observatory as Cultural Centre

NASA Astrophysics Data System (ADS)

Mickaelian, A. M.; Farmanyan, S. V.

2017-07-01

NAS RA V. Ambartsumian Byurakan Astrophysical Observatory is presented as a cultural centre for Armenia and the Armenian nation in general. Besides being scientific and educational centre, the Observatory is famous for its unique architectural ensemble, rich botanical garden and world of birds, as well as it is one of the most frequently visited sightseeing of Armenia. In recent years, the Observatory has also taken the initiative of the coordination of the Cultural Astronomy in Armenia and in this field, unites the astronomers, historians, archaeologists, ethnographers, culturologists, literary critics, linguists, art historians and other experts. Keywords: Byurakan Astrophysical Observatory, architecture, botanic garden, tourism, Cultural Astronomy.

Outcome of severely injured trauma patients at a designated trauma centre in the Hong Kong Special Administrative Region.

PubMed

Leung, Ka Kit Gilberto; Ho, Wendy; Tong, King Hung Daniel; Yuen, Wai Key

2010-05-20

The Hong Kong Special Administrative Region (HKSAR) of the People's Republic of China (PRC) has seen significant changes in its trauma service over the last ten years including the implementation of a regional trauma system. The author's institution is one of the five trauma centres designated in 2003. This article reports our initial clinical experience. A prospective single-centre trauma registry from January 2004 to December 2008 was reviewed. The primary clinical outcome measure was hospital mortality. The Trauma and Injury Severity Score (TRISS) methodology was used for bench-marking with the North America Major Trauma Outcome Study (MTOS) database. There were 1451 patients. The majority (83.9%) suffered from blunt injury. The overall mortality rate was 7.8%. Severe injury, defined as the Injury Severity Score > 15, occurred in 22.5% of patients, and was associated with a mortality rate of 31.6%. A trend of progressive improvement was noted. The M-statistic was 0.99, indicating comparable case-mix with the MTOS. The Z- and W-statistics of each individual year revealed fewer, but not significantly so, number of survivors than expected. Trauma centre designation was feasible in the HKSAR and was associated with a gradual improvement in patient care. Trauma system implementation may be considered in regions equipped with the necessary socio-economic and organizational set-up.

Evaluation of the Training Centre Infrastructure Fund (TCIF). Final Report

ERIC Educational Resources Information Center

Human Resources and Skills Development Canada, 2009

2009-01-01

The Training Centre Infrastructure Fund (TCIF) was initially announced in Budget 2004 and represented an immediate measure of the broader Workplace Skills Strategy. TCIF was a three-year $25 million pilot project, designed to address the growing need for union-employer training centres to replace aging equipment and simulators that were not up to…

Learner-centred teaching in a non-learner-centred world: An interpretive phenomenological study of the lived experience of clinical nursing faculty.

PubMed

Oyelana, Olabisi; Martin, Donna; Scanlan, Judith; Temple, Beverley

2018-08-01

With the growing complexities in the contemporary health care system, there is a challenge of preparing nurses for the practice demands. To this end, learner-centred teaching has emerged in many nursing curricula in Canada and evidence indicates its effectiveness in developing the essential practice skills in nursing students. It is important to examine the experience of the clinical faculty members who implement learner-centred teaching, as doing so would provide an insight to the factors that may hinder the implementation of learner-centred teaching in the practice settings. This phenomenological study aimed to address two research questions: what does learner-centred teaching mean to clinical nurse faculty? What is the lived experience of clinical nursing faculty who incorporate learner-centred teaching? Ten clinical nurse faculty members who had at least two years of clinical teaching experience volunteered to participate in the study. Data were collected using a semi-structured interview guide and audio recorder. Additional data sources included a demographic survey and a reflective journal. Multiple sub-themes emerged from this study from which three significant themes were consolidated: diversity of meanings, facilitators of LCT, and barriers to LCT. However, an overarching theme of "learner-centred teaching in a non-learner-centred world" was coined from participants' accounts of their experiences of barriers in incorporating LCT in the practice settings. A collaborative effort between faculty and the stakeholders is paramount to a successful implementation of learner-centred teaching in practice settings. Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.

Pitfalls in diagnosis and management of distal vaginal agenesis: 10-year experience at a single centre.

PubMed

Ugur, M G; Balat, O; Ozturk, E; Bekerecioglu, M; Dikensoy, E

2012-07-01

To discuss common pitfalls in diagnosis and management of distal vaginal agenesis, and summarize 10 years of experience among 11 patients using an interposition full-thickness graft and fibrin glue. Eleven patients with distal vaginal agenesis were evaluated and managed with an interposition full-thickness graft to bridge the gap between the upper vagina and the introitus. Associated renal abnormalities and complications including infection, total lack of skin graft take, stress urinary incontinence, partial graft loss, vaginal stricture and graft uptake were all investigated. The mean age of the patients was 12.91 (standard deviation 1.22) years. All patients had primary amenorrhoea, cryptomenorrhea, and cyclical or constant pelvic pain. None of the patients had associated urological abnormalities, and there were no cases of infection, total lack of skin graft take, stress urinary incontinence, partial graft loss or vaginal stricture. Graft uptake was 100% in 10 of the 11 patients. Four patients have subsequently married and report a satisfactory sex life. Accurate diagnosis of distal vaginal agenesis and careful pre-operative set-up, including evaluation of associated anomalies, bowel preparation, available vaginal stents and a multidisciplinary approach for the potential need for grafts, may be key to success. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Coeliac disease in a 15-year period of observation (1997 and 2011) in a Hungarian referral centre.

PubMed

Kocsis, Dorottya; Miheller, Pál; Lőrinczy, Katalin; Herszényi, László; Tulassay, Zsolt; Rácz, Károly; Juhász, Márk

2013-07-01

The aim of this study is to evaluate the experience of a single coeliac centre over a 15-year-long study period (between November of 1997 and September of 2011). Charts of 178 patients (139 females) with coeliac disease were retrospectively evaluated. Tests performed: multiple duodenal biopsies, anti-tissue transglutaminase and anti-endomysium antibodies, body mass index calculation, osteodensitometry, evaluation of disorders associated with coeliac disease, and implementation of family screening. Histological samples were available in 133 cases, distribution according to Marsh-Oberhuber classification: M0 in 7%, M1-M2 in 4%, M3a in 26%, M3b in 13%, and M3c in 50% of cases, respectively. Anti-tissue transglutaminase and anti-endomysium antibody tests were available in 158 cases, 132/158 showed seropositivity. Mean body mass index values were 23.05kg/m(2) for males, and 21.07kg/m(2) for females, respectively. Osteodensitometry showed normal values in 46%, osteopenia in 36%, and osteoporosis in 18% of cases, respectively. Coeliac disease associated disorders was present in 63/178 (35%) patients. Ninety coeliacs brought 197 first degree relatives for screening, with 47/197 (23%) relatives proving to have coeliac disease. Correlations between anti-tissue transglutaminase antibody titres and Marsh-Oberhuber classification, and anti-tissue transglutaminase antibody titres and bone mineral density values were found to be statistically significant (p=0.0011, and p=0.001, respectively). Coeliac disease can become overt at any age. Female predominance is significant. Histology usually showed advanced villous atrophy. Mean body mass index values were within normal range. The high prevalence of associated disorders is also noted. The prevalence of 24% of coeliac disease among first degree relatives underlines the necessity of family screening. Copyright © 2013 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

Extraction of pacemaker and implantable cardioverter defibrillator leads: a single-centre study of electrosurgical and laser extraction.

PubMed

Scott, Paul A; Chow, Whitney; Ellis, Elizabeth; Morgan, John M; Roberts, Paul R

2009-11-01

Both electrosurgical dissection (EDS) and laser tools are effective in the extraction of chronic implanted endovascular leads. It is unclear which is superior. We undertook a retrospective single-centre study to assess this. In our institution from 2000 to 2004, all extractions requiring an ablative sheath were performed using the EDS system. In 2004, an excimer laser system was acquired, which became the first choice. Consecutive patients undergoing extraction requiring an ablative sheath (EDS or laser) were studied. From 2000 to 2007, 140 leads were extracted from 74 patients (EDS 31 and laser 43). Procedural success was non-significantly higher in the laser vs. the EDS group (95 vs. 87%). In the EDS group, one patient suffered tamponade requiring surgery; in the laser group, one patient suffered a significant pericardial effusion treated conservatively. There were no deaths. Procedure and fluoroscopy times were similar between groups. More patients were referred for primary surgical extraction in the EDS vs. the laser era (7 vs. 0, P = 0.003). Lead extraction using an ablative sheath is safe and effective. In our small study, there were no significant differences between EDS and laser sheaths in terms of success, time, or safety.

Individuals with Single Versus Multiple Suicide Attempts Over 10 Years of Prospective Follow-Up

PubMed Central

Boisseau, Christina L.; Yen, Shirley; Markowitz, John C.; Grilo, Carlos M.; Sanislow, Charles A.; Shea, M. Tracie; Zanarini, Mary C.; Skodol, Andrew E.; Gunderson, John G.; Morey, Leslie C.; McGlashan, Thomas H.

2012-01-01

Background The study attempted to identify characteristics that differentiate multiple suicide attempters from single attempters in individuals with personality disorders (PDs) and/or major depression. Method Participants were 431 participants enrolled in the Collaborative Longitudinal Study of Personality Disorders from July 1996 to June 2008. Suicide attempts were assessed with the Longitudinal Interval Follow-up Evaluation at 6 and 12 months, then yearly through 10 years. Logistic regression was used to compare single attempters to multiple attempters on Axis I and II psychiatric disorders and personality trait variables. Results Twenty-one percent of participants attempted suicide during the 10 years of observation, with 39 (9.0%) reporting a single suicide attempt and 54 (12.5%) reporting multiple suicide attempts. Although no significant differences in were found in baseline Axis I disorders, multiple attempters were significantly more likely to meet criteria for borderline personality disorder and to have higher impulsivity scores than single attempters. Conclusion These results underscore the importance of considering both personality disorders and traits in the assessment of suicidality. PMID:22995448

Hydroxyurea therapy in UK children with sickle cell anaemia: A single-centre experience.

PubMed

Phillips, Kate; Healy, Laura; Smith, Louise; Keenan, Russell

2018-02-01

Despite the demonstrated efficacy of hydroxyurea therapy, children with sickle cell anaemia in the UK are preferentially managed with supportive care or transfusion. Hydroxyurea is reserved for children with severe disease phenotype. This is in contrast to North America and other countries where hydroxyurea is widely used for children of all clinical phenotypes. The conservative UK practice may in part be due to concerns about toxicity, in particular marrow suppression with high doses, and growth in children. We monitored 37 paediatric patients with sickle cell anaemia who were treated with hydroxyurea at a single UK treatment centre. Therapy was well tolerated and mild transient cytopenias were the only toxicity observed. Comparative analysis of patients receiving ≥26 mg/kg/day versus <26 mg/kg/day demonstrates increasing dose has a significant positive effect on foetal haemoglobin (Hb; 29.2% vs. 20.4%, P = 0.0151), mean cell volume (94.4 vs. 86.5, P = 0.0183) and reticulocyte count (99.66 × 10 9 /l vs. 164.3 × 10 9 /l, P = 0.0059). Marrow suppression was not a clinical problem with high-dose treatment, Hb 92.25 g/l versus 91.81 g/l (ns), neutrophil count 3.3 × 10 9 /l versus 4.8 × 10 9 /l (ns) and platelet count 232.4 × 10 9 /l versus 302.2 × 10 9 /l (ns). Normal growth rates were maintained in all children. Good adherence to therapy was a significant factor in reducing hospitalisations. This study demonstrates the effectiveness and safety in practice of high-dose hydroxyurea as a disease-modifying therapy, which we advocate for all children with sickle cell anaemia. © 2017 The Authors. Pediatric Blood & Cancer Published by Wiley Periodicals, Inc.

Septic arthritis in haemodialysis patients: a seven-year multi-centre review.

PubMed

Al-Nammari, S S; Gulati, V; Patel, R; Bejjanki, N; Wright, M

2008-04-01

To determine relevant demographics, clinical features, and outcomes for septic arthritis in patients on haemodialysis for end-stage renal failure. A multi-centre retrospective review was performed from 1999 to 2005. 15 cases were identified. The mean age of the patients at diagnosis was 67 (range, 23-89) years and 11 were male. All had multiple co-morbidities and additional risk factors for sepsis. The primary sources of sepsis were dialysis access-related (n=12), unknown in 2, and unrelated soft tissue infection in one. All patients presented with acute monoarticular symptoms; the knee joint was affected in 11 patients. The white cell count, neutrophil count, and C-reactive protein concentration were elevated in 10, 10, and 15 patients, respectively. All patients had positive synovial fluid cultures and blood cultures were positive in 14. Organisms isolated were all skin commensals, being staphylococcal in 13 and streptococcal in 2. Six patients had concomitant rheumatological disease (gout in 4, pseudogout in one, and rheumatoid arthritis in one). Two had urate crystals in the synovial fluid (noted by microscopy). All patients underwent antimicrobial therapy for a mean of 36 days, together with joint washouts and debridement. 12 patients were cured of infection; 2 developed chronic sepsis secondary to localised osteomyelitis; and one died of sepsis. Septic arthritis is a potentially devastating condition. Early and aggressive joint lavage and debridement combined with appropriate antimicrobial therapy is imperative. A high index of suspicion is necessary in haemodialysis patients; the diagnosis of septic arthritis must be presumed until proven otherwise.

Studies using single-subject designs in sport psychology: 30 years of research

PubMed Central

Martin, Garry L.; Thompson, Kendra; Regehr, Kaleigh

2004-01-01

A prominent feature of behavior-analytic research has been the use of single-subject designs. We examined sport psychology journals and behavioral journals published during the past 30 years, and located 40 studies using single-subject designs to assess interventions for enhancing the performance of athletes and coaches. In this paper, we summarize that body of research, discuss its strengths and limitations, and identify areas for future research. PMID:22478434

Assuring optimal trauma care: the role of trauma centre accreditation

PubMed Central

Simons, Richard; Kirkpatrick, Andrew

2002-01-01

Optimal care of the injured patient requires the delivery of appropriate, definitive care shortly after injury. Over the last 30 to 40 years, civilian trauma systems and trauma centres have been developed in the United States based on experience gained in military conflicts, particularly in Korea and Vietnam. A similar process is evolving in Canada. National trauma committees in the US and Canada have defined optimal resources to meet the goal of rapid, appropriate care in trauma centres. They have introduced programs (verification or accreditation) to externally audit trauma centre performance based on these guidelines. It is generally accepted that implementing trauma systems results in decreased preventable death and improved survival after trauma. What is less clear is the degree to which each facet of trauma system development contributes to this improvement. The relative importance of national performance guidelines and trauma centre audit as integral steps toward improved outcomes following injury are reviewed. Current Trauma Association of Canada guidelines for trauma centres are presented and the process of trauma centre accreditation is discussed. PMID:12174987

Tasmania's Child and Family Centres: A Place-Based Early Childhood Services Model for Families and Children from Pregnancy to Age Five

ERIC Educational Resources Information Center

Taylor, Catherine L.; Jose, Kim; van de Lageweg, Wietse I.; Christensen, Daniel

2017-01-01

Tasmania's child and family centres (Centres) provide a single entry point to early childhood services (ECS) for children and families living in amongst the most disadvantaged communities in Australia. This study investigated the impact of Centres on parents' use and experiences of ECS using a mixed methods approach. The results showed that Centre…

Anisotropic interactions of a single spin and dark-spin spectroscopy in diamond

NASA Astrophysics Data System (ADS)

Epstein, R. J.; Mendoza, F. M.; Kato, Y. K.; Awschalom, D. D.

2005-11-01

Experiments on single nitrogen-vacancy (N-V) centres in diamond, which include electron spin resonance, Rabi oscillations, single-shot spin readout and two-qubit operations with a nearby13C nuclear spin, show the potential of this spin system for solid-state quantum information processing. Moreover, N-V centre ensembles can have spin-coherence times exceeding 50 μs at room temperature. We have developed an angle-resolved magneto-photoluminescence microscope apparatus to investigate the anisotropic electron-spin interactions of single N-V centres at room temperature. We observe negative peaks in the photoluminescence as a function of both magnetic-field magnitude and angle that are explained by coherent spin precession and anisotropic relaxation at spin-level anti-crossings. In addition, precise field alignment unmasks the resonant coupling to neighbouring `dark' nitrogen spins, otherwise undetected by photoluminescence. These results demonstrate the capability of our spectroscopic technique for measuring small numbers of dark spins by means of a single bright spin under ambient conditions.

Heart lesion after the first attack of the rheumatic Fever 22 years experience in single centre.

PubMed

Bejiqi, Ramush A; Retkoceri, Ragip; Zeka, Naim; Bejiqi, Hana; Retkoceri, Arber

2015-02-01

Acute rheumatic fever and its sequels, rheumatic heart diseases, remain major unsolved preventable health problems in Kosovo population, particularly among the disadvantages indigenous Albanian and Egyptians people. In Kosovo, despite of performing secondary prophylaxis with benzathine penicillin, acute rheumatic fever hospitalization rates have remained essentially unchanged for the last 20 years. The role of echocardiography in the diagnosis of acute rheumatic carditis was established over the last 20 years. In this study we aimed to determine the prevalence of rheumatic heart disease in children from Kosovo population with first attack of acute rheumatic fever. Also, we presented that echocardiography examination detects a greater prevalence of rheumatic heart disease than other diagnostic procedures. We aimed to compare the sensitivity and specificity of cardiac auscultation, ECG record, lab analysis to echocardiography and to determine the feasibility of specific age in this setting. To optimize accurate diagnosis of rheumatic fever and rheumatic heart disease, we utilized two group models. In the first group of 388 children, hospitalized and treated before 1999, diagnosis of rheumatic fever was decided basing on the clinical and laboratory findings whereas in second group (221 children treated from1999 to 2010) clinical and lab diagnosis were amplified also on the detection by echocardiography. In second group, using echocardiography as a method of diagnosis and assessment children with rheumatic fever, we found high rates of undetected rheumatic heart disease in this high-risk group population. Echocardiographic examination of children with rheumatic fever for rheumatic heart disease may over diagnose rheumatic heart disease unless congenital mitral valve anomalies and physiological regurgitation are excluded.

Oo-Za-We-Kwun Centre Incorporated

ERIC Educational Resources Information Center

Findlay, P. R.; And Others

1976-01-01

The Centre is described as being designed to help native people participate more effectively in a modern Canadian environment. The residential family program includes a five-week Life Skills course followed by a two-year transfer of learning period during which counseling, paid employment, and community activities are available. (Author/MS)

Safety and efficacy of dual-lead thalamic deep brain stimulation for patients with treatment-refractory multiple sclerosis tremor: a single-centre, randomised, single-blind, pilot trial.

PubMed

Oliveria, Seth F; Rodriguez, Ramon L; Bowers, Dawn; Kantor, Daniel; Hilliard, Justin D; Monari, Erin H; Scott, Bonnie M; Okun, Michael S; Foote, Kelly D

2017-09-01

Efficacy in previous studies of surgical treatments of refractory multiple sclerosis tremor using lesioning or deep brain stimulation (DBS) has been variable. The aim of this study was to investigate the safety and efficacy of dual-lead thalamic DBS (one targeting the ventralis intermedius-ventralis oralis posterior nucleus border [the VIM lead] and one targeting the ventralis oralis anterior-ventralis oralis posterior border [the VO lead]) for the treatment of multiple sclerosis tremor. We did a single centre, single-blind, prospective, randomised pilot trial at the University of Florida Center for Movement Disorders and Neurorestoration clinic (Gainesville, FL, USA). We recruited adult patients with a clinical diagnosis of multiple sclerosis tremor refractory to previous medical therapy. Before surgery to implant both leads, we randomly assigned patients (1:1) to receive 3 months of optimised single-lead DBS-either VIM or VO. We did the randomisation with a computer-generated sequence, using three blocks of four patients, and independent members of the Center did the assignment. Patients and all clinicians other than the DBS programming nurse were masked to the choice of lead. Patients underwent surgery 1 month after their baseline visit for implantation of the dual lead DBS system. A pulse generator and two extension cables were implanted in a second surgery 3-4 weeks later. Patients then received an initial 3-month period of continuous stimulation of either the VIM or VO lead followed by blinded safety assessment of their tremor with the Tolosa-Fahn-Marin Tremor Rating Scale (TRS) during optimised VIM or VO lead stimulation at the end of the 3 months. After this visit, both leads were activated in all patients for an additional 3 months, and optimally programmed during serial visits as dictated by a prespecified programming algorithm. At the 6-month follow-up visit, TRS score was measured, and mood and psychological batteries were administered under four

Surgical intervention for paediatric liver injuries is almost history - a 12-year cohort from a major Scandinavian trauma centre.

PubMed

Koyama, Tomohide; Skattum, Jorunn; Engelsen, Peder; Eken, Torsten; Gaarder, Christine; Naess, Pål Aksel

2016-11-29

Although nonoperative management (NOM) has become standard care, optimal treatment of liver injuries in children is still challenging since many of these patients have multiple injuries. Moreover, the role of angiography remains poorly defined, and a high index of suspicion of complications is warranted. This study reviews treatment and outcomes in children with liver injuries at a major Scandinavian trauma centre over a 12-year period. Patients <17 years old with liver injury admitted to Oslo University Hospital Ullevaal during the period 2002-2013 were retrospectively reviewed. Data were compiled from the institutional trauma registry and medical records. A total of 66 children were included. The majority was severely injured as reflected by a median injury severity score of 20.5 (mean 22.2). NOM was attempted in 60 (90.9%) patients and was successful in 57, resulting in a NOM success rate of 95.0% [95% CI 89.3 to 100]. Only one of the three NOM failures was liver related, occurred in the early part of the study period, and consisted in operative placement of drains for bile leak. Two (3.0%) patients underwent angiographic embolization (AE). Complications occurred in 18 (27.3% [95 % CI 16.2 to 38.3]) patients. Only 2 (3.0%) patients had liver related complications, in both cases bile leak. Six (9.1%) patients underwent therapeutic laparotomy for non-liver related injuries. Two (3.0%) patients died secondary to traumatic brain injury. This single institution paediatric liver injury cohort confirms high attempted NOM and NOM success rates even in patients with high grade injuries and multiple accompanying injuries. AE can be a useful NOM adjunct in the treatment of paediatric liver injuries, but is seldom indicated. Moreover, bile leak is the most common liver-related complication and the need for liver-related surgery is very infrequent. NOM is the treatment of choice in almost all liver injuries in children, with operative management and interventional radiology

Incremental cost-effectiveness of trauma service improvements for road trauma casualties: experience of an Australian major trauma centre.

PubMed

Dinh, Michael M; Bein, Kendall J; Hendrie, Delia; Gabbe, Belinda; Byrne, Christopher M; Ivers, Rebecca

2016-09-01

Objective The aim of the present study was to estimate the cost-effectiveness of trauma service funding enhancements at an inner city major trauma centre. Methods The present study was a cost-effectiveness analysis using retrospective trauma registry data of all major trauma patients (injury severity score >15) presenting after road trauma between 2001 and 2012. The primary outcome was cost per life year gained associated with the intervention period (2007-12) compared with the pre-intervention period (2001-06). Incremental costs were represented by all trauma-related funding enhancements undertaken between 2007 and 2010. Risk adjustment for years of life lost was conducted using zero-inflated negative binomial regression modelling. All costs were expressed in 2012 Australian dollar values. Results In all, 876 patients were identified during the study period. The incremental cost of trauma enhancements between 2007 and 2012 totalled $7.91million, of which $2.86million (36%) was attributable to road trauma patients. After adjustment for important covariates, the odds of in-hospital mortality reduced by around half (adjusted odds ratio (OR) 0.48; 95% confidence interval (CI) 0.27, 0.82; P=0.01). The incremental cost-effectiveness ratio was A$7600 per life year gained (95% CI A$5524, $19333). Conclusion Trauma service funding enhancements that enabled a quality improvement program at a single major trauma centre were found to be cost-effective based on current international and Australian standards. What is known about this topic? Trauma quality improvement programs have been implemented across most designated trauma hospitals in an effort to improve hospital care processes and outcomes for injured patients. These involve a combination of education and training, the use of audit and key performance indicators. What does this paper add? A trauma quality improvement program initiated at an Australian Major Trauma Centre was found to be cost-effective over 12 years with

Childhood intussusception: 17-year experience at a tertiary referral centre in Hong Kong.

PubMed

Wong, Carol W Y; Chan, Ivy H Y; Chung, Patrick H Y; Lan, Lawrence C L; Lam, Wendy W M; Wong, Kenneth K Y; Tam, Paul K H

2015-12-01

To review all paediatric patients with intussusception over the last 17 years. Retrospective case series. A tertiary centre in Hong Kong. Children who presented with intussusception from January 1997 to December 2014 were reviewed. The duration of symptoms, successful treatment modalities, complication rate, and length of hospital stay were studied. A total of 173 children (108 male, 65 female) presented to our hospital with intussusception during the study period. Their median age at presentation was 12.5 months (range, 2 months to 16 years) and the mean duration of symptoms was 2.3 (standard deviation, 1.8) days. Vomiting was the most common symptom (76.3%) followed by abdominal pain (46.2%), per rectal bleeding or red currant jelly stool (40.5%), and a palpable abdominal mass (39.3%). Overall, 160 patients proceeded to pneumatic or hydrostatic reduction, among whom 127 (79.4%) were successful. Three (1.9%) patients had bowel perforation during the procedure. Early recurrence of intussusception occurred in four (3.1%) patients with non-operative reduction. No recurrence was reported in the operative group. The presence of a palpable abdominal mass was a risk factor for operative treatment (relative risk=2.0; 95% confidence interval, 1.8-2.2). Analysis of our results suggested that duration of symptoms did not affect the success rate of non-operative reduction. Non-operative reduction has a high success rate and low complication rate, but the presence of a palpable abdominal mass is a risk factor for failure. Operative intervention should not be delayed in those patients who encounter difficult or doubtful non-operative reduction.

Efficiency of piezosurgery technique in miniscrew supported en-masse retraction: a single-centre, randomized controlled trial.

PubMed

Tunçer, Nilüfer Irem; Arman-Özçirpici, Ayça; Oduncuoglu, Bahar Füsun; Göçmen, Jülide Sedef; Kantarci, Alpdogan

2017-11-30

Piezoelectric surgery is a newly introduced technique for rapid tooth movement. However, the efficiency of this technique has not been investigated on en-masse retraction cases yet. To investigate the efficiency of piezosurgery technique in accelerating miniscrew supported en-masse retraction and study the biological tissue response. In addition, to show if this technique induces a difference in dental, skeletal and soft tissue changes on lateral cephalograms, and in canine and molar rotations, besides intercanine and intermolar widths on dental casts. We conducted a randomized, single-centred, parallel-group, controlled trial, requiring upper right and left first premolar extractions on 30 patients above the minimum age of 14 years at the beginning of retraction. Piezosurgery-assisted versus conventional en-masse retraction anchored from miniscrews placed between second premolars and first molars, bilaterally. The main outcome was the en-masse retraction rate. Secondary outcomes were gingival crevicular fluid (GCF) volume and GCF content of receptor activator of nuclear factor κβ ligand (RANKL), changes regarding cephalometric and dental cast variables, and miniscrew success rates. Accomplished with opaque, sealed envelopes. Applicable for data assessment only. Commenced in February 2013 and ended in October 2014. Thirty-one patients were included in the study and divided into 2 groups of piezosurgery (n = 16) and control (n = 15). After 9.3 months of follow-up, no statistically significant difference was observed between groups for neither retraction rates (P = 0.958) nor GCF parameters (P > 0.05). Changes in lateral cephalometric and dental cast variables, and miniscrew success rates did not show significant differences either. Based on the results of this study, piezosurgery technique was found to be ineffective in accelerating en-masse retraction, and promoting a difference in the studied GCF parameters, skeletal and dental variables. The trial was not

Person-Centred Reviews and Transition: An Exploration of the Views of Students and Their Parents/Carers

ERIC Educational Resources Information Center

White, Julie; Rae, Tina

2016-01-01

The person-centred review (PCR) is a model for the review of a student's special educational needs (SEN) which places the young person and their family at the centre of the process. This mixed-methods, exploratory study investigated the views of 16 students with SEN aged between 10-11 years (Year 6) and 13-14 years (Year 9), and their…

Impaired laparoscopic performance of novice surgeons due to phone call distraction: a single-centre, prospective study.

PubMed

Yang, Cui; Heinze, Julia; Helmert, Jens; Weitz, Juergen; Reissfelder, Christoph; Mees, Soeren Torge

2017-12-01

Distractions such as phone calls during laparoscopic surgery play an important role in many operating rooms. The aim of this single-centre, prospective study was to assess if laparoscopic performance is impaired by intraoperative phone calls in novice surgeons. From October 2015 to June 2016, 30 novice surgeons (medical students) underwent a laparoscopic surgery training curriculum including two validated tasks (peg transfer, precision cutting) until achieving a defined level of proficiency. For testing, participants were required to perform these tasks under three conditions: no distraction (control) and two standardised distractions in terms of phone calls requiring response (mild and strong distraction). Task performance was evaluated by analysing time and accuracy of the tasks and response of the phone call. In peg transfer (easy task), mild distraction did not worsen the performance significantly, while strong distraction was linked to error and inefficiency with significantly deteriorated performance (P < 0.05). Precision cutting (difficult task) was not slowed down by mild distraction, but surgical and cognitive errors were significantly increased when participants were distracted (P < 0.05). Compared to mild distraction, participants reported a more severe subjective disturbance when they were diverted by strong distraction (P < 0.05). Our data reveals that phone call distractions result in impaired laparoscopic performance under certain circumstances. To ensure patient safety, phone calls should be avoided as far as possible in operating rooms.

Efficacy and safety of canakinumab therapy in paediatric patients with cryopyrin-associated periodic syndrome: a single-centre, real-world experience.

PubMed

Russo, Ricardo A G; Melo-Gomes, Sonia; Lachmann, Helen J; Wynne, Karen; Rajput, Kaukab; Eleftheriou, Despina; Edelsten, Clive; Hawkins, Philip N; Brogan, Paul A

2014-04-01

The aim of this study was to determine the short- and long-term efficacy and safety of 8-weekly canakinumab therapy in children with cryopyrin-associated periodic syndromes (CAPS) in routine clinical practice. A single-centre observational study was performed. Patients were assessed every 8 weeks at a dedicated clinic. Standardized assessments were the 10-domains DAS for CAPS, acute phase reactants (APRs), physician's global assessment of disease activity, Child Health Assessment Questionnaire (CHAQ) and Child Health Questionnaire Parent Form 28 (CHQPF-28). The primary endpoint was clinical improvement, defined as a reduction of DAS score 8 weeks after commencing therapy. Secondary endpoints included sustained clinical improvement in APRs, relapses, CHAQ score and CHQPF-28 score. Ten children with CAPS [eight Muckle-Wells syndrome (MWS), two chronic infantile cutaneous neurological articular (CINCA); median age 6.3 years] received 8-weekly canakinumab treatments at 2-8.7 mg/kg for a median of 21 months (range 12-31 months). Nine of 10 patients improved after the first dose: baseline median DAS of 7.5/20 decreased to 3.5/20 at 8 weeks (P = 0.04). This clinical improvement was sustained at a median follow-up of 21 months (range 12-31 months). Children with CINCA required higher doses of canakinumab than those with MWS. CHAQ and CHQ scores indicated improvement in functioning and health-related quality of life (HRQoL). Treatment was well tolerated, with no injection site reactions and no serious infections. Canakinumab, although costly, is a safe and effective treatment for CAPS in children, leading to sustained improvement in disease activity, serological markers, functional ability and HRQoL.

Heart Lesion After the First Attack of the Rheumatic Fever 22 Years Experience in Single Centre

PubMed Central

Bejiqi, Ramush A.; Retkoceri, Ragip; Zeka, Naim; Bejiqi, Hana; Retkoceri, Arber

2015-01-01

Background: Acute rheumatic fever and its sequels, rheumatic heart diseases, remain major unsolved preventable health problems in Kosovo population, particularly among the disadvantages indigenous Albanian and Egyptians people. In Kosovo, despite of performing secondary prophylaxis with benzathine penicillin, acute rheumatic fever hospitalization rates have remained essentially unchanged for the last 20 years. The role of echocardiography in the diagnosis of acute rheumatic carditis was established over the last 20 years. Aims: In this study we aimed to determine the prevalence of rheumatic heart disease in children from Kosovo population with first attack of acute rheumatic fever. Also, we presented that echocardiography examination detects a greater prevalence of rheumatic heart disease than other diagnostic procedures. We aimed to compare the sensitivity and specificity of cardiac auscultation, ECG record, lab analysis to echocardiography and to determine the feasibility of specific age in this setting. Methods: To optimize accurate diagnosis of rheumatic fever and rheumatic heart disease, we utilized two group models. In the first group of 388 children, hospitalized and treated before 1999, diagnosis of rheumatic fever was decided basing on the clinical and laboratory findings whereas in second group (221 children treated from1999 to 2010) clinical and lab diagnosis were amplified also on the detection by echocardiography. Conclusion: In second group, using echocardiography as a method of diagnosis and assessment children with rheumatic fever, we found high rates of undetected rheumatic heart disease in this high-risk group population. Echocardiographic examination of children with rheumatic fever for rheumatic heart disease may over diagnose rheumatic heart disease unless congenital mitral valve anomalies and physiological regurgitation are excluded. PMID:25870479

RTEMS Centre - Support and Maintenance Centre to RTEMS Operating System

NASA Astrophysics Data System (ADS)

Silva, H.; Constantino, A.; Freitas, D.; Coutinho, M.; Faustino, S.; Mota, M.; Colaço, P.; Sousa, J.; Dias, L.; Damjanovic, B.; Zulianello, M.; Rufino, J.

2009-05-01

RTEMS CENTRE - Support and Maintenance Centre to RTEMS Operating System is a joint ESA/Portuguese Task Force initiative to develop a support and maintenance centre to the Real-Time Executive for Multiprocessor Systems (RTEMS). This paper gives a high level visibility of the progress, the results obtained and the future work in the RTEMS CENTRE [6] and in the RTEMS Improvement [7] projects. RTEMS CENTRE started officially in November 2006, with the RTEMS 4.6.99.2 version. A full analysis of RTEMS operating system was produced. The architecture was analysed in terms of conceptual, organizational and operational concepts. The original objectives [1] of the centre were primarily to create and maintain technical expertise and competences in this RTOS, to develop a website to provide the European Space Community an entry point for obtaining support (http://rtemscentre.edisoft.pt), to design, develop, maintain and integrate some RTEMS support tools (Timeline Tool, Configuration and Management Tools), to maintain flight libraries and Board Support Packages, to develop a strong relationship with the World RTEMS Community and finally to produce some considerations in ARINC-653, DO-178B and ECSS E-40 standards. RTEMS Improvement is the continuation of the RTEMS CENTRE. Currently the RTEMS, version 4.8.0, is being facilitated for a future qualification. In this work, the validation material is being produced following the Galileo Software Standards Development Assurance Level B [5]. RTEMS is being completely tested, errors analysed, dead and deactivated code removed and tests produced to achieve 100% statement and decision coverage of source code [2]. The SW to exploit the LEON Memory Management Unit (MMU) hardware will be also added. A brief description of the expected implementations will be given.

Cost comparison of re-usable and single-use fibrescopes in a large English teaching hospital.

PubMed

McCahon, R A; Whynes, D K

2015-06-01

A number of studies in the U.S.A. and mainland Europe have described the costs of fibreoptic tracheal intubation. However, no such data from the UK appear available. We performed a cost assessment of fibreoptic intubation, using re-usable (various devices from Olympus, Acutronic and Karl Storz) and single-use (Ambu aScope) fibrescopes, at the Queens Medical Centre, Nottingham, U.K., between 1 January 2009 and 31 March 2014. The total annual cost of fibreoptic intubation with re-usable fibrescopes was £46,385. Based on 141 fibreoptic intubations per year, this equated to £329 per use, an average dominated by repair/maintenance costs (43%) and capital depreciation costs (42%). In comparison, the total annual cost of using single-use fibrescopes for the same work would have been around £200 per use. The analysis enabled us to develop a generic model, wherein we were able to describe the relationship between total cost of use vs number of uses for a fibrescope. An 'isopleth' was identified for this relationship: a line that joined all the points where the cost of re-usable vs single-use fibrescopes was equal. It appears cheaper to use single-use fibrescopes at up to 200 fibreoptic intubations per year (a range commensurate with normal practice) even when the repair rate for re-usable fibrescopes is low. Any centre, knowing its fibrescope use and repair rate, can plot its data similarly to help ascertain which of the re-usable or single-use fibrescope represents better value. © 2015 The Association of Anaesthetists of Great Britain and Ireland.

How Quickly Do Asymptomatic Infrarenal Abdominal Aortic Aneurysms Grow and What Factors Affect Aneurysm Growth Rates? Analysis of a Single Centre Surveillance Cohort Database.

PubMed

Ahmad, Mehtab; Mistry, Rakesh; Hodson, James; Bradbury, Andrew W

2017-11-01

Abdominal aortic aneurysm (AAA) maximum antero-posterior diameter (MAPD) is the parameter most commonly used to inform the timing of surgical intervention. However, other factors, such as growth rates and patient comorbidities are likely to be important considerations as they may influence AAA related complications including rupture, operative outcomes, and the clinical and cost effectiveness of continued surveillance. This was a retrospective analysis of a 20 year period of a single centre AAA surveillance database. In total, 5363 AAA measurements in 692 patients were analysed for patient demographics, including comorbidity and drug history, growth and rupture rates, and cause of death. A significant proportion of patients (n = 73; 11%) were kept under surveillance despite having a MAPD < 30 mm. Overall, mean aneurysm growth rate was 2.3 mm/year. Elective repair was undertaken in 20.1% and those who required surgical intervention had significantly faster growth rates. Only 3.9% of patients in surveillance ruptured, 40.7% of whom had a MAPD <55 mm at their last scan. Of the 214 deaths recorded, only 11.7% were related to AAA. The majority of patients who died in surveillance did so from malignancy. Patients with larger AAA (MAPD > 40 mm) on entry into surveillance were significantly more likely to receive surgical intervention, as were those whose AAA expanded >4 mm/year. Females had significantly higher growth rates, and those with diabetes had significantly smaller growth rates. Other comorbidities and drug history were not associated with AAA growth, or 5 and 10 year surgery free survival. The results highlight several areas for service improvement. Specifically, it is important not to maintain surveillance in patients who are very unlikely to ever grow to a point where AAA surgery would be contemplated on grounds or age and/or comorbidity. Similarly, patients should be discharged from surveillance when this likelihood becomes apparent. Crown

In the Field: The Canadian Ecology Centre.

ERIC Educational Resources Information Center

Magee, Clare

2000-01-01

The Canadian Ecology Centre (Ontario) offers year-round residential and day programs in outdoor and environmental education for secondary students, field placement and internship opportunities for college students, and ecotourism programs, while providing employment and tax revenues to the local community. Dubbed consensus environmentalism, the…

UK Renal Registry 16th annual report: chapter 14 2012 multisite dialysis access audit in England, Northern Ireland and Wales and 2011 PD one year follow-up: national and centre-specific analyses.

PubMed

Briggs, Victoria; Pitcher, David; Shaw, Catriona; Fluck, Richard; Wilkie, Martin

2013-01-01

Dialysis access should be timely, minimise complications and maintain functionality. Good functional access is required for renal replacement therapy (RRT) to be successful. The aim of the combined vascular and peritoneal dialysis access audit was to examine practice patterns with respect to dialysis access and highlight variations in practice between renal centres. The UK Renal Registry collected centre-specific information on vascular and peritoneal access outcome measures including patient demographics, dialysis access type (at start of dialysis and three months after start of dialysis), surgical assessment and access functionality. The combined access audit covered incident haemodialysis (HD) and peritoneal dialysis (PD) patients in 2012 from England, Northern Ireland and Wales. Centres who had reported data on incident PD patients for the previous audit in 2011 were additionally asked to provide one year follow up data for this group. Fifty-one centres in England, Wales and Northern Ireland (representing 82% of all centres) returned data on first access from 3,720 incident HD patients and 1,018 incident PD patients. A strong relationship was seen between surgical assessment and the likelihood of starting HD with an arteriovenous fistula (AVF). Type of first access was related to the length of time known to renal services with higher numbers of AVFs and PD catheters used in patients known to renal services for at least one year. Three month and one year outcomes of HD and PD access were poorly reported. This audit provides information on important patient related outcome measures with the potential to lead to an improvement in access provision. This represents an important advance, however data collection remains suboptimal. There is wide practice variation across the England, Wales and Northern Ireland in provision of both HD and PD access which requires further exploration. © 2014 S. Karger AG, Basel.

Single-Ventricle Palliation in a 4-Year-Old With Ehlers-Danlos Syndrome.

PubMed

DeBoard, Zach M; Eckhauser, Aaron W; Griffiths, Eric

2018-01-01

We report the case of a 4-year-old boy with Ehlers-Danlos syndrome undergoing single-ventricle palliation for an unbalanced atrioventricular canal defect. No reports of single-ventricle palliation in the setting of connective tissue disorders exist in the current literature. Unique findings on the patient's preoperative imaging included a disproportionately large neoaortic root and a regurgitant atrioventricular valve, which may foretell the need for future intervention. Copyright © 2018 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Delayed Single Stage Perineal Posterior Urethroplasty.

PubMed

Ali, Shahzad; Shahnawaz; Shahzad, Iqbal; Baloch, Muhammad Umar

2015-06-01

To determine the delayed single stage perineal posterior urethroplasty for treatment of posterior urethral stricture/distraction defect. Descriptive case series. Department of Urology, Jinnah Postgraduate Medical Centre, Karachi, from January 2009 to December 2011. Patients were selected for delayed single stage perineal posterior urethroplasty for treatment of posterior urethral stricture / distraction defect. All were initially suprapubically catheterized followed by definitive surgery after at least 3 months. Thirty male patients were analyzed with a mean follow-up of 10 months, 2 patients were excluded as they developed failure in first 3 months postoperatively. Mean patient's age was 26.25 ± 7.9 years. On follow-up, 7 patients (23.3%) experienced recurrent stricture during first 10 months. Five (16.6%) patients were treated successfully with single direct visual internal urethrotomy. Two patients (6.6%) had more than one direct visual internal urethrotomy and considered failed. Re-do perineal urethroplasty was eventually performed. The overall success rate was 93.3% with permissive criteria allowing single direct visual internal urethrotomy and 76.6% with strict criteria allowing no more procedures postoperatively. Posterior anastomotic urethroplasty offers excellent long-term results to patients with posterior urethral trauma and distraction defect even after multiple prior procedures.

The Search for Centre

ERIC Educational Resources Information Center

Nunes, April

2006-01-01

This paper acknowledges the importance of a dancer's centre but likewise highlights the problematic nature of the communication of this concept from dance teacher to student. After a brief introduction of orthodox approaches in finding centre, this paper suggests a method of locating centre through the ancient somatic technique.

An Audit of Clinical Practice in a Single Centre in Kuwait: Management of Children on Continuous Subcutaneous Insulin Infusion and Cardiovascular Risk Factors Screening.

PubMed

Omar, Dina; Alsanae, Hala; Al Khawari, Mona; Abdulrasoul, Majedah; Rahme, Zahraa; Al Refaei, Faisal; Behbehani, Kazem; Shaltout, Azza

2017-01-01

To audit the current clinical practice of continuous subcutaneous insulin infusion (CSII) for the treatment of type 1 diabetes mellitus (T1D) in children and adolescents attending a single centre in Kuwait. A one year retrospective audit was performed in children and adolescents with T1D on CSII, who attended the paediatric diabetes clinic, Dasman Diabetes Institute during 2012. The primary outcome measure was glycaemic control as evidenced by glycated haemoglobin (HbA1c) level and the secondary outcome measures were the frequency of monitoring of the risk for microvascular complications and occurrence of acute complications and adverse events. 58 children and adolescents (mean age ± SD: 12.6 ± 4.1 years) were included. Mean HbA1c at baseline was 8.8% (72.7 mmol/mol) and 8.9% (73.8 mmol/mol) at the end of a 12 months observation period. Children with poor control (HbA1c >9.5% (80 mmol/mol) had a significant 1.4% reduction in HbA1c compared with the overall reduction of 0.1% (p=0.7). Rate of screening for cardiovascular risk factors and for long term complications were well documented. However, there was underreporting of acute complications such as severe hypoglycaemia and diabetic ketoacidosis. Only 1.7% of patients discontinued the pump. There was no significant change in HbA1c values at the end of 12 months follow up. However, HbA1c values in poorly controlled children improved. CSII requires care by skilled health professionals as well as education and selection of motivated parents and children.

Design-corrected variation by centre in mortality reduction in the ERSPC randomised prostate cancer screening trial.

PubMed

Hakama, Matti; Moss, Sue M; Stenman, Ulf-Hakan; Roobol, Monique J; Zappa, Marco; Carlsson, Sigrid; Randazzo, Marco; Nelen, Vera; Hugosson, Jonas

2017-06-01

Objectives To calculate design-corrected estimates of the effect of screening on prostate cancer mortality by centre in the European Randomised Study of Screening for Prostate Cancer (ERSPC). Setting The ERSPC has shown a 21% reduction in prostate cancer mortality in men invited to screening with follow-up truncated at 13 years. Centres either used pre-consent randomisation (effectiveness design) or post-consent randomisation (efficacy design). Methods In six centres (three effectiveness design, three efficacy design) with follow-up until the end of 2010, or maximum 13 years, the effect of screening was estimated as both effectiveness (mortality reduction in the target population) and efficacy (reduction in those actually screened). Results The overall crude prostate cancer mortality risk ratio in the intervention arm vs control arm for the six centres was 0.79 ranging from a 14% increase to a 38% reduction. The risk ratio was 0.85 in centres with effectiveness design and 0.73 in those with efficacy design. After correcting for design, overall efficacy was 27%, 24% in pre-consent and 29% in post-consent centres, ranging between a 12% increase and a 52% reduction. Conclusion The estimated overall effect of screening in attenders (efficacy) was a 27% reduction in prostate cancer mortality at 13 years' follow-up. The variation in efficacy between centres was greater than the range in risk ratio without correction for design. The centre-specific variation in the mortality reduction could not be accounted for by the randomisation method.

CHANGING PATTERN OF DRUG ABUSE AMONG PATIENTS ATTENDING DE-ADDICTION CENTRE AT FARIDKOT

PubMed Central

Sachadev, Jaswant Singh; Yakhmi, Ranvir Singh; Sharma, Ajay Kumar

2002-01-01

Prevalence and patten of drug abuse among patients attending deaddiction centre of GGS Medical College and Hospital Faridkot in the year 1994 were analysed and compared with pattern of drug abuse among the patients attending the same centre in 1998 It was observed that there was an increase in the patients using the drugs available over the counter with chemists. It was also found that there was a decrease in the number of patients using raw opium in the year 1998 as compared to the year 1994. PMID:21206599

Pesticide intoxications in the Centre of Portugal: three years analysis.

PubMed

Teixeira, Helena; Proença, Paula; Alvarenga, Margarida; Oliveira, Margarida; Marques, Estela P; Vieira, Duarte Nuno

2004-07-16

Pesticides are used in most countries around the world to protect agricultural and horticultural crops against damage. Poisoning by these toxicant agents occurs as a result of misuse or accidental exposure, and also by oral ingestion (voluntary or not). In Portugal, pesticide intoxications are still a cause of death, found in a considerable number of cases. The authors retrospectively examined the cases of pesticide poisoning in the Centre of Portugal, from autopsies performed in the Forensic Pathology Service of Coimbra's Delegation of the National Institute of Legal Medicine (NILM) and from other autopsies carried out in the Centre of Portugal, as well as some samples taken in hospitals in cases of suspected intoxication. In this study, the positive cases have been especially studied, in order to identify the pesticide used, as well as the etiology. The frequency of intoxications and its distribution by sex and age were also analyzed. Between January 2000 and December 2002, the Forensic Toxicology Laboratory received 639 pesticide analysis requests. In 2000, in a total of 149 analysis requests, 30 cases were positive, 63.3% from male individuals and 36.7% from female. In 2001, the analysis requests increased to 240 as well as the positive cases (43), 74.4% from male individuals and 25.6% from female and in 2002, the total cases analyzed also increased to 250, with 38 positive (73.6% from male individuals and 26.4% from female). Among the pesticides, organophosphorus insecticides still constitute the most important class detected in forensic intoxications, representing 63% of the total positive cases, followed by herbicides, with 33% of the positive results. Quinalphos is the most important organophosphorus insecticide, present in 32 of the 111 positive cases, followed by the herbicide paraquat, detected in 31 cases. The study emphasizes the increasing number of pesticide analyses, particularly relevant for the organophosphorus compounds and herbicides

Reducing cooling energy consumption in data centres and critical facilities

NASA Astrophysics Data System (ADS)

Cross, Gareth

Given the rise of our everyday reliance on computers in all walks of life, from checking the train times to paying our credit card bills online, the need for computational power is ever increasing. Other than the ever-increasing performance of home Personal Computers (PC's) this reliance has given rise to a new phenomenon in the last 10 years ago. The data centre. Data centres contain vast arrays of IT cabinets loaded with servers that perform millions of computational equations every second. It is these data centres that allow us to continue with our reliance on the internet and the PC. As more and more data centres become necessary due to the increase in computing processing power required for the everyday activities we all take for granted so the energy consumed by these data centres rises. Not only are more and more data centres being constructed daily, but operators are also looking at ways to squeeze more processing from their existing data centres. This in turn leads to greater heat outputs and therefore requires more cooling. Cooling data centres requires a sizeable energy input, indeed to many megawatts per data centre site. Given the large amounts of money dependant on the successful operation of data centres, in particular for data centres operated by financial institutions, the onus is predominantly on ensuring the data centres operate with no technical glitches rather than in an energy conscious fashion. This report aims to investigate the ways and means of reducing energy consumption within data centres without compromising the technology the data centres are designed to house. As well as discussing the individual merits of the technologies and their implementation technical calculations will be undertaken where necessary to determine the levels of energy saving, if any, from each proposal. To enable comparison between each proposal any design calculations within this report will be undertaken against a notional data facility. This data facility will

Colorectal cancer patients in a tertiary referral centre in Malaysia: a five year follow-up review.

PubMed

Rashid, Mohd Radzniwan A; Aziz, Aznida Firzah Abdul; Ahmad, Saharuddin; Shah, Shamsul Azhar; Sagap, Ismail

2009-01-01

Colorectal cancer (CRC) is one of the major malignancies in the world. In Malaysia, CRC is fast becoming the commonest cause of cancer death. Its etiology is complex, involving both environmental and genetic factors. This study looked at the profile and outcome of five-year follow-up of patients with CRC. Retrospective case review study done on CRC patients at University Kebangsaan Malaysia Medical Centre (UKMMC), Kuala Lumpur, Malaysia. Patientsandapos; socio-demographic characteristics, modalities of treatment, cancer characteristics and outcome at 5-year follow up were extracted from the case records. A total of 107 case records of patients were analyzed. Peak age of CRC presentation was 40-69 years (71.1%). Male to female ratio was 1.2:1 with Chinese predominance (52.3%). Anaemia and its related symptoms including per rectal bleeding was the commonest clinical presentation. The median duration of clinical presentation was 13 weeks (IQR 21.8). More than two-thirds presented as non-emergency cases (69.2%). Most patients presented with Dukes C stage (40.2%). The overall 5-year survival rate was 40% with local recurrence rate of 19.6%. Metastasis after curative-intend treatment (surgery with adjuvant therapy) developed in 26% of patients. Lower recurrence (p = 0.016, OR = 0.205) and metastatic disease (p = 0.02, OR = 0.24) found among the Chinese patients. Almost half of the patients defaulted follow up care (43%), most often within the first year of treatment (22.4%) and the Chinese were the least likely to default (p= 0.04, OR = 0.45). Socio-demographic profile of CRC patients in UKMMC is comparable to Asia pacific region. Apparent delay in seeking treatment gives rise to poor overall survival and local recurrence rates.

Safety in Numbers: Mathematics Support Centres and Their Derivatives as Social Learning Spaces

ERIC Educational Resources Information Center

Solomon, Yvette; Croft, Tony; Lawson, Duncan

2010-01-01

This article reports on data gathered from second and third year mathematics undergraduates at two British universities which have developed Mathematics Support Centres, primarily with a view to supporting skills development for engineering students. However, an unforeseen consequence of the support centres was the mathematics students'…

Haemodialysis in an emerging centre in a developing country: a two year review and predictors of mortality

PubMed Central

2011-01-01

Background Haemodialysis is the most common form of renal replacement therapy in Nigeria. The high cost of haemodialysis has made optimal therapy of end-stage renal disease difficult in Nigeria. This paper is a review of data collected over two years of provision of dialysis services in a new tertiary hospital in Southern Nigeria. Methods This retrospective analysis is done on data obtained from the patient case files and dialysis records in the first two years of provision of dialysis services in our centre. A gender comparison of the patients' baseline sociodemographic, clinical and biochemical was performed and a logistic regression model used to assess the predictors of mortality. Results A total of 98 patients had 471 sessions in the two years under review. Males and females had similar characteristics at baseline except for a higher median serum urea in the males. The commonest causes of end-stage renal disease were chronic glomerulonephritis (34.5%), hypertension (32.1%) and diabetes mellitus (17.9%). The main predictor of mortality was under treatment with haemodialysis due to inability to pay for more than a few dialysis sessions. Conclusions This study has highlighted the unchanging demographics of our advanced kidney failure patients. Efforts should be aimed at subsidizing the cost of dialysis for our teeming population of dialysis dependent chronic kidney disease patients. PMID:21962220

Neoadjuvant/adjuvant treatment of high-risk retinoblastoma: a report from the German Retinoblastoma Referral Centre.

PubMed

Künkele, Annette; Wilm, Josephine; Holdt, Markus; Lohmann, Dietmar; Bornfeld, Norbert; Eggert, Angelika; Temming, Petra; Schulte, Johannes H

2015-07-01

Retinoblastoma can extend beyond the structures of the eye, where cells can enter the bloodstream and cause metastases. Various types of protocols for adjuvant treatment risk-adapted according to histopathological risk factors are used worldwide. Between 1997 and 2009, 420 children were diagnosed with retinoblastoma at the German Retinoblastoma Referral Centre and risk factors were assessed. Patients with post-laminar optic nerve infiltration or choroid or minor scleral invasion received six courses of adjuvant chemotherapy using vincristine, etoposide, carboplatin and cyclophosphamide (group 1). Patients with microscopic extension beyond the sclera to the resection margin of the optic nerve or potential spread due to vitrectomy received chemotherapy plus orbital radiotherapy (group 2). Neoadjuvant chemotherapy was performed in patients with local extraocular invasion detected on MRI. Following this protocol, 42 of the 420 patients and 21 referred from other centres showed high-risk histopathological factors qualifying for adjuvant therapy (57 in group 1 and 6 in group 2). Seven of the 63 patients received neoadjuvant and adjuvant treatment. During a mean follow-up of 5.8 (range 0.4-15.4) years, one of six patients in group 2 developed metastases and died. No patients died from toxicity. The 5-year overall survival was 100% for group 1 and 80% for group 2. This retrospective single-site study reveals a 10% incidence of high-risk features in children with retinoblastoma diagnosed at the German Retinoblastoma Referral Centre. Overall survival rates of 98.3% underline the safety of this adjuvant chemotherapy protocol and its efficiency in preventing metastasis. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Outcome of lupus nephritis in childhood onset SLE in North and Central India: single-centre experience over 25 years.

PubMed

Srivastava, P; Abujam, B; Misra, R; Lawrence, A; Agarwal, V; Aggarwal, A

2016-04-01

Childhood SLE (cSLE) has a higher prevalence of lupus nephritis (LN), and there are ethnic variations in response to treatment as well as outcome of LN. There are limited data on long-term outcome of LN in cSLE from the Indian subcontinent. Retrospective analysis of case records of patients with cSLE (satisfying revised American College of Rheumatology (ACR) 1997 criteria for diagnosis) and age of onset <18 years was conducted from 1989 to 2013. Data on clinical features, renal involvement and biopsy findings, treatment, renal outcome, damage accrual and mortality were collected. End-stage renal disease (ESRD) was defined as the need for renal replacement therapy. Actuarial ESRD-free survival was studied as the primary outcome measure using Kaplan-Meier analysis. Among 205 children with cSLE, 134 (121 girls) had evidence of LN. The mean age at disease onset was 13.7 ± 3.5 years and the mean disease duration at presentation was 1.9 ± 2.5 years. Kidney biopsy was available for 92 patients, and histology included: 13 (14.2%) Class II, 24 (26%) Class III, 43 (46.7%) Class IV and 12 (13.1%) Class V LN. The mean follow-up period was 6.75 ± 5.7 years. At last visit, 81 (60.4%) children were in complete remission, 28 (20.9%) were in partial remission, 15 (11.2%) still had active nephritis and 10 (7.4%) had progressed to ESRD. Almost two-thirds (62.9%) of patients experienced lupus flares, and mean flare rate was 0.09 flares/patient follow-up year. Fifty-six (43.8%) children accrued damage and the mean Systemic Lupus International Collaborating Clinics (SLICC)/ACR damage score was 0.79 ± 1.13. Actuarial ESRD-free survival at five, 10 and 15 years was 91.1%, 79% and 76.2%, and five-, 10- and 15-year renal survival was 93.8%, 87.1% and 84%, respectively. Although multiple factors individually predicted poor outcome (death/ESRD), only raised serum creatinine at onset (R square = 0.65, p ≤ 0.0001) and damage accrual (R square = 0.62, p�

Six-year clinical outcome of single implant-retained mandibular overdentures--a pilot study.

PubMed

Passia, Nicole; Wolfart, Stefan; Kern, Matthias

2015-10-01

The aim of this prospective pilot study was to evaluate the prosthodontic maintenance as well as the implant outcome of single implant-retained mandibular overdentures over an observation period of 6 years. Eleven edentulous patients received one single implant in the midline of the mandible. Denture bases were temporarily relined and 2 months later provided with a ball attachment for implant retention. Implant related parameters and prosthodontic maintenance interventions were assessed 4 weeks after implant loading and then once a year. Over a mean observation period of 75.9 months, no implant was lost. The most frequent prosthetic maintenance intervention was activation of the matrix due to loss of retention, followed by exchange of the female part. Eight denture bases had to be repaired after a fracture in the midline area. Within the limitations of this preliminary clinical study, the concept of a single midline implant to retain a mandibular complete denture was a successful treatment option for elderly edentulous patients. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Ibrutinib in combination with rituximab in relapsed or refractory mantle cell lymphoma: a single-centre, open-label, phase 2 trial.

PubMed

Wang, Michael L; Lee, Hun; Chuang, Hubert; Wagner-Bartak, Nicolaus; Hagemeister, Frederick; Westin, Jason; Fayad, Luis; Samaniego, Felipe; Turturro, Francesco; Oki, Yasuhiro; Chen, Wendy; Badillo, Maria; Nomie, Krystle; DeLa Rosa, Maria; Zhao, Donglu; Lam, Laura; Addison, Alicia; Zhang, Hui; Young, Ken H; Li, Shaoying; Santos, David; Medeiros, L Jeffrey; Champlin, Richard; Romaguera, Jorge; Zhang, Leo

2016-01-01

Ibrutinib is approved in the EU, USA, and other countries for patients with mantle cell lymphoma who received one previous therapy. In a previous phase 2 study with single-agent ibrutinib, the proportion of patients who achieved an objective response was 68%; 38 (34%) of 111 patients had transient lymphocytosis. We hypothesised that adding rituximab could target mantle cell lymphoma cells associated with redistribution lymphocytosis, leading to more potent antitumour activity. Patients with a confirmed mantle cell lymphoma diagnosis (based on CD20-positive and cyclin D1-positive cells in tissue biopsy specimens), no upper limit on the number of previous treatments received, and an Eastern Cooperative Oncology Group performance status score of 2 or less were enrolled in this single-centre, open-label, phase 2 study. Patients received continuous oral ibrutinib (560 mg) daily until progressive disease or unacceptable toxic effects. Rituximab 375 mg/m(2) was given intravenously once per week for 4 weeks during cycle 1, then on day 1 of cycles 3-8, and thereafter once every other cycle up to 2 years. The primary endpoint was the proportion of patients who achieved an objective response in the intention-to-treat population and safety assessed in the as-treated population. The study is registered with ClinicalTrials.gov, number NCT01880567, and is still ongoing, but no longer accruing patients. Between July 15, 2013, and June 30, 2014, 50 patients were enrolled. Median age was 67 years (range 45-86), and the median number of previous regimens was three (range 1-9). At a median follow-up of 16·5 months (IQR 12·09-19·28), 44 (88%, 95% CI 75·7-95·5) patients achieved an objective response, with 22 (44%, 30·0-58·7) patients achieving a complete response, and 22 (44%, 30·0-58·7) a partial response. The only grade 3 adverse event in >=10% of patients was atrial fibrillation, which was noted in six (12%) patients. Grade 4 diarrhoea and neutropenia occurred in one

Safety of supramesocolic surgery in patients with portal cavernoma without portal vein decompression. Large single centre experience.

PubMed

Dokmak, Safi; Aussilhou, Béatrice; Sauvanet, Alain; Lévy, Philippe; Plessier, Aurélie; Ftériche, Fadhel S; Farges, Olivier; Vilgrain, Valérie; Valla, Dominique C; Belghiti, Jacques

2016-07-01

Supra-mesocolic surgery (SMS) is complicated in patients with portal vein cavernoma (PC) and portal decompression is recommended. The aim of this study was to report a large single centre of SMS in patients with PC without portal decompression. Between 2006 and 2013, all patients who met inclusion criteria were analyzed retrospectively. The primary endpoint was the feasibility rate, surgical and postoperative outcome. The secondary endpoints were the long-term outcome of patients who underwent biliary bypass for cholangitis. Risk factors for complications were studied. Thirty patients underwent 51 procedures. Pancreatitis was the main etiology of PC (19/30) and biliary obstruction was mainly related to the underlying disease and not to portal cholangiopathy (12/14). All planned procedures were successfully completed. Fourteen patients underwent biliary bypass. Median blood loss (250 ml), transfusion (n = 7), mortality (n = 0), overall morbidity (n = 12) and the median hospital stay (10 days). Good long-term control of cholangitis was achieved in the 9 patients alive with available follow-up. Significant risk factors for complications were a previous abdominal wall scar, previous intra-abdominal surgical field and liver fibrosis. SMS can be safely performed in patients with PC. In patients with risk factors for complications, portal decompression should be discussed. Copyright © 2016 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.

Management for the anterior combined with posterior urethral stricture: a 9-year single centre experience

PubMed Central

Deng, Tuo; Liao, Banghua; Luo, Deyi; Liu, Bing; Wang, Kunjie; Liu, Jiaming; Jin, Tao

2015-01-01

Objective: Therapy for anterior combined with posterior urethral stricture is difficult and controversial. This study aims to introduce a standard process for managing anterior combined with posterior urethral stricture. Patients and methods: 19 patients with anterior combined with posterior urethral stricture were treated following our standard process. Average (range) age was 52 (21-72) years old. In this standard process, anterior urethral stricture should be treated first. Endoscopic surgery is applied for anterior urethra stricture as a priority as long as obliteration does not occur, and operation for posterior urethral stricture can be conducted in the same stage. Otherwise, an open reconstructive urethroplasty for anterior urethral is needed; while in this condition, the unobliterated posterior urethra can also be treated with endoscopic surgery in the same stage; however, if posterior urethra obliteration exists, then open reconstructive urethroplasty for posterior urethral stricture should be applied 2-3 months later. Results: The median (range) follow-up time was 25.8 (3-56) months. All 19 patients were normal in urethrography after 1 month of the surgery. 4 patients (21.1%) recurred urethral stricture during follow-up, and the locations of recurred stricture were bulbomembranous urethra (2 cases), bulbar urethra (1 case) and bladder neck (1 case). 3 of them restored to health through urethral dilation, yet 1 underwent a second operation. 2 patients (10.5%) complaint of dripping urination. No one had painful erection, stress urinary incontinence or other complications. Conclusions: The management for anterior combined with posterior urethral stricture following our standard process is effective and safe. PMID:26064293

[Periprocedural and late complications after percutaneous closure of patent foramen ovale: a single centre experience].

PubMed

Węglarz, Przemysław; Konarska Kuszewska, Ewa; Spisak Borowska, Katarzyna; Machowski, Jerzy; Drzewiecka-Gerber, Agnieszka; Kuszewski, Piotr; Jackson, Christopher L; Opala, Grzegorz; Trusz Gluza, Maria

2012-01-01

Patent foramen ovale (PFO) is a potential risk factor for ischaemic stroke in young individuals. An interventional method of secondary stroke prevention in PFO patients is its percutaneous closure. To assess safety and effectiveness (i.e. lack of residual shunt) of percutaneous PFO closure in patients with history of cryptogenic cerebrovascular event. 149 patients (56 men/93 women), aged 39 ± 12 years, underwent percutaneous PFO closure. The implantation was performed under local anaesthesia, guided by trans-oesophageal echocardiography (TEE) and fluoroscopy. Follow-up trans-thoracic echocardiography (TTE) was performed at 1 month and follow-up TEE at 6-months. In cases of residual shunt, additional TEE was performed after ensuing 6 months. Effective PFO closure (no residual shunt) was achieved in 91.3% patients at 6 months and 95.3% patients at 12 months. In 2 patients transient atrial fibrillation was observed during the procedure. In 2 patients, a puncture site haematoma developed and in 1 patient superficial thrombophlebitis was noted. In 1 patient a small pericardial effusion was observed, which resolved at day 3 post-procedurally, after administration of non-steroidal anti-inflammatory drugs. Percutaneous PFO closure seems to be a safe procedure when performed in a centre with adequate expertise with regard to these procedures.

UK Renal Registry 17th Annual Report: Chapter 10 2013 Multisite Dialysis Access Audit in England, Northern Ireland and Wales and 2012 PD One Year Follow-up: National and Centre-specific Analyses.

PubMed

Rao, Anirudh; Pitcher, David; Fluck, Richard; Kumwenda, Mick

2015-01-01

Dialysis access should be timely, minimize complications and maintain functionality. The aim of the second combined vascular and peritoneal dialysis access audit was to examine practice patterns with respect to dialysis access and highlight variations in practice between renal centres. The UK Renal Registry collected centre-specific information on incident vascular and peritoneal dialysis access outcome measures in patients from England, Wales and Northern Ireland (EW&NI), including patient demographics, dialysis access type (at start of dialysis and three months after start of dialysis), surgical assessment and access functionality. Centres who had reported data on incident PD patients for the previous 2012 audit were additionally asked to provide one year follow up data for this group. The findings were compared to the audit measures stated in Renal Association clinical practice guidelines for dialysis access. Fifty-seven centres in EW&NI (representing 92% of all centres) returned data on first access from 3,663 incident HD patients and 1,022 incident PD patients. A strong relationship was seen between surgical assessment and the likelihood of starting HD with an arteriovenous fistula (AVF). Twenty-four centres were at least two standard deviations below the 65% target for incident patients starting haemodialysis on AVF and only eight centres (14%) were within two standard deviations of the 85% target for prevalent haemodialysis patients on AVF. There was wide practice variation across the UK in provision of both HD and PD access which requires further exploration.

Managing a tier-2 computer centre with a private cloud infrastructure

NASA Astrophysics Data System (ADS)

Bagnasco, Stefano; Berzano, Dario; Brunetti, Riccardo; Lusso, Stefano; Vallero, Sara

2014-06-01

In a typical scientific computing centre, several applications coexist and share a single physical infrastructure. An underlying Private Cloud infrastructure eases the management and maintenance of such heterogeneous applications (such as multipurpose or application-specific batch farms, Grid sites, interactive data analysis facilities and others), allowing dynamic allocation resources to any application. Furthermore, the maintenance of large deployments of complex and rapidly evolving middleware and application software is eased by the use of virtual images and contextualization techniques. Such infrastructures are being deployed in some large centres (see e.g. the CERN Agile Infrastructure project), but with several open-source tools reaching maturity this is becoming viable also for smaller sites. In this contribution we describe the Private Cloud infrastructure at the INFN-Torino Computer Centre, that hosts a full-fledged WLCG Tier-2 centre, an Interactive Analysis Facility for the ALICE experiment at the CERN LHC and several smaller scientific computing applications. The private cloud building blocks include the OpenNebula software stack, the GlusterFS filesystem and the OpenWRT Linux distribution (used for network virtualization); a future integration into a federated higher-level infrastructure is made possible by exposing commonly used APIs like EC2 and OCCI.

Artificial insemination with donor sperm (AID): heterogeneity in sperm banking facilities in a single country (Belgium).

PubMed

Thijssen, A; Dhont, N; Vandormael, E; Cox, A; Klerkx, E; Creemers, E; Ombelet, W

2014-01-01

Due to the high inflow of foreign patients seeking cross-border reproductive care in Belgium and the increased number of lesbian couples and single women who call for artificial insemination with donor sperm (AID), Belgian sperm banks nowadays face a shortage in donor sperm. However, since there is no central registration system for sperm donors in Belgium, no figures are currently available supporting this statement. Therefore a study was performed to obtain a detailed overview of the sperm banking facilities in Belgium. Questionnaires were sent to all Belgian centres for assisted reproduction with laboratory facilities (n = 18) to report on their sperm banking methods. The results showed that 82% of the centres rely partially or completely on foreign donor sperm. Moreover, four of the thirteen centres that have their own sperm bank use imported donor sperm in > 95% AID cycles. Our results show that in 63% of the Belgian AID cycles imported Danish donor sperm is being used. Donor recruitment is mainly performed through the centre's website (61%) or by distributing flyers in the centre (46%) and 9 to 180 potential donors have been recruited per centre in 2013. Eventually, 15 to 50% of these candidate donors were accepted. Different criteria for donor acceptance are handled by the centres: donor age limits range from 18-25 to 36-46 years old, and thresholds for sperm normality differ considerably. We can conclude that a wide variation in methods associated with sperm banking is observed in Belgian centres.

Effects of unstratified and centre-stratified randomization in multi-centre clinical trials.

PubMed

Anisimov, Vladimir V

2011-01-01

This paper deals with the analysis of randomization effects in multi-centre clinical trials. The two randomization schemes most often used in clinical trials are considered: unstratified and centre-stratified block-permuted randomization. The prediction of the number of patients randomized to different treatment arms in different regions during the recruitment period accounting for the stochastic nature of the recruitment and effects of multiple centres is investigated. A new analytic approach using a Poisson-gamma patient recruitment model (patients arrive at different centres according to Poisson processes with rates sampled from a gamma distributed population) and its further extensions is proposed. Closed-form expressions for corresponding distributions of the predicted number of the patients randomized in different regions are derived. In the case of two treatments, the properties of the total imbalance in the number of patients on treatment arms caused by using centre-stratified randomization are investigated and for a large number of centres a normal approximation of imbalance is proved. The impact of imbalance on the power of the study is considered. It is shown that the loss of statistical power is practically negligible and can be compensated by a minor increase in sample size. The influence of patient dropout is also investigated. The impact of randomization on predicted drug supply overage is discussed. Copyright © 2010 John Wiley & Sons, Ltd.

Introduction of Sprotte needles to a single-centre acute neurology service: before and after study

PubMed Central

Vakharia, Vejay N; Lote, Hazel

2012-01-01

Objectives To introduce atraumatic (Sprotte) lumbar puncture needles and compare complication rates with traumatic (Quincke) needles. Design Complication rates associated with traumatic needle use were retrospectively analysed over a four-week period. Atraumatic needles were then implemented and a prospective analysis of the complication rates was undertaken for a further six weeks. Setting A single-centre acute neurology unit in a London teaching hospital Participants Traumatic needles (n = 24 patients); atraumatic needles (n = 36 patients) Main outcome measures Headache rates, use of over-the-counter medications, further medical assistance, time off work, nausea and vomiting, traumatic taps (as per the count of red blood cells per millilitre in the first sample of cerebrospinal fluid [CSF]) and back pain. Results A comparison of traumatic and atraumatic needles revealed a significant reduction in the incidence of post-lumbar puncture headaches (*P < 0.01), headaches requiring over-the-counter medication (*P < 0.00001), need for further medical assistance (*P < 0.006), time off work (*P < 0.003), nausea and vomiting (*P < 0.01) and traumatic taps as per the count of red blood cells per millilitre in the first sample of CSF (*P < 0.02). There was no significant difference in the incidence of back pain (P > 0.05). Conclusions Most complication outcomes are significantly lower with the use of atraumatic lumbar puncture needles. We present for the first time in the literature that the rate of ‘traumatic taps’ are significantly lower with atraumatic needles. The implementation of atraumatic needles in an acute neurology service is safe and produces reliable, reproducible results in keeping with previously published randomized controlled trials. PMID:23476725

Antibacterial prophylaxis with ciprofloxacin for patients with multiple myeloma and lymphoma undergoing autologous haematopoietic cell transplantation: a quasi-experimental single-centre before-after study.

PubMed

Yeshurun, M; Vaxman, I; Shargian, L; Yahav, D; Bishara, J; Pasvolsky, O; Wolach, O; Lahav, M; Gurion, R; Magen, H; Vidal, L; Herscovici, C; Peck, A; Moshe, M; Sela-Navon, M; Naparstek, E; Raanani, P; Rozovski, U

2018-07-01

We aimed to study whether ciprofloxacin prophylaxis reduces infectious complications in patients undergoing autologous haematopoietic cell transplantation (AHCT). This is a quasi-experimental, retrospective, before-after study. We compared the incidence of bacterial-related complications among 356 patients with multiple myeloma (MM) (n = 202) and lymphoma (n = 154) who underwent AHCT with (n = 177) or without (n = 179) ciprofloxacin prophylaxis between 03/2007 and 10/2012 and between 10/2012 and 07/2016, respectively, at a single centre. Febrile neutropaenia, bacteraemia, and pneumonia were significantly more common among patients who underwent AHCT during the second study period and did not receive antibacterial prophylaxis compared with patients who underwent AHCT during the first study period and received antibacterial prophylaxis (89.9% (161/179) vs. 83.1% (147/177), difference 6.9%, 95% CI 0-14.1%, P = 0.002; 15.1% (27/179) vs. 4.5% (8/177), difference 10.6%, 95% CI 4.4-16.9%, p < 0.0001; 12.3% (22/179) vs. 6.2% (11/177), difference 6.1%, 95% CI 0-12.3%, p = 0.04, respectively). The number-needed-to-treat to prevent one episode of bacteraemia, pneumonia, and febrile neutropaenia was 8.6, 8.5, and 13.7, respectively. Patients with ciprofloxacin prophylaxis had higher rates of ciprofloxacin-resistant bacteraemia (62.5% (5/8) vs. 18.5% (5/27), difference 44%, 95% CI 7-70%, p = 0.01). In multivariate analysis, ciprofloxacin prophylaxis significantly decreased the odds of bacteraemia (OR 0.19, 95% CI 0.07-0.52; p < 0.0001) and pneumonia (OR 0.37, 95% CI 0.16-0.85, p = 0.02). According to our single-centre experience, patients with MM and lymphoma undergoing AHCT may benefit from antibacterial prophylaxis with ciprofloxacin. Copyright © 2017 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

Quality of life in a large cohort of adult Brazilian patients with 46,XX and 46,XY disorders of sex development from a single tertiary centre.

PubMed

Cassia Amaral, Rita; Inacio, Marlene; Brito, Vinicius N; Bachega, Tania A S S; Oliveira, Ari A; Domenice, Sorahia; Denes, Francisco T; Sircili, Maria Helena; Arnhold, Ivo J P; Madureira, Guiomar; Gomes, Larissa; Costa, Elaine M F; Mendonca, Berenice B

2015-02-01

Few studies have focused on the quality of life (QoL) of patients with disorders of sex development (DSD). Our aim was to evaluate QoL in DSD patients with defined diagnoses followed until adulthood in a single tertiary centre. Adult patients with DSD (56 patients with 46,XX DSD - 49 with female social sex and 7 with male social sex as well as 88 patients with 46,XY DSD - 54 with female social sex and 34 with male social sex). QoL using WHOQOL-Bref questionnaire. Both patients with 46,XX DSD and patients with 46,XY DSD had similar QoL scores on the WHOQOL-Bref, comparable to the scores of the Brazilian general population. The chronological age at the start of treatment was negatively and significantly associated with general QoL score. Patients with male social sex DSD had better scores on the psychological domain than patients with female social sex DSD, as found in the Brazilian general population. In addition, among the 46,XY DSD group, the male social sex patients had better QoL compared with the female social sex patients. There was a positive and significant correlation between sexual performance and general QoL, although it explained only 4% of the variability of the general QoL score. The most influencing variables were general health, positive feelings and spirituality, religion and personal beliefs, each of them contributing with 18% of the variability of the general QoL score. Our large cohort of adult patients with DSD, which was followed by a multidisciplinary team in a single tertiary centre, had good QoL in adulthood; in addition, late treatment compromised the QoL of patients with DSD, whereas sexual performance has little influence on QoL. © 2014 John Wiley & Sons Ltd.

Centre-related variability in hospital admissions of patients with spondyloarthritis.

PubMed

Andrés, Mariano; Sivera, Francisca; Pérez-Vicente, Sabina; Carmona, Loreto; Vela, Paloma

2016-09-01

The aim of this study was to explore the variability in hospital admissions of patients with spondyloarthritis (SpA) in Spain, and the centre factors that may influence that variability. Descriptive cross-sectional study, part of the emAR II study, performed in Spain (2009-2010). Health records of patients with a diagnosis of SpA and at least one visit to the rheumatology units within the previous 2 years were reviewed. Variables related to hospital admissions, to the SpA, and to the patient and centre were collected. A multilevel logistic regression analysis of random intercept with non-random slopes was performed to assess variability between centres. From 45 centres, 1168 patients' health records were reviewed. Main SpA forms were ankylosing spondylitis (55.2 %) and psoriatic arthritis (22.2 %). A total of 248 admissions were registered for 196 patients (19.2 %, n = 1020). An adjusted variability of 17.6 % in hospitalizations between centres was noted. The following hospital-related factors showed a significant association with admissions: the total number of admissions of the centre, the existence of electronic admission, and the availability of ultrasound in rheumatology. However, these factors only explained 42.9 % of the inter-centre variability. The risk of a patient with SpA of being admitted could double (median OR 2.09), depending on the hospital where the patient was being managed. Hospital admissions of patients with SpA varied between hospitals due to centre characteristics. Further studies are needed to ascertain which specific factors may be causing the variation, as studied variables explained less than half of the variability.

Defining and describing birth centres in the Netherlands - a component study of the Dutch Birth Centre Study.

PubMed

Hermus, M A A; Boesveld, I C; Hitzert, M; Franx, A; de Graaf, J P; Steegers, E A P; Wiegers, T A; van der Pal-de Bruin, K M

2017-07-03

During the last decade, a rapid increase of birth locations for low-risk births, other than conventional obstetric units, has been seen in the Netherlands. Internationally some of such locations are called birth centres. The varying international definitions for birth centres are not directly applicable for use within the Dutch obstetric system. A standard definition for a birth centre in the Netherlands is lacking. This study aimed to develop a definition of birth centres for use in the Netherlands, to identify these centres and to describe their characteristics. International definitions of birth centres were analysed to find common descriptions. In July 2013 the Dutch Birth Centre Questionnaire was sent to 46 selected Dutch birth locations that might qualify as birth centre. Questions included: location, reason for establishment, women served, philosophies, facilities that support physiological birth, hotel-facilities, management, environment and transfer procedures in case of referral. Birth centres were visited to confirm the findings from the Dutch Birth Centre Questionnaire and to measure distance and time in case of referral to obstetric care. From all 46 birth locations the questionnaires were received. Based on this information a Dutch definition of a birth centre was constructed. This definition reads: "Birth centres are midwifery-managed locations that offer care to low risk women during labour and birth. They have a homelike environment and provide facilities to support physiological birth. Community midwives take primary professional responsibility for care. In case of referral the obstetric caregiver takes over the professional responsibility of care." Of the 46 selected birth locations 23 fulfilled this definition. Three types of birth centres were distinguished based on their location in relation to the nearest obstetric unit: freestanding (n = 3), alongside (n = 14) and on-site (n = 6). Transfer in case of referral was necessary for all

Student Experience of a Scenario-Centred Curriculum

ERIC Educational Resources Information Center

Bell, Sarah; Galilea, Patricia; Tolouei, Reza

2010-01-01

In 2006 UCL implemented new scenario-centred degree programmes in Civil and Environmental Engineering. The new curriculum can be characterised as a hybrid of problem-based, project-based and traditional approaches to learning. Four times a year students work in teams for one week on a scenario which aims to integrate learning from lecture and…

A cross-sectional study of knife injuries at a London major trauma centre.

PubMed

Pallett, J R; Sutherland, E; Glucksman, E; Tunnicliff, M; Keep, J W

2014-01-01

No national recording systems for knife injuries exist in the UK. Understanding the true size and nature of the problem of knife injuries is the first stage in reducing the burden of this injury. The aim of this study was to survey every knife injury seen in a single inner city emergency department (ED) over a one-year period. A cross-sectional observational study was performed of all patients attending with a knife injury to the ED of a London major trauma centre in 2011. Demographic characteristics, patterns of injury, morbidity and mortality data were collected. A total of 938 knife injuries were identified from 127,191 attendances (0.77% of all visits) with a case fatality rate of 0.53%. A quarter (24%) of the major trauma team's caseload was for knife injuries. Overall, 44% of injuries were selfreported as assaults, 49% as accidents and 8% as deliberate self-harm. The highest age specific incident rate occurred in the 16-24 year age category (263/100,000). Multiple injuries were seen in 19% of cases, of which only 81% were recorded as assaults. The mean length of stay for those admitted to hospital was 3.04 days. Intrathoracic injury was seen in 26% of cases of chest trauma and 24% of abdominal injuries had a second additional chest injury. Violent intentional injuries are a significant contributory factor to the workload of the major trauma team at this centre. This paper contributes to a more comprehensive understanding of the nature of these injuries seen in the ED.

Immediate functional loading of single implants: a multicenter study with 4 years of follow-up

PubMed Central

Raes, Filiep; Eccellente, Tammaro; Lenzi, Carolina; Ortolani, Michele; Luongo, Giuseppe; Mangano, Carlo; Mangano, Francesco

2018-01-01

Background. In the current scientific literature there are only few studies on the immediate functional loading of single implants. The aim of the present present study was to evaluate the 4-year survival rate, complication rate and peri-implant marginal bone loss (PIMBL) of immediately loaded single implants inserted in healed ridges and fresh post-extraction sites. Methods. Six centers were involved in this prospective study. The surgical and prosthetic protocol was defined in detail, before the start of recruiting patients. Recruitment of patients and performance of surgeries took place between February 2012 and February 2013. Criteria for inclusion were single-tooth gaps in healed ridges and fresh post-extraction sockets. All the fixtures (Anyridge®, Megagen Corporation, Gyeongbuk, South Korea) were functionally loaded immediately after insertion and followed for a period of 4 years. Outcome measures were implant survival, complications and PIMBL. Results. Forty-six patients (18‒73 years of age) were selected. In total, 57 fixtures were placed (10 in fresh post-extraction sockets). After 4 years of functional loading, only one fixture was lost; therefore, high survival rates (97.6% patient-based; 98.1% implant-based) were reported. In addition, a limited incidence of biologic (4.8% patient-based; 3.8% implant-based) and prosthetic (9.7% patient-based; 7.6% implant-based) complications was reported. The overall 4-year PIMBL amounted to 0.38±0.21 mm (healed ridges: 0.4±0.21 mm; fresh post-extraction sockets: 0.33±0.20 mm). Conclusion. Loading single implants immediately seems to be a highly successful treatment modality. However, long-term data are needed to confirm these positive outcomes. PMID:29732018

Estimation of single-year-of-age counts of live births, fetal losses, abortions, and pregnant women for counties of Texas.

PubMed

Singh, Bismark; Meyers, Lauren Ancel

2017-05-08

We provide a methodology for estimating counts of single-year-of-age live-births, fetal-losses, abortions, and pregnant women from aggregated age-group counts. As a case study, we estimate counts for the 254 counties of Texas for the year 2010. We use interpolation to estimate counts of live-births, fetal-losses, and abortions by women of each single-year-of-age for all Texas counties. We then use these counts to estimate the numbers of pregnant women for each single-year-of-age, which were previously available only in aggregate. To support public health policy and planning, we provide single-year-of-age estimates of live-births, fetal-losses, abortions, and pregnant women for all Texas counties in the year 2010, as well as the estimation method source code.

Protocol for a single-centre prospective observational study of postoperative delirium following total joint arthroplasties among South East Asians.

PubMed

Abdullah, Hairil Rizal; Tan, Sapphire RouXi; Lee, Si Jia; Bin Abd Razak, Hamid Rahmatullah; Seet, Rachel Huiqi; Ying, Hao; Sethi, Ervin; Sim, Eileen Yilin

2018-03-06

Postoperative delirium is a serious and common complication in older adults following total joint arthroplasties (TJA). It is associated with increased risk of postoperative complications, mortality, length of hospital stay and postdischarge institutionalisation. Thus, it has a negative impact on the health-related quality of life of the patient and poses a large economic burden. This study aims to characterise the incidence of postoperative delirium following TJA in the South East Asian population and investigate any risk factors or associated outcomes. This is a single-centre prospective observational study recruiting patients between 65 and 90 years old undergoing elective total knee arthroplasty or total hip arthroplasty. Exclusion criteria included patients with clinically diagnosed dementia. Preoperative and intraoperative data will be obtained prospectively. The primary outcome will be the presence of postoperative delirium assessed using the Confusion Assessment Method on postoperative days 1, 2 and 3 and day of discharge. Other secondary outcomes assessed postoperatively will include hospital outcomes, pain at rest, knee and hip function, health-related quality of life and Postoperative Morbidity Survey-defined morbidity. Data will be analysed to calculate the incidence of postoperative delirium. Potential risk factors and any associated outcomes of postoperative delirium will also be determined. This study has been approved by the Singapore General Hospital Institutional Review Board (SGH IRB) (CIRB Ref: 2017/2467) and is registered on the ClinicalTrials.gov registry (Identified: NCT03260218). An informed consent form will be signed by all participants before recruitment and translators will be made available to non-English-speaking participants. The results of this study will be presented at international conferences and submitted to a peer-reviewed journal. The data collected will also be made available in a public data repository. NCT03260218. �

Patient preferences for single rooms or shared accommodation in a district general hospital.

PubMed

Florey, L; Flynn, R; Isles, C

2009-05-01

To determine whether patients who have used a Scottish district general hospital would prefer single or shared accommodation on a future admission. We surveyed 80 in-patients in January 2008 in order to obtain 20 medical and 20 surgical patients in single rooms and the same number in shared accommodation. Each patient received a seven point questionnaire that had been validated in another centre. Forty four men and 36 women, median 64 years, who had been in hospital for a median of 4.5 days (range 1 to 53 days) participated in the survey. Seventy per cent of patients in shared and 40% of patients in single rooms said they would prefer shared accommodation during a future hospital admission. Those expressing a preference for shared accommodation were older (median age 68 versus 58 years) and had been in hospital for longer (median 5.5 versus 3.5 days) than those who said they would prefer a single room. It is likely that the desire for company among older people who have to spend a week or more in hospital is driving the responses we obtained. Our findings do not support claims that the argument in favour of 100% single rooms is 'overwhelming'.

CADC and CANFAR: Extending the role of the data centre

NASA Astrophysics Data System (ADS)

Gaudet, Severin

2015-12-01

Over the past six years, the CADC has moved beyond the astronomy archive data centre to a multi-service system for the community. This evolution is based on two major initiatives. The first is the adoption of International Virtual Observatory Alliance (IVOA) standards in both the system and data architecture of the CADC, including a common characterization data model. The second is the Canadian Advanced Network for Astronomical Research (CANFAR), a digital infrastructure combining the Canadian national research network (CANARIE), cloud processing and storage resources (Compute Canada) and a data centre (Canadian Astronomy Data Centre) into a unified ecosystem for storage and processing for the astronomy community. This talk will describe the architecture and integration of IVOA and CANFAR services into CADC operations, the operational experiences, the lessons learned and future directions

Ascertainment bias in dementias: a secondary to tertiary centre analysis in Central Italy and conceptual review.

PubMed

Bonanni, L; Bontempo, G; Borrelli, I; Bifolchetti, S; Buongarzone, M P; Carlesi, N; Carolei, A; Ciccocioppo, F; Colangelo, U; Colonna, G; Desiderio, M; Ferretti, S; Fiorelli, L; D'Alessio, O; D'Amico, A; D'Amico, M C; De Lucia, R; Del Re, L; Di Blasio, F; Di Giacomo, R; Di Iorio, A; Di Santo, E; Di Giuseppe, M; Felice, N; Litterio, P; Gabriele, A; Mancino, E; Manzoli, L; Maruotti, V; Mearelli, S; Molino, G; Monaco, D; Nuccetelli, F; Onofrj, M; Perfetti, B; Sacchet, C; Sensi, F; Sensi, S; Sucapane, P; Taylor, J P; Thomas, A; Viola, P; Viola, S; Zito, M; Zhuzhuni, H

2013-06-01

Ascertainment bias (AB) indicates a bias of an evaluation centre in estimating the prevalence/incidence of a disease due to the specific expertise of the centre. The aim of our study was to evaluate classification of different types of dementia in new cases appearing in secondary and tertiary centres, in order to evidence possible occurrence of AB in the various (secondary to tertiary) dementia centres. To assess the mechanism of AB, the rates of new cases of the different forms of dementia reported by different centres were compared. The centres involved in the study were 11 hospital-based centres including a tertiary centre, located in the University Department of Clinical Neurology. The tertiary centre is endowed with state-of-the-art diagnostic facilities and its scientific production is prominently focused on dementia with Lewy bodies (DLB) thus suggesting the possible occurrence of a bias. Four main categories of dementia were identified: Alzheimer's disease (AD), DLB, fronto-temporal dementia (FTD), vascular dementia (VaD), with other forms in a category apart. The classification rate of new cases of dementia in the tertiary centre was compared with rates reported by secondary centres and rates of recoding were calculated during a follow-up of 2 years. The study classified 2,042 newly diagnosed cases of dementia in a population of 1,370,000 inhabitants of which 315,000 were older than 65. AD was categorized in 48-52 % of cases, DLB in 25-28 %, FTD in 2-4 % and VaD in 17-28 %. During the 2-year follow-up the diagnosis was re-classified in 40 patients (3 %). The rate of recoding was 5 % in the tertiary centre, 2-8 % in referrals from secondary to tertiary centre, 2-10 % in recodings performed in secondary centres and addressed to tertiary centre. Recoding or percentages of new cases of AD or DLB were not different in the comparison between secondary or between secondary and tertiary centres. FTD and VaD were instead significantly recoded. The results

A 5-year prospective study on single immediate implants in the aesthetic zone.

PubMed

Cosyn, Jan; Eghbali, Aryan; Hermans, Alexander; Vervaeke, Stijn; De Bruyn, Hugo; Cleymaet, Roberto

2016-08-01

There is a paucity of long-term data on soft tissue aesthetics of single immediate implants. The objective of this study was to evaluate the 5-year clinical and aesthetic outcome of this treatment concept. Twenty-two periodontally healthy patients (12 men, 10 women; mean age 50) with low risk for aesthetic complications (thick gingival biotype, intact buccal bone wall, both neighbouring teeth present) were consecutively treated with a single immediate implant in the aesthetic zone (15-25). Flapless surgery was performed and the gap between the implant and buccal bone wall was systematically filled with bovine bone particles. Implants were immediately non-functionally loaded with a screw-retained provisional crown. Cases demonstrating major alveolar process changes and/or advanced mid-facial recession (>1 mm) at 3 months were additionally treated with a connective tissue graft (CTG). Permanent crowns were installed at 6 months. The clinical and aesthetic results at 5 years were compared to those obtained at 1 year. Seventeen patients attended the 5-year re-assessment, of whom five had been treated with a CTG for early aesthetic complications. There was one early implant failure and one complication after 1 year (porcelain chipping). Mean marginal bone loss was 0.12 mm at 1 year and 0.19 mm at 5 years (p = 0.595) with the moment of implant installation as baseline. Papilla height increased between 1 and 5 years (p ≤ 0.007), whereas mid-facial contour (p = 0.005) and alveolar process deficiency (p = 0.008) deteriorated. Mean mid-facial recession was on average 0.28 mm (SD 0.48) at 1 year and 0.53 mm (SD 0.53) at 5 years (p = 0.072) with the preoperative status as baseline. Three implants demonstrated advanced mid-facial recession (>1 mm) at 5 years. All three were in a central incisor position and none had been treated with a CTG. Thus, 8/17 implants showed aesthetic complications (five early and three late aesthetic complications). Implants

First-episode psychosis at the West Bologna Community Mental Health Centre: results of an 8-year prospective study.

PubMed

Tarricone, I; Mimmi, S; Paparelli, A; Rossi, E; Mori, E; Panigada, S; Carchia, G; Bandieri, V; Michetti, R; Minenna, G; Boydell, J; Morgan, C; Berardi, D

2012-11-01

Research mostly conducted in the UK and northern Europe has established that there are high rates of first-episode psychosis (FEP) in large cities and immigrant populations; moreover, psychosis has been found to be associated with cannabis use and early trauma. The present study aimed to evaluate the incidence rate of FEP and the distribution of several risk factors (e.g. age, ethnicity, substance abuse) in Bologna, Italy. The Bologna FEP (BoFEP) study is an 8-year prospective study. All FEP patients, 18-64 years old, consecutively referred to the West Bologna Community Mental Health Centre (CMHC) from 2002 to 2009 were evaluated. Sociodemographic information, migration history and clinical data were collected through an ad-hoc schedule. Psychiatric diagnoses were recorded using the Schedule for Clinical Assessment of Neuropsychiatry (SCAN). The overall incidence rate (IR) in the BoFEP study was 16.4 per 100 000 person-years [95% confidence interval (CI) 13.9-18.9]. The incidence was higher in young people, men and migrants (MI). The IR of FEP found by the Bologna study is lower than that found by other European studies. However, as in other studies, the incidence was higher in certain groups. This heterogeneity has implications for policy and mental health service development, and for understanding the aetiology of psychosis.

Single-dose Universal Hepatitis A Immunization in One-year-old Children in Argentina: High Prevalence of Protective Antibodies up to 9 Years After Vaccination.

PubMed

Urueña, Analía; González, Jorge E; Rearte, Analía; Pérez Carrega, María E; Calli, Rogelio; Pagani, María F; Uboldi, Andrea; Vicentín, Rosalía; Caglio, Patricia; Cañero-Velasco, María C; Gentile, Angela; Ramonet, Margarita; Vizzotti, Carla

2016-12-01

Single-dose hepatitis A virus (HAV) vaccination was implemented in all Argentinean children 12 months of age in 2005. Previous studies demonstrated high prevalence of protective antibody response 4 years after single-dose vaccination. This study assessed long-term seroprotection against HAV after vaccination. Children who received 1 dose of HAV vaccine at 1 year of age at least 6 years before enrollment were included at 5 centers in Argentina between 2013 and 2014. Demographic and socioeconomic characteristics were collected through a questionnaire. Blood samples were tested for anti-HAV antibodies. Antibody values ≥10 mIU/mL were considered seroprotective. Logistic regression analysis was performed to evaluate the association between demographic and socioeconomic variables and seroprotection. A total of 1088 children were included, with a median postvaccination interval of 7.7 years (range 6.3-9.2 years). Of these children, 97.4% (95% confidence interval: 96.3%-98.3%) had protective antibodies against HAV. No association between demographic or socioeconomic variables and seroprotection was found. Geometric mean concentration of antibody levels against HAV was 170.5 mUI/mL (95% confidence interval: 163.2-178.2 mUI/mL). Single-dose universal hepatitis A immunization in 1-year-old children resulted in sustained immunologic protection for up to 9 years in Argentina. These findings, along with the low current disease burden, confirm the success of the intervention.

Artificial insemination with donor sperm (AID): heterogeneity in sperm banking facilities in a single country (Belgium)

PubMed Central

Thijssen, A.; Dhont, N.; Vandormael, E.; Cox, A.; Klerkx, E.; Creemers, E.; Ombelet, W.

2014-01-01

Due to the high inflow of foreign patients seeking cross-border reproductive care in Belgium and the increased number of lesbian couples and single women who call for artificial insemination with donor sperm (AID), Belgian sperm banks nowadays face a shortage in donor sperm. However, since there is no central registration system for sperm donors in Belgium, no figures are currently available supporting this statement. Therefore a study was performed to obtain a detailed overview of the sperm banking facilities in Belgium. Questionnaires were sent to all Belgian centres for assisted reproduction with laboratory facilities (n = 18) to report on their sperm banking methods. The results showed that 82% of the centres rely partially or completely on foreign donor sperm. Moreover, four of the thirteen centres that have their own sperm bank use imported donor sperm in > 95% AID cycles. Our results show that in 63% of the Belgian AID cycles imported Danish donor sperm is being used. Donor recruitment is mainly performed through the centre’s website (61%) or by distributing flyers in the centre (46%) and 9 to 180 potential donors have been recruited per centre in 2013. Eventually, 15 to 50% of these candidate donors were accepted. Different criteria for donor acceptance are handled by the centres: donor age limits range from 18-25 to 36-46 years old, and thresholds for sperm normality differ considerably. We can conclude that a wide variation in methods associated with sperm banking is observed in Belgian centres. PMID:25009728

Multicolour versus monocolour inking specimens after pancreaticoduodenectomy for periampullary cancer: A single centre prospective randomised clinical trial.

PubMed

Casadei, Riccardo; Ricci, Claudio; Taffurelli, Giovanni; Pacilio, Carlo Alberto; Santini, Donatella; Di Marco, Mariacristina; Minni, Francesco

2018-03-01

R status represents an important prognostic factors in periampullary cancers. Thus, it is useful to verify if it can be influenced by different techniques of margination. Single-centre, randomised clinical trial of patients affected by periampullary cancer who underwent pancreaticoduodenectomies which included two different types of margination: arm A (multicolour inking) and arm B (monocolour inking). The primary endpoint was the overall R1 resection rate and its difference between the two arms. The secondary endpoints were the R1 resection rate in each margin and its difference between the two arms, and the impact of margin status on survival. Fifty patients were randomised, 41 analysed: 22 in arm A, 19 arm B. The overall R1 status was 61%, without significant differences between the two arms. The margin most commonly involved was the superior mesenteric artery (SMA) (36.6%). A trend in favour of arm B was shown for the superior mesenteric artery margin (arm A = 22.7% versus arm B = 52.6%; P = 0.060). The anterior surface (P = 0.015), SMA (P = 0.047) and pancreatic remnant (P = 0.018) margins significantly influenced disease-free survival. The R status was not influenced by different techniques of margination using a standardised pathological protocol. The SMA margin seemed to be the most important margin for evaluating both R status and disease-free survival. Copyright © 2018. Published by Elsevier Ltd.

First results of the Nordic and Baltic GNSS Analysis Centre

NASA Astrophysics Data System (ADS)

Lahtinen, Sonja; Pasi, Häkli; Jivall, Lotti; Kempe, Christina; Kollo, Karin; Kosenko, Ksenija; Pihlak, Priit; Prizginiene, Dalia; Tangen, Oddvar; Weber, Mette; Paršeliūnas, Eimuntas; Baniulis, Rimvydas; Galinauskas, Karolis

2018-03-01

The Nordic Geodetic Commission (NKG) has launched a joint NKG GNSS Analysis Centre that aims to routinely produce high qualityGNSS solutions for the common needs of the NKG and the Nordic and Baltic countries. A consistent and densified velocity field is needed for the constraining of the gla-cial isostatic adjustment (GIA) modelling that is a key component of maintaining the national reference frame realisations in the area. We described the methods of the NKG GNSS Analysis Centre including the defined processing setup for the local analysis centres (LAC) and for the combination centres.We analysed the results of the first 2.5 years (2014.5-2016). The results showed that different subnets were consistent with the combined solution within 1-2 mm level. We observed the so called network effect affecting our reference frame alignment. However, the accuracy of the reference frame alignment was on a few millimetre level in the area of the main interest (Nordic and Baltic Countries). TheNKGGNSS AC was declared fully operational in April 2017.

Work experiences among attendees of day centres for people with psychiatric disabilities.

PubMed

Eklund, Mona; Sandlund, Mikael

2015-01-01

It is possible that people with psychiatric disabilities who visit day centres have previous work experiences that may be seen as resources for their current engagement in day centre activities. Research in this respect seems to lack, however. To investigate work experiences among attendees at day centres for people with psychiatric disabilities and relationships with current type of day centre (work-oriented, meeting place-oriented or mixed), engagement in day centre activities, motivation and socio-demographic and health-related factors. Seventy-seven attendees responded to questionnaires. Global Assessment of Functioning, GAF, was also used. Work was categorised into Group I (professionals, semi-professionals), Group II (clerical support, services workers) and Group III (e.g. craft workers, elementary occupations). Almost everyone had previously had open-market employment; more than half for ≥ 10 years. Group I was more common in mixed centres, Group II in meeting place-oriented ones and Group III in work-oriented ones. Group I more frequently had college degree and was rated high on GAF functioning. Women were over-represented in Group II, and men in Group III and in meeting place-oriented centres. Attending mixed centres was more likely when having a college degree, scoring high on GAF functioning and being highly engaged in activities. Attendees at work-oriented day centres were characterised by being motivated for spending time alone and reporting a diagnosis of psychosis. The participants had unused working capacity. No clear-cut relationships were found between work experiences and the investigated correlates.

Longitudinal changes in tooth/single-implant relationship and bone topography: an 8-year retrospective analysis.

PubMed

Chang, Moontaek; Wennström, Jan L

2012-06-01

To evaluate longitudinal changes in tooth/implant relationship and bone topography at single implants with a microthreaded, conical marginal portion (Astra Tech ST® implants, Astra Tech AB, Mölndal, Sweden). Thirty-one subjects with single implant-supported restorations in the esthetic zone were included. Radiographs obtained at crown installation and 1, 5, and 8 years of follow-up were analyzed with regard to changes in (1) bone level at the implant and adjacent teeth and (2) vertical position of adjacent teeth relative to the single implant. The mean marginal bone loss amounted to 0.1 mm at both implants and adjacent teeth during the 8 years of follow-up. Regression analysis failed to identify significant explanatory factors for observed variance in bone level change at the adjacent tooth surfaces. Vertical change in position of the teeth relative to the implants was more frequent and significantly greater in incisor compared with premolar tooth region but not associated with gender or age. The marginal bone level at teeth adjacent to single implants with a microthreaded conical marginal part was not influenced by horizontal and vertical tooth-implant distances. Continuous eruption of adjacent teeth may result in infraocclusal positioning of a single-implant restoration. © 2010 Wiley Periodicals, Inc.

Burns in patients over 90: a fifteen-year series from a regional burns centre.

PubMed

Shariff, Zakir; Rodrigues, Jeremy N; Anwar, Umair; Austin, Orla; Phipps, Alan

2015-03-01

The elderly constitute an expanding subgroup within society, and may have differences in health needs compared to younger patients. The specific needs and outcomes of elderly patients with burns have been widely studied. However, the definition of elderly often used in previous studies is a cut off of 65 years old. Within this broadly defined group, the very elderly may have distinct health care needs and issues. This study investigated aetiology, management and outcome of burns in those over 90 years treated at a single UK burns service over a period of 15 years between 1998 and 2013, and compares these data to published data describing 'younger' elderly burns patients. Twenty two patients were included, with a 2:1 female:male ration, and a mean 9%TBSA burn. Six of the 22 died during their admission, and those who survived averaged 8 days inpatient stay per %TBSA. The very elderly with burns may fare worse than younger elderly patients. Although burns in the very elderly are relatively infrequent events, they require significant resource. Further work to optimise their outcome is required. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.

Ninety day mortality following pancreatoduodenectomy in England: has the optimum centre volume been identified?

PubMed

Liu, Z; Peneva, I S; Evison, F; Sahdra, S; Mirza, D F; Charnley, R M; Savage, R; Moss, P A; Roberts, K J

2018-06-09

Mortality following pancreatoduodenectomy is related to centre volume although the optimal volume is not defined. Patients undergoing PD between 2001 and 2016 were identified from UK national databases. The effects of patient variables, centre volume and time period upon 90 day mortality were studied. 90 day mortality (970/14,935, 6.5%) was related to advanced age, comorbidity, diagnosis, ethnicity, deprivation, centre volume and time period. Mortality rates fell markedly from 10.0% in 2001-4 to 4.1% in 2013-16. There was no difference in 90 day mortality between high (36 -60 PD per year) and very high volume (>60) centres. However, patients operated upon at very high volume centres were more elderly (66, 58 -73 vs 65, 56 -72; median, IQR; p = 0.006), deprived (38.7 vs 34.6%; p < 0.001) and co morbid (48.9 vs 46.1%; p = 0.027). Although a plateau in the centre volume and mortality relationship appears to have been demonstrated those patients treated at the highest volume centres were at higher risk of mortality. This data suggests therefore that to further understand outcomes from specialist centres characteristics of the patient population should be defined, not just centre volume. Copyright © 2018. Published by Elsevier Ltd.

Sneeze related area in the medulla: localisation of the human sneezing centre?

PubMed

Seijo-Martínez, M; Varela-Freijanes, A; Grandes, J; Vázquez, F

2006-04-01

Sneezing is a rarely explored symptom in neurological practice. In the cat, a sneeze evoking centre is located in the medulla. The existence of a sneezing centre has not been confirmed in humans. A case with abnormal sneezing secondary to a strategic infarct in the right latero-medullary region is presented. A 66 year old man suddenly presented paroxysmal sneezing followed by ataxia, right sided motor and sensory symptoms, and hoarseness. The application of stimuli to the right nasal fossa did not evoke sneezing nor the wish to sneeze. The same stimuli to the contralateral nasal fossa evoked normal sneezing. The preservation of the superficial sensitivity of the nasal fossa indicates that the lesion was localised in the hypothetical human sneezing centre, very close to the spinal trigeminal tract and nucleus. This centre appears to be bilateral and functionally independent on both sides.

Effectiveness of a learner-centred training programme for primary care physicians in using a patient-centred consultation style.

PubMed

Moral, R R; Alamo, M M; Jurado, M A; de Torres, L P

2001-02-01

The aim of the present study was to find out if a training programme adapted to family physicians with several years of clinical experience changes their behaviour when they deal with fibromyalgic patients in the sense of introducing the communication skills that define the 'patient-centred' approach. A randomized, and simple blind, educative study was carried out. Twenty full-time family physicians were invited to participate. They were allocated randomly to two groups: an intervention and a control group. A total of 110 patients were recruited from people attending physicians' surgeries for the first time and who complained of generalized pain that finally fulfilled criteria for generalized musculoskeletal chronic pain/fibromyalgia. This was done for an entire year. The intervention group received an 18 hour intensive course. One week after the course, all doctors carried out a video-recorded encounter with a patient who played the part of a typical fibromyalgia clinical case. The interviews were coded by an observer blind to the training status of the participants, using the GATHARES-CP questionnaire. All patients were contacted by telephone during a 1-2-month period by a different interviewer who was 'blinded' to the patient's experimental status. They were asked to respond to three questions that represent the key components of patient-centred style. The average score on the GATHARES-CP questionnaire was 11.3 +/- 0.9 and 9 +/- 2.3, for doctors from the intervention and control groups, respectively (P < 0.01). For 11 items, scores were higher in the intervention group. The patients' answers to all three questions showed statistically significant differences in a positive direction for the trained doctors. The doctors improved the use of strategies and skills for carrying out patient-centred consultations after they had received an interactive course. The doctors' behaviour appeared to have changed as much in a more experimental situation as in the actual

Combination of hyper-CVAD with ponatinib as first-line therapy for patients with Philadelphia chromosome-positive acute lymphoblastic leukaemia: a single-centre, phase 2 study.

PubMed

Jabbour, Elias; Kantarjian, Hagop; Ravandi, Farhad; Thomas, Deborah; Huang, Xuelin; Faderl, Stefan; Pemmaraju, Naveen; Daver, Naval; Garcia-Manero, Guillermo; Sasaki, Koji; Cortes, Jorge; Garris, Rebecca; Yin, C Cameron; Khoury, Joseph D; Jorgensen, Jeffrey; Estrov, Zeev; Bohannan, Zachary; Konopleva, Marina; Kadia, Tapan; Jain, Nitin; DiNardo, Courtney; Wierda, William; Jeanis, Vicky; O'Brien, Susan

2015-11-01

Combination of chemotherapy with a tyrosine-kinase inhibitor is effective in the treatment of Philadelphia chromosome-positive acute lymphoblastic leukaemia. Ponatinib is a more potent BCR-ABL1 inhibitor than all other tyrosine-kinase inhibitors and selectively suppresses the resistant T315I clones. We examined the activity and safety of combining chemotherapy with ponatinib for patients with Philadelphia chromosome-positive acute lymphoblastic leukaemia in this continuing phase 2 trial. In this single-centre, phase 2, single-arm trial, adult patients with previously untreated Philadelphia chromosome-positive acute lymphoblastic leukaemia were sequentially enrolled. Patients who had received fewer than two courses of previous chemotherapy with or without tyrosine-kinase inhibitors were also eligible. Patients had to be aged 18 years or older, have an Eastern Cooperative Oncology Group performance status of 2 or less, have normal cardiac function (defined by ejection fraction above 50%), and have adequate organ function (serum bilirubin ≤3·0 mg/dL and serum creatinine ≤3·0 mg/dL, unless higher concentrations were believed to be due to a tumour). Patients received eight cycles of hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone (hyper-CVAD) alternating with high-dose methotrexate and cytarabine every 21 days. Ponatinib 45 mg was given daily for the first 14 days of cycle 1 then continuously for the subsequent cycles. Patients in complete remission received maintenance with ponatinib 45 mg daily with vincristine and prednisone monthly for 2 years followed by ponatinib indefinitely. The primary endpoint for this study was event-free survival. The trial is registered at ClinicalTrials.gov, number NCT01424982. 37 patients were enrolled and treated from Nov 1, 2011, to Sept 1, 2013. 2-year event-free survival rate was 81% (95% CI 64-90). Grade 3 or more toxic effects included infections during induction (20 [54%] patients), increased

Hysteroscopic enlargement metroplasty for T-shaped uterus: 24 years' experience at the Strasbourg Medico-Surgical and Obstetrical Centre (CMCO).

PubMed

Ducellier-Azzola, G; Lecointre, L; Hummel, M; Pontvianne, M; Garbin, O

2018-05-12

What is the impact of hysteroscopic enlargement metroplasty for T-shaped uterus on the live birth rate? Performing enlargement metroplasty appears to improve the obstetrical prognosis and fertility in patients with a T-shaped uterus. T-shaped uterus is linked to an excess of myometrium in the uterine walls giving rise to a subcornual constriction ring which causes dysmorphism and hypoplasia of the uterine cavity. It is commonly associated with infertility or a sequence of repeated miscarriages. Single-centre observational cohort study in 112 patients who underwent enlargement metroplasty for T-shaped uterus between 1992 and 2016 in a Strasbourg university hospital centre. The mean age of patients was 33.2; they had been attempting to conceive on average for 56 months for subfertile patients and 42.2 months for infertile patients. Prior to surgery, patients had succeeded in becoming pregnant 161 times, i.e. a mean gravidity of 1.4 pregnancies. For subfertile patients the mean gravidity was 2.67. Mean parity was 0.04. In the overall population, one hundred pregnancies occurred following enlargement metroplasty. The live birth rate increased in a statistically significant manner following enlargement metroplasty: 4 (2.5%) vs. 60 (60%), p < 0.05. In parallel, the miscarriage rate was statistically reduced: 126 (78.3%) vs. 22 (22%), pnull< .05. Intraoperative complications were 1 case of cervical laceration (0.9%) and 1 case of false passage (0.9%). Subsequent pregnancies remained at risk of miscarriage (22%) and premature delivery (20%) but not extra uterine gestation. Delivery took place by Caesarean section in 61% of cases. In the subgroup of infertile patients, the live birth rate was also markedly increased and 49% of pregnancies which occurred were spontaneous. This study was descriptive and retrospective. These results are consistent with those in the literature. Hysteroscopic enlargement metroplasty is now a well-established technique with few

EVerT2—needling versus non-surgical debridement for the treatment of verrucae: study protocol for a single-centre randomised controlled trial

PubMed Central

Hashmi, Farina; Torgerson, David; Fairhurst, Caroline; Cockayne, Sarah; Bell, Kerry; Cullen, Michelle; Harrison-Blount, Michael

2015-01-01

Introduction Verrucae are extremely common, and are experienced by most people at some time during their lives. Although most verrucae will spontaneously disappear without treatment, many patients seek treatment, often because they have persisted for many years, are unsightly or painful or prevent them from doing sports or other activities. There are many different treatments available; including the Falknor's needling procedure. To date, there has only been one small trial evaluating the clinical effectiveness of this treatment and no health economic analysis has been undertaken. The Effective Verruca Treatments (EVerT2) trial aims to evaluate the clinical and cost-effectiveness of the needling procedure for the treatment of verrucae. Methods and analysis This single-centre randomised controlled trial will recruit 58 participants (aged 18 years and over with a plantar verruca) from Salford Podiatry Clinic patient lists and the surrounding area. If the participant presents with multiple verrucae, an ‘index’ verruca (largest and thickest lesion) will be identified and patients will be randomised 1:1 to the intervention group to receive the needling treatment or the control group to have the callus overlying the verruca debrided. The primary outcome is complete clearance of the index verruca at 12 weeks after randomisation. Secondary outcomes include clearance and recurrence of the treated verruca, clearance of all verrucae, number of verrucae remaining, change in size of the index verruca, pain, and participant satisfaction. A cost-effectiveness analysis of the needling versus callus debridement will be carried out from the perspective of health services over a time horizon of 12 weeks. Ethics and dissemination Ethical approval has been obtained from the University of Salford, Department of Health Sciences Ethical Approval Committee (HSCR15/24) and the University of York, Department of Health Sciences Research Governance Committee (HSRGC/2014/98/B

Clinicopathological profile and surgical treatment of abdominal tuberculosis: a single centre experience in northwestern Tanzania

PubMed Central

2013-01-01

Background Abdominal tuberculosis continues to be a major public health problem worldwide and poses diagnostic and therapeutic challenges to general surgeons practicing in resource-limited countries. This study was conducted to describe the clinicopathological profile and outcome of surgical treatment of abdominal tuberculosis in our setting and compare with what is described in literature. Methods A prospective descriptive study of patients who presented with abdominal tuberculosis was conducted at Bugando Medical Centre (BMC) in northwestern Tanzania from January 2006 to February 2012. Ethical approval to conduct the study was obtained from relevant authorities. Statistical data analysis was performed using SPSS version 17.0. Results Out of 256 patients enrolled in the study, males outnumbered females. The median age was 28 years (range = 16–68 years). The majority of patients (77.3%) had primary abdominal tuberculosis. A total of 127 (49.6%) patients presented with intestinal obstruction, 106 (41.4%) with peritonitis, 17 (6.6%) with abdominal masses and 6 (2.3%) patients with multiple fistulae in ano. Forty-eight (18.8%) patients were HIV positive. A total of 212 (82.8%) patients underwent surgical treatment for abdominal tuberculosis. Bands /adhesions (58.5%) were the most common operative findings. Ileo-caecal region was the most common bowel involved in 122 (57.5%) patients. Release of adhesions and bands was the most frequent surgical procedure performed in 58.5% of cases. Complication and mortality rates were 29.7% and 18.8% respectively. The overall median length of hospital stay was 32 days and was significantly longer in patients with complications (p < 0.001). Advanced age (age ≥ 65 years), co-morbid illness, late presentation, HIV positivity and CD4+ count < 200 cells/μl were statistically significantly associated with mortality (p < 0.0001). The follow up of patients were generally poor as only 37.5% of patients were available for follow up at

Perceptual centres in speech - an acoustic analysis

NASA Astrophysics Data System (ADS)

Scott, Sophie Kerttu

Perceptual centres, or P-centres, represent the perceptual moments of occurrence of acoustic signals - the 'beat' of a sound. P-centres underlie the perception and production of rhythm in perceptually regular speech sequences. P-centres have been modelled both in speech and non speech (music) domains. The three aims of this thesis were toatest out current P-centre models to determine which best accounted for the experimental data bto identify a candidate parameter to map P-centres onto (a local approach) as opposed to the previous global models which rely upon the whole signal to determine the P-centre the final aim was to develop a model of P-centre location which could be applied to speech and non speech signals. The first aim was investigated by a series of experiments in which a) speech from different speakers was investigated to determine whether different models could account for variation between speakers b) whether rendering the amplitude time plot of a speech signal affects the P-centre of the signal c) whether increasing the amplitude at the offset of a speech signal alters P-centres in the production and perception of speech. The second aim was carried out by a) manipulating the rise time of different speech signals to determine whether the P-centre was affected, and whether the type of speech sound ramped affected the P-centre shift b) manipulating the rise time and decay time of a synthetic vowel to determine whether the onset alteration was had more affect on P-centre than the offset manipulation c) and whether the duration of a vowel affected the P-centre, if other attributes (amplitude, spectral contents) were held constant. The third aim - modelling P-centres - was based on these results. The Frequency dependent Amplitude Increase Model of P-centre location (FAIM) was developed using a modelling protocol, the APU GammaTone Filterbank and the speech from different speakers. The P-centres of the stimuli corpus were highly predicted by attributes of

Impact of body weight, low energy diet and gastric bypass on drug bioavailability, cardiovascular risk factors and metabolic biomarkers: protocol for an open, non-randomised, three-armed single centre study (COCKTAIL)

PubMed Central

Andersson, Shalini; Sandbu, Rune; Robertsen, Ida; Johnson, Line Kristin; Angeles, Philip Carlo; Hertel, Jens Kristoffer; Skovlund, Eva; Heijer, Maria; Ek, Anna-Lena; Krogstad, Veronica; Karlsen, Tor-Ivar; Christensen, Hege; Andersson, Tommy B; Karlsson, Cecilia

2018-01-01

Introduction Roux-en-Y gastric bypass (GBP) is associated with changes in cardiometabolic risk factors and bioavailability of drugs, but whether these changes are induced by calorie restriction, the weight loss or surgery per se, remains uncertain. The COCKTAIL study was designed to disentangle the short-term (6 weeks) metabolic and pharmacokinetic effects of GBP and a very low energy diet (VLED) by inducing a similar weight loss in the two groups. Methods and analysis This open, non-randomised, three-armed, single-centre study is performed at a tertiary care centre in Norway. It aims to compare the short-term (6 weeks) and long-term (2 years) effects of GBP and VLED on, first, bioavailability and pharmacokinetics (24 hours) of probe drugs and biomarkers and, second, their effects on metabolism, cardiometabolic risk factors and biomarkers. The primary outcomes will be measured as changes in: (1) all six probe drugs by absolute bioavailability area under the curve (AUCoral/AUCiv) of midazolam (CYP3A4 probe), systemic exposure (AUCoral) of digoxin and rosuvastatin and drug:metabolite ratios for omeprazole, losartan and caffeine, levels of endogenous CYP3A biomarkers and genotypic variation, changes in the expression and activity data of the drug-metabolising, drug transport and drug regulatory proteins in biopsies from various organs and (2) body composition, cardiometabolic risk factors and metabolic biomarkers. Ethics and dissemination The COCKTAIL protocol was reviewed and approved by the Regional Committee for Medical and Health Research Ethics (Ref: 2013/2379/REK sørøst A). The results will be disseminated to academic and health professional audiences and the public via presentations at conferences, publications in peer-reviewed journals and press releases and provided to all participants. Trial registration number NCT02386917. PMID:29844102

The Scottish Centre for Mathematics, Science and Technical Education

ERIC Educational Resources Information Center

Sandercock, E. R.

1977-01-01

The Centre's functions are described. A flow diagram, developed for the Scottish Integrated Science Course, showing a modular approach to science for mixed ability or low ability students is given. This course is intended for students in their first two years of secondary education. (AJ)

Influence of complex impurity centres on radiation damage in wide-gap metal oxides

NASA Astrophysics Data System (ADS)

Lushchik, A.; Lushchik, Ch.; Popov, A. I.; Schwartz, K.; Shablonin, E.; Vasil'chenko, E.

2016-05-01

Different mechanisms of radiation damage of wide-gap metal oxides as well as a dual influence of impurity ions on the efficiency of radiation damage have been considered on the example of binary ionic MgO and complex ionic-covalent Lu3Al5O12 single crystals. Particular emphasis has been placed on irradiation with ∼2 GeV heavy ions (197Au, 209Bi, 238U, fluence of 1012 ions/cm2) providing extremely high density of electronic excitations within ion tracks. Besides knock-out mechanism for Frenkel pair formation, the additional mechanism through the collapse of mobile discrete breathers at certain lattice places (e.g., complex impurity centres) leads to the creation of complex defects that involve a large number of host atoms. The experimental manifestations of the radiation creation of intrinsic and impurity antisite defects (Lu|Al or Ce|Al - a heavy ion in a wrong cation site) have been detected in LuAG and LuAG:Ce3+ single crystals. Light doping of LuAG causes a small enhancement of radiation resistance, while pair impurity centres (for instance, Ce|Lu-Ce|Al or Cr3+-Cr3+ in MgO) are formed with a rise of impurity concentration. These complex impurity centres as well as radiation-induced intrinsic antisite defects (Lu|Al strongly interacting with Lu in a regular site) tentatively serve as the places for breathers collapse, thus decreasing the material resistance against dense irradiation.

A cross-sectional study of knife injuries at a London major trauma centre

PubMed Central

Sutherland, E; Glucksman, E; Tunnicliff, M; Keep, JW

2014-01-01

INTRODUCTION No national recording systems for knife injuries exist in the UK. Understanding the true size and nature of the problem of knife injuries is the first stage in reducing the burden of this injury. The aim of this study was to survey every knife injury seen in a single inner city emergency department (ED) over a one-year period. METHODS A cross-sectional observational study was performed of all patients attending with a knife injury to the ED of a London major trauma centre in 2011. Demographic characteristics, patterns of injury, morbidity and mortality data were collected. RESULTS A total of 938 knife injuries were identified from 127,191 attendances (0.77% of all visits) with a case fatality rate of 0.53%. A quarter (24%) of the major trauma team’s caseload was for knife injuries. Overall, 44% of injuries were selfreported as assaults, 49% as accidents and 8% as deliberate self-harm. The highest age specific incident rate occurred in the 16–24 year age category (263/100,000). Multiple injuries were seen in 19% of cases, of which only 81% were recorded as assaults. The mean length of stay for those admitted to hospital was 3.04 days. Intrathoracic injury was seen in 26% of cases of chest trauma and 24% of abdominal injuries had a second additional chest injury. CONCLUSIONS Violent intentional injuries are a significant contributory factor to the workload of the major trauma team at this centre. This paper contributes to a more comprehensive understanding of the nature of these injuries seen in the ED. PMID:24417825

Children's Preferences for Group Musical Activities in Child Care Centres: A Cross-Cultural Study

ERIC Educational Resources Information Center

Yim, Hoi Yin Bonnie; Ebbeck, Marjory

2009-01-01

This paper reports on a cross-cultural research study of children's preferences for group musical activities in child care centres. A total of 228 young children aged 4-5 years in seven child care centres in Hong Kong and in the Adelaide City of South Australia participated in the study. Both qualitative and quantitative data were collected via a…

Sneeze related area in the medulla: localisation of the human sneezing centre?

PubMed Central

Seijo‐Martínez, M; Varela‐Freijanes, A; Grandes, J; Vázquez, F

2006-01-01

Sneezing is a rarely explored symptom in neurological practice. In the cat, a sneeze evoking centre is located in the medulla. The existence of a sneezing centre has not been confirmed in humans. A case with abnormal sneezing secondary to a strategic infarct in the right latero‐medullary region is presented. A 66 year old man suddenly presented paroxysmal sneezing followed by ataxia, right sided motor and sensory symptoms, and hoarseness. The application of stimuli to the right nasal fossa did not evoke sneezing nor the wish to sneeze. The same stimuli to the contralateral nasal fossa evoked normal sneezing. The preservation of the superficial sensitivity of the nasal fossa indicates that the lesion was localised in the hypothetical human sneezing centre, very close to the spinal trigeminal tract and nucleus. This centre appears to be bilateral and functionally independent on both sides. PMID:16354739

Exploring the characteristics of patients with mesothelioma who chose active symptom control over chemotherapy as first-line treatment: a prospective, observational, single centre study.

PubMed

Bibby, Anna C; De Fonseka, Duneesha; Morley, Anna J; Keenan, Emma; Addeo, Alfredo; Smith, Sarah; Edey, Anthony J; Maskell, Nick A

2017-12-08

Mesothelioma is an aggressive thoracic tumour with a poor prognosis. The only treatment that extends survival is chemotherapy. However, in the UK, up to 50% of patients who are suitable for chemotherapy choose not to receive it, opting for active symptom control instead. The aim of this prospective, single-centre observational study was to describe the characteristics of patients who chose active symptom control over chemotherapy and explore their reasons for doing so. Two hundred consecutive patients with mesothelioma from one UK centre were included. Eligibility for chemotherapy and choice of first-line treatment were recorded prospectively. Patient characteristics and outcomes were compared using descriptive statistics, regression analysis and survival analysis. Reasons for choosing active symptom control over chemotherapy were extracted, retrospectively. People who chose active symptom control were older, more likely to be female and had worse performance statuses than patients who received front-line chemotherapy. Concern over side effects, the modest survival benefit and previous adverse experiences with chemotherapy were reported as reasons for the decision. Median survival was 13.9 months in the chemotherapy group compared with 6.7 months in the active symptom control group. This is the first study to describe the characteristics of patients with mesothelioma who chose active symptom control over chemotherapy, in the front-line setting. Important differences were seen between this group and patients who received chemotherapy, although confounding is likely to have affected some outcomes. Future research could use qualitative methods to explore patients' reasons for choosing active symptom control, and to further elucidate the decision-making process.

The UK Haemophilia Doctors Organisation triennial audit of UK Comprehensive Care Haemophilia Centres.

PubMed

Wilde, J T

2012-07-01

Under the auspices of the United Kingdom Haemophilia Doctors Organisation (UKHCDO) the UK Comprehensive Care Haemophilia Centres (CCCs) have undergone a three yearly formal audit assessment since 1993. This report describes the evolution of the audit process and details the findings of the most recent audit round, the sixth since inception. The audit reports from the 2009 audit round were reviewed by the audit organizing group and a structured analysis of the data was compiled. CCCs in the UK offer a high standard of comprehensive care services. The main areas of concern were the state of the premises (seven centres), lack of dental services (seven centres), physiotherapy (seven centres) and social work support (11 centres). Major concerns were identified at eight centres requiring a formal letter from the chairman of UKHCDO to the chief executive of the host trust. Since inception of the triennial audit process centre report recommendations have resulted in major improvements in the services available at UK CCCs. The audit process is considered to be a highly effective means of improving the quality of care for patients with bleeding disorders and can be used as a model for the introduction of a similar process in other countries. © 2012 Blackwell Publishing Ltd.

The largest survivorship and clinical outcomes study of the fixed bearing Stryker Triathlon Partial Knee Replacement - A multi-surgeon, single centre cohort study with a minimum of two years of follow-up.

PubMed

Middleton, S W F; Schranz, P J; Mandalia, V I; Toms, A D

2018-05-03

The surgical management of isolated medial compartment degenerative disease of the knee causes debate. Unicompartmental arthroplasty options include fixed and mobile bearing implant designs with fixed bearing becoming increasingly popular. We present the largest cohort of a fixed bearing single radius design, Stryker Triathlon Partial Knee Replacement (PKR). We prospectively collected demographic data and patient reported outcome measures (PROMs) on our cohort of PKR implants since its adoption in our unit, 2009 until March 2015. A total of 129 implants in 115 patients with a mean follow-up of 5.5 years (2.5 to 8.5 years) were included. There were 11 revisions at an average of 1.7 years (0.6-4.1 years), two for infection, two for mal-alignment, five for progression of disease and two for loosening. The survivorship of the implants at five years is 90%. The PKR provides good survivorship at five years and PROM scores that are equal to the largest and most popular comparable implants. There is an associated learning curve with this implant, as there is with all systems and this is reflected in our results. Crown Copyright © 2018. Published by Elsevier B.V. All rights reserved.

Person-centred Leadership: a relational approach to leadership derived through action research.

PubMed

Cardiff, Shaun; McCormack, Brendan; McCance, Tanya

2018-04-21

How does person-centred leadership manifest in clinical nursing. Person-centred practice fosters healthful relationships and is gaining increasing attention in nursing and healthcare, but nothing is known about the influence of a person-centred approach to leadership practice. Most leadership models used in nursing were originally developed outside of nursing. A three year participatory action research study where participant leaders planned, researched and learned from their practice development. After an orientation phase, four action spirals focused on: critical and creative reflective inquiries into leadership practice change; leading the implementation and evaluation of a new nursing system; facilitating storytelling sessions with staff and annually reflecting on personal leadership change. Multiple data gathering methods offered insight into leadership development from several perspectives. Critical and creative thematic data analysis revealed a set of attributes, relational processes and contextual factors that influenced the being and becoming of a person-centred leader. Comparing the findings with nursing leadership literature supports a conceptual framework for person-centred leadership. Person-centred leadership is a complex, dynamic, relational and contextualised practice that aims to enable associates and leaders achieve self-actualisation, empowerment and wellbeing. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

RTEMS CENTRE- Support and Maintenance CENTRE to RTEMS Operating System

NASA Astrophysics Data System (ADS)

Silva, H.; Constantino, A.; Coutunho, M.; Freitas, D.; Faustino, S.; Mota, M.; Colaço, P.; Zulianello, M.

2008-08-01

RTEMS stands for Real-Time Operating System for Multiprocessor Systems. It is a full featured Real Time Operating System that supports a variety of open APIs and interface standards. It provides a high performance environment for embedded applications, including a fixed-priority preemptive/non-preemptive scheduler, a comprehensive set of multitasking operations and a large range of supported architectures. Support and maintenance CENTRE to RTEMS operating system (RTEMS CENTRE) is a joint initiative of ESA-Portugal Task force, aiming to build a strong technical competence in the space flight (on- board) software, to offer support, maintenance and improvements to RTEMS. This paper provides a high level description of the current and future activities of the RTEMS CENTRE. It presents a brief description of the RTEMS operating system, a description of the tools developed and distributed to the community [1] and the improvements to be made to the operating system, including facilitation for the qualification of RTEMS (4.8.0) [2] for the space missions.

Mortality in coeliac disease: a population-based cohort study from a single centre in Southern Derbyshire, UK

PubMed Central

Holmes, Geoffrey K T; Muirhead, Andrew

2018-01-01

Objective With the advent of screening tests, it was hypothesised that milder cases of coeliac disease coming to diagnosis might have reduced risk of mortality. An earlier publication did not support this view. We have re-examined this issue employing a larger number of patients followed for a further 8 years. Design Patients with coeliac disease from Southern Derbyshire, UK, were followed prospectively from 1978 to 2014 and included those diagnosed by biopsy and serology. Causes of death were ascertained. Standardised mortality ratios were calculated for all deaths, cardiovascular disease, malignancy, accidents and suicides, respiratory and digestive disease. Ratios were calculated for individual causes. Analysis centred on the postdiagnosis period that included follow-up time beginning 2 years from the date of coeliac disease diagnosis to avoid ascertainment bias. Patients were stratified according to date of diagnosis to reflect increasing use of serological methods. Results All-cause mortality increase was 57%. Mortality in the serology era declined overall. Mortality from cardiovascular disease, specifically, decreased significantly over time. Death from respiratory disease significantly increased in the postdiagnosis period. The standardised mortality ratio for non-Hodgkin’s lymphoma was 6.32, for pneumonia 2.58, for oesophageal cancer 2.80 and for liver disease 3.10. Survival in those who died after diagnosis increased by three times over the past three decades. Conclusions Serological testing has impacted on the risk of mortality in coeliac disease. There is an opportunity to improve survival by implementing vaccination programmes for pneumonia and more prompt, aggressive treatments for liver disease. PMID:29686881

Dietary supplement use among participants of a databank and biorepository at a comprehensive cancer centre

PubMed Central

Luc, LeQuyen; Baumgart, Charlotte; Weiss, Edward; Georger, Lesley; Ambrosone, Christine B; Zirpoli, Gary; McCann, Susan E

2015-01-01

Objective We assessed the prevalence, patterns and predictors of dietary supplement use among participants of the databank and biorepository (DBBR) at a comprehensive cancer centre in western New York. Design Archived epidemiological questionnaire data were obtained from the DBBR at Roswell Park Cancer Institute. Descriptive statistics and logistic regression explored the prevalence, patterns and predictors of lifetime use of four common supplements (multivitamins, vitamin C, vitamin E and calcium) and use of multivitamins, sixteen single vitamins/minerals and eighteen herbal/specialty supplements within the previous 10 years. Setting Western New York, USA. Subjects DBBR participants (n 8096) enrolled between December 2003 and July 2012 were included in these analyses: 66.9 % (n 5418) with cancer, 65.6 % (n 5309) women, mean age for patients ν. cancer-free controls 59.9 (sd 12.6) years and 50.7 (sd 15.4) years, respectively. Results Overall, 54.4 % of DBBR participants reported lifetime use of one or more supplements and 63.1 % reported use of one or more supplements within the previous 10 years (excluding multivitamins). Multivitamin use was high in this sample (lifetime: 64.1 %; 10 years: 71.3 %; current: 51.8 %). Supplementation was higher among cancer-free controls than cancer patients. Vitamin C, calcium and fish oil were the most common single vitamin, mineral and specialty product, respectively. Conclusions A consistently high and increasing proportion of dietary supplement use over time remains clear. Supplementation is prevalent among cancer patients and may even be higher than predicted in cancer-free individuals. Further studies should assess the safety and efficacy of specific supplements in reducing disease risk. PMID:24866812

The politics of patient-centred care.

PubMed

Kreindler, Sara A

2015-10-01

Despite widespread belief in the importance of patient-centred care, it remains difficult to create a system in which all groups work together for the good of the patient. Part of the problem may be that the issue of patient-centred care itself can be used to prosecute intergroup conflict. This qualitative study of texts examined the presence and nature of intergroup language within the discourse on patient-centred care. A systematic SCOPUS and Google search identified 85 peer-reviewed and grey literature reports that engaged with the concept of patient-centred care. Discourse analysis, informed by the social identity approach, examined how writers defined and portrayed various groups. Managers, physicians and nurses all used the discourse of patient-centred care to imply that their own group was patient centred while other group(s) were not. Patient organizations tended to downplay or even deny the role of managers and providers in promoting patient centredness, and some used the concept to advocate for controversial health policies. Intergroup themes were even more obvious in the rhetoric of political groups across the ideological spectrum. In contrast to accounts that juxtaposed in-groups and out-groups, those from reportedly patient-centred organizations defined a 'mosaic' in-group that encompassed managers, providers and patients. The seemingly benign concept of patient-centred care can easily become a weapon on an intergroup battlefield. Understanding this dimension may help organizations resolve the intergroup tensions that prevent collective achievement of a patient-centred system. © 2013 John Wiley & Sons Ltd.

Combined use of directional atherectomy and drug-coated balloon for the endovascular treatment of common femoral artery disease: immediate and one-year outcomes.

PubMed

Cioppa, Angelo; Stabile, Eugenio; Salemme, Luigi; Popusoi, Grigore; Pucciarelli, Armando; Iacovelli, Fortunato; Arcari, Antonella; Coscioni, Enrico; Trimarco, Bruno; Esposito, Giovanni; Tesorio, Tullio

2017-02-20

Surgical endarterectomy is the therapy of choice for atherosclerotic common femoral artery (CFA) obstruction. Recently, some large single-centre series have shown encouraging results for the percutaneous treatment of CFA obstructions. The purpose of this study was to evaluate the safety, feasibility, and one-year efficacy of the endovascular treatment of CFA obstructions with combined use of directional atherectomy (DA) and a paclitaxel-coated balloon (DCB). Between January 2012 and July 2014, 30 consecutive patients with severely calcified obstructions of the common femoral artery were treated in our centre using DA followed by DCB dilatation. Provisional stenting was allowed in the case of a suboptimal result. Twenty cases (66%) were isolated CFA interventions, whereas five (17%) and five (17%) also involved inflow and outflow vessels, respectively. Chronic total CFA occlusions (CTO) were recanalised in six cases (20%). Procedural success was achieved in all cases; stenting was needed in three cases (10%). At one year, restenosis and target lesion revascularisation were observed in two of 30 (6.6%) and one of 30 (3.3%) patients, respectively. The secondary patency rate was 96.7%. This single-centre prospective study suggests that the combined use of DA and DCB is a safe and effective alternative to surgery, a treatment option for common femoral artery lesions and provides encouraging results in this setting.

Step Forward. Single Parent/Homemaker Annual Report for the Fiscal Year 1990-1991.

ERIC Educational Resources Information Center

Kentucky Tech Region 5, Elizabethtown.

The Step Forward Single Parent/Homemaker Program in Elizabethtown, Kentucky, was developed to provide information on career opportunities and assist the target individuals in career assessment, career counseling, and goal setting in order to develop self-esteem and time management skills. During the second year of the Step Forward program in…

Self-referral psychological treatment centre for young adults: a 2-year observational evaluation of routine practice before and after treatment

PubMed Central

Halje, Karin; Timpka, Toomas; Tylestedt, Petra; Adler, Anna-Karin; Fröberg, Lena; Schyman, Tommy; Johansson, Kristoffer; Dahl, Katarina

2015-01-01

Objectives To examine a self-referral psychological service provided to young adults with regard to effects on anxiety, depression and psychological distress and to explore client factors predicting non-adherence and non-response. Design Observational study over a 2-year period. Setting Young Adults Centre providing psychological services by self-referral (preprimary care) to Linköping, Åtvidaberg, and Kinda municipalities (combined population 145 000) in Östergötland county, Sweden. Participants 607 young adults (16–25 years of age); 71% females (n=429). Intervention Individually scheduled cognitive behavioural therapy delivered in up to six 45 min sessions structured according to an assessment of the client's mental health problems: anxiety, depression, anxiety and depression combined, or decreased distress without specific anxiety or depression. Primary outcome measures Pre–post intervention changes in psychological distress (General Health Questionnaire-12, GHQ-12), Hospital Anxiety and Depression Scale Anxiety/Depression (HADS-A/D). Results 192 clients (32.5%) discontinued the intervention on their own initiative and 39 clients (6.6%) were referred to a psychiatric clinic during the course of the intervention. Intention-to-treat analyses including all clients showed a medium treatment effect size (d=0.64) with regard to psychological distress, and small effect sizes were observed with regard to anxiety (d=0.58) and depression (d=0.57). Restricting the analyses to clients who adhered to the agreed programme, a large effect size (d=1.26) was observed with regard to psychological distress, and medium effect sizes were observed with regard to anxiety (d=1.18) and depression (d=1.19). Lower age and a high initial HADS-A score were the strongest risk factors for non-adherence, and inability to concentrate and thinking of oneself as a worthless person increased the risk for discontinuation. Conclusions We conclude that provision of psychological

Cost analysis of a primary health centre in northern India.

PubMed

Anand, K; Kapoor, S K; Pandav, C S

1993-01-01

Cost data are useful in health planning, budgeting and for assessing the efficiency of services. However, such data are not easily available from developing countries. We therefore estimated the cost incurred for the year 1991-92 on a primary health centre in northern India, which is affiliated to an academic institution. The total costs incurred included the capital costs for land, building, furniture, vehicles and equipment as well as the recurrent costs for salaries, drugs and vaccines, diesel and maintenance. Except for land, where the 'opportunity cost' was calculated, the current market rates were considered for all other factors. A discount rate of 10% was used in the study. A total of Rs 777,015 (US $24,282) was incurred on the primary health centre in the study year, 80% being recurrent costs. Salaries constituted 62% of the total costs. A sum of Rs 30 (US $0.94) per head per year on primary health care was being incurred. Salaries constitute the bulk of the cost incurred on health. Approximately Rs 28 (40%) of the Rs 69 spent per head per year on health services by the Government of India is incurred on providing primary health care services.

Campylobacter bacteremia in London: A 44-year single-center study.

PubMed

O'Hara, Geraldine A; Fitchett, Joseph R A; Klein, John L

2017-09-01

Campylobacter species are a well-recognized but rare cause of bloodstream infection. Here we reviewed 41 cases of Campylobacter bloodstream infection occurring at a single center in London over 44years, comprising 0.2% of all recorded episodes during this time period. Patients had a mean age of 46years and, contrasting with previous reports, nearly 50% of our patients did not have significant comorbidities. Ciprofloxacin resistance increased over the study period with 35% of isolates overall being resistant compared with only 3% exhibiting macrolide resistance. Despite a minority of patients receiving appropriate empirical antibiotic therapy, overall mortality was only 7%. Campylobacter bacteremia remains a rare but significant cause of morbidity with a low associated mortality. Underlying immunosuppressive conditions are common but by no means universal. In our setting, macrolides would be favored as empirical agents to treat suspected Campylobacter enteritis, including cases with associated bacteremia. Copyright © 2017 Elsevier Inc. All rights reserved.

Addiction research centres and the nurturing of creativity. Monitoring the European drug situation: the ongoing challenge for the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA).

PubMed

Griffiths, Paul; Mounteney, Jane; Lopez, Dominique; Zobel, Frank; Götz, Wolfgang

2012-02-01

The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) is the designated hub for drug-related information in the European Union. The organization's role is to provide the European Union (EU) and its Member States with a factual overview of European drug problems and a common information framework to support the drugs debate. In order to achieve its mission, the EMCDDA coordinates and relies on a network of 30 national monitoring centres, the Reitox National Focal Points. The Centre publishes on a wide range of drug-related topics, across epidemiology, interventions, laws and policies. Every November, the EMCDDA publishes its Annual Report, providing a yearly update on the European drug situation, translated into 23 EU languages. In line with its founding regulation, the EMCDDA has a role acting as an interface between the worlds of science and policy. While not a research centre in the formal sense, the results the Centre generates serve as catalysts for new research questions and help to identify priorities. Current challenges facing the agency include continuing to increase scientific standards while maintaining a strong institutional role, as well as supporting European efforts to identify, share and codify best practice in the drugs field. © 2011 EMCDDA.

Safety Assurances at Space Test Centres: Lessons Learned

NASA Astrophysics Data System (ADS)

Alarcon Ruiz, Raul; O'Neil, Sean; Valls, Rafel Prades

2010-09-01

The European Space Agency’s(ESA) experts in quality, cleanliness and contamination control, safety, test facilities and test methods have accumulated valuable experience during the performance of dedicated audits of space test centres in Europe over a period of 10 years. This paper is limited to a summary of the safety findings and provides a valuable reference to the lessons learned, identifying opportunities for improvement in the areas of risk prevention measures associated to the safety of all test centre personnel, the test specimen, the test facilities and associated infrastructure. Through the analysis of the audit results the authors present what are the main lessons learned, and conclude how an effective safety management system will contribute to successful test campaigns and have a positive impact on the cost and schedule of space projects.

Mortality on the Waiting List for Lung Transplantation in Patients with Idiopathic Pulmonary Fibrosis: A Single-Centre Experience.

PubMed

Bennett, David; Fossi, Antonella; Bargagli, Elena; Refini, Rosa Metella; Pieroni, Maria; Luzzi, Luca; Ghiribelli, Claudia; Paladini, Piero; Voltolini, Luca; Rottoli, Paola

2015-10-01

Lung transplantation (LTX) is nowadays accepted as a treatment option for selected patients with end-stage pulmonary disease. Idiopathic pulmonary fibrosis (IPF) is characterized by the radiological and histologic appearance of usual interstitial pneumonia. It is associated with a poor prognosis, and LTX is considered an effective treatment to significantly modify the natural history of this disease. The aim of the present study was to analyse mortality during the waiting list in IPF patients at a single institution. A retrospective analysis on IPF patients (n = 90) referred to our Lung Transplant Program in the period 2001-2014 was performed focusing on patients' characteristics and associated risk factors. Diagnosis of IPF was associated with high mortality on the waiting list with respect to other diagnosis (p < 0.05). No differences in demographic, clinical, radiological data and time spent on the waiting list were observed between IPF patients who underwent to LTX or lost on the waiting list. Patients who died showed significant higher levels of pCO2 and needed higher flows of O2-therapy on effort (p < 0.05). Pulmonary function tests failed to predict mortality and no other medical conditions were associated with survival. Patients newly diagnosed with IPF, especially in small to medium lung transplant volume centres and in Countries where a long waiting list is expected, should be immediately referred to transplantation, delay results in increased mortality. Early identification of IPF patients with a rapid progressive phenotype is strongly needed.

The UK Centre for Astrobiology: A Virtual Astrobiology Centre. Accomplishments and Lessons Learned, 2011-2016.

PubMed

Cockell, Charles S; Biller, Beth; Bryce, Casey; Cousins, Claire; Direito, Susana; Forgan, Duncan; Fox-Powell, Mark; Harrison, Jesse; Landenmark, Hanna; Nixon, Sophie; Payler, Samuel J; Rice, Ken; Samuels, Toby; Schwendner, Petra; Stevens, Adam; Nicholson, Natasha; Wadsworth, Jennifer

2018-02-01

The UK Centre for Astrobiology (UKCA) was set up in 2011 as a virtual center to contribute to astrobiology research, education, and outreach. After 5 years, we describe this center and its work in each of these areas. Its research has focused on studying life in extreme environments, the limits of life on Earth, and implications for habitability elsewhere. Among its research infrastructure projects, UKCA has assembled an underground astrobiology laboratory that has hosted a deep subsurface planetary analog program, and it has developed new flow-through systems to study extraterrestrial aqueous environments. UKCA has used this research backdrop to develop education programs in astrobiology, including a massive open online course in astrobiology that has attracted over 120,000 students, a teacher training program, and an initiative to take astrobiology into prisons. In this paper, we review these activities and others with a particular focus on providing lessons to others who may consider setting up an astrobiology center, institute, or science facility. We discuss experience in integrating astrobiology research into teaching and education activities. Key Words: Astrobiology-Centre-Education-Subsurface-Analog research. Astrobiology 18, 224-243.

Two-year experience of multi-disciplinary team (MDT) outcomes for brain metastases in a tertiary neuro-oncology centre.

PubMed

Loh, Daniel; Hogg, Florence; Edwards, Penelope; MacColl, Jillian; Brogna, Christian; Bhangoo, Ranjeev; Ashkan, Keyoumars; Vergani, Francesco

2017-08-24

Brain metastases (BMs) are the most common intracranial tumour in adults and form a significant proportion of the neuro-oncology workload. Their management has progressed significantly in the last few decades but a gold-standard evidence-based management strategy has not been defined to date and several guidelines based on available evidence exist to support clinical decision-making. This paper evaluates the decision-making process of the neuro-oncology multi-disciplinary team (MDT) in a tertiary neuro-oncology centre over a two-year period. A retrospective review of all patients with BM discussed in the MDT was conducted. Data on patient demographics, tumour characteristics and MDT decision were collected from the MDT database, clinical notes and imaging studies. Patients were stratified into the three recursive partitioning analysis (RPA) classes and according to the graded prognostic assessment (GPA) score. MDT decisions were analysed by RPA class and for GPA score as well as single versus multiple BM. There were 362 patients with BM, representing 22% of the total cases discussed at the MDT. Decision-making was largely consistent with available guidelines. A concrete treatment decision was reached in 77.5% of patients and 32.2% of these received neurosurgical input. More patients with solitary BM underwent surgery compared to multiple BM (p = 0.001), and more patients in RPA classes I and II had surgical resection compared to class III (p = 0.005 and 0.001, respectively). Surgical patients also had higher GPA scores compared to palliative patients (p = 0.005). A greater absolute number and proportion of patients in RPA class II vs. class I underwent neurosurgical intervention. These patients were stratified into class II because of their age but would otherwise have been placed into class I. Survival data were available for 195 patients (53.8%) at 1 year post MDT discussion. A pattern of declining survival was observed along RPA classes which was

Single-centre experience with the frozen elephant trunk technique in 251 patients over 15 years.

PubMed

Shrestha, Malakh; Martens, Andreas; Kaufeld, Tim; Beckmann, Erik; Bertele, Sebastian; Krueger, Heike; Neuser, Julia; Fleissner, Felix; Ius, Fabio; Abd Alhadi, Firas; Hanke, Jasmin; Schmitto, Jan D; Cebotari, Serghei; Karck, Matthias; Haverich, Axel; Chavan, Ajay

2017-11-01

Our goal was to present our 15-year experience (2001-2015) with the frozen elephant trunk (FET) technique. A total of 251 patients (82 with aortic aneurysms, 96 with acute aortic dissection type A, 4 with acute type B dissections, 52 with chronic aortic dissection type A, 17 with chronic type B dissection and 67 redo cases) underwent FET implantation with either the custom-made Chavan-Haverich (n = 66), the Jotec E-vita (n = 31) or the Vascutek Thoraflex hybrid (n = 154) prosthesis. The cases were assigned to an early period (2001-2011) and a contemporary period (2012-present). Mean cardiopulmonary bypass time, aortic cross-clamp time, circulatory arrest time and selective antegrade cerebral perfusion time were 241 ± 72, 125 ± 59, 56 ± 30 and 81 ± 34 min, respectively. Incidence of rethoracotomy for bleeding, stroke, spinal cord injury, prolonged ventilatory support (>96 h) and long-term dialysis were 18, 14, 2, 24 and 2%, respectively. The in-hospital mortality rate was 11% (in acute aortic dissection type A, 12%). Of the 2 patients with graft infections, 1 died and the other had a protracted hospital stay. There were 49 second-stage procedures in the downstream aorta: either open surgical [n = 25 (thoraco-abdominal, n = 15; descending, n = 6; infrarenal, n = 4)] or transfemoral endovascular (n = 23). Elective thoracic endovascular aneurysm repair R implantation was successful in all 23 cases. FET results are comparable with those of the published results of the conventional elephant trunk technique. FET is an ideal landing zone for subsequent transfemoral endovascular completion. Patients with graft infections may have dismal results. © The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Complete quantum control of exciton qubits bound to isoelectronic centres.

PubMed

Éthier-Majcher, G; St-Jean, P; Boso, G; Tosi, A; Klem, J F; Francoeur, S

2014-05-30

In recent years, impressive demonstrations related to quantum information processing have been realized. The scalability of quantum interactions between arbitrary qubits within an array remains however a significant hurdle to the practical realization of a quantum computer. Among the proposed ideas to achieve fully scalable quantum processing, the use of photons is appealing because they can mediate long-range quantum interactions and could serve as buses to build quantum networks. Quantum dots or nitrogen-vacancy centres in diamond can be coupled to light, but the former system lacks optical homogeneity while the latter suffers from a low dipole moment, rendering their large-scale interconnection challenging. Here, through the complete quantum control of exciton qubits, we demonstrate that nitrogen isoelectronic centres in GaAs combine both the uniformity and predictability of atomic defects and the dipole moment of semiconductor quantum dots. This establishes isoelectronic centres as a promising platform for quantum information processing.

Small Steps towards Student-Centred Learning

ERIC Educational Resources Information Center

Jacobs, George M.; Toh-Heng, Hwee Leng

2013-01-01

Student centred learning classroom practices are contrasted with those in teacher centred learning classrooms. The discussion focuses on the theoretical underpinnings of the former, and provides nine steps and tips on how to implement student centred learning strategies, with the aim of developing the 21st century skills of self-directed and…

Sperm banking for male reproductive preservation: a 6-year retrospective multi-centre study in China

PubMed Central

Ping, Ping; Zhu, Wen-Bing; Zhang, Xin-Zong; Yao, Kang-Shou; Xu, Peng; Huang, Yi-Ran; Li, Zheng

2010-01-01

Sperm banking can preserve male fertility effectively, but the current conditions of sperm cryopreservation in China have not been investigated. This retrospective investigation was based on data collected at multiple centres in China from January 2003 to December 2008. The collected data included urogenital history, indication for cryopreservation, semen parameters, use rate, type of assisted reproductive technique (ART) treatment and pregnancy outcome. The study population included 1 548 males who had banked their semen during the study period at one of the clinics indicated above. Approximately 1.9% (30/1 548) of the cryopreserved semen samples were collected from cancer patients; about 88.8% (1 374/1 548) of the patients had banked their semen for ART and 8.6% (134/1 548) had a male infertility disease (such as anejaculation, severe oligozoospermia and obstructive azoospermia). The total use rate of cryopreserved semen was 22.7% (352/1 548), with 119 live births. The cancer group use rate was 6.7% (2/30), with one live birth by intracytoplasmic single sperm injection (ICSI). The ART group use rate was 23.2% (319/1 374), with 106 live births. The reproductive disease group use rate was 23.1% (31/134), with 12 live births. The semen parameters in each category varied; the cancer patient and infertility disease groups had poor semen quality. In vitro fertilization (IVF) and ICSI were the most common ART treatments for cryopreserved sperm. Semen cryopreservation as a salvage method is effective, but in many conditions it is underutilized, especially in cancer patients. Lack of awareness, urgency of cancer treatment and financial constraints are the main causes of the low access rate. The concept of fertility preservation should be popularized to make better use of this medical service in China. PMID:20348941

Comparative dosimetry study of three UK centres implementing total skin electron treatment through external audit.

PubMed

Misson-Yates, S; Gonzalez, R; McGovern, M; Greener, A

2015-05-01

This article describes the external audit measurements conducted in two UK centres implementing total skin electron beam therapy (TSEBT) and the results obtained. Measurements of output, energy, beam flatness and symmetry at a standard distance (95 or 100 cm SSD) were performed using a parallel plate chamber in solid water. Similarly, output and energy measurements were also performed at the treatment plane for single and dual fields. Clinical simulations were carried out using thermoluminescent dosemeters (TLDs) and Gafchromic® film (International Specialty Products, Wayne, NJ) on an anthropomorphic phantom. Extended distance measurements confirmed that local values for the beam dosimetry at Centres A and B were within 2% for outputs and 1-mm agreement of the expected depth at which the dose is 50% of the maximum for the depth-dose curve in water (R50,D) value. Clinical simulation using TLDs) showed an agreement of -1.6% and -6.7% compared with the expected mean trunk dose for each centre, respectively, and a variation within 10% (±1 standard deviation) across the trunk. The film results confirmed that the delivery of the treatment technique at each audited centre complies with the European Organisation for Research and Treatment of Cancer recommendations. This audit methodology has proven to be a successful way to confirm the agreement of dosimetric parameters for TSEBT treatments at both audited centres and could serve as the basis for an audit template to be used by other audit groups. TSEBT audits are not established in the UK owing to a limited number of centres carrying out the treatment technique. This article describes the audits performed at two UK centres prior to their clinical implementation.

African experiences of humanitarian cardiovascular medicine: the Cardiac Centre of St. Elizabeth Catholic General Hospital, Shisong.

PubMed

Budzee, Sr Appolonia; Tchoumi, Jc Tantchou; Giamberti, Alessandro; Ambassa, Jc; Cirri, Sylvia; Butera, Gianfranco

2012-06-01

The cardiac centre of Shisong inaugurated few years ago is a good example of the mobilization of humanitarian resources from the north and south for the improvement of cardiovascular diagnosis and treatment in Africa. From the inauguration of the Center to December 2011, 23 surgical missions have been organized, (5 peadiatric and 18 adults) and 204 patients have been operated with the help of the partners: Associazione Bambini Cardiopatici nel Mondo and Cuore Fratello. The Catheterisation Laboratory has performed a total of 117 diagnostic and interventional procedures while 22 pace makers were implanted (12 single-chambers and 10 dual-chambers). Many problems and challenges are faced everyday but with the enthusiasm, the dynamism and the professional skills of the personnel, the help of the partners we see a bright future.

African experiences of humanitarian cardiovascular medicine: the Cardiac Centre of St. Elizabeth Catholic General Hospital, Shisong

PubMed Central

Budzee, Sr. Appolonia; Giamberti, Alessandro; Ambassa, JC; Cirri, Sylvia; Butera, Gianfranco

2012-01-01

The cardiac centre of Shisong inaugurated few years ago is a good example of the mobilization of humanitarian resources from the north and south for the improvement of cardiovascular diagnosis and treatment in Africa. From the inauguration of the Center to December 2011, 23 surgical missions have been organized, (5 peadiatric and 18 adults) and 204 patients have been operated with the help of the partners: Associazione Bambini Cardiopatici nel Mondo and Cuore Fratello. The Catheterisation Laboratory has performed a total of 117 diagnostic and interventional procedures while 22 pace makers were implanted (12 single-chambers and 10 dual-chambers). Many problems and challenges are faced everyday but with the enthusiasm, the dynamism and the professional skills of the personnel, the help of the partners we see a bright future. PMID:24282709

Can Chemistry Teachers' Centres Survive?

ERIC Educational Resources Information Center

Garforth, F. M.

1972-01-01

The difficulties faced by the Hull Chemistry Teachers' Centre in England are discussed. The lack of finances and time, as well as organizational difficulties in relationship with Science Centres and universities are among the problems. (TS)

From Animaculum to single molecules: 300 years of the light microscope.

PubMed

Wollman, Adam J M; Nudd, Richard; Hedlund, Erik G; Leake, Mark C

2015-04-01

Although not laying claim to being the inventor of the light microscope, Antonj van Leeuwenhoek (1632-1723) was arguably the first person to bring this new technological wonder of the age properly to the attention of natural scientists interested in the study of living things (people we might now term 'biologists'). He was a Dutch draper with no formal scientific training. From using magnifying glasses to observe threads in cloth, he went on to develop over 500 simple single lens microscopes (Baker & Leeuwenhoek 1739 Phil. Trans. 41, 503-519. (doi:10.1098/rstl.1739.0085)) which he used to observe many different biological samples. He communicated his finding to the Royal Society in a series of letters (Leeuwenhoek 1800 The select works of Antony Van Leeuwenhoek, containing his microscopical discoveries in many of the works of nature, vol. 1) including the one republished in this edition of Open Biology. Our review here begins with the work of van Leeuwenhoek before summarizing the key developments over the last ca 300 years, which has seen the light microscope evolve from a simple single lens device of van Leeuwenhoek's day into an instrument capable of observing the dynamics of single biological molecules inside living cells, and to tracking every cell nucleus in the development of whole embryos and plants.

From Animaculum to single molecules: 300 years of the light microscope

PubMed Central

Wollman, Adam J. M.; Nudd, Richard; Hedlund, Erik G.; Leake, Mark C.

2015-01-01

Although not laying claim to being the inventor of the light microscope, Antonj van Leeuwenhoek (1632–1723) was arguably the first person to bring this new technological wonder of the age properly to the attention of natural scientists interested in the study of living things (people we might now term ‘biologists’). He was a Dutch draper with no formal scientific training. From using magnifying glasses to observe threads in cloth, he went on to develop over 500 simple single lens microscopes (Baker & Leeuwenhoek 1739 Phil. Trans. 41, 503–519. (doi:10.1098/rstl.1739.0085)) which he used to observe many different biological samples. He communicated his finding to the Royal Society in a series of letters (Leeuwenhoek 1800 The select works of Antony Van Leeuwenhoek, containing his microscopical discoveries in many of the works of nature, vol. 1) including the one republished in this edition of Open Biology. Our review here begins with the work of van Leeuwenhoek before summarizing the key developments over the last ca 300 years, which has seen the light microscope evolve from a simple single lens device of van Leeuwenhoek's day into an instrument capable of observing the dynamics of single biological molecules inside living cells, and to tracking every cell nucleus in the development of whole embryos and plants. PMID:25924631

Pattern of severe electrical injuries in a Nigerian regional burn centre.

PubMed

Opara, K O; Chukwuanukwu, T O G; Ogbonnaya, I S; Nwadinigwe, C U

2006-12-01

Electrical injuries, though uncommon usually have devastating consequences. They are largely preventable. The objectives of the study were to highlight the pattern of severe electrical injuries seen in our environment, the management problems faced here compared with other studies and proffer suggestions for improvement and prevention. A 10-year retrospective study of case files of patients seen with electrical injuries in our centre was carried out from January 1995 to December 2004. Case notes were retrieved and data collated from them were analysed by descriptive statistics. Twenty four (24) case files met the inclusion criteria and were analysed. Electrical burns constituted 2.8% of total burn admissions. Patients' ages ranged from 15 months to 42 years. Male: Female ratio was 4.8:1. Seven (29%) had high voltage injuries, mostly work-related. Sixteen (67%) had low voltage injuries while one (4%) had a lightening injury. Fourteen (58%) presented or were referred more than 24 hours post injury. Fifteen (63%) had a form of surgical treatment with wound debridement (33%) skin grafting (38%) and amputations (29%) being the commonest ones. The mortality was 12.5% with septicaemia as the leading cause of death. Late presentation of patients to specialised centres, inadequate management at the primary centres of treatment, poverty and inadequate facilities even at the specialised centres were the main problems encountered. We recommend re-education of the populace including medical practitioners, enforcement of safety rules in the home and workplaces and upgrading of our health facilities to decrease the menace of severe electrical injuries.

Physician trust and depression influence adherence to factor replacement: a single-centre cross-sectional study.

PubMed

Tran, D Q; Barry, V; Antun, A; Ribeiro, M; Stein, S; Kempton, C L

2017-01-01

Poor adherence to factor replacement therapy among patients with haemophilia can lead to joint bleeding and eventual disability. The aim of this study was to determine patient-related characteristics associated with adherence to factor replacement in adults with haemophilia. Adults with haemophilia were recruited to participate in this cross-sectional study. Adherence was measured using either the Validated Hemophilia Regimen Treatment Adherence Scale (VERITAS)-Pro or the VERITAS-PRN questionnaire. Simple and multiple regression analyses that controlled for confounding were performed to determine the association between patient-related characteristics and adherence to factor replacement therapy. Of the 99 subjects enrolled, all were men; 91% had haemophilia A and 78% had severe disease. Age ranged from 18 to 62 years. Most (95%) had functional health literacy; but only 23% were numerate. Mean adherence scores were 45.6 (SD 18) and 51.0 (SD 15) for those on a prophylactic and those on an episodic regimen, respectively, with a lower score indicating better adherence. On multivariable analysis, being on any chronic medication, longer duration followed at our haemophilia treatment centre, higher physician trust and better quality of life were associated with higher adherence. A history of depression was associated with lower adherence. Two potentially modifiable characteristics, physician trust and depression, were identified as motivator and barrier to adherence to factor replacement therapy. Promoting a high level of trust between the patient and the healthcare team as well as identifying and treating depression may impact adherence to factor replacement therapy and accordingly reduce joint destruction. © 2016 John Wiley & Sons Ltd.

The cost effectiveness of single-level instrumented posterolateral lumbar fusion at 5 years after surgery.

PubMed

Glassman, Steven D; Polly, David W; Dimar, John R; Carreon, Leah Y

2012-04-20

Cost effectiveness analysis for single-level instrumented fusion during a 5-year postoperative interval. To determine the cost/quality-adjusted life year (QALY) gained for single-level instrumented posterolateral lumbar fusion for degenerative lumbar spine conditions during a 5-year period. Cost/QALY has become a standard measure among healthcare economists because it is generic and can be used across medical treatments. Prior studies have reported widely variable estimates of cost/QALY for lumbar spine fusion. This variability may be related to factors including study design, sample population, baseline assumptions, and length of the observation period. To determine QALY, the Short Form 6D (SF-6D), a utility index derived from the Short Form (36) Health Survey (SF-36) was used. Cost analysis was performed based on actual reimbursements from third-party payors, including those for the index surgical procedure, treatment of complications, emergency room outpatient visits, and revision surgery. A second cost analysis using only the contemporaneous Medicare Fee schedule was also performed, in addition to a subanalysis including indirect costs from days off work. The mean SF-6D health utility value showed a gradual increase throughout the follow-up period. The mean health utility value gained in each year postoperatively was 0.12, 0.14, 0.13, 0.15, and 0.15, for a cumulative 0.69 QALY improvement during the 5-year interval. Mean direct medical costs based on actual reimbursements for 5 years after surgery, including the index and revision procedures, was $22,708. The resultant cost per QALY gained at the 5-year postoperative interval was $33,018. The analogous mean direct cost based on Medicare reimbursement for 5 years was $20,669, with a resultant cost per QALY gained of $30,053. The mean total work productivity cost for 5 years was $14,377. The resultant total cost (direct and indirect) per QALY gained ranged from $53,949 to $53,914 at 5 years postoperatively. In

Does foreign aid crowd out government investments? Evidence from rural health centres in Rwanda.

PubMed

Lu, Chunling; Cook, Benjamin; Desmond, Chris

2017-01-01

Rural healthcare facilities in low-income countries play a major role in providing primary care to rural populations. We examined the link of foreign aid with government investments and medical service provision in rural health centres in Rwanda. Using the District Health System Strengthening Tool, a web-based database built by the Ministry of Health in Rwanda, we constructed two composite indices representing provision of (1) child and maternal care and (2) HIV, tuberculosis (TB) and malaria services in 330 rural health centres between 2009 and 2011. Financing variables in a healthcare centre included received funds from various sources, including foreign donors and government. We used multilevel random-effects model in regression analyses and examined the robustness of results to a range of alternative specification, including scale of dependent variables, estimation methods and timing of aid effects. Both government and foreign donors increased their direct investments in the 330 rural healthcare centres during the period. Foreign aid was positively associated with government investments (0.13, 95% CI 0.06 to 0.19) in rural health centres. Aid in the previous year was positively associated with service provision for child and maternal health (0.008, 95% CI 0.002 to 0.014) and service provision for HIV, TB and malaria (0.014, 95% CI 0.004 to 0.022) in the current year. The results are robust when using fixed-effects models. These findings suggest that foreign aid did not crowd out government investments in the rural healthcare centres. Foreign aid programmes, conducted in addition to government investments, could benefit rural residents in low-income countries through increased service provision in rural healthcare facilities.

An account of the real-life hepatitis C management in a single specialized viral hepatitis treatment centre in Egypt: results of treating 7042 patients with 7 different direct acting antiviral regimens.

PubMed

El Kassas, Mohamed; Alboraie, Mohamed; Omran, Dalia; Salaheldin, Mohamed; Wifi, Mohamed Naguib; ElBadry, Mohamed; El Tahan, Adel; Ezzat, Sameera; Moaz, Enass; Farid, Amir M; Omar, Heba; Abouelkhair, Mahmoud; Afify, Shimaa; Elsaeed, Kadry; Shazly, Yehia; Doss, Wahid; Esmat, Gamal

2018-05-14

A large Egyptian treatment program for HCV was launched in 2014 after the introduction of direct-acting antiviral agents (DAAs). This program depended mainly on establishing specialized independent centres for HCV treatment. These centres represent the major strengths in the Egyptian model of care, as they provide integrated care for HCV patients and have enabled Egypt to treat more than one million patients in 3 years. The New Cairo Viral Hepatitis Treatment Center (NCVHTC) is an example of these specialized centres. The Egyptian experience in the management of HCV was evaluated by analysing the data of real-life HCV management in the NCVHTC from 2014 to 2017. Results of different treatment regimens in addition to their strengths, limitations and areas for improvement are discussed in this report. A total of 7042 HCV patients have been evaluated for treatment in the NCVHTC. Among them, 5517 patients received treatment by seven different DAA regimens with excellent results. All regimens were highly effective at treating HCV in a real-life setting, apart from SOF/RBV, which was the least effective. A nationwide screening program and enhancing the follow-up of treated patients are the main missing pillars in the Egyptian model.

The Educational Technology Centre: A Window to View the Progress of Chinese ICT-Based Higher Education

ERIC Educational Resources Information Center

Zhou, Rong; Xie, Baizhi

2010-01-01

In China, after many years, the current status and challenges of e-learning development in higher education have been gradually understood. The educational technology centre (ECT) serves as the key unit to promote e-learning initiatives, but the performance of some centres still trails their foreign counterparts. Under such conditions, the project…

Conducting a paediatric multi-centre RCT with an industry partner: challenges and lessons learned.

PubMed

Maskell, Jessica; Newcombe, Peter; Martin, Graham; Kimble, Roy

2012-11-01

There are many benefits of multi-centred research including large sample sizes, statistical power, timely recruitment and generalisability of results. However, there are numerous considerations when planning and implementing a multi-centred study. This article reviews the challenges and successes of planning and implementing a multi-centred prospective randomised control trial involving an industry partner. The research investigated the impact on psychosocial functioning of a cosmetic camouflage product for children and adolescents with burn scarring. Multi-centred studies commonly have many stakeholders. Within this study, six Australian and New Zealand paediatric burn units as well as an industry partner were involved. The inclusion of an industry partner added complexities as they brought different priorities and expectations to the research. Further, multifaceted ethical and institutional approval processes needed to be negotiated. The challenges, successes, lessons learned and recommendations from this study regarding Australian and New Zealand ethics and research governance approval processes, collaboration with industry partners and the management of differing expectations will be outlined. Recommendations for future multi-centred research with industry partners include provision of regular written reports for the industry partner; continual monitoring and prompt resolution of concerns; basic research practices education for industry partners; minimisation of industry partner contact with participants; clear roles and responsibilities of all stakeholders and utilisation of single ethical review if available. © 2012 The Authors. Journal of Paediatrics and Child Health © 2012 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

Single cell elemental analysis using nuclear microscopy

NASA Astrophysics Data System (ADS)

Ren, M. Q.; Thong, P. S. P.; Kara, U.; Watt, F.

1999-04-01

The use of Particle Induced X-ray Emission (PIXE), Rutherford Backscattering Spectrometry (RBS) and Scanning Transmission Ion Microscopy (STIM) to provide quantitative elemental analysis of single cells is an area which has high potential, particularly when the trace elements such as Ca, Fe, Zn and Cu can be monitored. We describe the methodology of sample preparation for two cell types, the procedures of cell imaging using STIM, and the quantitative elemental analysis of single cells using RBS and PIXE. Recent work on single cells at the Nuclear Microscopy Research Centre,National University of Singapore has centred around two research areas: (a) Apoptosis (programmed cell death), which has been recently implicated in a wide range of pathological conditions such as cancer, Parkinson's disease etc, and (b) Malaria (infection of red blood cells by the malaria parasite). Firstly we present results on the elemental analysis of human Chang liver cells (ATTCC CCL 13) where vanadium ions were used to trigger apoptosis, and demonstrate that nuclear microscopy has the capability of monitoring vanadium loading within individual cells. Secondly we present the results of elemental changes taking place in individual mouse red blood cells which have been infected with the malaria parasite and treated with the anti-malaria drug Qinghaosu (QHS).

Nanodiamond-based nanostructures for coupling nitrogen-vacancy centres to metal nanoparticles and semiconductor quantum dots

DOE PAGES

Gong, Jianxiao; Steinsultz, Nat; Ouyang, Min

2016-06-08

The ability to control the interaction between nitrogen-vacancy centres in diamond and photonic and/or broadband plasmonic nanostructures is crucial for the development of solid-state quantum devices with optimum performance. However, existing methods typically employ top-down fabrication, which restrict scalable and feasible manipulation of nitrogen-vacancy centres. Here, we develop a general bottom-up approach to fabricate an emerging class of freestanding nanodiamond-based hybrid nanostructures with external functional units of either plasmonic nanoparticles or excitonic quantum dots. Precise control of the structural parameters ( including size, composition, coverage and spacing of the external functional units) is achieved, representing a pre-requisite for exploring themore » underlying physics. Fine tuning of the emission characteristics through structural regulation is demonstrated by performing single-particle optical studies. Lastly, this study opens a rich toolbox to tailor properties of quantum emitters, which can facilitate design guidelines for devices based on nitrogen vacancy centres that use these freestanding hybrid nanostructures as building blocks.« less

Nanodiamond-based nanostructures for coupling nitrogen-vacancy centres to metal nanoparticles and semiconductor quantum dots

NASA Astrophysics Data System (ADS)

Gong, Jianxiao; Steinsultz, Nat; Ouyang, Min

2016-06-01

The ability to control the interaction between nitrogen-vacancy centres in diamond and photonic and/or broadband plasmonic nanostructures is crucial for the development of solid-state quantum devices with optimum performance. However, existing methods typically employ top-down fabrication, which restrict scalable and feasible manipulation of nitrogen-vacancy centres. Here, we develop a general bottom-up approach to fabricate an emerging class of freestanding nanodiamond-based hybrid nanostructures with external functional units of either plasmonic nanoparticles or excitonic quantum dots. Precise control of the structural parameters (including size, composition, coverage and spacing of the external functional units) is achieved, representing a pre-requisite for exploring the underlying physics. Fine tuning of the emission characteristics through structural regulation is demonstrated by performing single-particle optical studies. This study opens a rich toolbox to tailor properties of quantum emitters, which can facilitate design guidelines for devices based on nitrogen-vacancy centres that use these freestanding hybrid nanostructures as building blocks.

Outcomes and complications of trans-vaginal mesh repair using the Prolift™ kit for pelvic organ prolapse at 4 years median follow-up in a tertiary referral centre.

PubMed

Khan, Zainab A; Thomas, Lee; Emery, Simon J

2014-12-01

To evaluate the anatomical, functional and post-operative outcomes of polypropylene mesh (Prolift™) in the surgical management of pelvic organ prolapse (POP). A single-centre observational study of 106 successive patients, who underwent Prolift™ mesh repair (POP ≥ 2) with a median follow-up of 4 years, was performed. Outcomes of interest measured included patient demographics, intra and post-operative complications, concomitant procedures for POP or urinary incontinence. Using the Baden-Walker classification, grade ≥2 prolapses in the operated compartment were deemed as surgical failure. Validated questionnaires including ICIQ-VS and ICIQ-UI were used to assess functional outcome. Of the 106 patients, 56 had an anterior, 36 a posterior and 14 a total Prolift™. 101 patients were available for follow-up (median 4 years). 82 women underwent a clinical follow-up whilst 19 underwent a telephonic follow-up. Peri-operative bladder injury was noted in 2 (1.9 %) cases. Six (5.6 %) patients developed mesh exposure post-operatively. Re-operation rates for recurrent prolapse in the operated compartment were 2.8 % (n = 3). At follow-up, prolapse recurrence in the operated compartment was noted in another 7.3 % (n = 6) patients. Combining re-operations for POP and recurrences noted during follow-up, the revised failure rate was 10.1 % (n = 9). De novo prolapse in the non-operated compartment occurred in 19.5 % (n = 16) women. Our study demonstrates that Prolift™ vaginal mesh surgery offers anatomical cure rates of 89.9 %. A higher rate of de novo recurrence in the non-operated compartment was noted suggesting that surgical correction in one compartment may exacerbate recurrence in other compartments.

Risk strata-based therapy and outcome in stage Ib-IIa carcinoma cervix: single-centre ten-year experience.

PubMed

Kundargi, Rajshekar S; Guruprasad, B; Rathod, Praveen Shankar; Shakuntala, Pn; Shobha, K; Pallavi, Vr; Uma Devi, K; Bafna, Ud

2013-01-01

To review the outcome of stage (Ib, IIa), cervical cancer patients were primarily treated with radical hysterectomy and risk-based postoperative therapy. Between January 2001 and December 2011, 601 cases underwent surgery followed by tailored therapy. Patients were classified into low risk (pelvic lymph node negative, tumour less than 4 cm, no evidence of lympho-vascular invasion, less than one-third of thickness of surgical stoma involved), intermediate risk (positive lympho-vascular space invasion, tumour size more than 4 cm, and deep invasion of cervical stroma), and high risk (pelvic lymph node involved, positive parametrial, or vaginal margins) groups. Postoperative adju-vant therapy in the form of radiotherapy alone to those with intermediate risk and chemo-radiotherapy to those with high risk was given to patients. The median follow-up was 60 months. The majority of patients had intermediate risk. The overall event-free survival (EFS) at five years was 74.37%, with EFS of 86.5% in those from the low-risk group, 73% in those from the intermediate-risk group, and 64% in those from the high-risk group. In conclusion, risk strata-based adjuvant postoperative therapy is able to provide a favourable outcome in patients with stage Ib-IIa cervical cancer with a nearly 11% improvement in survival compared with historical control.

Trends in referral to a single encopresis clinic over 20 years.

PubMed

Fishman, Laurie; Rappaport, Leonard; Schonwald, Alison; Nurko, Samuel

2003-05-01

To compare the characteristics of children with encopresis referred to a single encopresis clinic over the course of 20 years, including symptoms, previous diagnostic and therapeutic interventions, and parental attitudes. A retrospective study was conducted of an encopresis clinic at a tertiary care pediatric hospital. Questionnaires at initial evaluation elicited information about bowel habits, soiling, previous evaluations, previous treatments, and parental attitudes. In 503 children with encopresis, the average age of referral dropped from 115 months during the earliest 5 years to 77 months during the most recent 5 years. Children who had soiling for >3 years before referral decreased from 63% to 12%. The use of barium enema before referral decreased from 14% to 5%, as did psychological evaluation, from 25% to 14%. Previous therapy with enemas decreased from 45% to 27%. Mineral oil use remained at approximately 50%, and 20% of children had no previous treatment. Symptoms at referral and parental attitudes did not change across the years. Children are now referred at an earlier age to our tertiary encopresis clinic. The number of invasive and psychological evaluations has decreased before referral. However, treatment by many primary care providers before the referral has not changed. These data may suggest that pediatricians have increased awareness of encopresis and greater appreciation of its primarily physical rather than psychological nature. Additional studies will be needed to determine how these factors affect outcome.

Young people with psychiatric disabilities and their views of day centres.

PubMed

Gunnarsson, A Birgitta; Eklund, Mona

2017-05-01

Young people with psychiatric disabilities may require support in structuring their everyday life. To learn more about the relevance of day centres in this respect, this study aimed to examine the experiences of young people with psychiatric disabilities. A particular focus was on the perceptions of meaningful occupation when visiting day centres, their reasons for not choosing this option when given it and what they desired instead. A qualitative design based on individual interviews was used. Twelve women and eight men between 18 and 35 years, with a need for organized daily occupations, participated as informants. Qualitative content analysis revealed three categories: 'Being in a context', 'Balancing between developing and stagnating', and 'Longing for something more'. The findings indicated that the occupations were inherently age neutral, as were the possibilities for socializing. There was a desire for more activities in the community and more support for engaging in occupations that other young people did. A major issue in the accomplishment of this was the need to earn money, and the lack of opportunities for doing that in the day centre context was a considerable drawback. The findings highlight the importance of identifying young people's views when designing day centres.

[Professional self-perception, resources, stress and job satisfaction of psychologists in rehabilitation centres].

PubMed

Reese, C; Bengel, J; Mittag, O

2014-07-01

Psychologists from rehabilitation centres were surveyed about their current job situation. Following areas were included: (a) professional self-perception, (b) occupational resources and stress, (c) job satisfaction. A nationwide survey of psychologists of all rehabilitation centres in Germany was conducted. Overall, 1,461 rehabilitation centres of all specialties were contacted in writing, of which 623 psychologists participated in the survey. Some of the results can be compared with reference data from previous surveys. The professional self-perception has hardly changed over the last 10 years. Counselling and psychotherapy in one-to-one sessions and group interventions still play an essential role. Overall, job satisfaction and resources are high. General job satisfaction can be best predicted by career opportunities and opportunities for qualification. The results of the study indicate which resources should be strengthened in order to enhance job satisfaction of psychologists in medical rehabilitation. Particular thought should be given to improving career opportunities for psychologists in rehabilitation centres. © Georg Thieme Verlag KG Stuttgart · New York.

Pilomatricoma in childhood: a retrospective study from three European paediatric centres.

PubMed

Cigliano, Bruno; Baltogiannis, Nikolaos; De Marco, Marianna; Faviou, Elsa; Settimi, Alesandro; Tilemis, Stefanos; Soutis, Michail; Papandreou, Evangellos; D'Agostino, Sergio; Fabbro, Maria Angelica

2005-11-01

Pilomatricoma is characterised as a common, slowly growing benign cutaneous tumour that appears generally within the first decades of life. The clinical diagnosis is frequently missed, especially by the paediatrician unfamiliar with these tumours. We present the experience gained in three European tertiary care paediatric centres with the treatment of pilomatricoma and also current data on the aetiology, clinical presentation and management. A retrospective study was carried out in 83 patients suspected for pilomatricoma during a 7-year period (1996-2002) at the departments of Paediatric Surgery of the Children's University Hospital "Federico II", Naples, Hospital "San Bortolo", Vicenza and "Aghia Sophia" Children's Hospital, Athens. The age range was from 10 months to 17 years, median age 8 years. All patients were treated by surgical excision and all specimens were examined by histopathological assessment. The follow-up varied from 5 months to 6 years. The correct diagnosis was made preoperatively in 68 patients (82%). The female/male ratio was 2:1. The sites of occurrence were the head (47.5%), especially in the periorbital region, the neck (9%), the upper limbs (35.5%), the inferior limbs (4%) and the thorax (4%). Each patient exhibited a single pilomatricoma except for two patients who had multiple lesions (2.4%). One of them had Steinert disease (myotonic dystrophy). No recurrences were observed during the follow-up period. Pilomatricoma is one of the most common cutaneous adnexal neoplasms in children. Surgical excision including clear margins and its overlying skin in most cases is the treatment of choice. The recurrence as well as malignant evolution is rare.

Outcomes of Cryoballoon Ablation in High- and Low-Volume Atrial Fibrillation Ablation Centres: A Russian Pilot Survey

PubMed Central

Mikhaylov, Evgeny N.; Lebedev, Dmitry S.; Pokushalov, Evgeny A.; Davtyan, Karapet V.; Ivanitskii, Eduard A.; Nechepurenko, Anatoly A.; Kosonogov, Alexey Ya.; Kolunin, Grigory V.; Morozov, Igor A.; Termosesov, Sergey A.; Maykov, Evgeny B.; Khomutinin, Dmitry N.; Eremin, Sergey A.; Mayorov, Igor M.; Romanov, Alexander B.; Shabanov, Vitaliy V.; Shatakhtsyan, Victoria; Tsivkovskii, Viktor; Revishvili, Amiran Sh.; Shlyakhto, Evgeny V.

2015-01-01

Purpose. The results of cryoballoon ablation (CBA) procedure have been mainly derived from studies conducted in experienced atrial fibrillation (AF) ablation centres. Here, we report on CBA efficacy and complications resulting from real practice of this procedure at both high- and low-volume centres. Methods. Among 62 Russian centres performing AF ablation, 15 (24%) used CBA technology for pulmonary vein isolation. The centres were asked to provide a detailed description of all CBA procedures performed and complications, if encountered. Results. Thirteen sites completed interviews on all CBAs in their centres (>95% of CBAs in Russia). Six sites were high-volume AF ablation (>100 AF cases/year) centres, and 7 were low-volume AF ablation. There was no statistical difference in arrhythmia-free rates between high- and low-volume centres (64.6 versus 60.8% at 6 months). Major complications developed in 1.5% of patients and were equally distributed between high- and low-volume centres. Minor procedure-related events were encountered in 8% of patients and were more prevalent in high-volume centres. Total event and vascular access site event rates were higher in women than in men. Conclusions. CBA has an acceptable efficacy profile in real practice. In less experienced AF ablation centres, the major complication rate is equal to that in high-volume centres. PMID:26640789

Surgical Management of Head and Neck Soft Tissue Sarcoma: 11-Year Experience at a Tertiary Care Centre in South India.

PubMed

Sharma, Nivedita; George, Nebu Abraham; Singh, Rajesh; Iype, Elizabeth Mathew; Varghese, Bipin T; Thomas, Shaji

2018-06-01

Head and neck soft tissue sarcoma (HNSTS) is a rare neoplasm accounting for 1% of all head and neck tumours. Because of rarity and varied biological behaviour among various subtypes, knowledge about these tumours is limited. This study aimed at analysing clinicopathological, recurrence and survival pattern of surgically treated HNSTS. Case records of 28 patients of HNSTS who underwent surgery at the Regional Cancer Centre (RCC), Trivandrum (India) between 2002 and 2012 were analysed retrospectively for demographic profile, clinical features, treatment given, recurrence pattern and outcome. The median age of patients was 37 years (range, 3-79) with male:female ratio of 3:2. Majority of patients presented with painless lump in the neck as the most common subsite affected followed by scalp and face. One patient had nodal disease, while none had distant metastasis at presentation. The most frequent histological subtypes were synovial sarcoma and fibrosarcoma followed by malignant fibrous histiocytoma, angiosarcoma and rhabdomyosarcoma. Majority (78.5%) of patients received adjuvant therapy in the form of radiation, chemotherapy or chemo-radiation. After mean follow-up of 49 months, four patients had died, and six developed local recurrence and four distant metastasis. The overall 5-year survival was 82.7% while 5-year disease-free survival was 55.3%. HNSTS is a rare entity that requires multimodality treatment to achieve optimum locoregional control and survival.

Clustering of trauma and associations with single and co-occurring depression and panic attack over twenty years.

PubMed

McCutcheon, Vivia V; Heath, Andrew C; Nelson, Elliot C; Bucholz, Kathleen K; Madden, Pamela A F; Martin, Nicholas G

2010-02-01

Individuals who experience one type of trauma often experience other types, yet few studies have examined the clustering of trauma. This study examines the clustering of traumatic events and associations of trauma with risk for single and co-occurring major depressive disorder (MDD) and panic attack for 20 years after first trauma. Lifetime histories of MDD, panic attack, and traumatic events were obtained from participants in an Australian twin sample. Latent class analysis was used to derive trauma classes based on each respondent's trauma history. Associations of the resulting classes and of parental alcohol problems and familial effects with risk for a first onset of single and co-occurring MDD and panic attack were examined from the year of first trauma to 20 years later. Traumatic events clustered into three distinct classes characterized by endorsement of little or no trauma, primarily nonassaultive, and primarily assaultive events. Individuals in the assaultive class were characterized by a younger age at first trauma, a greater number of traumatic events, and high rates of parental alcohol problems. Members of the assaultive trauma class had the strongest and most enduring risk for single and co-occurring lifetime MDD and panic attack. Assaultive trauma outweighed associations of familial effects and nonassaultive trauma with risk for 10 years following first trauma.

Improving the layout of recycling centres by use of lean production principles.

PubMed

Sundin, Erik; Björkman, Mats; Eklund, Mats; Eklund, Jörgen; Engkvist, Inga-Lill

2011-06-01

There has been increased focus on recycling in Sweden during recent years. This focus can be attributed to external environmental factors such as tougher legislation, but also to the potential gains for raw materials suppliers. Recycling centres are important components in the Swedish total recycling system. Recycling centres are manned facilities for waste collection where visitors can bring, sort and discard worn products as well as large-sized, hazardous, and electrical waste. The aim of this paper was to identify and describe the main flows and layout types at Swedish recycling centres. The aim was also to adapt and apply production theory for designing and managing recycling centre operations. More specifically, this means using lean production principles to help develop guidelines for recycling centre design and efficient control. Empirical data for this research was primarily collected through interviews and questionnaires among both visitors and employees at 16 Swedish recycling centres. Furthermore, adapted observation protocols have been used in order to explore visitor activities. There was also close collaboration with a local recycling centre company, which shared their layout experiences with the researchers in this project. The recycling centres studied had a variety of problems such as queues of visitors, overloading of material and improper sorting. The study shows that in order to decrease the problems, the recycling centres should be designed and managed according to lean production principles, i.e. through choosing more suitable layout choices with visible and linear flows, providing better visitor information, and providing suitable technical equipment. Improvements can be achieved through proper planning of the layout and control of the flow of vehicles, with the result of increased efficiency and capacity, shorter visits, and cleaner waste fractions. The benefits of a lean production mindset include increased visitor capacity, waste

The clinical utility of PGD with HLA matching: a collaborative multi-centre ESHRE study.

PubMed

Kakourou, G; Kahraman, S; Ekmekci, G C; Tac, H A; Kourlaba, G; Kourkouni, E; Sanz, A Cervero; Martin, J; Malmgren, H; Giménez, C; Gold, V; Carvalho, F; Billi, C; Chow, J F C; Vendrell, X; Kokkali, G; Liss, J; Steffann, J; Traeger-Synodinos, J

2018-02-08

), Athens. Continuous variables are presented using mean, standard deviation, median and interquartile range, and categorical variables are presented as absolute and relative frequencies. The data included 704 HLA-PGD cycles. Mean maternal age was 33.5 years. Most couples (81.3%) requested HLA-typing with concurrent exclusion of a single monogenic disease (58.6% for beta-thalassaemia). In 92.5% couples, both partners were fertile, with an average 1.93 HLA-PGD cycles/couple. Overall, 9751 oocytes were retrieved (13.9/cycle) and 5532 embryos were analysed (7.9/cycle). Most cycles involved fresh oocytes (94.9%) and Day 3 embryo biopsy (85.3%). In 97.5% of cycles, the genotyping method involved PCR only. Of 4343 embryos diagnosed (78.5% of analysed embryos), 677 were genetically suitable (15.4% of those analysed for HLA alone, 11.6% of those analysed for HLA with exclusion of monogenic disease). Of the 364 couples, 56.6% achieved an embryo transfer (ET) and 598 embryos were transferred in 382 cycles, leading to 164 HCG-positive pregnancies (pregnancy rate/ET 41.3%, pregnancy rate/initiated cycle 23.3%) and 136 babies born (live birth rate/ET 34.3%, live birth rate/initiated cycle 19.3%) to 113 couples. Data analysis identified the following limitations to the overall success of the HLA-PGD procedure: the age of the mother undergoing the treatment cycle, the number of oocytes collected per cycle and genetic chance. HSCT was reported for 57 cases, of which 64.9% involved combined umbilical cord-blood and bone marrow transplantation from the HLA-identical sibling donor; 77.3% of transplants reported no complications. The findings of the study may be limited as not all PGD centres with PGD-HLA experience participated. Reporting bias on completion of the online database may be another potential limitation. Furthermore, the study is based on retrospective data collection from centres with variable practices and strategies for ART, embryology and genetic diagnosis. This is the first

How to make a particular case for person-centred patient care: A commentary on Alexandra Parvan.

PubMed

Graham, George

2018-06-14

In recent years, a person-centred approach to patient care in cases of mental illness has been promoted as an alternative to a disease orientated approach. Alexandra Parvan's contribution to the person-centred approach serves to motivate an exploration of the approach's most apt metaphysical assumptions. I argue that a metaphysical thesis or assumption about both persons and their uniqueness is an essential element of being person-centred. I apply the assumption to issues such as the disorder/disease distinction and to the continuity of mental health and illness. © 2018 John Wiley & Sons, Ltd.

"Less than a Dog": Interrogating Theatre for Debate in Westville Female Correctional Centre, Durban South Africa

ERIC Educational Resources Information Center

Young-Jahangeer, Miranda

2013-01-01

Incarcerated women at Westville Female Correctional Centre in Durban, South Africa have been using popular participatory theatre (PPT) to create a space to generate debate about aspects of prison life for over 10 years. This article explores how these women engaged the issue of lesbianism in the Correctional Centre and how the process and form was…

Residential proximity to urban centres, local-area walkability and change in waist circumference among Australian adults.

PubMed

Sugiyama, Takemi; Niyonsenga, Theo; Howard, Natasha J; Coffee, Neil T; Paquet, Catherine; Taylor, Anne W; Daniel, Mark

2016-12-01

Consistent associations have been observed between macro-level urban sprawl and overweight/obesity, but whether residential proximity to urban centres predicts adiposity change over time has not been established. Further, studies of local-area walkability and overweight/obesity have generated mixed results. This study examined 4-year change in adults' waist circumference in relation to proximity to city centre, proximity to closest suburban centre, and local-area walkability. Data were from adult participants (n=2080) of a cohort study on chronic conditions and health risk factors in Adelaide, Australia. Baseline data were collected in 2000-03 with a follow-up in 2005-06. Multilevel regression models examined in 2015 the independent and joint associations of the three environmental measures with change in waist circumference, accounting for socio-demographic covariates. On average, waist circumference rose by 1.8cm over approximately 4years. Greater distance to city centre was associated with a greater increase in waist circumference. Participants living in distal areas (20km or further from city centre) had a greater increase in waist circumference (mean increase: 2.4cm) compared to those in proximal areas (9km or less, mean increase: 1.2cm). Counterintuitively, living in the vicinity of a suburban centre was associated with a greater increase in adiposity. Local-area walkability was not significantly associated with the outcome. Residential proximity to city centre appears to be protective against excessive increases in waist circumference. Controlled development and targeted interventions in the urban fringe may be needed to tackle obesity. Additional research needs to assess behaviours that mediate relationships between sprawl and obesity. Copyright © 2016 Elsevier Inc. All rights reserved.

Comparative dosimetry study of three UK centres implementing total skin electron treatment through external audit

PubMed Central

Gonzalez, R; McGovern, M; Greener, A

2015-01-01

Objective: This article describes the external audit measurements conducted in two UK centres implementing total skin electron beam therapy (TSEBT) and the results obtained. Methods: Measurements of output, energy, beam flatness and symmetry at a standard distance (95 or 100 cm SSD) were performed using a parallel plate chamber in solid water. Similarly, output and energy measurements were also performed at the treatment plane for single and dual fields. Clinical simulations were carried out using thermoluminescent dosemeters (TLDs) and Gafchromic® film (International Specialty Products, Wayne, NJ) on an anthropomorphic phantom. Results: Extended distance measurements confirmed that local values for the beam dosimetry at Centres A and B were within 2% for outputs and 1-mm agreement of the expected depth at which the dose is 50% of the maximum for the depth–dose curve in water (R50,D) value. Clinical simulation using TLDs) showed an agreement of −1.6% and −6.7% compared with the expected mean trunk dose for each centre, respectively, and a variation within 10% (±1 standard deviation) across the trunk. The film results confirmed that the delivery of the treatment technique at each audited centre complies with the European Organisation for Research and Treatment of Cancer recommendations. Conclusion: This audit methodology has proven to be a successful way to confirm the agreement of dosimetric parameters for TSEBT treatments at both audited centres and could serve as the basis for an audit template to be used by other audit groups. Advances in knowledge: TSEBT audits are not established in the UK owing to a limited number of centres carrying out the treatment technique. This article describes the audits performed at two UK centres prior to their clinical implementation. PMID:25761213

Medical students' and patients' perceptions of patient-centred attitude.

PubMed

Hur, Yera; Cho, A Ra; Choi, Chang Jin

2017-03-01

Patient-centred care can increase patient satisfaction and lead to better clinical outcomes for them, such as improved physical status and higher health-related quality of life. However, doctors' and patients' views on patient-centred attitude might differ and could be affected by culture and the community environment. To clarify the differences in primary care patients' and senior medical students' perceptions of medical students' patient-centred attitude. A total of 1,025 subjects-827 patients from primary care institutions and 198 fourth-year medical students from a medical college in South Korea-completed the Patient Practitioner Orientation Scale (PPOS). The students completed the self-reported questionnaire at the end of their clinical clerkship. Descriptive statistics, t-tests, and one-way analysis of variances were conducted in SPSS version 21.0. Firstly, sharing subscale scores were higher among patients than among medical students (students, 3.61 vs. patients, 3.76; p<0.001), but secondly, caring subscale scores were higher among medical students (students, 4.18 vs. patients, 3.82; p<0.001). Thirdly, PPOS total scores were higher among medical students (students, 3.90 vs. patients, 3.79; p=0.001). Finally, male students had the lowest sharing scores (F=6.811, p<0.001) and female students showed the highest PPOS total scores (F=5.805, p=0.001). Significant differences between medical students' and patients' perceptions of medical students' patient-centred attitudes suggest the necessity of educational efforts to overcome the gap between the groups.

Prevalence of ethanol and illicit drugs in road traffic accidents in the centre of Portugal: An eighteen-year update.

PubMed

Costa, Nádia; Silva, Rosário; Mendonça, M Cristina; Real, Francisco Corte; Vieira, Duarte Nuno; Teixeira, Helena M

2012-03-10

This study presents the prevalence of ethanol and illicit drugs in fatal road traffic accident victims in the Centre of Portugal between January 1990 and December 2007. Among the violent deaths, road traffic accidents presented the highest percentage (around 35%; n=3095), but decreasing throughout the years. Accidents were preponderant in males (about 80%; n=2402), between 21 and 30 years-old. Accidents involving drivers (55%; n=1310) were of the most common, being the car the main vehicle (45%), followed by the motorcycle (40%). An alcohol analysis request was present in 50% of the cases (n=1687), but increasing each year. Ethanol concentrations >1.2g/L, the legal limit in Portugal, were found in 55% (n=283) of the cases. Concerning drugs of abuse requests, only 4.4% (n=137) and 17.3% (58 cases) of the cases included the analysis at the Forensic Pathology Department (FPD) and at the Medico-Legal Office (MLO), respectively. Among the road accident cases analysed, 18 were positive, mainly in men (84%), between 21 and 30 years-old; opiates (47.1%; n=8) and cannabinoids (50%; n=4) were the most found, at the FPD and at the MLO, respectively. In conclusion, ethanol was identified as a key factor to traffic accidents, which explains the definition of specific legislation and methods of enforcement to prohibit this form of impairing. Nevertheless, ethanol still remains the psychoactive substance most frequently identified in the blood of divers killed in road-traffic crashes, recommending additional actions of supervision and control. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Minister unveils new nanotech centres

NASA Astrophysics Data System (ADS)

Dumé, Belle

2009-06-01

Three new nanotechnology research centres are to be set up in France as part of a €70m government plan to help French companies in the sector. Researchers at the new centres, which will be located in Grenoble, Saclay (near Paris) and Toulouse, will be encouraged to collaborate with industry to develop new nanotech-based products. Dubbed NANO-INNOV, the new plan includes €46m for two new buildings at Saclay, with the rest being used to buy new equipment at the three centres and to fund grant proposals from staff to the French National Research Agency (ANR).

Typology of birth centres in the Netherlands using the Rainbow model of integrated care: results of the Dutch Birth Centre Study.

PubMed

Boesveld, Inge C; Bruijnzeels, Marc A; Hitzert, Marit; Hermus, Marieke A A; van der Pal-de Bruin, Karin M; van den Akker-van Marle, M E; Steegers, Eric A P; Franx, Arie; de Vries, Raymond G; Wiegers, Therese A

2017-06-21

The goal of integrated care is to offer a continuum of care that crosses the boundaries of public health, primary, secondary, and tertiary care. Integrated care is increasingly promoted for people with complex needs and has also recently been promoted in maternity care systems to improve the quality of care. Especially when located near an obstetric unit, birth centres are considered to be ideal settings for the realization of integrated care. At present, however, we know very little about the degree of integration in these centres and we do not know if increased levels of integration improve the quality of the care delivered. The Dutch Birth Centre Study is designed to evaluate birth centres and their contribution to the Dutch maternity care system. The aim of this particular sub-study is to classify birth centres in clusters with similar characteristics based on integration profiles, to support the evaluation of birth centre care. This study is based on the Rainbow Model of Integrated Care. We used a survey followed by qualitative interviews in 23 birth centres in the Netherlands to determine which integration profiles can be distinguished and to describe their discriminating characteristics. Cluster analysis was used to classify the birth centres. Birth centres were classified into three clusters: 1)"Mono-disciplinary-oriented birth centres" (n = 10): which are mainly owned by primary care organizations and established as physical facilities to provide an alternative birthplace for low risk births; 2) "Multi-disciplinary-oriented birth centres" (n = 6): which are mainly multi-disciplinary oriented and can be regarded as facilities to give birth, with a focus on integrated birth care; 3) "Mixed Cluster of birth centres" (n = 7): which have a range of organizational forms that differentiate them from centres in the other clusters. We identified a recognizable classification, with similar characteristics between birth centres in the clusters. The results of

Evolution in practice: how has British neurosurgery changed in the last 10 years?

PubMed

Tarnaris, A; Arvin, B; Ashkan, K

2008-09-01

Neurosurgery is a fast-evolving surgical subspecialty driven by technological advances, socio-economic factors and patient expectations. In this study, we have compared the work-load volume in a single institution in the years of 1994 and 2004 and commented on the possible reasons for the changes and the impacts they may have for the future. A retrospective, log-book review of all operations performed in the years 1994 and 2004 in a single, tertiary, neurosurgical centre was performed. Neurosurgical practice has evolved over this period. Current practice has moved away from clipping of aneurysms and towards coil embolisation performed by interventional radiologists. Electrode stimulation of deep brain regions for movement disorders is the current practice, whereas 10 years ago the same disorders were dealt with by lesioning of the relevant regions. In spinal neurosurgery, instrumentation is increasingly favoured currently. In the field of neuro-oncology, current practice favours minimal access to the target area by the use of stereotactic localisation. Changes were most pronounced in the subspecialties of vascular, functional and spinal neurosurgery within this 10-year period. Knowledge of such dynamics is valuable in health resource management as well as planning for neurosurgical training programmes.

Mid-term 4-Year Outcomes with Single Anastomosis Duodenal-Ileal Bypass with Sleeve Gastrectomy Surgery at a Single US Center.

PubMed

Zaveri, Hinali; Surve, Amit; Cottam, Daniel; Cottam, Austin; Medlin, Walter; Richards, Christina; Belnap, LeGrand; Cottam, Samuel; Horsley, Benjamin

2018-06-16

Single anastomosis duodenal-ileal bypass with sleeve gastrectomy (SADI-S) is a modification of Roux-en-Y duodenal switch (RYDS). Long-term data on this operation is lacking in the literature. We reviewed our mid-term data of this RYDS modification. To analyze the outcomes with SADI-S at 4 years. Data from patients who underwent a primary SADI-S procedure performed by three surgeons at a single institution from June 2013 through February 2018 were retrospectively reviewed. All revision bariatric surgeries were excluded. Regression analyses were performed for all follow-up weight loss data. There were 437 patients in our database. The pre-operative mean body mass index (BMI) was 49.8 ± 8.8 kg/m 2 . The 30-day complication rate was 7.7%. The 30-day readmission, reoperation, and mortality rates were 1.8, 1.3, and 0.2%, respectively. The long-term complication rate was 10.9%. Seventy-nine patients were 4 years post SADI-S surgery and follow-up was possible for 44 patients (55.7%). At 4 years, patients had an average change in BMI of 18.1 ± 6 units with an excess weight loss (EWL) of 85.7 ± 27.3%. At 4 years, 97.6% patients were able to maintain HbA1c < 6% with or without the use of diabetic medication. There was a statistically significant difference between most of the pre-operative and post-operative nutritional data. SADI-S is a safe and effective procedure in both short- and mid-term data points. Diabetes resolution and weight loss appear similar to traditional RYDS and better than RYGB.

Single versus bilateral lung transplantation for idiopathic pulmonary fibrosis: a ten-year institutional experience.

PubMed

Meyers, B F; Lynch, J P; Trulock, E P; Guthrie, T; Cooper, J D; Patterson, G A

2000-07-01

Between July 1988 and July 1998, we performed 433 lung transplants. Forty-five patients had idiopathic pulmonary fibrosis, and operations for these patients included 32 single lung transplants and 13 bilateral sequential lung transplants. This study reviews this experience and compares single lung transplantation and bilateral lung transplantation for pulmonary fibrosis. We performed a retrospective review, including inpatient hospital charts, outpatient clinic records, and telephone contact with patients to verify current health status. Perioperative mortality was 4 (8.9%) patients. One patient underwent redo bilateral lung transplantation for reperfusion injury and graft failure after single lung transplantation. The median hospitalization was 22 days. Actuarial survival at 1 and 5 years was 75.5% and 53.5%, respectively, which was not significantly different from our survival for all recipients (85.5% and 56.4%, respectively). Seventeen (41%) of 41 operative survivors have died. Late causes of death included obliterative bronchiolitis with respiratory failure (9), malignancy (3), and cytomegalovirus pneumonitis (2). Hospital mortality was 3 (9.4%) of 32 after single lung transplantation and 1 (7.7%) of 13 after bilateral lung transplantation. There was no difference between single and bilateral lung transplantation with regard to hospital stay. Four (12.5%) of the 32 patients undergoing single lung transplantation required tracheostomy, whereas 3 (23%) of 13 recipients undergoing bilateral lung transplantation required tracheostomy. Single or bilateral lung transplantations offer viable therapy for patients with pulmonary fibrosis. We demonstrate no benefit of bilateral over single lung transplantation for patients with this diagnosis. Survival after transplantation appears better than that of historic control subjects receiving standard medical care at other institutions.

Low Cost Balloon programme of Indian Centre for Space Physics

NASA Astrophysics Data System (ADS)

Chakrabarti, Sandip Kumar

2016-07-01

Indian Centre for Space Physics has launched 89 Missions to near space using single or multiple weather balloons or very light plastic balloons. Basic goal was to capitalize miniaturization of equipments in modern ages. Our typical payload of less than 4kg weight consists of GPS, video camera, cosmic ray detectors, Attitude measurement unit, sunsensor and most importantly a 50-100sqcm X-ray/Gamma-ray detector (usually a scintillator type). The main purpose of the latter is to study spectra of secondary cosmic ray spectra (till our ceiling altitude of 36-42km) over the years and their seasonal variation or variation with solar cycle. We also study solar X-ray spectra, especially of solar flares. We have detected a Gamma Ray Burst (GRB) and pulsars. Our observation of black hole candidates did not yield satisfactory result yet mainly because of poor collimation (~ 10 deg x 10 deg) by lead collimator which introduces strong background also. Our effort with multiple balloon flights enabled us to have long duration flights. We believe that our procedure is very futuristic and yet at an affordable cost.

Patient-centred outcomes research: perspectives of patient stakeholders.

PubMed

Chhatre, Sumedha; Gallo, Joseph J; Wittink, Marsha; Schwartz, J Sanford; Jayadevappa, Ravishankar

2017-11-01

To elicit patient stakeholders' experience and perspectives about patient-centred care. Qualitative. A large urban healthcare system. Four patient stakeholders who are prostate cancer survivors. Experience and perspectives of patient stakeholders regarding patient-centred care and treatment decisions. Our patient stakeholders represented a diverse socio-demographic group. The patient stakeholders identified engagement and dialogue with physicians as crucial elements of patient-centred care model. The degree of patient-centred care was observed to be dependent on the situations. High severity conditions warranted a higher level of patient involvement, compared to mild conditions. They agreed that patient-centred care should not mean that patients can demand inappropriate treatments. An important attribute of patient-centred outcomes research model is the involvement of stakeholders. However, we have limited knowledge about the experience of patient stakeholders in patient-centred outcomes research. Our study indicates that patient stakeholders offer a unique perspective as researchers and policy-makers aim to precisely define patient-centred research and care.

Does foreign aid crowd out government investments? Evidence from rural health centres in Rwanda

PubMed Central

Lu, Chunling; Cook, Benjamin; Desmond, Chris

2017-01-01

Background Rural healthcare facilities in low-income countries play a major role in providing primary care to rural populations. We examined the link of foreign aid with government investments and medical service provision in rural health centres in Rwanda. Methods Using the District Health System Strengthening Tool, a web-based database built by the Ministry of Health in Rwanda, we constructed two composite indices representing provision of (1) child and maternal care and (2) HIV, tuberculosis (TB) and malaria services in 330 rural health centres between 2009 and 2011. Financing variables in a healthcare centre included received funds from various sources, including foreign donors and government. We used multilevel random-effects model in regression analyses and examined the robustness of results to a range of alternative specification, including scale of dependent variables, estimation methods and timing of aid effects. Findings Both government and foreign donors increased their direct investments in the 330 rural healthcare centres during the period. Foreign aid was positively associated with government investments (0.13, 95% CI 0.06 to 0.19) in rural health centres. Aid in the previous year was positively associated with service provision for child and maternal health (0.008, 95% CI 0.002 to 0.014) and service provision for HIV, TB and malaria (0.014, 95% CI 0.004 to 0.022) in the current year. The results are robust when using fixed-effects models. Conclusions These findings suggest that foreign aid did not crowd out government investments in the rural healthcare centres. Foreign aid programmes, conducted in addition to government investments, could benefit rural residents in low-income countries through increased service provision in rural healthcare facilities. PMID:29082015

Ten years of barcoding at the African Centre for DNA Barcoding.

PubMed

Bezeng, B S; Davies, T J; Daru, B H; Kabongo, R M; Maurin, O; Yessoufou, K; van der Bank, H; van der Bank, M

2017-07-01

The African Centre for DNA Barcoding (ACDB) was established in 2005 as part of a global initiative to accurately and rapidly survey biodiversity using short DNA sequences. The mitochondrial cytochrome c oxidase 1 gene (CO1) was rapidly adopted as the de facto barcode for animals. Following the evaluation of several candidate loci for plants, the Plant Working Group of the Consortium for the Barcoding of Life in 2009 recommended that two plastid genes, rbcLa and matK, be adopted as core DNA barcodes for terrestrial plants. To date, numerous studies continue to test the discriminatory power of these markers across various plant lineages. Over the past decade, we at the ACDB have used these core DNA barcodes to generate a barcode library for southern Africa. To date, the ACDB has contributed more than 21 000 plant barcodes and over 3000 CO1 barcodes for animals to the Barcode of Life Database (BOLD). Building upon this effort, we at the ACDB have addressed questions related to community assembly, biogeography, phylogenetic diversification, and invasion biology. Collectively, our work demonstrates the diverse applications of DNA barcoding in ecology, systematics, evolutionary biology, and conservation.

Two billion years of magmatism recorded from a single Mars meteorite ejection site

PubMed Central

Lapen, Thomas J.; Righter, Minako; Andreasen, Rasmus; Irving, Anthony J.; Satkoski, Aaron M.; Beard, Brian L.; Nishiizumi, Kunihiko; Jull, A. J. Timothy; Caffee, Marc W.

2017-01-01

The timing and nature of igneous activity recorded at a single Mars ejection site can be determined from the isotope analyses of Martian meteorites. Northwest Africa (NWA) 7635 has an Sm-Nd crystallization age of 2.403 ± 0.140 billion years, and isotope data indicate that it is derived from an incompatible trace element–depleted mantle source similar to that which produced a geochemically distinct group of 327- to 574-million-year-old “depleted” shergottites. Cosmogenic nuclide data demonstrate that NWA 7635 was ejected from Mars 1.1 million years ago (Ma), as were at least 10 other depleted shergottites. The shared ejection age is consistent with a common ejection site for these meteorites. The spatial association of 327- to 2403-Ma depleted shergottites indicates >2 billion years of magmatism from a long-lived and geochemically distinct volcanic center near the ejection site. PMID:28164153

Addiction research centres and the nurturing of creativity. The Centre for Alcohol and Drug Research: social science alcohol and drug research in Denmark.

PubMed

Pedersen, Mads U; Elmeland, Karen; Frank, Vibeke A

2011-12-01

The purpose of this paper is to introduce the social science alcohol and drug research undertaken by the Centre for Alcohol and Drug Research (CRF) and at the same time offer an insight into the development in Danish alcohol and drug research throughout the past 15-20 years. A review of articles, books and reports published by researcher from CRF from the mid-1990s until today and an analysis of the policy-making in the Danish substance use and misuse area. CRF is a result of the discussions surrounding social, health and allocation policy questions since the mid-1980s. Among other things, these discussions led to the formal establishment of the Centre in 1991 under the Aarhus University, the Faculty of Social Science. Since 2001 the Centre has received a permanent basic allocation, which has made it possible to appoint tenured senior researchers; to work under a more long-term research strategy; to function as a milieu for educating PhD students; and to diversify from commissioned research tasks to initiating projects involving more fundamental research. Research at the Centre is today pivoted around four core areas: consumption, policy, prevention and treatment. The emergence, continuation, financing and character of the research taking place at CRF can be linked closely to the specific Danish drug and alcohol discourse and to the division of the responsibility for alcohol and drug research into separate Ministries. © 2010 The Authors, Addiction © 2010 Society for the Study of Addiction.

Ocular related emergencies in Zagreb University Hospital Centre--ten month analysis.

PubMed

Skegro, Ivan; Kordić, Rajko; Kuzman, Tomislav; Perić, Sanja; Kutija, Marija Barisić; Jandroković, Sonja; Jukić, Tomislav

2013-04-01

To determine number, demographic characteristics and presenting symptoms of patients admitted to Emergency ophthalmologic department of Zagreb University hospital centre. Prospective analysis of data of 743 patients admitted to Emergency ophthalmologic department of University hospital centre Zagreb during period of 10 month. Main presenting symptoms at admission were red eye, pain and foreign body sensation. 64% of all patients admitted to emergency unit were male. Almost 40% of them were between 20 and 40 years of age. In female population majority is between 50 and 60 years old (19.33%). The study shows that the most frequent reason for admission in emergency ophthalmic unit is red eye, pain and foreign body sensation. These symptoms were present most frequently in young male patients. Considering fact of their working ability, data can suggest that they don't comply with occupational safety measures. Further research in this direction is needed.

Breast cancer scenario in a regional cancer centre in Eastern India over eight years--still a major public health problem.

PubMed

Datta, Karabi; Choudhuri, Maitrayee; Guha, Subhas; Biswas, Jaydip

2012-01-01

In spite of screening and early diagnostic tests, the upward trend of breast cancer has become a matter of great concern in both developed and developing countries. The data collected by Population Based Cancer Registry in Chittaranjan National Cancer Institute, a regional cancer centre in Kolkata, from 1997 to 2004 gives an insight about the scenario of breast cancer in this part of Eastern India. The total no of female breast cancer cases were steadily increasing from 1997 to 2001 and only slightly lower from 2002 to 2004. and majority were in the 40-49 year old age group during this period. The next most commonly affected age group was 50-59 years. Regarding the distribution according to treatment, the main modality was surgery and radiotherapy followed by combined surgery, chemotherapy and radiotherapy and then combined surgery and chemotherapy. The commonest type was ductal followed by lobular cancer. In this eight year study in CNCI, status of patients on last day of the respective year was assessed. Number of patients alive was 43.5% in 1997. The percentage gradually increased up to 2000 and then gradually decreased to 47.4% in 2004. Also with every passing year, percentage mortality gradually decreased from 25.7% in 1997 to 16.8% in 2004. Better pattern of care (diagnosis and treatment) was reflected in this picture. However, lost to follow up, which also implies non compliance to treatment, increased to 30.8% in 1997 to 35.8% in 2004. Due to the small number of male breast cancers, only female cases were considered. In conclusion, breast cancer continues to be a major problem in Kolkata, India.

Second malignant neoplasms in childhood cancer survivors in a tertiary paediatric oncology centre in Hong Kong, China.

PubMed

Sun, Wai-Fun; Cheng, Frankie Wai-Tsoi; Lee, Vincent; Leung, Wing-Kwan; Shing, Ming-Kong; Yuen, Patrick Man-Pan; Li, Chi-Kong

2011-11-01

Childhood cancer survivors were at risk of development of second malignant neoplasms. The aim of this study is to evaluate the incidence, risk factors and outcome of second malignant neoplasms in childhood cancer survivors in a tertiary paediatric oncology centre in Hong Kong, China. We performed a retrospective review of patients with childhood cancer treated in Children's Cancer Centre in Prince of Wales Hospital, Hong Kong, China between May 1984 and June 2009. Case records of patients who developed second malignant neoplasms were reviewed. Totally 1374 new cases aged less than 21-year old were treated in our centre in this 25-year study period. Twelve cases developed second malignant neoplasms with 10-year and 20-year cumulative incidence of 1.3% (95% confidence interval 0.3% - 2.3%) and 2.9% (95% confidence interval 1.1% - 4.7%) respectively. Another 4 cases were referred to us from other centres for the management of second malignant neoplasms. In this cohort of 16 children with second malignant neoplasms, the most frequent second malignant neoplasms were acute leukemia or myelodysplastic syndrome (n = 6) and central nervous system tumor (n = 4). Median interval between diagnosis of primary and second malignant neoplasms was 7.4 years (range 2.1 - 13.3 years). Eight patients developed second solid tumor within the previous irradiated field. Radiotherapy significantly increased the risk of development of second solid tumor in patients with acute lymphoblastic leukemia (P = 0.027). Seven out of 16 patients who developed second malignant neoplasms had a family history of cancer among the first or second-degree relatives. Nine patients died of progression of second malignant neoplasms, mainly resulted from second central nervous system tumor and osteosarcoma. Cumulative incidence of second cancer in our centre was comparable to western countries. Radiotherapy was associated with second solid tumour among patients with acute lymphoblastic leukemia. Patients who

Implementation of preventive strength training in residential geriatric care: a multi-centre study protocol with one year of interventions on multiple levels.

PubMed

Brach, Michael; Nieder, Frank; Nieder, Ulrike; Mechling, Heinz

2009-11-24

There is scientific evidence that preventive physical exercise is effective even in high age. In contrast, there are few opportunities of preventive exercise for highly aged people endangered by or actually in need of care. For example, they would not be able to easily go to training facilities; standard exercises may be too intensive and therefore be harmful to them; orientation disorders like dementia would exacerbate individuals and groups in following instructions and keeping exercises going. In order to develop appropriate interventions, these and other issues were assigned to different levels: the individual-social level (ISL), the organisational-institutional level (OIL) and the political-cultural level (PCL). Consequently, this conceptional framework was utilised for development, implementation and evaluation of a new strength and balance exercise programme for old people endangered by or actually in need of daily care. The present paper contains the development of this programme labeled "fit for 100", and a study protocol of an interventional single-arm multi-centre trial. The intervention consisted of (a) two group training sessions every week over one year, mainly resistance exercises, accompanied by sensorimotor and communicative group exercises and games (ISL), (b) a sustainable implementation concept, starting new groups by instructors belonging to the project, followed by training and supervision of local staff, who stepwise take over the group (OIL), (c) informing and convincing activities in professional, administrative and governmental contexts, public relation activities, and establishing an advisory council with renowned experts and public figures (PCL). Participating institutions of geriatric care were selected through several steps of quality criteria assessment. Primary outcome measures were continuous documentation of individual participation (ISL), number of groups continued without external financial support (at the end of the project, and

Emotional impact of severe post-partum haemorrhage on women and their partners: an observational, case-matched, prospective, single-centre pilot study.

PubMed

Ricbourg, Aude; Gosme, Christelle; Gayat, Etienne; Ventre, Chloé; Barranger, Emmanuel; Mebazaa, Alexandre

2015-10-01

This observational, matched-control, prospective, single-centre study sought to estimate the emotional impact of post-partum haemorrhage (PPH) on women and their partners, including its influences on post-traumatic stress disorder (PTSD), postpartum depression and the mother/child relationship. All consecutive women who were admitted for PPH from December 2010 through December 2011 and their partners were screened for eligibility. Emotional impact was assessed using three self-reported questionnaires (Impact of Event Scale-Revised to assess PTSD, Edinburgh Post Natal Depression Scale to assess post-natal depression and Mother-Infant Bonding Scale to assess the relationship between mother and child). Each PPH patient was matched with a control woman for whom the delivery was not complicated by PPH. The results showed (a) that women with PPH and their partners were more likely to report symptoms related to PTSD compared with controls, (b) that women with PPH were less likely to suffer from postnatal depression and (c) that there was no difference in the mother/child relationship between women with PPH and controls. PPH is associated with a high incidence of PTSD-related symptoms in both women and their partners. PTSD in the context of PPH is likely an under-recognised phenomenon by health care professionals. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Communicating astronomy by the Unizul Science Centre

NASA Astrophysics Data System (ADS)

Beesham, A.; Beesham, N.

2015-03-01

The University of Zululand, situated along the east coast of KwaZulu-Natal, has a thriving Science Centre (USC) situated in the developing port city of Richards Bay. Over 30 000 learners visit the centre annually, and it consists of an exhibition area, an auditorium, lecture areas and offices. The shows consist of interactive games, science shows, competitions, quizzes and matriculation workshops. Outreach activities take place through a mobile science centre for schools and communities that cannot visit the centre.

Centre-level variation in behaviour and the predictors of behaviour in 5-year-old children with non-syndromic unilateral cleft lip: The Cleft Care UK study. Part 5.

PubMed

Waylen, A; Mahmoud, O; Wills, A K; Sell, D; Sandy, J R; Ness, A R

2017-06-01

The aims of this study were to describe child behavioural and psychosocial outcomes associated with appearance and speech in the Cleft Care UK (CCUK) study. We also wanted to explore centre-level variation in child outcomes and investigate individual predictors of such outcomes. Two hundred and sixty-eight five-year-old children with non-syndromic unilateral cleft lip and palate (UCLP) recruited to CCUK. Parents completed the Strengths and Difficulties questionnaire (SDQ) and reported their own perceptions of the child's self-confidence. Child facial appearance and symmetry were assessed using photographs, and intelligibility of speech was derived from audio-visual speech recordings. Centre-level variation in behavioural and psychosocial outcomes was examined using hierarchical models, and associations with clinical outcomes were examined using logit regression models. Children with UCLP had a higher hyperactive difficulty score than the general population. For boys, the average score was 4.5 vs 4.1 (P=.03), and for girls, the average score was 3.8 vs 3.1 (P=.008). There was no evidence of centre-level variation for behaviour or parental perceptions of the child's self-confidence. There is no evidence of associations between self-confidence and SDQ scores and either facial appearance or behaviour. Children born with UCLP have higher levels of behaviour problems than the general population. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Impact of body weight, low energy diet and gastric bypass on drug bioavailability, cardiovascular risk factors and metabolic biomarkers: protocol for an open, non-randomised, three-armed single centre study (COCKTAIL).

PubMed

Hjelmesæth, Jøran; Åsberg, Anders; Andersson, Shalini; Sandbu, Rune; Robertsen, Ida; Johnson, Line Kristin; Angeles, Philip Carlo; Hertel, Jens Kristoffer; Skovlund, Eva; Heijer, Maria; Ek, Anna-Lena; Krogstad, Veronica; Karlsen, Tor-Ivar; Christensen, Hege; Andersson, Tommy B; Karlsson, Cecilia

2018-05-29

Roux-en-Y gastric bypass (GBP) is associated with changes in cardiometabolic risk factors and bioavailability of drugs, but whether these changes are induced by calorie restriction, the weight loss or surgery per se, remains uncertain. The COCKTAIL study was designed to disentangle the short-term (6 weeks) metabolic and pharmacokinetic effects of GBP and a very low energy diet (VLED) by inducing a similar weight loss in the two groups. This open, non-randomised, three-armed, single-centre study is performed at a tertiary care centre in Norway. It aims to compare the short-term (6 weeks) and long-term (2 years) effects of GBP and VLED on, first, bioavailability and pharmacokinetics (24 hours) of probe drugs and biomarkers and, second, their effects on metabolism, cardiometabolic risk factors and biomarkers. The primary outcomes will be measured as changes in: (1) all six probe drugs by absolute bioavailability area under the curve (AUC oral /AUC iv ) of midazolam (CYP3A4 probe), systemic exposure (AUC oral ) of digoxin and rosuvastatin and drug:metabolite ratios for omeprazole, losartan and caffeine, levels of endogenous CYP3A biomarkers and genotypic variation, changes in the expression and activity data of the drug-metabolising, drug transport and drug regulatory proteins in biopsies from various organs and (2) body composition, cardiometabolic risk factors and metabolic biomarkers. The COCKTAIL protocol was reviewed and approved by the Regional Committee for Medical and Health Research Ethics (Ref: 2013/2379/REK sørøst A). The results will be disseminated to academic and health professional audiences and the public via presentations at conferences, publications in peer-reviewed journals and press releases and provided to all participants. NCT02386917. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Analysis of fatal accidents with tractors in the Centre of Portugal: Ten years analysis.

PubMed

Antunes, Soraia M; Cordeiro, Cristina; Teixeira, Helena M

2018-06-01

Tractors have been described as one of the deadliest farming implements concerning agricultural activity. In Portugal, the scientific investigations about this problem are practically non-existent, with only statistical studies performed by entities related to road traffic safety, not in accordance to the study now performed, pinpointing the possibility of an underreporting of these accidents. This work aims to characterize the fatal tractor accidents in Portugal, autopsied at the Forensic Pathology Department of the Centre Branch of the National Institute of Legal Medicine and Forensic Sciences of Portugal, analysing several variables: gender, age, occupation, survival time, the victim position in the tractor, cause of death, toxicological and histological exams, year/month/day of the week, type of agricultural machine, existence of rollover protective structures (ROPS), type of accident, ground conditions, circumstantial information and geographic distribution of the accidents. All the autopsies between 2005 and 2014 were analysed. The victim profile corresponded to a man (89.5%), between 61 and 70 years old (33.3%), retired (43.9%), being the tractor driver (45.6%). In most of the cases, death occurred in less than 24h after the accident. These fatalities arose mainly in May and October. Rollover in sloping land was the most common type of accident, and cranioencephalic, thoracic and abdominal traumatic injuries were the main cause of death. In 16.2% of the cases, blood alcohol concentration was above the lower limit established in our road traffic law (<0.5g/L). There was lack information about the use of ROPS (95.9%), and even when existent, the protections were not used or were incorrectly used. This is the first national study involving the description of the forensic achievements in each autopsy related to tractor accidents, and the corresponding circumstances that contributed to the death. Many barriers remain about this matter, but the Portuguese

Double- and single-lung transplantation: an analysis of twenty years of OPTN/UNOS registry data.

PubMed

Cai, Junchao

2007-01-01

1. Within the past 2 decades, the annual number of lung transplants, especially double-lung transplants, has steadily increased every year and exceeded 1,400 in the last 2 years. 2. Overall 1-, 5-, and 10-year graft survival rates for double-lung transplant recipients were 79.5%, 50.6%, and 30.4% respectively; those for left-lung transplant recipients were 76.0%, 41.8%, and 17.1%; and for right-lung transplant recipients were 78.3%, 44.8%, and 19.2%. 3. The improvement in long-term graft survival in the most recent transplant era was mainly due to improved one-year survival, more precisely, due to the increased early outcome within the first 2-3 months after transplantation. 4. A negative association between HLA mismatch and graft survival is statistically significant in both double and left-lung transplants. 5. Female COPD and ATD single-lung recipients had high long-term graft survival when they received right-lung transplants. While for male single-lung recipients, CF patients had better graft survival when they received left lung transplants; but PPH patients had higher graft survival when receiving right-lung transplants. This association between recipient gender and/or different original diseases and graft survival requires further investigation.

Does current reporting of lung function by the UK cystic fibrosis registry allow a fair comparison of adult centres?

PubMed

Nightingale, Julia Anne; Osmond, Clive

2017-09-01

Outcome data for UK cystic fibrosis centres are publicly available in an annual report, which ranks centres by median FEV 1 % predicted. We wished to assess whether there are differences in lung function outcomes between adult centres that might imply differing standards of care. UK Registry data from 4761 subjects at 34 anonymised adult centres were used to calculate mean FEV 1 % and rate of change of lung function for 2007-13. These measures were used to rank centres and compare outcomes. There are minor differences between centres for mean FEV 1 % for some years of the study and for rate of change of lung function over the study period. However, rankings are critically dependent on the outcome measure chosen and centre variation becomes negligible once patient population characteristics are taken into account. We have demonstrated that the ranking of centres is biased and any apparent difference in respiratory outcomes is unlikely to be related to differing standards of care between centres. Copyright © 2017 European Cystic Fibrosis Society. Published by Elsevier B.V. All rights reserved.

Results of open pararenal abdominal aortic aneurysm repair: single centre series and pooled analysis of literature.

PubMed

van Lammeren, Guus W; Ünlü, Çağdaş; Verschoor, Sjoerd; van Dongen, Eric P; Wille, Jan; van de Pavoordt, Eric Dwm; de Vries-Werson, Debbie Ab; De Vries, Jean-Paul Pm

2017-06-01

Objectives Endovascular treatment of pararenal abdominal aortic aneurysm has gained terrain over the past decade, despite the substantial need for reinterventions during follow-up. However, open repair is still a well-established treatment option. With the current study we report the results of a consecutive series of elective primary open pararenal abdominal aortic aneurysm repair in a tertiary vascular referral centre, combined with an overview of current literature and pooled data analysis of perioperative mortality of open and endovascular pararenal abdominal aortic aneurysm repair. Methods A retrospective analysis of a prospective database of all elective open pararenal abdominal aortic aneurysm repairs in the St. Antonius Hospital between 2005 and 2014 was performed. Primary endpoint was 30-day mortality. Secondary endpoints were 30-day morbidity, new onset dialysis, reintervention free survival, and overall survival during follow-up. Results Between 2005 and 2014, 214 consecutive patients underwent elective open pararenal abdominal aortic aneurysm repair. Mean age was 69.8 (±7.1) years, 82.7% (177/214) were men, and mean abdominal aortic aneurysm diameter was 62 (±11) mm. Thirty-day mortality was 3.4%. Thirty-day morbidity was 27.1%, which predominantly consisted of pneumonia (18.7% (40/214)), cardiac events (3.3% (7/214)), and new onset dialysis (2.8% (6/214)). Estimated five-year overall survival rate was 74.2%. 0.9% (2/214) of patients required abdominal aortic aneurysm-related reintervention, and an additional 2.3% (5/214) required surgical repair of an incisional hernia. Pooled analysis of literature revealed a 30-day mortality of 3.0% for open pararenal repair and 1.9% for fenestrated endovascular repair. Conclusion Open pararenal abdominal aortic aneurysm repair in the era of increasing endovascular options results in acceptable perioperative morbidity and mortality rates. Mid-term reintervention rate is low compared to fenestrated endovascular

The "magic" of tutorial centres in Hong Kong: An analysis of media marketing and pedagogy in a tutorial centre

NASA Astrophysics Data System (ADS)

Koh, Aaron

2014-12-01

Why do more than three-quarters of Hong Kong's senior secondary students flock to tutorial centres like moths to light? What is the "magic" that is driving the popularity of the tutorial centre enterprise? Indeed, looking at the ongoing boom of tutorial centres in Hong Kong (there are almost 1,000 of them), it is difficult not to ask these questions. This paper examines the phenomenon of tutorial centres in Hong Kong and seeks to understand what draws students to these centres. Combining theories of marketing semiotics and emotion studies, the author investigates the pivotal role of media marketing in generating the "magic" of tutorial centres, whose advertising strategy includes, for example, a display of billboard posters featuring stylishly-dressed "celebrity teachers". The author reviews some of the literature available on the subject of tutorial centres. In a case study approach, he then maps out the pedagogy he observed in an English tutorial class, seeking heuristic insights into the kind of teaching students in the study were looking for. He argues that part of the "magical" attraction of what are essentially "cram schools" is their formulaic pedagogy of teaching and reinforcing exam skills. Finally, the paper considers the social implications of the tutorial centre industry in terms of media marketing of education and unequal access to tutorial services.

A prospective analysis of unplanned patient-initiated contacts in an adult cystic fibrosis centre.

PubMed

Burnet, Espérie; Hubert, Dominique; Champreux, Juliette; Honoré, Isabelle; Kanaan, Reem; Panzo, Rosewilta; Burgel, Pierre-Régis

2018-05-07

Timely response should be provided when patients contact the cystic fibrosis (CF) centre in between scheduled visits. Little data exist on unplanned patient-initiated contacts in CF adults. A two-stage prospective study was undertaken from 1 January to 31 December 2015 at Cochin Hospital, Paris (France). The first stage included all adults (≥18 years) who initiated unplanned contacts to the CF centre over four months. Four physicians and three nurses systematically recorded unplanned patient-initiated contacts. The data was analysed to determine why and how patients contacted the CF centre and time spent responding to their request(s). The second stage (one physician, three nurses) lasted twelve months and explored whether high contact frequency was associated with disease severity, using multivariate logistic regression. In the first stage, 259 of 410 patients (63%) initiated at least one unplanned contact, corresponding to 1067 contacts over 4 months. Patients favoured email with physicians (61% of contacts) and telephone with nurses (87% of contacts). Total time spent by the 7 caregivers on providing responses was 8 h/work week. Reasons for contacting the CF centre varied greatly, but <20% of contacts were directly related to symptom management. In the second stage, 180 of 212 patients (85%) initiated 1876 contacts over 12 months. Factors associated with ≥5 contacts/year were female sex, FEV 1  ≤ 30% predicted, ≥5 physician visits/year, and ≥ 1 hospital admission/year. Answering unplanned patient-initiated contacts represented a significant workload for CF caregivers. Increased disease severity was associated with high contact frequency. Copyright © 2018 European Cystic Fibrosis Society. Published by Elsevier B.V. All rights reserved.

Patient Education in Inflammatory Bowel Disease: A Patient-Centred, Mixed Methodology Study.

PubMed

McDermott, Edel; Healy, Gerard; Mullen, Georgina; Keegan, Denise; Byrne, Kathryn; Guerandel, Allys; Forry, Mary; Moloney, Jenny; Doherty, Glen; Cullen, Gareth; Malone, Kevin; Mulcahy, Hugh

2018-03-28

Consensus guidelines from the European Crohns and Colitis Organisation conclude that optimizing quality of care in inflammatory bowel disease [IBD] involves information and education. However, there is no standardized patient education programme in IBD and education varies from centre to centre. To assess patients' education needs in IBD to facilitate design of a patient education programme. We created focus groups of 12 patients with IBD and used qualitative analysis to generate hypotheses. We then developed a quantitative questionnaire which was disseminated to 327 IBD patients attending three different centres. Five patients declined to participate and thus 322 patients (159 [49%] male, 180 [58%] Crohn's disease, median age 38 years and disease duration 7 years) were included. Patients were most keen to receive education on medications, 'what to expect in future', living with IBD and diet. They wanted to receive this information from specialist doctors or nurses and believed it could improve their quality of life. Though the internet was the preferred source of general information [i.e. planning holidays], it was the least preferred source of IBD education. While there was a trend for females to prefer peer education, family history of IBD was the only statistically significant factor associated with information preferences. This is a patient-centred, mixed methodology study on patient education in IBD. Patients' preferences for education include components such as what to expect and diet and patients seem to distrust the internet as an IBD information source. International validation would be valuable to create a consensus education programme.

Impact of the introduction of a standardised ICD programming protocol: real-world data from a single centre.

PubMed

Sunderland, Nicholas; Kaura, Amit; Li, Anthony; Kamdar, Ravi; Petzer, Ed; Dhillon, Para; Murgatroyd, Francis; Scott, Paul A

2016-09-01

Randomised trials have shown that empiric ICD programming, using long detection times and high detection zones, reduces device therapy in ICD recipients. However, there is less data on its effectiveness in a "real-world" setting, especially secondary prevention patients. Our aim was to evaluate the introduction of a standardised programming protocol in a real-world setting of unselected ICD recipients. We analysed 270 consecutive ICD recipients implanted in a single centre-135 implanted prior to protocol implementation (physician-led group) and 135 after (standardised group). The protocol included long arrhythmia detection times (30/40 or equivalent) and high rate detection zones (primary prevention lower treatment zone 200 bpm). Programming in the physician-led group was at the discretion of the implanter. The primary endpoint was time-to-any therapy (ATP or shocks). Secondary endpoints were time-to-inappropriate therapy and time-to-appropriate therapy. The safety endpoints were syncopal episodes, hospital admissions and death. At 12 months follow-up, 47 patients had received any ICD therapy (physician-led group, n = 31 vs. standardised group, n = 16). There was a 47 % risk reduction in any device therapy (p = 0.04) and an 86 % risk reduction in inappropriate therapy (p = 0.009) in the standardised compared to the physician-led group. There was a non-significant 30 % risk reduction in appropriate therapy (p = 0.32). Results were consistent across primary and secondary prevention patients. There were no significant differences in the rates of syncope, hospitalisation, and death. In unselected patients in a real-world setting, introduction of a standardised programming protocol, using long detection times and high detection zones, significantly reduces the burden of ICD therapy without an increase in adverse outcomes.

Twenty-eight-year review of childhood renal diseases from renal biopsy data: A single centre in China.

PubMed

Jiang, Mengjie; Xiao, Zizheng; Rong, Liping; Xu, Yuanyuan; Chen, Lizhi; Mo, Ying; Sun, Liangzhong; Sun, Wei; Jiang, Xiaoyun

2016-12-01

The aim of the present study was to investigate the clinicopathologic characteristics of biopsy-proven childhood renal diseases and to compare the trends and changes during two different time intervals between 1984 and 2011 at the First Affiliated Hospital of Sun Yat-sen University in China. We retrospectively analyzed kidney biopsy data from children with renal diseases and compared the data during two time intervals, namely 1984-1997 and 1998-2011. A total of 1313 children were enrolled in the present study. There were 921 children with primary glomerular disease (PGD) and 312 children with secondary glomerular disease (SGD), accounting for 70.1% and 23.8% of participants, respectively. The major clinical manifestation of PGD was nephrotic syndrome (NS), which accounted for 31.2% of cases, while the main aetiology of SGD was lupus nephritis (40.7%). The main biopsy patterns of PGD were IgA nephritis (27.6%), minimal change disease (24.0%), and mesangial proliferative glomerulonephritis (16.9%). PGD was the major class of disease in both time intervals, but the ratio of PGD decreased over time, while the ratio of SGD and other glomerular diseases increased. PGD was also the major class of disease in each age group; however, the incidence of PGD decreased with increasing age. The incidence patterns of paediatric renal diseases changed over the 28-year period of this study. Our results show that different renal diseases characterize different age intervals. Furthermore, there are several associations between clinical presentation and biopsy features in childhood renal disease. © 2015 Asian Pacific Society of Nephrology.

Improving client-centred care and services: the role of front/back-office configurations.

PubMed

Broekhuis, Manda; de Blok, Carolien; Meijboom, Bert

2009-05-01

This paper is a report of a study conducted to explore the application of designing front- and back-office work resulting in efficient client-centred care in healthcare organizations that supply home care, welfare and domestic services. Front/back-office configurations reflect a neglected domain of design decisions in the development of more client-centred processes and structures without incurring major cost increases. Based on a literature search, a framework of four front/back-office configurations was constructed. To illustrate the usefulness of this framework, a single, longitudinal case study was performed in a large organization, which provides home care, welfare and domestic services for a sustained period (2005-2006). The case study illustrates how front/back-office design decisions are related to the complexity of the clients' demands and the strategic objectives of an organization. The constructed framework guides the practical development of front/back-office designs, and shows how each design contributes differently to such performance objectives as quality, speed and efficiency. The front/back-office configurations presented comprise an important first step in elaborating client-centred care and service provision to the operational level. It helps healthcare organizations to become more responsive and to provide efficient client-centred care and services when approaching demand in a well-tuned manner. In addition to its applicability in home care, we believe that a deliberate front/back-office configuration also has potential in other fields of health care.

Outcomes of arteriovenous fistula creation, effect of preoperative vein mapping and predictors of fistula success in incident haemodialysis patients: A single-centre experience.

PubMed

Lee, Kian-Guan; Chong, Tze-Tec; Goh, Nicholette; Achudan, Shaam; Tan, Yi-Liang; Tan, Ru-Yu; Choong, Hui-Lin; Tan, Chieh-Suai

2017-05-01

Vascular access in haemodialysis is critical for effective therapy. We aim to evaluate the outcomes of arteriovenous fistula (AVF) creation in incident haemodialysis patients, impact of preoperative vein mapping and predictors of successful AVF maturation in our centre. Data of End-stage Renal Disease (ESRD) patients initiated on haemodialysis from January 2010 to December 2012 in our centre were retrospectively obtained from electronic medical records and clinical notes. Demographic characteristics, medical comorbidities, perioperative details were collected, and patients were followed up until 1 January 2014. A total of 708 patients (median age 64, IQR 55-72) were included with mean duration of follow up of 2.3 ± 1.2 years, with access of AVF and arteriovenous graft (AVG) in 694 (98%) and 14 (2%) patients respectively. Eight patients were lost to follow-up. Successful AVF maturation was achieved in 542 patients (78%), with 1-year cumulative patency rate of 74%. Multivariate analysis revealed male gender, upper arm AVF and good postoperative thrill and pulse as predictors of successful AVF maturation. Preoperative vein mapping was performed in 42.5% (295/694) of patients, with mean vein diameter of 2.44 ± 0.82 mm. Maturation rates with and without vein mapping were 72.2% and 82.4%, respectively, (P = 0.001). In patients with vein diameters of <2 mm and ≥2 mm, there was no statistically significant difference in maturation rates (71.3% vs. 72.6%; P = 0.887) and median maturation time (66 vs. 78 days; P = 0.73). Arteriovenous fistula can be successfully created in most incident haemodialysis patients. Routine vein mapping is not necessary if veins are suitable on physical examination alone, and vein sizes of <2 mm on ultrasound is not associated with lower AVF maturation rate. © 2016 Asian Pacific Society of Nephrology.

Training potential in minimally invasive surgery in a tertiary care, paediatric urology centre.

PubMed

Schroeder, R P J; Chrzan, R J; Klijn, A J; Kuijper, C F; Dik, P; de Jong, T P V M

2015-10-01

Minimally invasive surgery (MIS) is being utilized more frequently as a surgical technique in general surgery and in paediatric urology. It is associated with a steep learning curve. Currently, the centre does not offer a MIS training programme. It is hypothesized that the number of MIS procedures performed in the low-volume specialty of paediatric urology will offer insufficient training potential for surgeons. To assess the MIS training potential of a highly specialized, tertiary care, paediatric urology training centre that has been accredited by the Joint Committee of Paediatric Urology (JCPU). The clinical activity of the department was retrospectively reviewed by extracting the annual number of admissions, outpatient consultations and operative procedures. The operations were divided into open procedures and MIS. Major ablative procedures (nephrectomy) and reconstructive procedures (pyeloplasty) were analysed with reference to the patients' ages. The centre policy is not to perform major MIS in children who are under 2 years old or who weigh less than 12 kg. Every year, this institution provides approximately 4300 out-patient consultations, 600 admissions, and 1300 procedures under general anaesthesia for children with urological problems. In 2012, 35 patients underwent major intricate MIS: 16 pyeloplasties, eight nephrectomies and 11 operations for incontinence (seven Burch, and four bladder neck procedures). In children ≥2 years of age, 16/21 of the pyeloplasties and 8/12 of the nephrectomies were performed laparoscopically. The remaining MIS procedures included 25 orchidopexies and one intravesical ureteral reimplantation. There is no consensus on how to assess laparoscopic training. It would be valuable to reach a consensus on a standardized laparoscopic training programme in paediatric urology. Often training potential is based on operation numbers only. In paediatric urology no minimum requirement has been specified. The number of procedures quoted

Improved event positioning in a gamma ray detector using an iterative position-weighted centre-of-gravity algorithm.

PubMed

Liu, Chen-Yi; Goertzen, Andrew L

2013-07-21

An iterative position-weighted centre-of-gravity algorithm was developed and tested for positioning events in a silicon photomultiplier (SiPM)-based scintillation detector for positron emission tomography. The algorithm used a Gaussian-based weighting function centred at the current estimate of the event location. The algorithm was applied to the signals from a 4 × 4 array of SiPM detectors that used individual channel readout and a LYSO:Ce scintillator array. Three scintillator array configurations were tested: single layer with 3.17 mm crystal pitch, matched to the SiPM size; single layer with 1.5 mm crystal pitch; and dual layer with 1.67 mm crystal pitch and a ½ crystal offset in the X and Y directions between the two layers. The flood histograms generated by this algorithm were shown to be superior to those generated by the standard centre of gravity. The width of the Gaussian weighting function of the algorithm was optimized for different scintillator array setups. The optimal width of the Gaussian curve was found to depend on the amount of light spread. The algorithm required less than 20 iterations to calculate the position of an event. The rapid convergence of this algorithm will readily allow for implementation on a front-end detector processing field programmable gate array for use in improved real-time event positioning and identification.

Robot-assisted single-site compared with laparoscopic single-incision cholecystectomy for benign gallbladder disease: protocol for a randomized controlled trial.

PubMed

Grochola, Lukasz Filip; Soll, Christopher; Zehnder, Adrian; Wyss, Roland; Herzog, Pascal; Breitenstein, Stefan

2017-02-09

Recent advances in robotic technology suggest that the utilization of the da Vinci Single-Site™ platform for cholecystectomy is safe, feasible and results in a shorter learning curve compared to conventional single-incision laparoscopic cholecystectomy. Moreover, the robot-assisted technology has been shown to reduce the surgeon's stress load compared to standard single-incision laparoscopy in an experimental setup, suggesting an important advantage of the da Vinci platform. However, the above-mentioned observations are based solely on case series, case reports and experimental data, as high-quality clinical trials to demonstrate the benefits of the da Vinci Single-Site™ cholecystectomy have not been performed to date. This study addresses the question whether robot-assisted Single-Site™ cholecystectomy provides significant benefits over single-incision laparoscopic cholecystectomy in terms of surgeon's stress load, while matching the standards of the conventional single-incision approach with regard to peri- and postoperative outcomes. It is designed as a single centre, single-blinded randomized controlled trial, which compares both surgical approaches with the primary endpoint surgeon's physical and mental stress load at the time of surgery. In addition, the study aims to assess secondary endpoints such as operating time, conversion rates, additional trocar placement, intra-operative blood loss, length of hospital stay, costs of procedure, health-related quality of life, cosmesis and complications. Patients as well as ward staff are blinded until the 1 st postoperative year. Sample size calculation based on the results of a previously published experimental setup utilizing an estimated effect size of surgeon's comfort of 0.8 (power of 0.8, alpha-error level of 0.05, error margin of 10-15%) resulted in a number of 30 randomized patients per arm. The study is the first randomized controlled trial that compares the da Vinci Single Site™ platform to

Mortality in bullous pemphigoid and prognostic factors in 1st and 3rd year of follow-up in specialized centre in Poland.

PubMed

Kalinska-Bienias, Agnieszka; Lukowska-Smorawska, Katarzyna; Jagielski, Pawel; Kowalewski, Cezary; Wozniak, Katarzyna

2017-11-01

Bullous pemphigoid (BP) is associated with higher mortality and coexisting comorbidities, some of them affecting poor prognosis. The aim of the study was to identify prognostic factors causing greater mortality both in the 1st and 3rd year of follow-up and to determine the 1-, 2-, 3-year mortality rates, standardized mortality ratio (SMR) in Polish BP patients. All patients with BP (a cohort of 205 patients, mean age 76.2 years) diagnosed between 5 January 2000 and 10 December 2013 in a referral unit for autoimmune bullous diseases at the university hospital in Poland were included retrospectively. Mortality data were obtained from the Centre for Document Personalization at the Minister of Interior and Administration. Our original observation was that prednisone in moderate dose (0.5 mg kg -1 ) in monotherapy was an independent risk factor of fatal prognosis in the 1st year of follow-up, assessed using multivariate analysis. We confirmed the strong correlation between neurological diseases and greater mortality. Both in the 1st and 3rd year of follow-up, dementia and Parkinson disease resulted in increased mortality. We also found that arrhythmias significantly increased mortality in the 1st and 3rd year of follow-up. The prognostic factors in BP changed over time of follow-up. In the 3rd year of observation, the age above 77, longer hospitalization and BP severity were associated with greater mortality. We observed poorer prognosis in BP patients than age-matched general Polish population. The 1-, 2-, 3-year mortality rates were 22.4, 31.2, 39.5% and SMR was 3.8 (95% CI 3.4-3.7).

Planetary Sciences Interoperability at VO Paris Data Centre

NASA Astrophysics Data System (ADS)

Le Sidaner, P.; Aboudarham, J.; Birlan, M.; Briot, D.; Bonnin, X.; Cecconi, B.; Chauvin, C.; Erard, S.; Henry, F.; Lamy, L.; Mancini, M.; Normand, J.; Popescu, F.; Roques, F.; Savalle, R.; Schneider, J.; Shih, A.; Thuillot, W.; Vinatier, S.

2015-10-01

The Astronomy community has been developing interoperability since more than 10 years, by standardizing data access, data formats, and metadata. This international action is led by the International Virtual Observatory Alliance (IVOA). Observatoire de Paris is an active participant in this project. All actions on interoperability, data and service provision are centralized in and managed by VOParis Data Centre (VOPDC). VOPDC is a coordinated project from all scientific departments of Observatoire de Paris..

Assessment and determinants of airborne bacterial and fungal concentrations in different indoor environments: Homes, child day-care centres, primary schools and elderly care centres

NASA Astrophysics Data System (ADS)

Madureira, Joana; Paciência, Inês; Rufo, João Cavaleiro; Pereira, Cristiana; Teixeira, João Paulo; de Oliveira Fernandes, Eduardo

2015-05-01

Until now the influence of risk factors resulting from exposure to biological agents in indoor air has been far less studied than outdoor pollution; therefore the uncertainty of health risks, and how to effectively prevent these, remains. This study aimed (i) to quantify airborne cultivable bacterial and fungal concentrations in four different types of indoor environment as well as to identify the recovered fungi; (ii) to assess the impact of outdoor bacterial and fungal concentrations on indoor air; (iii) to investigate the influence of carbon dioxide (CO2), temperature and relative humidity on bacterial and fungal concentrations; and (iv) to estimate bacterial and fungal dose rate for children (3-5 years old and 8-10 years old) in comparison with the elderly. Air samples were collected in 68 homes, 9 child day-care centres, 20 primary schools and 22 elderly care centres, in a total of 264 rooms with a microbiological air sampler and using tryptic soy agar and malt extract agar culture media for bacteria and fungi growth, respectively. For each building, one outdoor representative location were identified and simultaneously studied. The results showed that child day-care centres were the indoor microenvironment with the highest median bacterial and fungal concentrations (3870 CFU/m3 and 415 CFU/m3, respectively), whereas the lowest median concentrations were observed in elderly care centres (222 CFU/m3 and 180 CFU/m3, respectively). Indoor bacterial concentrations were significantly higher than outdoor concentrations (p < 0.05); whereas the indoor/outdoor ratios for the obtained fungal concentrations were approximately around the unit. Indoor CO2 levels were associated with the bacterial concentration, probably due to occupancy and insufficient ventilation. Penicillium and Cladosporium were the most frequently occurring fungi. Children's had two times higher dose rate to biological pollutants when compared to adult individuals. Thus, due to children

Frambu Health Centre: Promoting Family Focused Care for Disabled Children.

ERIC Educational Resources Information Center

Storhaug, Kari; Vandvik, Inger Helene

1983-01-01

The article describes services of the Frambu Health Centre in Norway, which has evolved during the past 30 years from a summer camp for children with poliomyelitis to a modern information and treatment center for families with disabled members, and offers fortnightly courses for patients with rare congenital and/or hereditary disorders. (Author/MC)

Regional cancer centre demonstrates voluntary conformity with the national Radiation Oncology Practice Standards

PubMed Central

Manley, Stephen; Last, Andrew; Fu, Kenneth; Greenham, Stuart; Kovendy, Andrew; Shakespeare, Thomas P

2015-01-01

Radiation Oncology Practice Standards have been developed over the last 10 years and were published for use in Australia in 2011. Although the majority of the radiation oncology community supports the implementation of the standards, there has been no mechanism for uniform assessment or governance. North Coast Cancer Institute's public radiation oncology service is provided across three main service centres on the north coast of NSW. With a strong focus on quality management, we embraced the opportunity to demonstrate conformity with the Radiation Oncology Practice Standards. The Local Health District's Clinical Governance units were engaged to perform assessments of our conformity with the standards and this was signed off as complete on 16 December 2013. The process of demonstrating conformity with the Radiation Oncology Practice Standards has enhanced the culture of quality in our centres. We have demonstrated that self-assessment utilising trained auditors is a viable method for centres to demonstrate conformity. National implementation of the Radiation Oncology Practice Standards will benefit individual centres and the broader radiation oncology community to improve the service delivered to our patients. PMID:26229680

Regional cancer centre demonstrates voluntary conformity with the national Radiation Oncology Practice Standards.

PubMed

Manley, Stephen; Last, Andrew; Fu, Kenneth; Greenham, Stuart; Kovendy, Andrew; Shakespeare, Thomas P

2015-06-01

Radiation Oncology Practice Standards have been developed over the last 10 years and were published for use in Australia in 2011. Although the majority of the radiation oncology community supports the implementation of the standards, there has been no mechanism for uniform assessment or governance. North Coast Cancer Institute's public radiation oncology service is provided across three main service centres on the north coast of NSW. With a strong focus on quality management, we embraced the opportunity to demonstrate conformity with the Radiation Oncology Practice Standards. The Local Health District's Clinical Governance units were engaged to perform assessments of our conformity with the standards and this was signed off as complete on 16 December 2013. The process of demonstrating conformity with the Radiation Oncology Practice Standards has enhanced the culture of quality in our centres. We have demonstrated that self-assessment utilising trained auditors is a viable method for centres to demonstrate conformity. National implementation of the Radiation Oncology Practice Standards will benefit individual centres and the broader radiation oncology community to improve the service delivered to our patients.

Perspectives on recycling centres and future developments.

PubMed

Engkvist, I-L; Eklund, J; Krook, J; Björkman, M; Sundin, E

2016-11-01

The overall aim of this paper is to draw combined, all-embracing conclusions based on a long-term multidisciplinary research programme on recycling centres in Sweden, focussing on working conditions, environment and system performance. A second aim is to give recommendations for their development of new and existing recycling centres and to discuss implications for the future design and organisation. Several opportunities for improvement of recycling centres were identified, such as design, layout, ease with which users could sort their waste, the work environment, conflicting needs and goals within the industry, and industrialisation. Combining all results from the research, which consisted of different disciplinary aspects, made it possible to analyse and elucidate their interrelations. Waste sorting quality was recognized as the most prominent improvement field in the recycling centre system. The research identified the importance of involving stakeholders with different perspectives when planning a recycling centre in order to get functionality and high performance. Practical proposals of how to plan and build recycling centres are given in a detailed checklist. Copyright © 2016 Elsevier Ltd. All rights reserved.

Patient-centred care: a review for rehabilitative audiologists.

PubMed

Grenness, Caitlin; Hickson, Louise; Laplante-Lévesque, Ariane; Davidson, Bronwyn

2014-02-01

This discussion paper aims to synthesise the literature on patient-centred care from a range of health professions and to relate this to the field of rehabilitative audiology. Through review of the literature, this paper addresses five questions: What is patient-centred care? How is patient-centred care measured? What are the outcomes of patient-centred care? What are the factors contributing to patient-centred care? What are the implications for audiological rehabilitation? Literature review and synthesis. Publications were identified by structured searches in PubMed, Cinahl, Web of Knowledge, and PsychInfo, and by inspecting the reference lists of relevant articles. Few publications from within the audiology profession address this topic and consequently a review and synthesis of literature from other areas of health were used to answer the proposed questions. This paper concludes that patient-centred care is in line with the aims and scope of practice for audiological rehabilitation. However, there is emerging evidence that we still need to inform the conceptualisation of patient-centred audiological rehabilitation. A definition of patient-centred audiological rehabilitation is needed to facilitate studies into the nature and outcomes of it in audiological rehabilitation practice.

Clinical features and laboratory findings of dengue fever in German travellers: A single-centre, retrospective analysis.

PubMed

Tavakolipoor, Pulad; Schmidt-Chanasit, Jonas; Burchard, Gerd Dieter; Jordan, Sabine

2016-01-01

Dengue fever (DF) is one of the most relevant human arboviral infections worldwide and has become a frequent cause of fever in the returning traveller. This retrospective study aimed to characterize epidemiological and clinical features and laboratory findings of dengue fever in German travellers. This descriptive study analyzed medical records of patients diagnosed with DF presenting at the Section of Tropical Medicine of the University Medical Centre Hamburg-Eppendorf from 2007 to 2011. Data were collected and analyzed retrospectively. In total, data of 119 DF patients (52 female, 67 male) were included in this study. The median age of the patients was 35 (range 15-75 years). DF was most frequently acquired in South-East Asia (n = 65; 54.7%), and in particular in Thailand (n = 23; 19.7%). A considerable percentage of DF infections (n = 14; 11.8%) was imported from Africa. Patients predominantly presented with fever, headache, rash, myalgia and arthralgia but also with gastrointestinal symptoms, i.e. diarrhoea. Nine patients showed signs of minor haemorrhagic manifestations. Neurological complications occurred in 13 patients. Low platelet count, leukopenia and elevated liver enzymes were the most relevant laboratory findings. Twenty patients (17.8%) had to be hospitalized. Overall, the clinical course was mostly mild to moderate, 13 patients (10.9%) showed DF warnings signs, no fatalities occurred. DF presented as a mostly mild to moderate disease in this study cohort. Outpatient treatment was adequate for the majority of patients. Still, detailed knowledge of clinical symptoms and laboratory features is essential for appropriate triage. Copyright © 2016 Elsevier Ltd. All rights reserved.

Assisted reproduction in a cohort of same-sex male couples and single men.

PubMed

Grover, Stephanie A; Shmorgun, Ziva; Moskovtsev, Sergey I; Baratz, Ari; Librach, Clifford L

2013-08-01

To date, there is limited published data on same-sex male couples and single men using assisted reproduction treatment to build their families. The objective of this retrospective study was to better understand treatment considerations and outcomes for this population when using assisted reproduction treatment. A total of 37 same-sex male couples and eight single men (seven homosexual and one heterosexual) who attended the CReATe Fertility Centre for assisted reproduction services were studied. There was a 21-fold increase in the number of same-sex male couples and single men undergoing assisted reproduction treatment since 2003. The mean age was 46years (24-58). Twenty-eight couples (76%) chose to use spermatozoa from both partners to fertilize their donated oocytes. Most men (32 same-sex male couples and seven single men; 87%) obtained oocytes from an anonymous donor, whereas five couples and one single man (13%) had a known donor. Anonymous donors who were open to be contacted by the child after the age of 18 were selected by 67% of patients. Of all 25 deliveries, eight (32%) were sets of twins. All of the twins were half genetic siblings. Copyright © 2013 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

Olfactory neuroblastoma: 14-year experience at an Australian tertiary centre and the role for longer-term surveillance.

PubMed

Schmidt, C; Potter, N; Porceddu, S; Panizza, B

2017-07-01

Olfactory neuroblastoma is a rare sinonasal malignancy, with poorly defined treatment protocols. Management at a tertiary centre was retrospectively evaluated to inform future treatment and follow up. Cases treated with curative intent (2000-2014) were included. Data were collected, and overall and disease-free survival rates were calculated. Eleven cases were identified, with a median follow up of 87 months. One patient was Kadish stage A, one was stage B, eight were stage C and one was stage D. The latter patient underwent chemoradiotherapy alone. The remaining patients proceeded to: endoscopic-assisted wide local excision (n = 2), anterior craniofacial resection (n = 4) or endoscopic craniofacial resection (n = 4). No patients had primary nodal disease or elective neck treatment. One patient had neoadjuvant chemoradiation. Six patients had post-operative radiotherapy; three received adjuvant chemotherapy. Two patients had late cervical node failure, and proceeded to neck dissection and post-operative radiotherapy. Two patients had late local recurrence. Ten-year overall and disease-free survival rates were 68.2 and 46.7 per cent, respectively. Longer-term follow up is supported given the incidence of late regional and local recurrence. Prophylactic treatment of cervical nodes in locally advanced disease is an area for further investigation.

What is the degree of innovation routinely implemented in Dutch radiotherapy centres? A multicentre cross-sectional study.

PubMed

Jacobs, Maria; Boersma, Liesbeth; Dekker, Andre; Bosmans, Geert; van Merode, Frits; Verhaegen, Frank; de Ruysscher, Dirk; Swart, Rachelle; Kengen, Cindy; Lambin, Philippe

2016-11-01

To study the implementation of innovation activities in Dutch radiotherapy (RT) centres in a broad sense (product, technological, market and organizational innovations). A descriptive cross-sectional study was conducted in 15 Dutch RT centres. A list of innovations implemented from 2011 to 2013 was drawn up for each centre using semi-structured interviews. These innovations were classified into innovation categories according to previously defined innovation indicators. Where applicable, each innovation was rated by each centre on the effort required to implement it and on its expected effects, to get an impression of how far reaching and radical the innovations were and to be able to compare the number of innovations between centres. The participating RT centres in the Netherlands implemented 12 innovations per year on average (range 5-25); this number was not significantly different for academic (n = 13) or non-academic centres (n = 10). Several centres were dealing with the same innovations at the same time. The average required effort and expected output did not differ significantly between product, technological and organizational innovation or between academic and non-academic centres. The number of innovations observed per centre varied across a large range, with a large overlap in terms of the type of innovations that were implemented. Registering innovations using the innovation indicators applied in our study would make it possible to improve collaboration between centres, e.g. with common training modules, to avoid duplication of work. Advances in knowledge: This study is the first of its kind investigating innovation implementation in RT in a broad sense.

Review of CERN Data Centre Infrastructure

NASA Astrophysics Data System (ADS)

Andrade, P.; Bell, T.; van Eldik, J.; McCance, G.; Panzer-Steindel, B.; Coelho dos Santos, M.; Traylen and, S.; Schwickerath, U.

2012-12-01

The CERN Data Centre is reviewing strategies for optimizing the use of the existing infrastructure and expanding to a new data centre by studying how other large sites are being operated. Over the past six months, CERN has been investigating modern and widely-used tools and procedures used for virtualisation, clouds and fabric management in order to reduce operational effort, increase agility and support unattended remote data centres. This paper gives the details on the project's motivations, current status and areas for future investigation.

Radiation dose from common radiological investigations and cumulative exposure in children with cystic fibrosis: an observational study from a single UK centre

PubMed Central

Ward, Rebecca; Carroll, William D; Cunningham, Paula; Ho, Sheng-Ang; Jones, Mary; Lenney, Warren; Thompson, David

2017-01-01

Objectives Cumulative radiation exposure is associated with increased risk of malignancy. This is important in cystic fibrosis (CF) as frequent imaging is required to monitor disease progression and diagnose complications. Previous estimates of cumulative radiation are outdated as the imaging was performed on older equipment likely to deliver higher radiation. Our objectives were to determine the radiation dose delivered to children during common radiological investigations using modern equipment and to identify the number of such investigations performed in a cohort of children with CF to calculate their cumulative radiation exposure. Design, setting and participants Data including age at investigation and radiation exposure measured as estimated effective dose (EED) were collected on 2827 radiological studies performed on children at one UK paediatric centre. These were combined with the details of all radiological investigations performed on 65 children with CF attending the same centre to enable calculation of each child’s cumulative radiation exposure. Results The mean EED for the common radiological investigations varied according to age. The range was 0.01–0.02 mSv for chest X-rays, 0.03–0.11 mSv for abdominal X-rays, 0.57–1.69 mSv for CT chest, 2.9–3.9 mSv for abdominal and pelvic CT, 0.20–0.21 mSv for sinus CT and 0.15–0.52 mSv for fluoroscopy-guided procedures. The mean EED was three to five times higher for helical compared with axial chest CT scans. The mean annual cumulative EED for our cohort of children with CF was 0.15 mSv/year with an estimated cumulative paediatric lifetime EED (0–18 years) of 3.5 mSv. Conclusions This study provides up-to-date estimations of the radiation exposure when using common radiological investigations. These doses and the estimates of cumulative radiation exposure in children with CF are lower than previously reported. This reflects the reduced EED associated with modern equipment and the

The 10-year Trend of Periprocedural Complication Following Carotid Artery Stenting; Single Center Experience

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hong, Jeong-Ho; Kang, Jihoon; Yeo, Min-Ju

PurposeCarotid endarterectomy and stenting are used to treat carotid stenosis, with the volume of carotid artery procedures increasing over the past decade. We investigated the 10-year trend of periprocedural complications with an increasing procedure volume of carotid stenting at a single tertiary hospital.MethodsWe collected 416 consecutive cases (384 patients) of carotid artery stenting performed for either symptomatic (231 cases, 55.5 %) or asymptomatic (185 cases, 44.5 %) internal carotid artery stenosis at a single center. Periprocedural complication was defined as any stroke, myocardial infarction, or death. Procedure-related outcome included any dissection, hemodynamic event, or periprocedural complication.ResultsThe mean age was 68.8 years (82.8 % males;more » range of 20–89 years); 23.9 % were older than 75 years. Before the procedure, 99.3 and 56.0 % of patients received antiplatelet and lipid-lowering medication, respectively. The overall periprocedural complication rate was 3.6 % (1.6 and 5.2 % in the asymptomatic and symptomatic group, respectively). The composite outcome of any stroke or death was 3.4 %. Periprocedural complication and procedure-related outcome showed a decremental trend with increasing procedure volume, and this trend remained after adjusting for confounders.ConclusionsOur study suggests that carotid stenting at an experienced center might reduce the periprocedural complications. Our periprocedural complication rate of carotid artery stenting may be comparable to, or somewhat lower than, that reported in other clinical trials.« less

Disaster preparedness of Canadian trauma centres: the perspective of medical directors of trauma

PubMed Central

Gomez, David; Haas, Barbara; Ahmed, Najma; Tien, Homer; Nathens, Avery

2011-01-01

Background Owing to their constant readiness to treat injured patients, trauma centres are essential to regional responses to mass casualty incidents (MCIs). Reviews of recent MCIs suggest that trauma centre preparedness has frequently been limited. We set out to evaluate Canadian trauma centre preparedness and the extent of their integration into a regional response to MCIs. Methods We conducted a survey of Canadian level-1 trauma centres (n = 29) to characterize their existing disaster-response plans and to identify areas where pre-paredness could be improved. The survey was directed to the medical director of trauma at each centre. Descriptive statistics were used to analyze responses. Results Twenty-three (79%) trauma centres in 5 provinces responded. Whereas most (83%) reported the presence of a committee dedicated to disaster preparedness, only half of the medical directors of trauma were members of these committees. Almost half (43%) the institutions had not run any disaster drill in the previous 2 years. Only 70% of trauma centres used communications assets designed to function during MCIs. Additionally, more than half of the trauma directors (59%) did not know if their institutions had the ability to sustain operations for at least 72 hours during MCIs. Conclusion The results of this study suggest important opportunities to better prepare Canadian trauma centers to respond to an MCI. The main areas identified for potential improvement include the need for the standardization of MCI planning and response at a regional level and the implementation of strategies such as stockpiling of resources and novel communication strategies to avoid functional collapse during an MCI. PMID:21251427

Intraocular straylight screening in medical testing centres for driver licence holders in Spain

PubMed Central

Michael, Ralph; Barraquer, Rafael I.; Rodríguez, Judith; Tuñi i Picado, Josep; Jubal, Joan Serra; González Luque, Juan Carlos; van den Berg, Tom

2010-01-01

Purpose To test the performance of the C-quant straylight meter during the daily routine work in medical testing centres for driver license applicants and driver license holders in Spain. Methods Altogether 914 subjects, of which 376 younger than 35 years, 428 between 35 and 60 years and 110 over 60 years were measured with the C-quant in three medical testing centres (Barcelona, Zaragoza and Palma de Mallorca) in 2006. Technicians were instructed once and the measurements were done during the daily routine work. We recorded: age, BCVA, self-reported subjective blinding at night; and from the C-quant: straylight parameter (log s), measurement quality parameters (ESD, Q) and test duration. Results Total C-quant test duration increases slightly with age from a mean of 7 min (< 35 years) to a mean of 9 min (> 60). At first attempt, 82 % of all subjects produced reliable results (ESD < 0.12). The straylight parameter for this group was independent of ESD and ESD was independent of total test duration. The known age dependence of the straylight parameter and the weak correlation with BCVA was confirmed. The distribution of subjective blinding at night was very different between test centres. Subjects with “very strong” subjective blinding had significantly higher straylight values than subjects with “no” subjective blinding. Subjects avoiding night driving had significant higher straylight values than subjects driving at night. Conclusion The C-quant measure is reasonable fast. Good subject instruction is important to get first attempt reliable results. Self-reported subjective blinding results depend strongly on the interviewer.

Stand development and yields of Appalachian hardwood stands managed with single-tree selection for at least 30 years

Treesearch

Neil I Lamson; H. Clay Smith; H. Clay Smith

1991-01-01

Appalachian hardwood stands in West Virginia were managed for 30 or more years using single-tree selection regeneration practices. Stand yield data suggest that current stand growth will provide economical harvest cuts for several future cutting cycles. This case study indicates that the single-tree selection practice has potential for landowners who want to maintain...

The "Magic" of Tutorial Centres in Hong Kong: An Analysis of Media Marketing and Pedagogy in a Tutorial Centre

ERIC Educational Resources Information Center

Koh, Aaron

2014-01-01

Why do more than three-quarters of Hong Kong's senior secondary students flock to tutorial centres like moths to light? What is the "magic" that is driving the popularity of the tutorial centre enterprise? Indeed, looking at the ongoing boom of tutorial centres in Hong Kong (there are almost 1,000 of them), it is difficult not to ask…

Comparison of planned menus and centre characteristics with foods and beverages served in New York City child-care centres.

PubMed

Breck, Andrew; Dixon, L Beth; Kettel Khan, Laura

2016-10-01

The present study evaluated the extent to which child-care centre menus prepared in advance correspond with food and beverage items served to children. The authors identified centre and staff characteristics that were associated with matches between menus and what was served. Menus were collected from ninety-five centres in New York City (NYC). Direct observation of foods and beverages served to children were conducted during 524 meal and snack times at these centres between April and June 2010, as part of a larger study designed to determine compliance of child-care centres with city health department regulations for nutrition. Child-care centres were located in low-income neighbourhoods in NYC. Overall, 87 % of the foods and beverages listed on the menus or allowed as substitutions were served. Menu items matched with foods and beverages served for all major food groups by >60 %. Sweets and water had lower match percentages (40 and 32 %, respectively), but water was served 68 % of the time when it was not listed on the menu. The staff person making the food and purchasing decisions predicted the match between the planned or substituted items on the menus and the foods and beverages served. In the present study, child-care centre menus included most foods and beverages served to children. Menus planned in advance have potential to be used to inform parents about which child-care centre to send their child or what foods and beverages their enrolled children will be offered throughout the day.

Comparison of planned menus and centre characteristics with foods and beverages served in New York City child-care centres

PubMed Central

Breck, Andrew; Dixon, L Beth; Khan, Laura Kettel

2016-01-01

Objective The present study evaluated the extent to which child-care centre menus prepared in advance correspond with food and beverage items served to children. The authors identified centre and staff characteristics that were associated with matches between menus and what was served. Design Menus were collected from ninety-five centres in New York City (NYC). Direct observation of foods and beverages served to children were conducted during 524 meal and snack times at these centres between April and June 2010, as part of a larger study designed to determine compliance of child-care centres with city health department regulations for nutrition. Setting Child-care centres were located in low-income neighbourhoods in NYC. Results Overall, 87% of the foods and beverages listed on the menus or allowed as substitutions were served. Menu items matched with foods and beverages served for all major food groups by > 60%. Sweets and water had lower match percentages (40 and 32%, respectively), but water was served 68% of the time when it was not listed on the menu. The staff person making the food and purchasing decisions predicted the match between the planned or substituted items on the menus and the foods and beverages served. Conclusions In the present study, child-care centre menus included most foods and beverages served to children. Menus planned in advance have potential to be used to inform parents about which child-care centre to send their child or what foods and beverages their enrolled children will be offered throughout the day. PMID:27280341

Long-term Outcomes after Truncus Arteriosus Repair: A Single-center Experience for More than 40 Years.

PubMed

Asagai, Seiji; Inai, Kei; Shinohara, Tokuko; Tomimatsu, Hirofumi; Ishii, Tetsuko; Sugiyama, Hisashi; Park, In-Sam; Nagashima, Mitsugi; Nakanishi, Toshio

2016-12-01

This study aimed to analyze long-term survival and functional outcomes after truncus arteriosus repair in a single institution with more than 40 years of follow-up. Medical records were analyzed retrospectively in 52 patients who underwent the Rastelli procedure for truncus arteriosus repair between 1974 and 2002. Thirty-five patients survived the initial repair. The median age at the initial operation was 2.8 months (range, 0.1-123 months) and the body weight was 3.9 kg (range, 1.6 to 15.0 kg). The median age at follow-up was 23.6 years (range, 12.4 to 44.5 years). The median follow-up duration was 23.4 years (range, 12.3 to 40.7 years). The actuarial survival rate was 97% at 10 years and 93% at both 20 years and 40 years after the initial operation. At follow-up, most patients were in New York Heart Association (NYHA) functional classes I (73%) and II (24%). Thirty-six percent of patients had full-time jobs, 40% were students, and 21% were unemployed. Most patients (97%) had undergone conduit reoperations. Freedom from reoperation for right ventricular (RV) outflow and pulmonary artery (PA) stenosis was 59% at 5 years, 28% at 10 years, and 3% at 20 years after the initial operation. Freedom from catheter interventions for RV outflow and PA stenosis was 59% at 5 years, 47% at 10 years, and 38% at 20 years after the initial operation. Freedom from truncal valve replacement was 88% at 5 years, 85% at 10 years, and 70% at 20 years after the initial operation. In this single-center retrospective study, with long-term follow-up after repair of truncus arteriosus, long-term survival and functional outcomes were acceptable, despite the requirement for reoperation and multiple catheter interventions for RV outflow and PA stenosis in almost all patients, and the frequent requirement for late truncal valve operations. © 2016 The Authors. Congenital Heart Disease published by Wiley Periodicals, Inc.

The illusion of client-centred practice.

PubMed

Gupta, Jyothi; Taff, Steven D

2015-07-01

A critical analysis of occupational therapy practice in the corporate health care culture in a free market economy was undertaken to demonstrate incongruence with the profession's philosophical basis and espoused commitment to client-centred practice. The current practice of occupational therapy in the reimbursement-driven practice arena in the United States is incongruent with the profession's espoused philosophy and values of client-centred practice. Occupational therapy differentiates itself from medicine's expert model aimed at curing disease and remediating impairment, by its claim to client-centred practice focused on restoring health through occupational enablement. Practice focused on impairment and function is at odds with the profession's core tenet, occupation, and minimizes the lasting impact of interventions on health and well-being. The profession cannot unleash the therapeutic power of human occupation in settings where body systems and body functions are not occupation-ready at the requisite levels for occupational participation. Client-centred practice is best embodied by occupation-focused interventions in the natural environment of everyday living. Providing services that are impairment-focused in unfamiliar settings is not a good fit for client-centred practice, which is the unique, authentic, and sustainable orientation for the profession.

Patient-Centred Innovations for Persons with Multimorbidity: funded evaluation protocol.

PubMed

Stewart, Moira; Fortin, Martin

2017-05-09

The high prevalence of multimorbidity necessitates rethinking of the health care system. The overarching goal of the Patient-Centred Innovations for Persons with Multimorbidity program is to build on existing structures and find and evaluate patient-centred innovations relevant to multimorbidity. We describe the protocol for a proposed multijurisdictional (Quebec and Ontario) concurrent triangulation mixed-methods study. In both provinces, a qualitative descriptive study will be used to explore innovations in patient-centred multimorbidity care. Two randomized controlled trials, 1 in either province, will evaluate the innovations in a wait-list-controlled design using patient-reported outcomes. An additional control group, matched on age, sex, enrolment/index date (± 3 mo) and propensity score, will be created with the use of health administrative data. Patients will be 18-80 years of age and will have 3 or more chronic conditions. The innovations will have elements of relevance to multimorbidity care, patient-centred partnerships and integration of care. The primary outcome measures will be 2 patient-reported outcomes: patient education and self-efficacy. Secondary outcomes will include patient-reported health status, quality of life, psychological distress and health behaviours, and costs of care. This protocol describes a mixed-method study in 2 jurisdictions. The studies will answer the questions of what innovations work and how they work for patients, health care professionals and policy-makers. Trial registration: ClinicalTrials.gov, no NCT02789800 (Quebec Trial), NCT02742597 (Ontario Trial). Copyright 2017, Joule Inc. or its licensors.

3D Printing/Additive Manufacturing Single Titanium Dental Implants: A Prospective Multicenter Study with 3 Years of Follow-Up

PubMed Central

2016-01-01

This prospective 3-year follow-up clinical study evaluated the survival and success rates of 3DP/AM titanium dental implants to support single implant-supported restorations. After 3 years of loading, clinical, radiographic, and prosthetic parameters were assessed; the implant survival and the implant-crown success were evaluated. Eighty-two patients (44 males, 38 females; age range 26–67 years) were enrolled in the present study. A total of 110 3DP/AM titanium dental implants (65 maxilla, 45 mandible) were installed: 75 in healed alveolar ridges and 35 in postextraction sockets. The prosthetic restorations included 110 single crowns (SCs). After 3 years of loading, six implants failed, for an overall implant survival rate of 94.5%; among the 104 surviving implant-supported restorations, 6 showed complications and were therefore considered unsuccessful, for an implant-crown success of 94.3%. The mean distance between the implant shoulder and the first visible bone-implant contact was 0.75 mm (±0.32) and 0.89 (±0.45) after 1 and 3 years of loading, respectively. 3DP/AM titanium dental implants seem to represent a successful clinical option for the rehabilitation of single-tooth gaps in both jaws, at least until 3-year period. Further, long-term clinical studies are needed to confirm the present results. PMID:27313616

3D Printing/Additive Manufacturing Single Titanium Dental Implants: A Prospective Multicenter Study with 3 Years of Follow-Up.

PubMed

Tunchel, Samy; Blay, Alberto; Kolerman, Roni; Mijiritsky, Eitan; Shibli, Jamil Awad

2016-01-01

This prospective 3-year follow-up clinical study evaluated the survival and success rates of 3DP/AM titanium dental implants to support single implant-supported restorations. After 3 years of loading, clinical, radiographic, and prosthetic parameters were assessed; the implant survival and the implant-crown success were evaluated. Eighty-two patients (44 males, 38 females; age range 26-67 years) were enrolled in the present study. A total of 110 3DP/AM titanium dental implants (65 maxilla, 45 mandible) were installed: 75 in healed alveolar ridges and 35 in postextraction sockets. The prosthetic restorations included 110 single crowns (SCs). After 3 years of loading, six implants failed, for an overall implant survival rate of 94.5%; among the 104 surviving implant-supported restorations, 6 showed complications and were therefore considered unsuccessful, for an implant-crown success of 94.3%. The mean distance between the implant shoulder and the first visible bone-implant contact was 0.75 mm (±0.32) and 0.89 (±0.45) after 1 and 3 years of loading, respectively. 3DP/AM titanium dental implants seem to represent a successful clinical option for the rehabilitation of single-tooth gaps in both jaws, at least until 3-year period. Further, long-term clinical studies are needed to confirm the present results.

The obtaining relative position of lunar centre masses and centre of the figure in selenocentric catalogues

NASA Astrophysics Data System (ADS)

Nefedjev, Yu. A.; Valeev, S. G.; Rizvanov, N. G.; Mikeev, R. R.; Varaksina, N. Yu.

2010-05-01

The relative position of lunar center masses relative to center of the figure in Kazan and Kiev selenocentric catalogues was customized. The expansions by spherical harmonics N=5 degree and order of the lunar function h(λ, β) with using the package ASNI USTU were executed. Module of the expansion of the local area to surfaces to full sphere was used. The parameters of cosmic missions are given for comparison (SAI; Bills, Ferrari). The normalized coefficients from expansions for eight sources hypsometric information are obtained: - Clementine (N=40), - Kazan (N=5), - Kiev (N=5), - SAI (N=10; Chuikova (1975)), - Bills, Ferrari, - Каguуа (Selena, Japan mission), - ULCN (The Uuified Lunaz Control Network 2005). The displacements of the lunar centre figure relative to lunar centre of the masses were defined from equations (Chuikova (1975)). The results of the obtaining relative position of the lunar centre masses and centre of the figure in Kazan selenocentric catalogue give good agreement with modern cosmic mission data.

Influence of social deprivation on provision of bariatric surgery: 10-year comparative ecological study between two UK specialist centres.

PubMed

Bhanderi, Shivam; Alam, Mushfique; Matthews, Jacob Henry; Rudge, Gavin; Noble, Hamish; Mahon, David; Richardson, Martin; Welbourn, Richard; Super, Paul; Singhal, Rishi

2017-10-12

To investigate the effect of residential location and socioeconomic deprivation on the provision of bariatric surgery. Retrospective cross-sectional ecological study. Patients resident local to one of two specialist bariatric units, in different regions of the UK, who received obesity surgery between 2003 and 2013. Demographic data were collected from prospectively collected databases. Index of Multiple Deprivation (IMD 2010) was used as a measure of socioeconomic status. Obesity prevalences were obtained from Public Health England (2006). Patients were split into three IMD tertiles (high, median, low) and also tertiles of time. A generalised linear model was generated for each time period to investigate the effect of socioeconomic deprivation on the relationship between bariatric case count and prevalence of obesity. We used these to estimate surgical intervention provided in each population in each period at differing levels of deprivation. Data were included from 1163 bariatric cases (centre 1-414, centre 2-749). Incidence rate ratios (IRRs) were calculated to measure the associations between predictor and response variables. Associations were highly non-linear and changed over the 10-year study period. In general, the relationship between surgical case volume and obesity prevalence has weakened over time, with high volumes becoming less associated with prevalence of obesity. As bariatric services have matured, the associations between demand and supply factors have changed. Socioeconomic deprivation is not apparently a barrier to service provision more recently, but the positive relationships between obesity and surgical volume we would expect to find are absent. This suggests that interventions are not being taken up in the areas of need. We recommend a more detailed national analysis of the relationship between supply side and demand side factors in the provision of bariatric surgery. © Article author(s) (or their employer(s) unless otherwise stated in the

The IOC Centres of Excellence bring prevention to sports medicine.

PubMed

Engebretsen, Lars; Bahr, Roald; Cook, Jill L; Derman, Wayne; Emery, Carolyn A; Finch, Caroline F; Meeuwisse, Willem H; Schwellnus, Martin; Steffen, Kathrin

2014-09-01

The protection of an athlete's health and preventing injuries and illnesses in sport are top priorities for the IOC and its Medical Commission. The IOC therefore partners with selected research centres around the world and supports research in the field of sports medicine. This has enabled the IOC to develop an international network of expert scientists and clinicians in sports injury and disease prevention research. The IOC wants to promote injury and disease prevention and the improvement of physical health of the athlete by: (1) establishing long-term research programmes on injury and disease prevention (including studies on basic epidemiology, risk factors, injury mechanisms and intervention), (2) fostering collaborative relationships with individuals, institutions and organisations to improve athletes' health, (3) implementing and collaborating with applied, ongoing and novel research and development within the framework and long-term strategy of the IOC and (4) setting up knowledge translation mechanisms to share scientific research results with the field throughout the Olympic Movement and sports community and converting these results into concrete actions to protect the health of the athletes. In 2009, the IOC also identified four research centres that had an established track record in research, educational and clinical activities to achieve these ambitions: (1) the Australian Centre for Research into Injury in Sport and its Prevention (ACRISP), Australia; (2) the Sport Injury Prevention Research Centre (SIPRC), Canada; (3) the Clinical Sport and Exercise Medicine Research (CSEM), South Africa and (4) the Oslo Sports Trauma Research Center (OSTRC), Norway. This paper highlights the work carried out by these four IOC Centres of Excellence over the past 6 years and their contribution to the world of sports medicine. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

The Construction of Teaching Roles at Aalborg University Centre, 1970-1980

ERIC Educational Resources Information Center

Servant-Miklos, Virginie F. C.; Spliid, Claus M.

2017-01-01

This paper proposes a historical analysis of the development of teaching roles at Aalborg University Centre in its first 10 years. The research highlights three processes through which the interpretation of the new "supervisor" roles was constructed within the problem-oriented, project-based educational model of AUC. First, the authors…

Predictive validity of a selection centre testing non-technical skills for recruitment to training in anaesthesia.

PubMed

Gale, T C E; Roberts, M J; Sice, P J; Langton, J A; Patterson, F C; Carr, A S; Anderson, I R; Lam, W H; Davies, P R F

2010-11-01

Assessment centres are an accepted method of recruitment in industry and are gaining popularity within medicine. We describe the development and validation of a selection centre for recruitment to speciality training in anaesthesia based on an assessment centre model incorporating the rating of candidate's non-technical skills. Expert consensus identified non-technical skills suitable for assessment at the point of selection. Four stations-structured interview, portfolio review, presentation, and simulation-were developed, the latter two being realistic scenarios of work-related tasks. Evaluation of the selection centre focused on applicant and assessor feedback ratings, inter-rater agreement, and internal consistency reliability coefficients. Predictive validity was sought via correlations of selection centre scores with subsequent workplace-based ratings of appointed trainees. Two hundred and twenty-four candidates were assessed over two consecutive annual recruitment rounds; 68 were appointed and followed up during training. Candidates and assessors demonstrated strong approval of the selection centre with more than 70% of ratings 'good' or 'excellent'. Mean inter-rater agreement coefficients ranged from 0.62 to 0.77 and internal consistency reliability of the selection centre score was high (Cronbach's α=0.88-0.91). The overall selection centre score was a good predictor of workplace performance during the first year of appointment. An assessment centre model based on the rating of non-technical skills can produce a reliable and valid selection tool for recruitment to speciality training in anaesthesia. Early results on predictive validity are encouraging and justify further development and evaluation.

Childhood intracranial ependymoma: twenty-year experience from a single institution.

PubMed

Shu, Hui-Kuo G; Sall, Walter F; Maity, Amit; Tochner, Zelig A; Janss, Anna J; Belasco, Jean B; Rorke-Adams, Lucy B; Phillips, Peter C; Sutton, Leslie N; Fisher, Michael J

2007-07-15

Because few large studies of pediatric ependymoma treatment are available, the authors believed that a retrospective review of treatment outcomes from a single institution would yield potentially valuable information regarding potential prognostic factors. In this article, they report their 20-year institutional experience with this disease. Medical records were reviews of patients with intracranial ependymoma who received their initial treatment at the Children's Hospital of Philadelphia (CHOP)/Hospital of the University of Pennsylvania (HUP) between January 1980 and December 2000. Of the 61 patients who were identified, 49 patients underwent primary therapy at CHOP/HUP and formed the basis for the study. Actuarial overall survival (OS) and progression-free survival (PFS) were determined by the Kaplan-Meier method. Univariate and multivariate analyses were performed using the log-rank test and Cox proportional-hazards models. With median follow-up of 110.2 months, the 5-year OS and PFS rates were 66.2% and 40.7%, respectively. Older age and higher radiation dose significantly predicted for improved OS. Anaplastic histology predicted for decreased PFS. Cervical spinal cord extension resulted in decreased OS primarily caused by failures outside the primary site. Patients who had a favorable prognosis (aged >/=3 years, no dissemination or cord extension, complete resection, and radiation dose >/=54 grays [Gy]) had 5-year OS and PFS rates of 83.1% and 60.6%, respectively. In this study of patients with pediatric intracranial ependymoma, OS and PFS rates were concordant with the rates published in other modern series. The finding of a dose response up to 54 Gy supported the current trend toward dose escalation. Tumor extension to the cervical spine was identified as a predictor for failure outside of the primary site. Although the survival rates were encouraging, there is still significant room for improvement in the management of this disease.

The Dutch Birth Centre Study: study design of a programmatic evaluation of the effect of birth centre care in the Netherlands.

PubMed

Hermus, Marieke A A; Wiegers, Therese A; Hitzert, Marit F; Boesveld, Inge C; van den Akker-van Marle, M Elske; Akkermans, Henk A; Bruijnzeels, Marc A; Franx, Arie; de Graaf, Johanna P; Rijnders, Marlies E B; Steegers, Eric A P; van der Pal-de Bruin, Karin M

2015-07-16

Birth centres are regarded as settings where women with uncomplicated pregnancies can give birth, assisted by a midwife and a maternity care assistant. In case of (threatening) complications referral to a maternity unit of a hospital is necessary. In the last decade up to 20 different birth centres have been instituted in the Netherlands. This increase in birth centres is attributed to various reasons such as a safe and easy accessible place of birth, organizational efficiency in integration of care and direct access to obstetric hospital care if needed, and better use of maternity care assistance. Birth centres are assumed to offer increased integration and quality of care and thus to contribute to better perinatal and maternal outcomes. So far there is no evidence for this assumption as no previous studies of birth centres have been carried out in the Netherlands. The aims are 1) Identification of birth centres and measuring integration of organization and care 2) Measuring the quality of birth centre care 3) Effects of introducing a birth centre on regional quality and provision of care 4) Cost-effectiveness analysis 5) In depth longitudinal analysis of the organization and processes in birth centres. Different qualitative and quantitative methods will be used in the different sub studies. The design is a multi-centre, multi-method study, including surveys, interviews, observations, and analysis of registration data and documents. The results of this study will enable users of maternity care, professionals, policy makers and health care financers to make an informed choice about the kind of birth location that is appropriate for their needs and wishes.

Percutaneous transhepatic cholangiographic endobiliary forceps biopsy versus endoscopic ultrasound fine needle aspiration for proximal biliary strictures: a single-centre experience.

PubMed

Mohkam, Kayvan; Malik, Yaseen; Derosas, Carlos; Isaac, John; Marudanayagam, Ravi; Mehrzad, Homoyoon; Mirza, Darius F; Muiesan, Paolo; Roberts, Keith J; Sutcliffe, Robert P

2017-06-01

Endoscopic ultrasound fine needle aspiration (EUS-FNA) and percutaneous transhepatic cholangiographic endobiliary forceps biopsy (PTC-EFB) are valid procedures for histological assessment of proximal biliary strictures (PBS), but their performances have never been compared. This study aimed to compare the diagnostic performance of these two techniques. The diagnostic performances of EUS-FNA and PTC-EFB were compared in a retrospective cohort of patients assessed for PBS from 2011 to 2015 at a single tertiary centre. An inverse probability of treatment weighting (IPTW) was performed to adjust for covariate imbalance. A total of 102 EUS-FNAs and 75 PTC-EFBs (performed in 137 patients) were compared. Patients in the PTC-EFB group had higher preoperative bilirubin (243 versus 169 μmol/l, p = 0.005) and a higher incidence of malignancy (87% versus 67%, p = 0.008). Both techniques showed specificity and positive predictive value of 100%, and similar sensitivity (69% versus 75%, p = 0.45), negative predictive value (58% versus 38%, p = 0.15) and accuracy (78% versus 79%, p = 1.00). After IPTW, the diagnostic performance of the two techniques remained similar. Compared to EUS-FNA, PTC-EFB provides similar sensitivity, negative predictive value and accuracy. It should therefore be considered as the preferred tissue-sampling procedure, if biliary drainage is indicated. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

Esthetic outcome and alterations of soft tissue around single implant crowns: a 2-year prospective study.

PubMed

Gu, Ying-Xin; Shi, Jun-Yu; Zhuang, Long-Fei; Qiao, Shi-Chong; Xu, You-You; Lai, Hong-Chang

2015-08-01

The aim of this prospective study was to assess the esthetic outcome and alterations of peri-implant soft tissue using tissue-level implants. Furthermore, the influencing factors, including grafting and gingival biotype, of esthetic outcome of peri-implant soft tissue were also evaluated. Of 38 patients with single missing anterior tooth in maxilla were treated with a Straumann (®) Standard Plus SLA implant. Bone augmentation was performed in 24 patients. Follow-up was conducted at 12 and 24 months after definitive crowns placement. Esthetic outcome using the pink esthetic score/white esthetic score (PES/WES) and clinical parameters were evaluated. The mean PES/WES value at baseline, 1-year, and 2-year examination was 13.79, 14.87, and 14.96. Significant improvement was found between baseline and 1-year examination (P < 0.01). And the improvement between 1-year and 2-year examination was not significant (P = 0.40). The mean PES changing value in patients with thick biotype was significantly higher than those with thin biotype at 2-year after definitive crowns placement (P = 0.03). Graft procedure had an unfavorable effect on mean PES value both at baseline and at follow-up (P < 0.01). No implants were lost at 2-year examination. Three patients experienced peri-implant infection. No significant difference was found with the passage of time in modified plaque index (mPI), probing pocket depth (PPD), and modified bleeding index (mBI). According to the present prospective clinical study, it can be concluded that it is feasible to use tissue-level implant to support single crowns in esthetic area. Favorable short-term esthetic outcome and stability of soft tissue around single implant crowns can be expected in patients with or without graft. However, graft procedures might have an unfavorable effect on the esthetic outcome. Gingival biotype can be considered as prognostic factor for esthetic outcome. RCTs with long-term follow-up are needed to provide evidence for the

Parental Perceptions of Child Care Quality in Centre-Based and Home-Based Settings: Associations with External Quality Ratings

ERIC Educational Resources Information Center

Lehrer, Joanne S.; Lemay, Lise; Bigras, Nathalie

2015-01-01

The current study examined how parental perceptions of child care quality were related to external quality ratings and considered how parental perceptions of quality varied according to child care context (home-based or centre-based settings). Parents of 179 4-year-old children who attended child care centres (n = 141) and home-based settings…

Atrial Fibrillation Radiofrequency Ablation: Safety Using Contact Force Catheter In A Low-Volume Centre.

PubMed

Vaccari Md, Diego; Giacopelli MSc, Daniele; Rocchetto MSc, Eros; Vittadello Md, Sabina; Mantovan Md, Roberto; Neri Md, Gianfilippo

2014-01-01

The tip-to-tissue contact force (CF) has been identified as a potential determinant of lesion quality during radiofrequency (RF) ablation. The aim of this paper is to report the experience of a single low-volume centre in the atrial fibrillation (AF) ablation procedure with an RF catheter capable of measuring this parameter. CF data and their possible implications on patient safety are presented. Thirty-nine consecutive patients suffering of paroxysmal or permanent AF received percutaneous ablation with the novel catheter studied. Procedural characteristics, CF applied and safety events related to the procedure were reported. During RF application the mean CF value was 17 ± 3 g, with a maximum mean value of 37 ± 8 g. CF value never exceeded 62 g and in the 74% of the RF applications ranged between 10 g and 30 g. No complication related to the catheter manipulation or to the energy delivered was observed. This study of a single centre with a low level of experience in AF ablation suggests that the ability to measure CF may provide additional useful information to the operator. It ensures uniform ablations, with little variability in the catheter manipulations, and it avoids excessive contact forces increasing the patient safety.

A comparison of patient characteristics and survival in two trauma centres located in different countries.

PubMed

Templeton, J; Oakley, P A; MacKenzie, G; Cook, A L; Brand, D; Mullins, R J; Trunkey, D D

2000-09-01

The aim of the study was to compare patient characteristics and mortality in severely injured patients in two trauma centres located in different countries, allowing for differences in case-mix. It represents a direct bench-marking exercise between the trauma centres at the North Staffordshire Hospital (NSH), Stoke-on-Trent, UK and the Oregon Health Sciences University (OHSU) Hospital, Portland, Oregon, USA. Patients of all ages admitted to the two hospitals during 1995 and 1996 with an Injury Severity Score >15 were included, except for those who died in the emergency departments. Twenty-three factors were studied, including the Injury Severity Score, Glasgow Coma Score, mechanism of injury and anatomical site of injury. Outcome analysis was based on mortality at discharge. The pattern of trauma differed significantly between Stoke and Portland. Patients from Stoke tended to be older, presented with a lower conscious level and a lower systolic blood pressure and were intubated less frequently before arriving at hospital. Mortality depended on similar factors in both centres, especially age, highest AIS score, systolic blood pressure and Glasgow Coma Score.The crude analysis of mortality showed a highly significant odds-ratio of 1.64 in Stoke compared with Portland. Single-factor adjustments were made for the above four factors, which had a similar influence on mortality in both centres. Adjusting for the first three factors individually did not alter the odds-ratio, which stayed in the range 1.53-1.59 and remained highly significant. Adjusting for the Glasgow Coma Score reduced the odds-ratio to 0.82 and rendered it non-significant. In a multi-factor logistic regression model incorporating all of the factors shown to influence mortality in either centre, the odds-ratio was 1.7 but was not significant. The analysis illustrates the limitations and pitfalls of making crude outcome comparisons between centres. Highly significant differences in crude mortality were

Minimising twins in in vitro fertilisation: a modelling study assessing the costs, consequences and cost-utility of elective single versus double embryo transfer over a 20-year time horizon.

PubMed

Scotland, G S; McLernon, D; Kurinczuk, J J; McNamee, P; Harrild, K; Lyall, H; Rajkhowa, M; Hamilton, M; Bhattacharya, S

2011-08-01

To assess the cumulative costs and consequences of double embryo transfer (DET) or elective single embryo transfer (eSET) in women commencing in vitro fertilisation (IVF) treatment aged 32, 36 and 39 years. Microsimulation model. Three assisted reproduction centres in Scotland. A total of 6153 women undergoing treatment at one of three Scottish IVF clinics, between January 1997 and June 2007. A microsimulation model, populated using data inputs derived from a large clinical data set and published literature, was developed to compare the costs and consequences of using eSET or DET over multiple treatment cycles. Disability-free live births; twin pregnancy rate; women's quality-adjusted life-years (QALYs); health service costs. Not only did DET produce a higher cumulative live birth rate compared with eSET for women of all three ages, but also a higher twin pregnancy rate. Compared with eSET, DET ranged from costing an additional £ 27,356 per extra live birth in women commencing treatment aged 32 years, to costing £ 15,539 per extra live birth in 39-year-old women. DET cost ∼ £ 28,300 and ∼ £ 20,300 per additional QALY in women commencing treatment aged 32 and 39 years, respectively. Considering the high twin pregnancy rate associated with DET, coupled with uncertainty surrounding QALY gains, eSET is likely to be the preferred option for most women aged ≤ 36 years. The cost-effectiveness of DET improves with age, and may be considered cost-effective in some groups of older women. The decision may best be considered on a case-by-case basis for women aged 37-39 years. © 2011 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2011 RCOG.

What is the degree of innovation routinely implemented in Dutch radiotherapy centres? A multicentre cross-sectional study

PubMed Central

Boersma, Liesbeth; Dekker, Andre; Bosmans, Geert; van Merode, Frits; Verhaegen, Frank; de Ruysscher, Dirk; Swart, Rachelle; Kengen, Cindy; Lambin, Philippe

2016-01-01

Objective: To study the implementation of innovation activities in Dutch radiotherapy (RT) centres in a broad sense (product, technological, market and organizational innovations). Methods: A descriptive cross-sectional study was conducted in 15 Dutch RT centres. A list of innovations implemented from 2011 to 2013 was drawn up for each centre using semi-structured interviews. These innovations were classified into innovation categories according to previously defined innovation indicators. Where applicable, each innovation was rated by each centre on the effort required to implement it and on its expected effects, to get an impression of how far reaching and radical the innovations were and to be able to compare the number of innovations between centres. Results: The participating RT centres in the Netherlands implemented 12 innovations per year on average (range 5–25); this number was not significantly different for academic (n = 13) or non-academic centres (n = 10). Several centres were dealing with the same innovations at the same time. The average required effort and expected output did not differ significantly between product, technological and organizational innovation or between academic and non-academic centres. Conclusion: The number of innovations observed per centre varied across a large range, with a large overlap in terms of the type of innovations that were implemented. Registering innovations using the innovation indicators applied in our study would make it possible to improve collaboration between centres, e.g. with common training modules, to avoid duplication of work. Advances in knowledge: This study is the first of its kind investigating innovation implementation in RT in a broad sense. PMID:27660890

Evolution in Practice: How has British Neurosurgery Changed in the Last 10 Years?

PubMed Central

Tarnaris, A; Arvin, B; Ashkan, K

2008-01-01

INTRODUCTION Neurosurgery is a fast-evolving surgical subspecialty driven by technological advances, socio-economic factors and patient expectations. In this study, we have compared the work-load volume in a single institution in the years of 1994 and 2004 and commented on the possible reasons for the changes and the impacts they may have for the future. PATIENTS AND METHODS A retrospective, log-book review of all operations performed in the years 1994 and 2004 in a single, tertiary, neurosurgical centre was performed. RESULTS Neurosurgical practice has evolved over this period. Current practice has moved away from clipping of aneurysms and towards coil embolisation performed by interventional radiologists. Electrode stimulation of deep brain regions for movement disorders is the current practice, whereas 10 years ago the same disorders were dealt with by lesioning of the relevant regions. In spinal neurosurgery, instrumentation is increasingly favoured currently. In the field of neuro-oncology, current practice favours minimal access to the target area by the use of stereotactic localisation. CONCLUSIONS Changes were most pronounced in the subspecialties of vascular, functional and spinal neurosurgery within this 10-year period. Knowledge of such dynamics is valuable in health resource management as well as planning for neurosurgical training programmes. PMID:18765031

Immediate Implant Placement in Single-Tooth Molar Extraction Sockets: A 1- to 6-Year Retrospective Clinical Study.

PubMed

Amato, Francesco; Polara, Giorgio

The aim of this study was to investigate the survival rate of implants immediately placed in fresh extraction sockets of molars in the maxilla and mandible with a single-stage procedure. A total of 102 patients were treated, and 107 implants (53 in the maxilla and 54 in the mandible) were placed in a fresh molar extraction socket and connected to a healing abutment. After a mean follow-up of 3 years (range: 1 to 6 years) 1 implant failed, for a cumulative success rate of 99.06% (98.11% for the mandible and 100% for the maxilla). The results of this study support placement of an implant immediately after the extraction of a molar, applying a single-stage procedure.

Tracking blood products in blood centres using radio frequency identification: a comprehensive assessment.

PubMed

Davis, Rodeina; Geiger, Bradley; Gutierrez, Alfonso; Heaser, Julie; Veeramani, Dharmaraj

2009-07-01

Radio frequency identification (RFID) can be a key enabler for enhancing productivity and safety of the blood product supply chain. This article describes a systematic approach developed by the RFID Blood Consortium for a comprehensive feasibility and impact assessment of RFID application in blood centre operations. Our comprehensive assessment approach incorporates process-orientated and technological perspectives as well as impact analysis. Assessment of RFID-enabled process redesign is based on generic core processes derived from the three participating blood centres. The technological assessment includes RFID tag readability and performance evaluation, testing of temperature and biological effects of RF energy on blood products, and RFID system architecture design and standards. The scope of this article is limited to blood centre processes (from donation to manufacturing/distribution) for selected mainstream blood products (red blood cells and platelets). Radio frequency identification can help overcome a number of common challenges and process inefficiencies associated with identification and tracking of blood products. High frequency-based RFID technology performs adequately and safely for red blood cell and platelet products. Productivity and quality improvements in RFID-enabled blood centre processes can recoup investment cost in a 4-year payback period. Radio frequency identification application has significant process-orientated and technological implications. It is feasible and economically justifiable to incorporate RFID into blood centre processes.

Inflammation and white matter degeneration persist for years after a single traumatic brain injury.

PubMed

Johnson, Victoria E; Stewart, Janice E; Begbie, Finn D; Trojanowski, John Q; Smith, Douglas H; Stewart, William

2013-01-01

A single traumatic brain injury is associated with an increased risk of dementia and, in a proportion of patients surviving a year or more from injury, the development of hallmark Alzheimer's disease-like pathologies. However, the pathological processes linking traumatic brain injury and neurodegenerative disease remain poorly understood. Growing evidence supports a role for neuroinflammation in the development of Alzheimer's disease. In contrast, little is known about the neuroinflammatory response to brain injury and, in particular, its temporal dynamics and any potential role in neurodegeneration. Cases of traumatic brain injury with survivals ranging from 10 h to 47 years post injury (n = 52) and age-matched, uninjured control subjects (n = 44) were selected from the Glasgow Traumatic Brain Injury archive. From these, sections of the corpus callosum and adjacent parasaggital cortex were examined for microglial density and morphology, and for indices of white matter pathology and integrity. With survival of ≥3 months from injury, cases with traumatic brain injury frequently displayed extensive, densely packed, reactive microglia (CR3/43- and/or CD68-immunoreactive), a pathology not seen in control subjects or acutely injured cases. Of particular note, these reactive microglia were present in 28% of cases with survival of >1 year and up to 18 years post-trauma. In cases displaying this inflammatory pathology, evidence of ongoing white matter degradation could also be observed. Moreover, there was a 25% reduction in the corpus callosum thickness with survival >1 year post-injury. These data present striking evidence of persistent inflammation and ongoing white matter degeneration for many years after just a single traumatic brain injury in humans. Future studies to determine whether inflammation occurs in response to or, conversely, promotes white matter degeneration will be important. These findings may provide parallels for studying neurodegenerative disease

Generation of colour centres in yttria-stabilized zirconia by heavy ion irradiations in the GeV range.

PubMed

Costantini, Jean-Marc; Beuneu, François; Schwartz, Kurt; Trautmann, Christina

2010-08-11

We have studied the colour centre production in yttria-stabilized zirconia (ZrO(2):Y(3 +)) by heavy ion irradiation in the GeV range using on-line UV-visible optical absorption spectroscopy. Experiments were performed with 11.4 MeV amu(-1) (127)Xe, (197)Au, (208)Pb and (238)U ion irradiations at 8 K or room temperature (RT). A broad and asymmetrical absorption band peaked at a wavelength about 500 nm is recorded regardless of the irradiation parameters, in agreement with previous RT irradiations with heavy ions in the 100 MeV range. This band is de-convoluted into two broad Gaussian-shaped bands centred at photon energies about 2.4 and 3.1 eV that are respectively associated with the F(+)-type centres (involving a singly ionized oxygen vacancy, VO· and T centres (i.e. Zr(3+) in a trigonal symmetry) observed by electron paramagnetic resonance (EPR) spectroscopy. In the case of 8 K Au ion irradiation at low fluences, six bands are used at about 1.9, 2.3, 2.7, 3.1 and 4.0 eV. The three bands near 2.0-2.5 eV can be assigned to oxygen divacancies (i.e. F(2)(+) centres). No significant effect of the irradiation temperature is found on the widths of all absorption bands for the same ion and fluence. This is attributed to the inhomogeneous broadening arising from the static disorder due to the native charge-compensating oxygen vacancies. However, the colour centre production yield is strongly enhanced at 8 K with respect to RT. When heating irradiated samples from 8 K to RT, the extra colour centres produced at low temperature do not recover completely to the level of RT irradiation. The latter results are accounted for by an electronically driven defect recovery process.

Clinical Outcome After 8 to 10 Years of Immediately Restored Single Implants Placed in Extraction Sockets and Healed Ridges.

PubMed

Raes, Stefanie; Cosyn, Jan; Noyelle, Anabel; Raes, Filiep; De Bruyn, Hugo

Recent systematic reviews point to the scarcity of single implants followed up longer than 5 years, and the incidence of biologic/technical complications is underreported. This prospective follow-up study documents 8- to 10-year clinical outcomes of immediately restored single implants in extraction sockets (immediate implant treatment [IIT]) and healed bone (conventional implant treatment [CIT]). Patients received a single, chemically modified, moderately rough titanium implant and a provisional crown on the day of surgery in the anterior maxilla (second premolar to second premolar). Provisional crowns were replaced by permanent crowns after 10 weeks. Implant survival, complications, crestal bone changes, plaque score, probing depth, and bleeding on probing were regularly recorded up to 10 years of follow-up. Of 16 patients who underwent IIT, 11 could be evaluated after 8 years. Of the 23 patients who received an implant in healed bone, 18 were finally evaluated. One implant failed in the IIT group at 12 weeks; all implants survived in the CIT group; 38% of the patients experienced at least one complication; 10% had one or more biologic complications, whereas 31% experienced one or more technical complications. There were no significant changes in crestal bone level from 1 to ≥ 8 years of follow-up for either group or between IIT and CIT at any time point (P ≥ .129). Only 6.9% (2 of 29) implants demonstrated progressive bone loss > 2 mm combined with pockets ≥ 6 mm. Immediately restored single implants in extraction sockets and healed ridges demonstrate good long-term outcomes in terms of implant survival, crestal bone loss, and peri-implant health. However, biologic and especially technical complications are common.

Evidence into practice: evaluating a child-centred intervention for diabetes medicine management The EPIC Project

PubMed Central

2010-01-01

Background There is a lack of high quality, child-centred and effective health information to support development of self-care practices and expertise in children with acute and long-term conditions. In type 1 diabetes, clinical guidelines indicate that high-quality, child-centred information underpins achievement of optimal glycaemic control with the aim of minimising acute readmissions and reducing the risk of complications in later life. This paper describes the development of a range of child-centred diabetes information resources and outlines the study design and protocol for a randomized controlled trial to evaluate the information resources in routine practice. The aim of the diabetes information intervention is to improve children and young people's quality of life by increasing self-efficacy in managing their type 1 diabetes. Methods/Design We used published evidence, undertook qualitative research and consulted with children, young people and key stakeholders to design and produce a range of child-centred, age-appropriate children's diabetes diaries, carbohydrate recording sheets, and assembled child-centred, age-appropriate diabetes information packs containing published information in a folder that can be personalized by children and young people with pens and stickers. Resources have been designed for children/young people 6-10; 11-15; and 16-18 years. To evaluate the information resources, we designed a pragmatic randomized controlled trial to assess the effectiveness, cost effectiveness, and implementation in routine practice of individually tailored, age-appropriate diabetes diaries and information packs for children and young people age 6-18years, compared with currently available standard practice. Children and young people will be stratified by gender, length of time since diagnosis (< 2years and > 2years) and age (6-10; 11-15; and 16-18 years). The following data will be collected at baseline, 3 and 6 months: PedsQL (generic, diabetes and parent

The status of occupational blood and infectious body fluids exposures in five blood centres in China: a 5-year review.

PubMed

Wang, Y J; Meng, Z H; Zheng, X F; Tang, X X; Sang, L Y; Du, X-M; Cheng, Y-Z

2015-12-01

Little information about the occupational exposures to blood and body fluid (BBF) among blood service workers (BSWs) in blood stations in China is available currently. To assess current status of occupational exposure to BBF and assess the knowledge about occupational blood-borne pathogen exposures and universal precaution among BSWs in blood donations in China. To understand the incidence of occupational exposure in five blood centres in China. A cross-sectional study was conducted from January 2008 to December 2013. There were a total of 99 BBF exposures reported during the study period. The total incidence of BBF exposures was 4.4 per 100 person-years. Higher rates were observed for persons employed less than five years and persons less than 45 years old. Nurses have the highest percentage (49.5%) of BBF exposures. BBF exposures occurred most commonly during the afternoon (62.7%). Percutaneous injuries were the most common BBF exposures. Most incidents occurred during sharps use (73.4%). The major cause of occupational exposure was that there was no continuous training (48.4%) and improper use of equipment (23.2%). Only 56.6% of BBF exposures had appropriate first aid measures. During this research work, one staff member was reported to have seroconverted to syphilis after BBF exposure. To reduce BBF exposures, it is urgent to take several effective actions in China, including improved occupational health systems, adequate education, administrative support, increased use of standard precautions, better safety devices/products and work practices. © 2015 British Blood Transfusion Society.

Building a Student-Centred Learning Framework Using Social Software in the Middle Years Classroom: An Action Research Study

ERIC Educational Resources Information Center

Casey, Gail

2013-01-01

This article discusses the development of the online spaces that were used to create a learning framework: a student-centred framework that combined face-to-face teaching with online social and participatory media. The author, as part of her Doctoral research study, used action research as a mechanism for continual improvement as she redesigned…

Online single particle measurement of fireworks pollution during Chinese New Year in Nanning.

PubMed

Li, Jingyan; Xu, Tingting; Lu, Xiaohui; Chen, Hong; Nizkorodov, Sergey A; Chen, Jianmin; Yang, Xin; Mo, Zhaoyu; Chen, Zhiming; Liu, Huilin; Mao, Jingying; Liang, Guiyun

2017-03-01

Time-resolved single-particle measurements were conducted during Chinese New Year in Nanning, China. Firework displays resulted in a burst of SO 2 , coarse mode, and accumulation mode (100-500nm) particles. Through single particle mass spectrometry analysis, five different types of particles (fireworks-metal, ash, dust, organic carbon-sulfate (OC-sulfate), biomass burning) with different size distributions were identified as primary emissions from firework displays. The fireworks-related particles accounted for more than 70% of the total analyzed particles during severe firework detonations. The formation of secondary particulate sulfate and nitrate during firework events was investigated on single particle level. An increase of sulfite peak (80SO 3 - ) followed by an increase of sulfate peaks (97HSO 4 - +96SO 4 - ) in the mass spectra during firework displays indicated the aqueous uptake and oxidation of SO 2 on particles. High concentration of gaseous SO 2 , high relative humidity and high particle loading likely promoted SO 2 oxidation. Secondary nitrate formed through gas-phase oxidation of NO 2 to nitric acid, followed by the condensation into particles as ammonium nitrate. This study shows that under worm, humid conditions, both primary and secondary aerosols contribute to the particulate air pollution during firework displays. Copyright © 2016. Published by Elsevier B.V.

Evaluating Three School-Based Integrated Health Centres Established by a Partnership in Cornwall to Inform Future Provision and Practice

ERIC Educational Resources Information Center

Macpherson, Reynold

2013-01-01

Purpose: The aim of this paper is to report the process, findings and implications of a three-year evaluation of integrated health centres (IHCs) established in three secondary schools in Cornwall by the School-Based Integrated Health Centres (SBIHC) partnership. Design/methodology/approach: When the partners had completed the capital works, an…

Influence of the Diameter of Dental Implants Replacing Single Molars: 3- to 6-Year Follow-Up.

PubMed

Mendonça, Jose Alfredo; Senna, Plinio Mendes; Francischone, Carlos Eduardo; Francischone Junior, Carlos Eduardo; Sotto-Maior, Bruno Salles

The aim of this study was to evaluate the influence of the implant diameter on marginal bone remodeling around dental implants replacing single molars after a follow-up period of 3 to 6 years. Patients who received dental implants with an external hexagon platform in healed sites to support a single metal-ceramic crown in the molar region were recalled to the office. The implantation sites and implant length information were recorded, and the implants were divided according to the implant diameter: regular (RP) or wide (WP). Each implant was assessed by digital periapical radiography, using a sensor holder for the paralleling technique. The marginal bone remodeling was determined as the distance from the implant platform to the first bone-to-implant contact, and the known implant length was used to calibrate the images in the computer software. The follow-up measurements were compared with those obtained from the radiograph taken at the time of prosthetic loading to determine the late bone remodeling. The independent t test was used to compare data. A total of 67 implants from 46 patients were evaluated with a mean follow-up period of 4.5 ± 1.0 years. The RP group comprised 36 implants from 29 patients (mean age: 58.3 ± 10.6 years), while 31 implants from 17 patients (mean age: 56.9 ± 11.5 years) were included in the WP group. The RP group presented lower survival rates (86.1%) than the WP group (100.0%). Similar marginal bone loss (P < .05) was identified for the RP and WP groups (1.35 ± 0.96 mm and 1.06 ± 0.70 mm, respectively). Although wide-diameter implants exhibited lower incidence failures, the bone levels were similar after the prosthetic loading around regular- and wide-diameter implants supporting single molar crowns.

Cefepime and amikacin as empirical therapy in patients with febrile neutropaenia: a single-centre phase II prospective survey.

PubMed

Mebis, J; Vandeplassche, S; Goossens, H; Berneman, Z N

2009-01-01

The aim of the survey was to prospectively evaluate the effectiveness of the combination therapy cefepime and amikacin in the initial treatment of haematology patients with febrile neutropaenia. Two hundred twenty (220) episodes of febrile neutropaenia were analysed in 54 males and 82 females (median age 58 years), most patients had a severe neutropaenia with in 72% of all periods a neutrophil count of less than 100. Microbiological infection was confirmed in 72 cases (32.8%). Sixty-one (61) bacteria were isolated from blood cultures of which 22 were identified as Gram-negative bacteria and 38 as Gram-positive bacteria. Sixty-three (63) episodes (28.6%) were clinically documented, 85 episodes (38.6%) were fever of unknown origin. Clinical cure was achieved in 123 febrile episodes (56%) after initiation of the current antibiotic protocol; another 22 patients (10%) became afebrile after modifying the initial antibiotic regimen 48 hours or longer after treatment initiation. In 61 cases (27.7%) there was persistent fever or re-occurrence of fever, these cases were considered as treatment failure. Eight patients (3.6%) died during the study. This survey has demonstrated that the combination therapy with cefepime and amikacin can be considered as an effective treatment for febrile neutropaenia in high-risk haematological patients in our centre with a high incidence of resistance to Gram-negative bacteria.

Regional cancer centre demonstrates voluntary conformity with the national Radiation Oncology Practice Standards

DOE Office of Scientific and Technical Information (OSTI.GOV)

Manley, Stephen, E-mail: stephen.manley@ncahs.health.nsw.gov.au; Last, Andrew; Fu, Kenneth

Radiation Oncology Practice Standards have been developed over the last 10 years and were published for use in Australia in 2011. Although the majority of the radiation oncology community supports the implementation of the standards, there has been no mechanism for uniform assessment or governance. North Coast Cancer Institute's public radiation oncology service is provided across three main service centres on the north coast of NSW. With a strong focus on quality management, we embraced the opportunity to demonstrate conformity with the Radiation Oncology Practice Standards. The Local Health District's Clinical Governance units were engaged to perform assessments of ourmore » conformity with the standards and this was signed off as complete on 16 December 2013. The process of demonstrating conformity with the Radiation Oncology Practice Standards has enhanced the culture of quality in our centres. We have demonstrated that self-assessment utilising trained auditors is a viable method for centres to demonstrate conformity. National implementation of the Radiation Oncology Practice Standards will benefit individual centres and the broader radiation oncology community to improve the service delivered to our patients.« less

Using practice development methodology to develop children's centre teams: ideas for the future.

PubMed

Hemingway, Ann; Cowdell, Fiona

2009-09-01

The Children's Centre Programme is a recent development in the UK and brings together multi-agency teams to work with disadvantaged families. Practice development methods enable teams to work together in new ways. Although the term practice development remains relatively poorly defined, its key properties suggest that it embraces engagement, empowerment, evaluation and evolution. This paper introduces the Children's Centre Programme and practice development methods and aims to discuss the relevance of using this method to develop teams in children's centres through considering the findings from an evaluation of a two-year project to develop inter-agency public health teams. The evaluation showed that practice development methods can enable successful team development and showed that through effective facilitation, teams can change their practice to focus on areas of local need. The team came up with their own process to develop a strategy for their locality.

Deformation-induced structural transition in body-centred cubic molybdenum

PubMed Central

Wang, S. J.; Wang, H.; Du, K.; Zhang, W.; Sui, M. L.; Mao, S. X.

2014-01-01

Molybdenum is a refractory metal that is stable in a body-centred cubic structure at all temperatures before melting. Plastic deformation via structural transitions has never been reported for pure molybdenum, while transformation coupled with plasticity is well known for many alloys and ceramics. Here we demonstrate a structural transformation accompanied by shear deformation from an original <001>-oriented body-centred cubic structure to a <110>-oriented face-centred cubic lattice, captured at crack tips during the straining of molybdenum inside a transmission electron microscope at room temperature. The face-centred cubic domains then revert into <111>-oriented body-centred cubic domains, equivalent to a lattice rotation of 54.7°, and ~15.4% tensile strain is reached. The face-centred cubic structure appears to be a well-defined metastable state, as evidenced by scanning transmission electron microscopy and nanodiffraction, the Nishiyama–Wassermann and Kurdjumov–Sachs relationships between the face-centred cubic and body-centred cubic structures and molecular dynamics simulations. Our findings reveal a deformation mechanism for elemental metals under high-stress deformation conditions. PMID:24603655

Ocular trauma injuries: a 1-year surveillance study in the University of Malaya Medical Centre, Malaysia. 2008.

PubMed

Soong, Terrence Kwong-Weng; Koh, Alan; Subrayan, Visvaraja; Loo, Angela Voon Pei

2011-12-01

To describe the epidemiology of ocular injuries presenting to the University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia. Prospective analysis of all ocular trauma injuries presenting to the Department of Ophthalmology in UMMC from 1 January 2008 to 31 December 2008. A total of 603 eyes of 546 patients were recruited for the study. All patients presenting to the department with ocular trauma injuries were assessed by an ophthalmologist. Data on the type and source of injury, demographic profile of the patients, and clinical presentation were documented using a uniform and validated datasheet. Among eye injury cases, 481 patients (88.1%) were male, with a male-to-female ratio of 7.4:1. Of the patients, 412 (75.5%) were Malaysian while the remaining 134 (24.5%) were of non-Malaysian nationality. The average age was 31.5 years (range 1-81 years). A total of 238 injured eyes (43.6%) were work-related. The common sources of eye trauma include the use of high-powered tools (30.8%), motor vehicle accident (23.1%), and domestic accidents (17.7%). Only six patients (2.5%) reported to having used eye protective device (EPD) at time of their work-related injuries. A major cause of preventable ocular injuries in Malaysia was work-related trauma. Ocular injuries can be reduced by the use of eye protection devices and the implementation of appropriate preventive strategies to address each risk factor. Effective training is an integral part of occupational safety and health, which should be made mandatory at the workplace. In addition, there should be a continual assessment of safety and health issues at the workplace. A long-term database of all ocular injuries in Malaysia is recommended, to aid research on a larger scale and the development of new preventive strategies for ocular injuries.

Pesticide poisoning trend analysis of 13 years: a retrospective study based on telephone calls at the National Poisons Information Centre, All India Institute of Medical Sciences, New Delhi.

PubMed

Peshin, Sharda Shah; Srivastava, Amita; Halder, Nabanita; Gupta, Yogendra Kumar

2014-02-01

The study was designed to analyze the incidence and pattern of pesticide poisoning calls reported to the National Poisons Information Centre (NPIC), AIIMS, New Delhi and highlight the common classes of pesticides involved in poisoning. The telephone calls received by the Centre during the thirteen year period (1999-2012) were entered into a preset proforma and then into a retrievable database. A total of 4929 calls of pesticide poisoning were recorded. The data was analyzed with respect to age, gender, mode and type of poisoning. The age ranged from 1 to 65 years with the preponderance of males (M = 62.19%, F = 37.80%). The age group mainly involved in poisoning was 18-35 years. While 59.38% calls pertained to household pesticides, 40.61% calls related to agricultural pesticides. The common mode of poisoning was intentional (64.60%) followed by accidental (34.40%) and unknown (1%). Amongst the household pesticides, the highest number of calls were due to pyrethroids (26.23%) followed by rodenticides (17.06%), organophosphates (6.26%), carbamates (4.95%) and others (4.86%). In agricultural pesticides group, the organophosphates (9.79%) ranked the first followed by, aluminium phosphide (9.65%), organochlorines (9.31%), pyrethroids (3.87%), herbicides, weedicides and fungicides (3.20%), ethylene dibromide (2.82%), and others (1.70%). The data analysis shows a high incidence of poisoning due to household pesticides as compared to agricultural pesticides, clearly emphasizing the need for creating awareness and education about proper use and implementation of prevention programmes. Copyright © 2013 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

A prospective 10-year study of metal ceramic single crowns and fixed dental prosthesis retainers in private practice settings.

PubMed

Reitemeier, Bernd; Hänsel, Kristina; Kastner, Christian; Weber, Anke; Walter, Michael H

2013-03-01

Metal ceramic restorations are widely used in prosthodontics, but long-term data on their clinical performance in private practice settings based on prospective trials are sparse. This clinical trial was designed to provide realistic long-term survival rates for different outcomes related to tooth loss, crown loss, and metal ceramic defect. Ninety-five participants were provided with 190 noble metal ceramic single crowns and 138 participants with 276 fixed dental prosthesis retainer crowns on vital posterior teeth. Follow-up examinations were scheduled 2 weeks after insertion, annually up to 8 years, and after 10 years. Kaplan-Meier survival analyses, Mantel-Cox logrank tests, and Cox regression analyses were conducted. Because of variations in the time of the last examinations, the maximum observation period was 12.1 years. For the primary outcome 'loss of crown or tooth', the Kaplan-Meier survival rate was 94.3% ±1.8% (standard error) at 8.0 years (last outcome event) for single crowns and 94.4% ±1.5% at 11.0 years for fixed dental prosthesis retainer crowns. The difference between the survival functions was not significant (P>.05). For the secondary outcome 'metal ceramic defect', the survival rate was 88.8% ±3.2% at 11.0 years for single crowns and 81.7% ±3.5% at 11.0 years for fixed dental prosthesis retainer crowns. In Cox regression models, the only significant covariates for the outcome event 'metal ceramic defect' were bruxism in the medical history (single crowns) and signs and symptoms of bruxism (fixed dental prosthesis retainer crowns) with hazard ratios of 3.065 (95% CI 1.063 - 8.832) and 2.554 (95% CI 1.307 - 4.992). Metal ceramic crowns provided in private practice settings show good longevity. Bruxism appears to indicate a risk for metal ceramic defects. Copyright © 2013 The Editorial Council of the Journal of Prosthetic Dentistry. Published by Mosby, Inc. All rights reserved.

The "basic" approach: a single-centre experience with a cost-reducing model for paediatric cardiac extracorporeal membrane oxygenation.

PubMed

Padalino, Massimo A; Tessari, Chiara; Guariento, Alvise; Frigo, Anna C; Vida, Vladimiro L; Marcolongo, Andrea; Zanella, Fabio; Harvey, Michael J; Thiagarajan, Ravi R; Stellin, Giovanni

2017-04-01

Extracorporeal membrane oxygenation (ECMO) is a lifesaving but expensive therapy in terms of financial, technical and human resources. We report our experience with a 'basic' ECMO support model, consisting of ECMO initiated and managed without the constant presence of a bedside specialist, to assess safety, clinical outcomes and financial impact on our health system. We did a retrospective single-centre study of paediatric cardiac ECMO between January 2001 and March 2014. Outcomes included postimplant complications and survival at weaning and at discharge. We used activity based costing to compare the costs of current basic ECMO with those of a 'full optional' dedicated ECMO team (hypothesis 1); ECMO with a bedside nurse and perfusionist (hypothesis 2), and ECMO with a bedside perfusionist (hypothesis 3). Basic cardiac ECMO was required for 121 patients (median age 75 days, median weight 4.4 kg). A total of 107 patients (88%) had congenital heart disease; 37 had univentricular physiology. The median duration of ECMO was 7 days (interquartile range [IQR], 4-15 days). Overall survival at weaning and at 30 days in the neonatal and paediatric age groups was 58.6% and 30.6%, respectively; these results were not significantly different from Extracorporeal Life Support Organization data. Cost analysis revealed a saving of €30 366, €22 144 and €13 837 for each patient on basic ECMO for hypotheses 1, 2 and 3, respectively. Despite reduced human, technical and economical resources, a basic ECMO model without a bedside specialist was associated with satisfactory survival and lower costs. © The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Centre-Based Child Care Quality in Urban Australia

ERIC Educational Resources Information Center

Ishimine, Karin; Wilson, Rachel

2009-01-01

This study investigates the quality of childcare centres in urban Australian communities designated according to different bands of Centre Location Demographics (CLD). Childcare centres were assessed using the Early Childhood Environment Rating Scale- Revised Edition (ECERS-R) and the Early Childhood Environment Rating Scale-Extension (ECERS-E).…

Single photon emitters in boron nitride: More than a supplementary material

NASA Astrophysics Data System (ADS)

Koperski, M.; Nogajewski, K.; Potemski, M.

2018-03-01

We present comprehensive optical studies of recently discovered single photon sources in boron nitride, which appear in form of narrow lines emitting centres. Here, we aim to compactly characterise their basic optical properties, including the demonstration of several novel findings, in order to inspire discussion about their origin and utility. Initial inspection reveals the presence of narrow emission lines in boron nitride powder and exfoliated flakes of hexagonal boron nitride deposited on Si/SiO2 substrates. Generally rather stable, the boron nitride emitters constitute a good quality visible light source. However, as briefly discussed, certain specimens reveal a peculiar type of blinking effects, which are likely related to existence of meta-stable electronic states. More advanced characterisation of representative stable emitting centres uncovers a strong dependence of the emission intensity on the energy and polarisation of excitation. On this basis, we speculate that rather strict excitation selectivity is an important factor determining the character of the emission spectra, which allows the observation of single and well-isolated emitters. Finally, we investigate the properties of the emitting centres in varying external conditions. Quite surprisingly, it is found that the application of a magnetic field introduces no change in the emission spectra of boron nitride emitters. Further analysis of the impact of temperature on the emission spectra and the features seen in second-order correlation functions is used to provide an assessment of the potential functionality of boron nitride emitters as single photon sources capable of room temperature operation.

Student-Centred Learning (SCL): Roles Changed?

ERIC Educational Resources Information Center

Onurkan Aliusta, Gülen; Özer, Bekir

2017-01-01

This paper addresses the espoused and enacted practices of high school teachers with regard to student-centred learning (SCL). Explanatory mixed-method design, where quantitative strand is followed by qualitative one, is employed. While the quantitative strand aims to explore teachers' perceptions regarding the extent student-centred teacher and…

Attenuation of centre-of-pressure trajectory fluctuations under the prosthetic foot when using an articulating hydraulic ankle attachment compared to fixed attachment.

PubMed

De Asha, Alan R; Johnson, Louise; Munjal, Ramesh; Kulkarni, Jai; Buckley, John G

2013-02-01

Disruptions to the progress of the centre-of-pressure trajectory beneath prosthetic feet have been reported previously. These disruptions reflect how body weight is transferred over the prosthetic limb and are governed by the compliance of the prosthetic foot device and its ability to simulate ankle function. This study investigated whether using an articulating hydraulic ankle attachment attenuates centre-of-pressure trajectory fluctuations under the prosthetic foot compared to a fixed attachment. Twenty active unilateral trans-tibial amputees completed walking trials at their freely-selected, comfortable walking speed using both their habitual foot with either a rigid or elastic articulating attachment and a foot with a hydraulic ankle attachment. Centre-of-pressure displacement and velocity fluctuations beneath the prosthetic foot, prosthetic shank angular velocity during stance, and walking speed were compared between foot conditions. Use of the hydraulic device eliminated or reduced the magnitude of posteriorly directed centre-of-pressure displacements, reduced centre-of-pressure velocity variability across single-support, increased mean forward angular velocity of the shank during early stance, and increased freely chosen comfortable walking speed (P ≤ 0.002). The attenuation of centre-of-pressure trajectory fluctuations when using the hydraulic device indicated bodyweight was transferred onto the prosthetic limb in a smoother, less faltering manner which allowed the centre of mass to translate more quickly over the foot. Copyright © 2012 Elsevier Ltd. All rights reserved.

Building Groups and Independence: The Role of Food in the Lives of Young People in Danish Sports Centres

ERIC Educational Resources Information Center

Sylow, Mine; Holm, Lotte

2009-01-01

This article, based on an ethnographic study, examines the role of food in the social interaction of 11- to 17-year-old youths in sports centres in Denmark. The sports centres serve as a free space where young people receive no adult supervision. This is underlined by their understanding and use of food in this environment. Food serves as a medium…

Therapeutic strategies in severe neuropsychiatric systemic lupus erythematosus: experience from a tertiary referral centre.

PubMed

Bortoluzzi, A; Padovan, M; Farina, I; Galuppi, E; De Leonardis, F; Govoni, M

2012-12-20

The management of neuropsychiatric systemic lupus erythematosus (NPSLE) still remains empirical and based on clinical experience due to the lack of randomized controlled trials. To report the experience accumulated in a single tertiary referral centre about treatment of severe cases of NPSLE patients and to discuss therapeutic strategies on the background of EULAR recommendations. Retrospective analysis of all consecutive cases of severe NPSLE treated in our centre since 1990 to 2010, satisfying the 1999 ACR criteria. Among 633 SLE patients who consecutively attended our centre, 231 (36%) displayed at least one neuropsychiatric (NP) manifestation for a total of 408 events attributable to SLE. Thirty-one patients (4.8%), 27 females and 4 males, experienced 35 major NP events requiring immunosuppressive therapy (including 3 relapses and 1 new event). An aggressive immunosuppressive strategy was applied to those patients with an immune mediated inflammatory NP event and to those patients with an increased disease activity as judged by ECLAM and SLEDAI scores. Overall at the end of the therapy 74% of the patients reached clinical remission or significant improvement of their symptoms measured by mean SLEDAI (from 10.09 ± 1.09 to 2.04 ± 0.52, P<0.0001) and ECLAM (from 4 ± 0.34 to 1.38 ± 0.37, P<0.001) scores. The prevalence of NP involvement, described in our case series, is similar to those reported in literature as well as the treatment strategies applied. Nowadays, it is not possible to establish a standardized approach for each single NPSLE manifestation, and different therapeutic strategies must be tailored taking into account the most probable pathogenic mechanism involved, the general disease activity background, the co-morbidities, the type and the stage of the systemic involvement.

[Health promotion in day-care centres in Reykjavík--intervention and result of actions].

PubMed

Gudmarsdóttir, Agústa; Tómasson, Kristinn

2007-03-01

The purpose of the study was to compare wellbeing, health and work environment before and after intervention among employees of Reykjavík city day-care centre. The study is a prospective interventions study. In the year 2000 employees of 16 day-care centres responded to a questionnaire regarding work environment, health and wellbeing. Work environment evaluation was completed and the centre classified into four groups accordingly. Subsequently, the "equipment was renewed" noise protection improved and the employee received education concerning occupational health. Six months, after interventions, in the year 2002 the same questionnaire was readministered. Response rate in 2002 was 88% (n=267) but 90% in the year 2000. Work environment had improved. More employees had received instruction on good workposture and good work technique than 2 years earlier. Fewer employees used awkward posture than before. Better workspace resulted in reduced number of symptoms, also for the youngest employees. Symptoms were also fewer where unskilled employees were in majority and where the fewest of them had received proper education on work posture. In the year 2002, psychosocial wellbeing was better or equal than two years earlier. This was associated with better education and higher age even despite less workspace. Employees awareness towards noise was greatly improved. It is possible to improve work methods and work environment of employees with goal directed intervention, thus laying the ground for wellbeing at work. The interplay between the factors education and age is complex, though. Thus it is important, that all workplaces, adopt the process of "risk assessment", intervention, and then reassessment of the work environment. By doing so the goals of health promotion and good occupational health can be reached.

Consumption of added fats and oils in the European Prospective Investigation into Cancer and Nutrition (EPIC) centres across 10 European countries as assessed by 24-hour dietary recalls.

PubMed

Linseisen, J; Bergström, E; Gafá, L; González, C A; Thiébaut, A; Trichopoulou, A; Tumino, R; Navarro Sánchez, C; Martínez Garcia, C; Mattisson, I; Nilsson, S; Welch, A; Spencer, E A; Overvad, K; Tjønneland, A; Clavel-Chapelon, F; Kesse, E; Miller, A B; Schulz, M; Botsi, K; Naska, A; Sieri, S; Sacerdote, C; Ocké, M C; Peeters, P H M; Skeie, G; Engeset, D; Charrondière, U R; Slimani, N

2002-12-01

To evaluate the consumption of added fats and oils across the European centres and countries participating in the European Prospective Investigation into Cancer and Nutrition (EPIC). 24-Hour dietary recalls were collected by means of standardised computer-guided interviews in 27 redefined EPIC centres across 10 European countries. From an initial number of 36 900 subjects, single dietary recalls from 22 924 women and 13 031 men in the age range of 35-74 years were included. Mean daily intake of added fats and oils varied between 16.2 g (Varese, Italy) and 41.1 g (Malmö, Sweden) in women and between 24.7 g (Ragusa, Italy) and 66.0 g (Potsdam, Germany) in men. Total mean lipid intake by consumption of added fats and oils, including those used for sauce preparation, ranged between 18.3 (Norway) and 37.2 g day-1 (Greece) in women and 28.4 (Heidelberg, Germany) and 51.2 g day-1 (Greece) in men. The Mediterranean EPIC centres with high olive oil consumption combined with low animal fat intake contrasted with the central and northern European centres where fewer vegetable oils, more animal fats and a high proportion of margarine were consumed. The consumption of added fats and oils of animal origin was highest in the German EPIC centres, followed by the French. The contribution of added fats and oils to total energy intake ranged from 8% in Norway to 22% in Greece. The results demonstrate a high variation in dietary intake of added fats and oils in EPIC, providing a good opportunity to elucidate the role of dietary fats in cancer aetiology.

Elderly Care Centre

NASA Astrophysics Data System (ADS)

Wagiman, Aliani; Haja Bava Mohidin, Hazrina; Ismail, Alice Sabrina

2016-02-01

The demand for elderly centre has increased tremendously abreast with the world demographic change as the number of senior citizens rose in the 21st century. This has become one of the most crucial problems of today's era. As the world progress into modernity, more and more people are occupied with daily work causing the senior citizens to lose the care that they actually need. This paper seeks to elucidate the best possible design of an elderly care centre with new approach in order to provide the best service for them by analysing their needs and suitable activities that could elevate their quality of life. All these findings will then be incorporated into design solutions so as to enhance the living environment for the elderly especially in Malaysian context.

Addiction research centres and the nurturing of creativity: The Centre for Alcohol Policy Research (CAPR), Melbourne: a decade on.

PubMed

Wilkinson, Claire; Pennay, Amy; MacLean, Sarah; Livingston, Michael; Room, Robin; Hamilton, Margaret; Laslett, Anne-Marie; Jiang, Heng; Callinan, Sarah; Waleewong, Orratai

2018-03-01

Established in 2006, the Centre for Alcohol Policy Research (CAPR) is Australia's only research centre with a primary focus on alcohol policy. CAPR has four main areas of research: alcohol policy impacts; alcohol policy formation and regulatory processes involved in implementing alcohol policies; patterns and trends in drinking and alcohol problems in the population; and the influence of drinking norms, cultural practices and social contexts, particularly in interaction with alcohol policies. In this paper, we give examples of key publications in each area. During the past decade, the number of staff employed at CAPR has increased steadily and now hovers at approximately 10. CAPR has supported the development of independent researchers who collaborate on a number of international projects, such as the Alcohol's Harm to Others study which is now replicated in approximately 30 countries. CAPR receives core funding from the Foundation for Alcohol Research and Education, and staff have been highly successful in securing additional competitive research funding. In 2016, CAPR moved to a new institutional setting at La Trobe University and celebrated 10 years of operation. © 2017 Society for the Study of Addiction.

Renal transplantation in systemic lupus erythematosus: outcome and prognostic factors in 50 cases from a single centre.

PubMed

Cairoli, Ernesto; Sanchez-Marcos, Carolina; Espinosa, Gerard; Glucksmann, Constanza; Ercilla, Guadalupe; Oppenheimer, Federico; Cervera, Ricard

2014-01-01

End-stage renal disease (ESRD) is an important cause of morbidity and mortality in patients with systemic lupus erythematosus (SLE). To analyze the outcome and prognostic factors of renal transplantation in patients with ESRD due to SLE from January 1986 to December 2013 in a single center. Fifty renal transplantations were performed in 40 SLE patients (32 female (80%), mean age at transplantation 36±10.4 years). The most frequent lupus nephropathy was type IV (72.2%). Graft failure occurred in a total of 15 (30%) transplantations and the causes of graft failure were chronic allograft nephropathy (n=12), acute rejection (n=2), and chronic humoral rejection (1). The death-censored graft survival rates were 93.9% at 1 year, 81.5% at 5 years, and 67.6% at the end of study. The presence of deceased donor allograft (P=0.007) and positive anti-HCV antibodies (P=0.001) negatively influence the survival of the renal transplant. The patient survival rate was 91.4% at the end of the study. Recurrence of lupus nephritis in renal allograft was observed in one patient. Renal transplantation is a good alternative for renal replacement therapy in patients with SLE. In our cohort, the presence of anti-HCV antibodies and the type of donor source were related to the development of graft failure.

Renal Transplantation in Systemic Lupus Erythematosus: Outcome and Prognostic Factors in 50 Cases from a Single Centre

PubMed Central

Cairoli, Ernesto; Sanchez-Marcos, Carolina; Espinosa, Gerard; Glucksmann, Constanza; Ercilla, Guadalupe; Oppenheimer, Federico; Cervera, Ricard

2014-01-01

Background. End-stage renal disease (ESRD) is an important cause of morbidity and mortality in patients with systemic lupus erythematosus (SLE). Objectives. To analyze the outcome and prognostic factors of renal transplantation in patients with ESRD due to SLE from January 1986 to December 2013 in a single center. Results. Fifty renal transplantations were performed in 40 SLE patients (32 female (80%), mean age at transplantation 36 ± 10.4 years). The most frequent lupus nephropathy was type IV (72.2%). Graft failure occurred in a total of 15 (30%) transplantations and the causes of graft failure were chronic allograft nephropathy (n = 12), acute rejection (n = 2), and chronic humoral rejection (1). The death-censored graft survival rates were 93.9% at 1 year, 81.5% at 5 years, and 67.6% at the end of study. The presence of deceased donor allograft (P = 0.007) and positive anti-HCV antibodies (P = 0.001) negatively influence the survival of the renal transplant. The patient survival rate was 91.4% at the end of the study. Recurrence of lupus nephritis in renal allograft was observed in one patient. Conclusion. Renal transplantation is a good alternative for renal replacement therapy in patients with SLE. In our cohort, the presence of anti-HCV antibodies and the type of donor source were related to the development of graft failure. PMID:25013800

The Irish Centre for Talented Youth

ERIC Educational Resources Information Center

Gilheany, Sheila

2005-01-01

Conducting potency tests on penicillin, discussing rocket technology with a NASA astronaut, analysing animal bone fragments from medieval times, these are just some of the activities which occupy the time of students at The Irish Centre for Talented Youth. The Centre identifies young students with exceptional academic ability and then provides…

Documentation Centre of the Association of African Universities.

ERIC Educational Resources Information Center

Chateh, Peter

This report presents the results of a study of the Documentation Centre of the Association of African Universities (AAU) undertaken to work out proposals for the rational organization of the Centre, and to explore the possibility of computerizing the Centre and linking it with other centers which provide automated documentation services. The…

The effect of nitisinone on homogentisic acid and tyrosine: a two-year survey of patients attending the National Alkaptonuria Centre, Liverpool.

PubMed

Milan, Anna M; Hughes, Andrew T; Davison, Andrew S; Devine, Jean; Usher, Jeannette; Curtis, Sarah; Khedr, Milad; Gallagher, James A; Ranganath, Lakshminarayan R

2017-05-01

Background Alkaptonuria is a rare, debilitating autosomal recessive disorder affecting tyrosine metabolism. Deficiency of homogentisate 1,2-dioxygenase leads to increased homogentisic acid which is deposited as ochronotic pigment. Clinical sequelae include severe early onset osteoarthritis, increased renal and prostate stone formation and cardiac complications. Treatment has been largely based on analgaesia and arthroplasty. The National Alkaptonuria Centre in Liverpool has been using 2 mg nitisinone (NTBC) off-license for all patients in the United Kingdom with alkaptonuria and monitoring the tyrosine metabolite profiles. Methods Patients with confirmed alkaptonuria are commenced on 2 mg dose (alternative days) of NTBC for three months with daily dose thereafter. Metabolite measurement by LC-MS/MS is performed at baseline, day 4, three-months, six-months and one-year post-commencing NTBC. Thereafter, monitoring and clinical assessments are performed annually. Results Urine homogentisic acid concentration decreased from a mean baseline 20,557 µmol/24 h (95th percentile confidence interval 18,446-22,669 µmol/24 h) by on average 95.4% by six months, 94.8% at one year and 94.1% at two year monitoring. A concurrent reduction in serum homogentisic acid concentration of 83.2% compared to baseline was also measured. Serum tyrosine increased from normal adult reference interval to a mean ± SD of 594 ± 184 µmol /L at year-two monitoring with an increased urinary excretion from 103 ± 81 µmol /24 h at baseline to 1071 ± 726 µmol /24 h two years from therapy. Conclusions The data presented represent the first longitudinal survey of NTBC use in an NHS service setting and demonstrate the sustained effect of NTBC on the tyrosine metabolite profile.

Charge transfer effects, thermo and photochromism in single crystal CVD synthetic diamond.

PubMed

Khan, R U A; Martineau, P M; Cann, B L; Newton, M E; Twitchen, D J

2009-09-09

We report on the effects of thermal treatment and ultraviolet irradiation on the point defect concentrations and optical absorption profiles of single crystal CVD synthetic diamond. All thermal treatments were below 850 K, which is lower than the growth temperature and unlikely to result in any structural change. UV-visible absorption spectroscopy measurements showed that upon thermal treatment (823 K), various broad absorption features diminished: an absorption band at 270 nm (used to deduce neutral single substitutional nitrogen (N(S)(0)) concentrations) and also two broad features centred at approximately 360 and 520 nm. Point defect centre concentrations as a function of temperature were also deduced using electron paramagnetic resonance (EPR) spectroscopy. Above ∼500 K, we observed a decrease in the concentration of N(S)(0) centres and a concomitant increase in the negatively charged nitrogen-vacancy-hydrogen (NVH) complex (NVH(-)) concentration. Both transitions exhibited an activation energy between 0.6 and 1.2 eV, which is lower than that for the N(S)(0) donor (∼1.7 eV). Finally, it was found that illuminating samples with intense short-wave ultraviolet light recovered the N(S)(0) concentration and also the 270, 360 and 520 nm absorption features. From these results, we postulate a valence band mediated charge transfer process between NVH and single nitrogen centres with an acceptor trap depth for NVH of 0.6-1.2 eV. Because the loss of N(S)(0) concentration is greater than the increase in NVH(-) concentration we also suggest the presence of another unknown acceptor existing at a similar energy to NVH. The extent to which the colour in CVD synthetic diamond is dependent on prior history is discussed.

A single-centre cohort study of National Early Warning Score (NEWS) and near patient testing in acute medical admissions.

PubMed

Abbott, Tom E F; Torrance, Hew D T; Cron, Nicholas; Vaid, Nidhi; Emmanuel, Julian

2016-11-01

The utility of an early warning score may be improved when used with near patient testing. However, this has not yet been investigated for National Early Warning Score (NEWS). We hypothesised that the combination of NEWS and blood gas variables (lactate, glucose or base-excess) was more strongly associated with clinical outcome compared to NEWS alone. This was a prospective cohort study of adult medical admissions to a single-centre over 20days. Blood gas results and physiological observations were recorded at admission. NEWS was calculated retrospectively and combined with the biomarkers in multivariable logistic regression models. The primary outcome was a composite of mortality or critical care escalation within 2days of hospital admission. The secondary outcome was hospital length of stay. After accounting for missing data, 15 patients out of 322 (4.7%) died or were escalated to the critical care unit. The median length of stay was 4 (IQR 7) days. When combined with lactate or base excess, NEWS was associated with the primary outcome (OR 1.18, p=0.01 and OR 1.13, p=0.03). However, NEWS alone was more strongly associated with the primary outcome measure (OR 1.46, p<0.01). The combination of NEWS with glucose was not associated with the primary outcome. Neither NEWS nor any combination of NEWS and a biomarker were associated with hospital length of stay. Admission NEWS is more strongly associated with death or critical care unit admission within 2days of hospital admission, compared to combinations of NEWS and blood-gas derived biomarkers. Copyright © 2016 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

Non-Hodgkin lymphoma in Romania: a single-centre experience.

PubMed

Fetica, Bogdan; Achimas-Cadariu, Patriciu; Pop, Bogdan; Dima, Delia; Petrov, Ljubomir; Perry, Anamarija M; Nathwani, Bharat N; Müller-Hermelink, Hans K; Diebold, Jacques; MacLennan, Kenneth A; Fulop, Annamaria; Blaga, Mihaiela L; Coza, Daniela; Nicula, Florian Al; Irimie, Alexandru; Weisenburger, Dennis D

2017-06-01

Epidemiologic studies of non-Hodgkin lymphoma (NHL) in Eastern Europe are scarce in the literature. We report the experience of the "Ion Chiricuta" Institute of Oncology in Cluj-Napoca (IOCN), Romania, in the diagnosis and outcome of patients with NHL. We studied 184 consecutive NHL patients diagnosed in the Pathology Department of IOCN during the years 2004-2006. We also obtained epidemiological data from the Northwestern (NW) Cancer Registry. In the IOCN series, the most common lymphoma subtype was diffuse large B-cell lymphoma (43.5%), followed by the chronic lymphocytic leukaemia/small lymphocytic lymphoma (21.2%). T-cell lymphomas represented a small proportion (8.2%). The median age of the patients was 57 years, with a male-to-female ratio of 0.94. Patients with indolent B-cell lymphomas had the best overall survival, whereas those with mantle cell lymphoma had the worst survival. The NW Cancer Registry data showed that the occurrence of NHL in the NW region of Romania was higher in men [world age-standardized incidence rate/100 000 (ASR)-5.9; 95% CI 5.1-6.6] than in women (ASR-4.1; 95% CI 3.5-4.7) with age-standardized male-to-female ratio of 1.44 (p = 0.038). Chronic lymphocytic leukaemia/small lymphocytic lymphoma was the most common NHL in the NW region of Romania, accounting for 43% of all cases, followed by diffuse large B-cell lymphoma (36%). The 5-year, age-standardized cumulative relative survival for NHL in the County of Cluj in NW Romania, for the period of 2006-2010, was 51.4%, with 58.4% survival for men and 43.2% for women. Additional studies of NHL in Eastern Europe are needed. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

[The Adamant, an unusual care centre].

PubMed

Khidichian, Frédéric

2011-01-01

The day care centre of the central Paris area has established itself in an unusual location--a 650 m2 floating building moored on the right bank of the Seine. Patients and caregivers were involved in the design of this original and ecological care centre, which places the emphasis on comfort and safety.

Life table analysis of the United States' Year 2000 mortality objectives.

PubMed

Rockett, I R; Pollard, J H

1995-06-01

The US Year 2000 mortality objectives are model standards cast as targeted changes in age-adjusted cause-specific death rates. This research centred on the projected impact of such changes on life expectancy and the mortality toll for each sex. A computer simulation was conducted using single decrement, multiple decrement and cause-elimination life table techniques, together with a decomposition procedure. Male and female life expectancy at birth was projected to increase by 1.71 and 1.51 years, respectively, between the designated 1987 baseline and 2000. The leading beneficiaries would be those aged 65 and older, followed by those aged 45-64, and infants. Declines in coronary heart disease, stroke and injury death rates would most influence the projected life expectancy changes, irrespective of sex. Approximately 782,000 male deaths and 730,000 female deaths would be averted under Year 2000 assumptions. Life expectancy would be a useful summary measure to incorporate into official evaluations of the Year 2000 mortality objectives. Targeting of excess male mortality in the US and other highly industrialized nations is recommended.

On the analysis of the double Hopf bifurcation in machining processes via centre manifold reduction

NASA Astrophysics Data System (ADS)

Molnar, T. G.; Dombovari, Z.; Insperger, T.; Stepan, G.

2017-11-01

The single-degree-of-freedom model of orthogonal cutting is investigated to study machine tool vibrations in the vicinity of a double Hopf bifurcation point. Centre manifold reduction and normal form calculations are performed to investigate the long-term dynamics of the cutting process. The normal form of the four-dimensional centre subsystem is derived analytically, and the possible topologies in the infinite-dimensional phase space of the system are revealed. It is shown that bistable parameter regions exist where unstable periodic and, in certain cases, unstable quasi-periodic motions coexist with the equilibrium. Taking into account the non-smoothness caused by loss of contact between the tool and the workpiece, the boundary of the bistable region is also derived analytically. The results are verified by numerical continuation. The possibility of (transient) chaotic motions in the global non-smooth dynamics is shown.

Outcomes of burns in the elderly: revised estimates from the Birmingham Burn Centre.

PubMed

Wearn, Christopher; Hardwicke, Joseph; Kitsios, Andreas; Siddons, Victoria; Nightingale, Peter; Moiemen, Naiem

2015-09-01

Outcomes after burn have continued to improve over the last 70 years in all age groups including the elderly. However, concerns have been raised that survival gains have not been to the same magnitude in elderly patients compared to younger age groups. The aims of this study were to analyze the recent outcomes of elderly burn injured patients admitted to the Birmingham Burn Centre, compare data with a historical cohort and published data from other burn centres worldwide. A retrospective review was conducted of all patients ≥65 years of age, admitted to our centre with cutaneous burns, between 2004 and 2012. Data was compared to a previously published historical cohort (1999-2003). 228 patients were included. The observed mortality for the study group was 14.9%. The median age of the study group was 79 years, the male to female ratio was 1:1 and median Total Body Surface Area (TBSA) burned was 5%. The incidence of inhalation injury was 13%. Median length of stay per TBSA burned for survivors was 2.4 days/% TBSA. Mortality has improved in all burn size groups, but differences were highly statistically significant in the medium burn size group (10-20% TBSA, p≤0.001). Burn outcomes in the elderly have improved over the last decade. This reduction has been impacted by a reduction in overall injury severity but is also likely due to general improvements in burn care, improved infrastructure, implementation of clinical guidelines and increased multi-disciplinary support, including Geriatric physicians. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

From Comfort Zone to Contact Zone Lessons from a Belfast Writing Centre

ERIC Educational Resources Information Center

Cain, Kathleen Shine

2011-01-01

American writing center director Kathleen Shine Cain analyzes the transformative experience of spending a year in a Belfast writing centre, resulting in a renewed appreciation of cross-national and cross-cultural partnerships. Although American writing center theory and pedagogy have informed the development of centers in Europe, Asia, and Africa,…

Leading Highly Performing Children's Centres: Supporting the Development of the "Accidental Leaders"

ERIC Educational Resources Information Center

Coleman, Andy; Sharp, Caroline; Handscomb, Graham

2016-01-01

There is wide recognition that early childhood experiences are critical to a child's development and their subsequent life chances. However, little research has been undertaken into leadership in early years settings, which is so influential in this regard. This article summarizes research into the leadership of Sure Start Children's Centres,…

[TRENDS OF PERMANENT PACEMAKER IMPLANTATION IN A SINGLE CENTER OVER A 20-YEAR PERIOD].

PubMed

Antonelli, Dante; Ilan, Limor Bushar; Freedberg, Nahum A; Feldman, Alexander; Turgeman, Yoav

2015-05-01

To review the changes in permanent pacemaker implantation indications, pacing modes and patients' demographics over a 20-year period. We retrospectively retrieved data on patients who underwent first implantation of the pacemaker between 1-1-1991 and 31-12-2010. One thousand and nine (1,009) patients underwent a first pacemaker implantation during that period; 535 were men (53%), their mean age was 74.6±19.5 years; the highest rate of implanted pacemaker was in patients ranging in age from 70-79 years, however there was an increasing number of patients aged over 80 years. The median survival time after initial pacemaker implantation was 8 years. Syncope was the most common symptom (62.5%) and atrioventricular block was the most common electrocardiographic indication (56.4%) leading to pacemaker implantation. There was increased utilization of dual chamber and rate responsive pacemakers over the years. There was no difference regarding mode selection between genders. Pacemaker implantation rates have increased over a 20-year period. Dual chamber replaced most of the single ventricular chamber pacemaker and rate responsive pacemakers became the norm. The data of a small volume center are similar to those reported in pacemaker surveys of high volume pacemaker implantation centers. They confirm adherence to the published guidelines for pacing.

Single 23S rRNA mutations at the ribosomal peptidyl transferase centre confer resistance to valnemulin and other antibiotics in Mycobacterium smegmatis by perturbation of the drug binding pocket.

PubMed

Long, Katherine S; Poehlsgaard, Jacob; Hansen, Lykke H; Hobbie, Sven N; Böttger, Erik C; Vester, Birte

2009-03-01

Tiamulin and valnemulin target the peptidyl transferase centre (PTC) on the bacterial ribosome. They are used in veterinary medicine to treat infections caused by a variety of bacterial pathogens, including the intestinal spirochetes Brachyspira spp. Mutations in ribosomal protein L3 and 23S rRNA have previously been associated with tiamulin resistance in Brachyspira spp. isolates, but as multiple mutations were isolated together, the roles of the individual mutations are unclear. In this work, individual 23S rRNA mutations associated with pleuromutilin resistance at positions 2055, 2447, 2504 and 2572 (Escherichia coli numbering) are introduced into a Mycobacterium smegmatis strain with a single rRNA operon. The single mutations each confer a significant and similar degree of valnemulin resistance and those at 2447 and 2504 also confer cross-resistance to other antibiotics that bind to the PTC in M. smegmatis. Antibiotic footprinting experiments on mutant ribosomes show that the introduced mutations cause structural perturbations at the PTC and reduced binding of pleuromutilin antibiotics. This work underscores the fact that mutations at nucleotides distant from the pleuromutilin binding site can confer the same level of valnemulin resistance as those at nucleotides abutting the bound drug, and suggests that the former function indirectly by altering local structure and flexibility at the drug binding pocket.

Goal-oriented cognitive rehabilitation in early-stage dementia: study protocol for a multi-centre single-blind randomised controlled trial (GREAT)

PubMed Central

2013-01-01

Background Preliminary evidence suggests that goal-oriented cognitive rehabilitation (CR) may be a clinically effective intervention for people with early-stage Alzheimer’s disease, vascular or mixed dementia and their carers. This study aims to establish whether CR is a clinically effective and cost-effective intervention for people with early-stage dementia and their carers. Methods/design In this multi-centre, single-blind randomised controlled trial, 480 people with early-stage dementia, each with a carer, will be randomised to receive either treatment as usual or cognitive rehabilitation (10 therapy sessions over 3 months, followed by 4 maintenance sessions over 6 months). We will compare the effectiveness of cognitive rehabilitation with that of treatment as usual with regard to improving self-reported and carer-rated goal performance in areas identified as causing concern by people with early-stage dementia; improving quality of life, self-efficacy, mood and cognition of people with early-stage dementia; and reducing stress levels and ameliorating quality of life for carers of participants with early-stage dementia. The incremental cost-effectiveness of goal-oriented cognitive rehabilitation compared to treatment as usual will also be examined. Discussion If the study confirms the benefits and cost-effectiveness of cognitive rehabilitation, it will be important to examine how the goal-oriented cognitive rehabilitation approach can most effectively be integrated into routine health-care provision. Our aim is to provide training and develop materials to support the implementation of this approach following trial completion. Trial registration Current Controlled Trials ISRCTN21027481 PMID:23710796

Waste management in primary healthcare centres of Iran.

PubMed

Mesdaghinia, Alireza; Naddafi, Kazem; Mahvi, Amir Hossein; Saeedi, Reza

2009-06-01

The waste management practices in primary healthcare centres of Iran were investigated in the present study. A total of 120 primary healthcare centres located across the country were selected using the cluster sampling method and the current situation of healthcare waste management was determined through field investigation. The quantities of solid waste and wastewater generation per outpatient were found to be 60 g outpatient(-1) day(-1) and 26 L outpatient(-1) day(-1), respectively. In all of the facilities, sharp objects were separated almost completely, but separation of other types of hazardous healthcare solid waste was only done in 25% of the centres. The separated hazardous solid waste materials were treated by incineration, temporary incineration and open burning methods in 32.5, 8.3 and 42.5% of the healthcare centres, respectively. In 16.7% of the centres the hazardous solid wastes were disposed of without any treatment. These results indicate that the management of waste materials in primary healthcare centres in Iran faced some problems. Staff training and awareness, separation of healthcare solid waste, establishment of the autoclave method for healthcare solid waste treatment and construction of septic tanks and disinfection units in the centres that were without access to a sewer system are the major measures that are suggested for improvement of the waste management practices.

The development of integrated service centre system for professional teachers empowerment in North Sumatera

NASA Astrophysics Data System (ADS)

Gultom, S.; Simanjorang, M. M.; Muchtar, Z.; Mansyur, A.

2018-03-01

Based on Act number 12 in year 2012 the function of higher education is related to individual, social community, knowledge and technology development. Hence, higher education providers need to think and develop policies in order to improve their service and fulfil the higher education function. As part of the effort to fulfil its function Universitas Negeri Medan (Unimed), which historically was a pre-service teacher training institute, should has a special interest on improving teachers’ professionalism. The Act number 14 in year 2005 described requirements for professional teacher, including academic qualification and set of competencies possessed by the teacher. The Act also guaranties teachers’ right to have opportunities for improving their competencies and academic qualification through training and other professionalism development programme. The question is how this guarantee can be implemented. In order to answer this question a developmental study has been done which aimed on developing an integrated service centre system for professional teachers empowerment. As the name implies, this integrated service centre system is expected to be a real manifestation of Unimed’s support towards the improvement of professional teachers quality, which in the end will boils down to the improvement of national education services quality. The result of this study is an integrated service centre system for professional teachers empowerment that fulfils the professionalism principles described in the Act number 14 in year 2005, which has been developed by considering problems faced by and also supports needed by teachers post certification programme.

Socioeconomic predictors of referral to a diagnostic centre on suspected adverse events following HPV vaccination.

PubMed

Weye, Nanna; Fonager, Kirsten; Lützen, Tina; Rytter, Dorte

2018-05-25

In Denmark, the human papillomavirus (HPV) vaccines have been suspected of adverse events since 2014. However, as no causal associations between the HPV vaccines and numerous diseases have been demonstrated, factors prior to vaccination may influence the risk of suspecting the HPV vaccines of causing symptoms. We studied the associations between individual and parental socioeconomic characteristics and the risk of referral to a diagnostic centre in a female population aged 11-29 years with a first HPV vaccination in January 2008 to June 2015. Individual and parental data from national registries were linked using the unique personal identification number. Logistic regression analyses were used to estimate crude and adjusted odds ratio's according to each individual and parental socioeconomic factor with two-sided 95% 95% CI. The cohort consisted of 453 216 individuals of which 1316 (0.29%) were referred to a diagnostic centre in 2015. Having a mother outside the workforce or an unemployed mother was associated with an increased risk of referral, while girls and women who had fathers with a higher educational level were less likely to be referred. In addition, women aged 20-29 years who were unemployed or outside the workforce prior to vaccination had increased odds of being referred to a diagnostic centre. We found social inequality in the referral to a diagnostic centre following HPV vaccination. This might be explained by an increased morbidity in girls and women of lower socioeconomic status.