Sample records for early peri-operative hyperglycaemia

  1. Peri-operative antibiotic treatment of bacteriuria reduces early deep surgical site infections in geriatric patients with proximal femur fracture. (United States)

    Langenhan, Ronny; Bushuven, Stefanie; Reimers, Niklas; Probst, Axel


    The aim of this study was to conduct a re-evaluation of current strategies for peri-operative prophylaxis of infections in orthopaedic surgery of geriatric patients (≥65 years) with proximal femoral fractures (PFF). Between 01/2010 and 08/2014 all post-operative infections after stabilization of PFF of 1,089 geriatric patients were recorded retrospectively. All patients pre-operatively received a single dose of 1.5 g cefuroxime (group 1). These were compared to prospectively determined post-operative rates of surgical site infection (SSI) of 441 geriatric patients, which were operated on between 09/2014 and 03/2017 due to PFF. In this second group we investigated the urinary tract on admission. Bacteriuria was treated with the pre-operative single dose of 1.5 g cefuroxime along with ciprofloxacin for five days, beginning on admission. Level of significance was set to p infection. Multi-resistant pathogens were found in 15 patients and pathogens were cefuroxime-resistant in 37. The differences of SSI after at least three months were 2.1% in group 1 and 0.45% in group 2 for all patients with surgery of PFF (p < 0.02) and for those with arthroplasty (p < 0.037) significant. The immediate antibiotic therapy of a prevalent bacteriuria for five days decreases the risk of SSI after surgery of PFF. Our single-centre study can only point out the problem of prevalent reservoirs of pathogens and the need for treatment. Evidence-based therapy concepts (indications of antibiotics, classes, duration) have to be developed in multi-centric and prospective studies.

  2. Peri-operative morbidity and early results of a randomised trial comparing TVT and TVT-O. (United States)

    Meschia, Michele; Bertozzi, Rosanna; Pifarotti, Paola; Baccichet, Roberto; Bernasconi, Francesco; Guercio, Elso; Magatti, Fabio; Minini, Gianfranco


    The aim of this study was to compare the morbidity and short-term efficacy of retro-pubic (TVT) and inside-out trans-obturator (TVT-O) sub-urethral sling in the treatment of stress urinary incontinence. This was a prospective multi-centre randomised trial; 231 women with primary stress urinary incontinence were randomised to TVT (114) or TVT-O (117). The International Consultation on Incontinence-Short Form (ICIQ-SF), Women Irritative Prostate Symptoms Score (W-IPSS) and Patient Global Impression of Severity (PGI-S) questionnaires were used to evaluate the impact of incontinence and voiding dysfunction on QoL and to measure the patient's perception of incontinence severity. The primary and secondary outcome measures were rates of success and complications. The SPSS software was used for data analysis. The TVT-O procedure was associated with significantly shorter operation time and with a more extensive use of general anaesthesia when compared with TVT. There were 5 (4%) bladder perforations in the TVT group compared with none in the TVT-O group. Rates of early post-operative urinary retention and voiding difficulty were similar for both groups and no difference was found in the average hospital stay. Six patients (5%) in the TVT-O group complained of thigh pain in the post-operative course. The median follow-up time was 6 months. Two hundred eighteen patients were available for the analysis of outcomes. Subjective and objective cure rates were 92% and 92% in the TVT group and 87% and 89% in the TVT-O group. The ICIQ-SF questionnaire symptoms score showed a highly statistical decrease in both groups, the W-IPSS on the contrary was unchanged. Our data show that both procedures were equally effective in the short-term for the treatment of stress urinary incontinence with a highly significant improvement in incontinence-related QoL.

  3. Perioperative hyperglycaemia

    African Journals Online (AJOL)

    with in-patient hyperglycaemia, which normalises when the admission-related stressor abates. Hyperglycaemia in these patients occurs in the face of a normal HbA1c, and can have a worse outcome than hyperglycaemia in patients with diabetes.2,8. This suggests a different pathophysiology to that of diabetes mellitus.2,8 ...

  4. Early postnatal hyperglycaemia is a risk factor for treatment-demanding retinopathy of prematurity. (United States)

    Slidsborg, Carina; Jensen, Louise Bering; Rasmussen, Steen Christian; Fledelius, Hans Callø; Greisen, Gorm; Cour, Morten de la


    To investigate whether neonatal hyperglycaemia in the first postnatal week is associated with treatment-demanding retinopathy of prematurity (ROP). This is a Danish national, retrospective, case-control study of premature infants (birth period 2003-2006). Three national registers were searched, and data were linked through a unique civil registration number. The study sample consisted of 106 cases each matched with two comparison infants. Matching criteria were gestational age (GA) at birth, ROP not registered and born at the same neonatal intensive care unit. Potential 'new' risk factors were analysed in a multivariate logistic regression model, while adjusted for previously recognised risk factors (ie, GA at birth, small for gestational age, multiple birth and male sex). Hospital records of 310 preterm infants (106 treated; 204 comparison infants) were available. Nutrition in terms of energy (kcal/kg/week) and protein (g/kg/week) given to the preterm infants during the first postnatal week were statistically insignificant between the study groups (Mann-Whitney U test; p=0.165/p=0.163). Early postnatal weight gain between the two study groups was borderline significant (t-test; p=0.047). Hyperglycaemic events (indexed value) were statistically significantly different between the two study groups (Mann-Whitney U test; p<0.001). Hyperglycaemia was a statistically independent risk factor (OR: 1.022; 95% CI 1.002 to 1.042; p=0.031). An independent association was found between the occurrence of hyperglycaemic events during the first postnatal week and later development of treatment-demanding ROP, when adjusted for known risk factors. © 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.

  5. Peri-operative cognitive dysfunction and protection

    DEFF Research Database (Denmark)

    Steinmetz, J; Rasmussen, L S


    factors, the predominant one being age. Ignorance of the causes for postoperative cognitive dysfunction contributes to the difficulty of conducting interventional studies. Postoperative cognitive disorders are associated with increased mortality and permanent disability. Peri-operative interventions can......Cognition may decline after surgery. Postoperative delirium, especially when hyperactive, may be easily recognised, whereas cognitive dysfunction is subtle and can only be detected using neuropsychological tests. The causes for these two conditions are largely unknown, although they share risk...

  6. Acute peri-operative beta-blockade in South Africa

    African Journals Online (AJOL)


    This paper considers the effect of physiochemical and/or pharmacokinetic properties on the cardioprotective efficacy of acute peri-operative beta-blockade, indications for peri- operative beta-blockers and economic viability in South. Africa. 1. Is there a preferable peri-operative beta-blocker based on physiochemical and ...

  7. Early postnatal hyperglycaemia is a risk factor for treatment-demanding retinopathy of prematurity

    DEFF Research Database (Denmark)

    Slidsborg, Carina; Jensen, Louise Bering; Rasmussen, Steen Christian


    Background To investigate whether neonatal hyperglycaemia in the first postnatal week is associated with treatment-demanding retinopathy of prematurity (ROP). Methods This is a Danish national, retrospective, case-control study of premature infants (birth period 2003-2006). Three national registers...

  8. Optimization of peri-operative care in colorectal surgery


    Kornmann, V.N.N.


    Colorectal cancer is an important health issue, and colorectal surgery is increasingly being performed. During the last years, quality and safety of care, new surgical techniques and attention for peri-operative risks resulted in reduction of postoperative morbidity and mortality. Despite these improvements, complications still occur. The aim of this thesis was to gain more insight in optimization of peri-operative care in colorectal surgery. Four main subjects were discussed in the presented...

  9. The need for peri-operative supplemental oxygen | Chikungwa ...

    African Journals Online (AJOL)

    The need for peri-operative supplemental oxygen. M. T. Chikungwa, K. Jonsson. Abstract. (Central African Journal of Medicine: 2002 48 (5-6): 72-73). AJOL African Journals Online. HOW TO USE AJOL... for Researchers · for Librarians · for Authors · FAQ's · More about AJOL · AJOL's Partners · Terms and Conditions of Use ...

  10. Prevention of wound sepsis in amputations by peri-operative ...

    African Journals Online (AJOL)

    number of patients presenting with septic complications of lower limb ischaemia. In many instances reconstructive vascular surgery is not feasible and an ablative procedure is the only alternative means of treatment. Because an adequate antimicro- bial agent is needed in the peri-operative period, a new antibiotic ...

  11. Epidural Anaesthesia Reduces Peri-Operative Morbidity and ...

    African Journals Online (AJOL)

    Epidural Anaesthesia Reduces Peri-Operative Morbidity and Mortality in Patients With Significant Cardio-Respiratory Diseases: Report of Five Cases. ... of five patients with multiple co-morbid cardio-respiratory diseases who had surgeries in the presence of severe respiratory and cardiovascular systems compromise.

  12. A systematic review of peri-operative melatonin

    DEFF Research Database (Denmark)

    Andersen, L P H; Werner, M U; Rosenberg, J


    We systematically reviewed randomised controlled trials of peri-operative melatonin. We included 24 studies of 1794 participants that reported eight peri-operative outcomes: anxiety; analgesia; sleep quality; oxidative stress; emergence behaviour; anaesthetic requirements; steal induction......; and safety. Compared with placebo, melatonin reduced the standardised mean difference (95% CI) pre-operative anxiety score by 0.88 (0.44-1.33) and postoperative pain score by 1.06 (0.23-1.88). The magnitude of effect was unreliable due to substantial statistical heterogeneity, with I(2) 87% and 94......%, respectively. Qualitative reviews suggested the melatonin improved sleep quality and emergence behaviour, and might be capable of reducing oxidative stress and anaesthetic requirements....

  13. Lower complication rates for cranioplasty with peri-operative bundle. (United States)

    Le, Catherine; Guppy, Kern H; Axelrod, Yekaterina V; Hawk, Mark W; Silverthorn, James; Inacio, Maria C; Akins, Paul T


    The overall benefits of craniectomy must include procedural risks from cranioplasty. Cranioplasty carries a high risk of surgical site infections (SSI) particularly with antibiotic resistant bacteria. The goal of this study was to measure the effect of a cranioplasty bundle on peri-operative complications. The authors queried a prospective, inpatient neurosurgery database at Kaiser Sacramento Medical Center for craniectomy and cranioplasty over a 7 year period. 57 patients who underwent cranioplasties were identified. A retrospective chart review was completed for complications, including surgical complications such as SSI, wound dehiscence, and re-do cranioplasty. We measured cranioplasty complication rates before and after implementation of a peri-operative bundle, which consisted of peri-operative vancomycin (4 doses), a barrier dressing through post-operative day (POD) 3, and de-colonization of the surgical incision using topical chlorhexidine from POD 4 to 7. The rate of MRSA colonization in cranioplasty patients is three times higher than the average seen on ICU admission screening (19% vs. 6%). The cranioplasty surgical complication rate was 22.8% and SSI rate was 10.5%. The concurrent SSI rate for craniectomy was 1.9%. Organisms isolated were methicillin-resistant Staphylococcus aureus (4), methicillin-sensitive S. aureus (1), Propionibacterium acnes (1), and Escherichia coli (1). Factors associated with SSI were peri-operative vancomycin (68.6% vs. 16.7%, p=0.0217). Complication rates without (n=21) and with (n=36) the bundle were: SSI (23.8% vs. 2.8%, p=0.0217) and redo cranioplasty (19% vs. 0%, p=0.0152). Bundle use did not affect rates for superficial wound dehiscence, seizures, or hydrocephalus. The cranioplasty bundle was associated with reduced SSI rates and the need for re-do cranioplasties. Copyright © 2014 Elsevier B.V. All rights reserved.

  14. Peri-operative glycaemic control regimens for preventing surgical site infections in adults. (United States)

    Kao, Lillian S; Meeks, Derek; Moyer, Virginia A; Lally, Kevin P


    Surgical site infections (SSIs) are associated with significant morbidity, mortality, and resource utilization and are potentially preventable. Peri-operative hyperglycaemia has been associated with increased SSIs and previous recommendations have been to treat glucose levels above 200 mg/dL. However, recent studies have questioned the optimal glycaemic control regimen to prevent SSIs. Whether the benefits of strict or intensive glycaemic control with insulin infusion as compared to conventional management outweigh the risks remains controversial. To summarise the evidence for the impact of glycaemic control in the peri-operative period on the incidence of surgical site infections, hypoglycaemia, level of glycaemic control, all-cause and infection-related mortality, and hospital length of stay and to investigate for differences of effect between different levels of glycaemic control. A search strategy was developed to search the following databases: Cochrane Wounds Group Specialised Register (searched 25 March 2009), The Cochrane Central Register of Controlled Trials, The Cochrane Library 2009, Issue 1; Ovid MEDLINE (1950 to March Week 2 2009); Ovid EMBASE (1980 to 2009 Week 12) and EBSCO CINAHL (1982 to March Week 3 2009). The search was not limited by language or publication status. Randomised controlled trials (RCTs) were eligible for inclusion if they evaluated two (or more) glycaemic control regimens in the peri-operative period (within one week pre-, intra-, and/or post-operative) and reported surgical site infections as an outcome. The standard method for conducting a systematic review in accordance with the Cochrane Wounds Group was used. Two review authors independently reviewed the results from the database searches and identified relevant studies. Two review authors extracted study data and outcomes from each study and reviewed each study for methodological quality. Any disagreement was resolved by discussion or by referral to a third review author. Five

  15. Current Thinking In Pediatric Peri-operative Fluid Therapy

    Directory of Open Access Journals (Sweden)

    Rajesh MC


    Full Text Available Proper perioperative fluid management is critical to maintain cardiovascular stability and adequate tissue perfusion. The volume and composition of fluid should be adapting to the physiology of the child and compensating for the peri-operative events. Traditionally physicians were calculating pediatric maintenance fluid requirements based on studies conducted on healthy children more than 50 years ago by Holliday and Segar. But a search of literature failed to reveal a relevant prospective study critically evaluating the content and volume of Holliday and Segar prescription. But off late there has been a major debate and re-evaluation about this concept because of serious concerns regarding development of hyponatremia and hyperglycemia. This can result in serious neurological damage or even death in a sick child. This brief review is an attempt to explain how the original concept was formed and what is the current thinking?

  16. The peri-operative cytokine response in infants and young children following major surgery

    DEFF Research Database (Denmark)

    Hansen, Tom Giedsing; Tønnesen, Else Kirstine; Andersen, J B


    The peri-operative cytokine response was studied in 13 infants and young children undergoing major surgery. All children were anaesthetized with a combined general and epidural anaesthetic technique, followed by post-operative epidural analgesia with bupivacaine and fentanyl. Blood samples were...... taken before and after surgery, 24 h post-operatively, and finally, when the children were mobilized and had regained gastrointestinal function. Plasma samples were analysed for tumour necrosis factor-alpha, interleukin-1 alpha, interleukin-1 beta, interleukin-6, interferon-gamma, interleukin-10...... and the interleukin-1 receptor antagonist. The cytokine responses were highly variable. Overall, no significant changes between pre- and post-operative plasma concentrations were found. Tumour necrosis factor-alpha and the interleukin-1 receptor antagonist were detectable in all children, and a trend towards an early...

  17. Peri-operative care for patients undergoing lymphaticovenular anastomosis: A systematic review

    NARCIS (Netherlands)

    Winters, H.; Tielemans, H.J.P.; Sprangers, P.N.; Ulrich, D.J.O.


    BACKGROUND: Lymphaticovenular anastomosis (LVA) is a supermicrosurgical procedure that involves the anastomosis of a functional lymphatic channel to a venule. Although peri-operative care might be an important contributor to the success of this technique, evidence about optimal peri-operative care

  18. The pharmaco-economics of peri-operative beta-blocker and statin ...

    African Journals Online (AJOL)

    We conducted a pharmaco-economic analysis of the prospective peri-operative studies of beta-blocker and statin administration for major elective non-cardiac surgery, using the Discovery Health claims costs for 2004. This analysis shows that acute peri-operative beta-blockade and statin therapy could result in a cost ...

  19. Pulsed-dose-rate peri-operative brachytherapy as an interstitial boost in organ-sparing treatment of breast cancer

    Directory of Open Access Journals (Sweden)

    Krystyna Serkies


    Full Text Available Purpose : To evaluate peri-operative multicatheter interstitial pulsed-dose-rate brachytherapy (PDR-BT with an intra-operative catheter placement to boost the tumor excision site in breast cancer patients treated conservatively. Material and methods: Between May 2002 and October 2008, 96 consecutive T1-3N0-2M0 breast cancer patients underwent breast-conserving therapy (BCT including peri-operative PDR-BT boost, followed by whole breast external beam radiotherapy (WBRT. The BT dose of 15 Gy (1 Gy/pulse/h was given on the following day after surgery. Results: No increased bleeding or delayed wound healing related to the implants were observed. The only side effects included one case of temporary peri-operative breast infection and 3 cases of fat necrosis, both early and late. In 11 patients (11.4%, subsequent WBRT was omitted owing to the final pathology findings. These included eight patients who underwent mastectomy due to multiple adverse prognostic pathological features, one case of lobular carcinoma in situ, and two cases with no malignant tumor. With a median follow-up of 12 years (range: 7-14 years, among 85 patients who completed BCT, there was one ipsilateral breast tumor and one locoregional nodal recurrence. Six patients developed distant metastases and one was diagnosed with angiosarcoma within irradiated breast. The actuarial 5- and 10-year disease free survival was 90% (95% CI: 84-96% and 87% (95% CI: 80-94%, respectively, for the patients with invasive breast cancer, and 91% (95% CI: 84-97% and 89% (95% CI: 82-96%, respectively, for patients who completed BCT. Good cosmetic outcome by self-assessment was achieved in 58 out of 64 (91% evaluable patients. Conclusions : Peri-operative PDR-BT boost with intra-operative tube placement followed by EBRT is feasible and devoid of considerable toxicity, and provides excellent long-term local control. However, this strategy necessitates careful patient selection and histological confirmation

  20. Rebound hyperglycaemia in diabetic cats. (United States)

    Roomp, Kirsten; Rand, Jacquie


    Rebound hyperglycaemia (also termed Somogyi effect) is defined as hyperglycaemia caused by the release of counter-regulatory hormones in response to insulin-induced hypoglycaemia, and is widely believed to be common in diabetic cats. However, studies in human diabetic patients over the past quarter century have rejected the common occurrence of this phenomenon. Therefore, we evaluated the occurrence and prevalence of rebound hyperglycaemia in diabetic cats. In a retrospective study, 10,767 blood glucose curves of 55 cats treated with glargine using an intensive blood glucose regulation protocol with a median of five blood glucose measurements per day were evaluated for evidence of rebound hyperglycaemic events, defined in two different ways (with and without an insulin resistance component). While biochemical hypoglycaemia occurred frequently, blood glucose curves consistent with rebound hyperglycaemia with insulin resistance was confined to four single events in four different cats. In 14/55 cats (25%), a median of 1.5% (range 0.32-7.7%) of blood glucose curves were consistent with rebound hyperglycaemia without an insulin resistance component; this represented 0.42% of blood glucose curves in both affected and unaffected cats. We conclude that despite the frequent occurrence of biochemical hypoglycaemia, rebound hyperglycaemia is rare in cats treated with glargine on a protocol aimed at tight glycaemic control. For glargine-treated cats, insulin dose should not be reduced when there is hyperglycaemia in the absence of biochemical or clinical evidence of hypoglycaemia. © ISFM and AAFP 2015.

  1. International consensus statement on the peri-operative management of anaemia and iron deficiency

    DEFF Research Database (Denmark)

    Muñoz, M.; Acheson, A. G.; Auerbach, M.


    Despite current recommendations on the management of pre-operative anaemia, there is no pragmatic guidance for the diagnosis and management of anaemia and iron deficiency in surgical patients. A number of experienced researchers and clinicians took part in an expert workshop and developed...... in the peri-operative period. These statements include: a diagnostic approach for anaemia and iron deficiency in surgical patients; identification of patients appropriate for treatment; and advice on practical management and follow-up. We urge anaesthetists and peri-operative physicians to embrace...... these recommendations, and hospital administrators to enable implementation of these concepts by allocating adequate resources....

  2. Peri-operative allogeneic blood transfusion and outcomes after radical cystectomy: a population-based study. (United States)

    Siemens, D Robert; Jaeger, Melanie T; Wei, Xuejiao; Vera-Badillo, Francisco; Booth, Christopher M


    To describe factors associated with peri-operative blood transfusion (PBT) at radical cystectomy (RC) for patients with bladder cancer and evaluate its association on both early and late outcomes. Electronic records of treatment and surgical pathology reports were linked to the population-based Ontario Cancer Registry to identify all patients who underwent RC between 2000 and 2008. Modified Poisson regression model was used to determine the factors associated with PBT. A Cox-proportional hazards regression model was used to explore the association between PBT and overall (OS) and cancer-specific (CSS) survival. Among 2593 patients identified, 62% received an allogeneic red blood cell transfusion. The frequency of PBT decreased over the study period (from 68 to 54%, p < 0.001). Factors associated with PBT included age, sex, greater co-morbidity, stage, and surgeon volume. PBT was associated with inferior outcomes, including median length of stay (11 vs. 9 days, p < 0.001), 90-day re-admission rate (38 vs. 29%, p < 0.001), and mortality (11 vs. 4%, p < 0.001). OS and CSS at 5 years were lower among patients with PBT on multivariate analysis (OS HR 1.33, 95% CI 1.20-1.48; CSS HR 1.39, 95% CI 1.23-1.56). Although rates are decreasing, these data suggest a very high utilization rate of PBT at time of RC in routine clinical practice. PBT is associated with substantially worse early outcomes and long-term survival. This association persists despite adjustment for disease-, patient-, and provider-related factors, suggesting that PBT is an important indicator of surgical care of RC.

  3. [Hyperglycaemia and Acute Coronary Syndrome]. (United States)

    Grembiale, A; Cloro, C; Iorio, F; Cufone, S; Succurro, E; Arturi, F


    Hyperglycaemia in patients with Acute Coronary Syndrome (ACS)is common, and is an independent predictor of mortality and morbidity in patients both with and without diabetes mellitus. Hyperglycaemia may be a marker of pre-existing diabetes or glucose intolerance or may also represent a transient stress response mediated through the autonomic nervous system with release of adrenal corticosteroids and catecholamines. Several evidences suggest that an intensive control of hyperglycaemia results in a significant improvement of the adverse outcomes in the short and long term. In fact, an intensive metabolic treatment can counteract the negative effects of hyperglycaemia. However, the main difficulty to intensive glucose control in patients with ACS remains hypoglycaemia that is associated with an increased risk of mortality and myocardial re-infarction. No definitive data are available about the beneficial effects of insulin intensive treatment. Therefore, randomized multicenter clinical trials will be needed to definitively establish whether intensive glucose control will reduce the associated increased mortality rate and higher rates of complications in hospitalized ACS patients with hyperglycaemia.

  4. A review of the peri-operative management of paediatric burns ...

    African Journals Online (AJOL)

    Reasons include peri-operative sepsis, bleeding, issues around thermoregulation, the hypermetabolic state, nutritional and electrolyte issues, inhalation injuries and the amount of movement during procedures to wash patients, change drapes and access different anatomical sites. The appropriate execution of surgery is ...

  5. Obstructive sleep apnoea in adults: peri-operative considerations: A narrative review. (United States)

    Roesslein, Martin; Chung, Frances


    : Obstructive sleep apnoea (OSA) is a common breathing disorder of sleep with a prevalence increasing in parallel with the worldwide rise in obesity. Alterations in sleep duration and architecture, hypersomnolence, abnormal gas exchange and also associated comorbidities may all feature in affected patients.The peri-operative period poses a special challenge for surgical patients with OSA who are often undiagnosed, and are at an increased risk for complications including pulmonary and cardiovascular, during that time. In order to ensure the best peri-operative management, anaesthetists caring for these patients should have a thorough understanding of the disorder, and be aware of the individual's peri-operative risk constellation, which depends on the severity and phenotype of OSA, the invasiveness of the surgical procedure, anaesthesia and also the requirement for postoperative opioids.The objective of this review is to educate clinicians in the epidemiology, pathogenesis and diagnosis of OSA in adults and also to highlight specific tasks in the preoperative assessment, namely to select a suitable intra-operative anaesthesia regimen, and manage the extent and duration of postoperative care to facilitate the best peri-operative outcome.

  6. Peri-operative care in adults with congenital heart disease : Room for improvement in after care

    NARCIS (Netherlands)

    Schoormans, D.; Smets, E.M.A.; Zwart, R.; Sprangers, M.A.G.; Veelenturg, T.H.; de Mol, B.A.; Hazekamp, M.G.; Koolbergen, D.R.; Sojak, V.; Bouma, B.J.; Groenink, M.; Boekholdt, M.S.; Backx, A.P.; Mulder, B.J.


    Patient satisfaction with care has received little attention within the field of congenital heart disease. Our objective was to examine patient satisfaction with the care received when undergoing open-heart surgery in order to identify the best and worst aspects of peri-operative care. Moreover, we

  7. Peri-operative care in adults with congenital heart disease: room for improvement in after care

    NARCIS (Netherlands)

    Schoormans, Dounya; Smets, Ellen M. A.; Zwart, Ronald; Sprangers, Mirjam A. G.; Veelenturg, Tonny H. M.; de Mol, Bas A. J. M.; Hazekamp, Mark G.; Koolbergen, Dave R.; Sojak, Vladimir; Bouma, Berto J.; Groenink, Maarten; Boekholdt, Matthijs S. M.; Backx, Ad P. C. M.; Mulder, Barbara J. M.


    Patient satisfaction with care has received little attention within the field of congenital heart disease. Our objective was to examine patient satisfaction with the care received when undergoing open-heart surgery in order to identify the best and worst aspects of peri-operative care. Moreover, we

  8. Peri-operative blood glucose management in general surgery - a potential element for improved diabetic patient outcomes - an observational cohort study. (United States)

    McCavert, M; Mone, F; Dooher, M; Brown, R; O'Donnell, M E


    Hyperglycaemia impairs many of the physiological processes involved in recovery from surgery but there is limited research on the effect of optimal peri-operative glucose control in diabetic general surgery patients. The objectives of this study were to assess blood glucose management in diabetic general surgical patients and to determine if protocol deviations were associated with adverse outcomes. All diabetic patients undergoing elective and emergency general surgical procedures between August 2007 and July 2008 were included in the study. The hospital protocol for peri-operative blood glucose control was based on the Alberti Regimen. Data was collected regarding blood glucose measurements, adherence to protocol and complications following surgery. A total of 69 adult patients (M = 44, F = 25; median age 61, range 15-93 years; T1DM = 35, T2DM = 34) were included. 38 patients underwent elective surgery (cholecystectomy, hernia repair, varicose vein surgery) and 31 underwent emergency surgical procedures (laparotomy, incision and drainage of abscess). 10.3% of capillary blood glucose readings were less than 6.1 mmol/l, 32.8% were between 6.1 and 10.0 mmol/l, 44.6% were greater than 10.0 mmol/l 12.3% of scheduled blood glucose measurements were not completed. An insulin-dextrose infusion was indicated in 30 patients, of which 14 (46.7%) were treated according to protocol. In the 16 protocol-deviation cases, insulin was generally either administered according to a sliding scale (6 patients) or not at all during their time on the ward. While an insulin-dextrose infusion was not indicated in 39 patients, 14 (35.9%) of these patients were inappropriately given insulin either as an infusion (8 patients) or according to a sliding scale (6 patients). Overall, only 39 (56.5%) patients were treated according to protocol. The overall complication rate was 29%, which included 7 out of 39 (17.9%) and 13 out of 30 (43.3%) protocol-based and protocol

  9. The history of stress hyperglycaemia. (United States)

    Balasanthiran, A; Shotliff, K


    Stress hyperglycaemia, is a common phenomenon, frequently associated with adverse outcomes in a number of prevalent conditions including myocardial infarction and stroke. Knowledge on stress hyperglycaemia evolved in tandem with knowledge relating to homeostasis, stress and disease and involved some of the world's most eminent thinkers. Despite this, it still remains under-recognised. This paper illustrates significant points in the history of stress hyperglycaemia, from antiquity through to the present day, as well as the challenges faced in translating research into clinical benefit for patients. Profiles of significant protagonists including Claude Bernard, Walter Cannon and Hans Seyle are presented, as well their roles in the emergence of modern-day terminology and pathophysiological models. Major themes such as 'fight or flight' and homeostasis are central to this discussion. Closer to the present day, the role of stress hyperglycaemia in a number of common medical conditions is explored in more detail. Contention around evidence for treatment and the future risk of diabetes mellitus are also discussed.

  10. In response to: Metformin for the Management of Peri-operative Hyperglycemia

    NARCIS (Netherlands)

    Hulst, A. H.; Hermanides, J.; DeVries, J. H.; Preckel, B.


    We thank Dr Brown and Dr Paul for their insightful commentary on our study(1) and the subject of perioperative continuation of metformin, stressing again the importance of perioperative hyperglycaemia and treatment of diabetes mellitus (DM)

  11. A stroke mimic: hemichorea Associated with non-ketotic hyperglycaemia

    DEFF Research Database (Denmark)

    Hald, Stine Munk; Krone, Willy; Minhas, Zahid Abbas


    , and antidiabetic and symptomatic treatment was initiated. The symptoms remitted completely after six days, and a follow-up CTC showed partial resolution of the striatal changes. This case illustrates the importance of considering if hyperglycaemia is the cause of hemichorea, as early diagnosis and treatment yield...... an excellent prognosis....

  12. Does training of fellows affect peri-operative outcomes of robot-assisted partial nephrectomy? (United States)

    Khene, Zine-Eddine; Peyronnet, Benoit; Bosquet, Elise; Pradère, Benjamin; Robert, Corentin; Fardoun, Tarek; Kammerer-Jacquet, Solène-Florence; Verhoest, Grégory; Rioux-Leclercq, Nathalie; Mathieu, Romain; Bensalah, Karim


    To evaluate the impact of fellows' involvement on the peri-operative outcomes of robot-assisted partial nephrectomy (RAPN). We analysed 216 patients who underwent RAPN for a small renal tumour. We stratified our cohort into two groups according to the involvement of a fellow surgeon during the procedure: expert surgeon operating alone (expert group) and fellow operating under the supervision of the expert surgeon (fellow group). Peri-operative data were compared between the two groups. Linear and logistic regression analyses were performed to assess the impact of fellows' involvement on peri-operative and postoperative outcomes. Trifecta and margins ischaemia complications (MIC) score achievement rates were used to assess the quality of surgery in both the expert and fellow groups. Trifecta was defined as a combination of warm ischaemia time <25 min, negative surgical margins and no peri-operative complications. MIC score was defined as negative surgical margins, ischaemia time <20 min, and absence of complications grade ≥3. Fellows were involved in a total of 89 procedures (41%). Patients' characteristics were similar in the two groups. Operating time and warm ischaemia time (WIT) were longer in the fellow group (180 vs 120 min, P < 0.001, and 18 vs 14 min, P = 0.002, respectively). Length of hospital stay (LOS) was longer in the fellow group (5 vs 4.3 days; P = 0.05) and patients in this group had higher estimated blood loss (EBL; 400 vs 300 mL; P = 0.01), but this had no impact on transfusion rate (14% vs 11%; P = 0.43). Positive surgical margin rates were similar in the fellow and expert groups (2.2% vs 3.1%; P = 0.70). Major complications were more frequent in the fellow group (12.3% vs 6.3%), but the difference was not significant (P = 0.10). In multivariable analysis, fellow involvement was predictive of longer WIT (β = 0.22; P = 0.003) and operating time (β = 0.49; P < 0.001), but was not associated with EBL (β = 0.12, P = 0.09) or LOS (β = 0.12, P

  13. Lipid profile, hyperglycaemia, systemic inflammation and ...

    African Journals Online (AJOL)

    Lipid profile, hyperglycaemia, systemic inflammation and anthropometry as cardiovascular risk factors and their association with dietary intakes in children from rural Cofimvaba, Eastern Cape, South Africa.

  14. The Peri-operative Bariatric Surgery Care in the Middle East Region. (United States)

    Nimeri, Abdelrahman; Al Hadad, Mohammed; Khoursheed, Mousa; Maasher, Ahmed; Al Qahtani, Aayed; Al Shaban, Talat; Fawal, Hayssam; Safadi, Bassem; Alderazi, Amer; Abdalla, Emad; Bashir, Ahmad


    Bariatric surgery is common in the Middle East region. However, regional accreditation bodies and guidelines are lacking. We present the current peri-operative practice of bariatric surgery in the Middle East region. Public and private practice in the Middle East region. A questionnaire was designed to study trends of peri-operative care in bariatric surgery. It was sent to members of the Pan Arab Society for Metabolic and Bariatric Surgery (PASMBS). Ninety-three surgeons (88.6%) responded, 63.4% were in private practice, 68.5% have been in practice for more than 5 years, and 61.1% performed more than 125 cases per year. Laparoscopic sleeve gastrectomy (LSG) was the commonest procedure performed, then laparoscopic Roux-en-Y gastric bypass (LRYGB), one anastomosis gastric bypass/mini gastric bypass (OAGB/MGB), and laparoscopic adjustable gastric banding (LAGB). Pre-operatively as a routine, 65% referred patients for dietitian and (78.3%) for smoking cessation. In contrast as a routine, 22.6% referred patients to a psychologist, 30% screened for obstructive sleep apnea (OSA), and when they did, they did not use a questionnaire. For patients 50 years of age, 22% performed a screening colonoscopy and 33.7% referred patients to a cardiologist. Intra-operatively as a routine, 25.3% placed a drain and 42.2% placed urinary catheters. In contrast, 77.1% performed a leak test (82.7% as a methylene blue leak test). Post-operatively, 79.5% used chemoprophylaxis for venous thromboembolism and 89% required patients to take vitamins. In contrast, 25% prescribed ursodeoxycholic acid. The wide variation in the peri-operative care of bariatric surgery in the Middle East region highlights the need for regional guidelines based on international guidelines.

  15. Insulin injection guidelines for peri-operative and critically ill patients

    Directory of Open Access Journals (Sweden)

    Sukhminder Jit Singh Bajwa


    Full Text Available Anesthesiologists and intensivists are encountering increasing number of diabetic patients in daily clinical practice. Majority of such patients may require insulin injections for control of hyperglycemia. Advancements in diabetes management have led to usage of newer insulin injections ranging from human insulin and insulin analogs to glucagon-like peptides-1 analogs. The adequacy of glycemic control and successful outcome with such therapeutic interventions depends upon the adoption of correct injection techniques and procedures. Peri-operative and critically ill diabetic patients are highly prone to develop acute complications of diabetes if appropriate therapeutic strategies are not formulated and implemented. As such, the in-depth knowledge and awareness about various injection technique guidelines is essential from the patient care and healthcare provider′s perspective in the operative and critical care settings. This description is an abridged version of the Forum for Injection Techniques, India: The first Indian recommendations for best practice in insulin injection technique and their significance in peri-operative period and critically ill patients in intensive care units (ICU. These insulin injection techniques are based on evidence-based recommendations and are meant to improve the management of diabetes by the attending staff and physicians in operative and critical care arenas.

  16. [Recommendations for the peri-operative management of bariatric surgery patients: results of a national survey]. (United States)

    Ortega, Joaquin; Cassinello, Norberto; Baltasar, Aniceto; Torres, Antonio J


    To standardise possible peri-operative bariatric surgery protocols, a survey was prepared to be filled in by members of the Spanish Society for Obesity (Sociedad Española de Cirugía de la Obesidad) (SECO), and to approve it at the XII National Congress. A total of 47 members of SECO from 14 autonomous communities responded, and it unanimously approved by the Congress. As highly recommended peri-operative procedures, were proposed: full laboratory analysis (98%) with an endocrine study (90%), ECG (96%), chest x-ray (98%), an oesophageal-gastric imaging test (endoscopy or gastro-duodenal transit study (98%), antibiotic prophylaxis (92%) and use of low molecular weight heparins pre-operatively (96%), and for 2 weeks (83%). Pre-surgical, abdominal ultrasound (86%), spirometry (80%), diet (88%) and psychological study (76%), and during surgery, use of elastic stockings (76%), leak tests (92%) and drainages (90%), were established as advisable procedures. Copyright © 2011 AEC. Published by Elsevier Espana. All rights reserved.

  17. Monitoring of peri-operative fluid administration by individualized goal-directed therapy

    DEFF Research Database (Denmark)

    Bundgaard-Nielsen, M; Holte, Kathrine; Secher, N H


    (n = 725) found a reduced hospital stay. Post-operative nausea and vomiting (PONV) and ileus were reduced in three studies and complications were reduced in four studies. Of the monitors that may be applied for goal-directed therapy, only oesophageal Doppler has been tested adequately; however...... referenced from these papers. Furthermore, methods applied in these studies and other monitors with a potential for goal-directed therapy are described. RESULTS: Nine studies were identified pertaining to fluid optimization during the intra- and post-operative period with goal-directed therapy. Seven studies......BACKGROUND: In order to avoid peri-operative hypovolaemia or fluid overload, goal-directed therapy with individual maximization of flow-related haemodynamic parameters has been introduced. The objectives of this review are to update research in the area, evaluate the effects on outcome and assess...

  18. Intensification of anxiety and depression, and personal resources among women during the peri-operative period

    Directory of Open Access Journals (Sweden)

    Magdalena Lewicka


    Full Text Available Aim. Surgical treatment of women due to gynaecological disorders is the cause of stress and may lead to psychological changes. Studies concerning human response to stress emphasize the importance of the effect of the level of the sense of coherence, anxiety, depression, dispositional optimism and skills of expressing emotions on the quality of feelings and experiences in difficult situations. Materials and methods. The study covered 232 women who had undergone gynaecological surgery due to various causes. Permission to conduct the research was obtained from the Bioethical Commission at the Medical University in Lublin. The study was carried out with the use of the State-Trait Anxiety Inventory (STAI, the Beck Depression Inventory, Courtauld Emotional Control Scale (CECS, and Life Orientation Test – Revised (LOT-R. Results and conclusions. The study showed that investigations of the sense of coherence, level of anxiety and depression, and personal resources allow determination of the characteristics of patients who should be covered with special psychoprophylactic care during the peri-operative period. In addition, the results of own studies obtained may be used for the development of adequate principles of psycho-prophylactic management in the course of the diagnostic-treatment proces with respect to women who had undergone surgical treatment due to gynaecological disorders.

  19. Nutrition for the pediatric surgical patient: approach in the peri-operative period

    Directory of Open Access Journals (Sweden)

    Falcão Mário Cícero


    Full Text Available Nutrition is essential for maintenance of physiologic homeostasis and growth. Hypermetabolic states lead to a depletion of body stores, with decreased immunocompetence and increased morbidity and mortality. The purpose of this paper is to provide an update regarding the provision of appropriate nutrition for the pediatric surgical patient, emphasizing the preoperative and postoperative periods. Modern nutritional support for the surgical patient comprises numerous stages, including assessment of nutritional status, nutritional requirements, and nutritional therapy. Nutritional assessment is performed utilizing the clinical history, clinical examination, anthropometry, and biochemical evaluation. Anthropometric parameters include body weight, height, arm and head circumference, and skinfold thickness measurements. The biochemical evaluation is conducted using determinations of plasma levels of proteins, including album, pre-albumin, transferrin, and retinol-binding protein. These parameters are subject to error and are influenced by the rapid changes in body composition in the peri-operative period. Nutritional therapy includes enteral and/or parenteral nutrition. Enteral feeding is the first choice for nutritional therapy. If enteral feeding is not indicated, parenteral nutrition must be utilized. In all cases, an individualized, adequate diet (enteral formula or parenteral solution is obligatory to decrease the occurrence of overfeeding and its undesirable consequences.

  20. [The importance of Dysphagia management during the peri-operative period to home elderly care]. (United States)

    Doi, Seiko; Iwai, Akiko; Mito, Saori; Utsumi, Tsukasa; Shinoki, Keiji; Nakashita, Chisako; Hata, Akiko; Ibata, Takeshi; Komuro, Ryutaro; Iijima, Andshohei


    Dysphagia is usually a major problem for the elderly to go home after a surgical treatment for the bone fracture of the thigh bone cervix or trochanter part in the leg. We analyzed each clinical course with regard to a change of the oral intake and the nutritional status, the activity of daily living(ADL)and a nutritional management and the place after the patient was discharged. According to our results, about 20% of the patients among those surgical cases were pointed with dysphagia, and there were many cases that ADL was ultimately gotten worse. We took care of disphagia by doing a best practice of changing in feedings and deglutition function. However, some of the patients with the problem finally moved to another elderly health care institute against their primary wishes to go home. Furthermore, 55% of the disphagia patients became dementia. It seems that dementia might be a high risk factor of disphagia. We should do more better job for managing disphargia during a peri-operative period just after admission.

  1. lipid profile, hyperglycaemia, systemic inflammation and ...

    African Journals Online (AJOL)


    Lipid profile, hyperglycaemia, systemic inflammation and anthropometry as cardiovascular risk factors and their association with dietary .... Training included sessions on ethical and general research philosophies applicable to ... the training sessions whereby the fieldworkers had to interview and complete multiple 24-hour.

  2. Patterns in current anaesthesiological peri-operative practice for colonic resections: a survey in five northern-European countries

    DEFF Research Database (Denmark)

    Hannemann, P; Lassen, K; Hausel, J


    -acting anaesthetic medication may be beneficial. We examined whether these strategies have been adopted in five northern-European countries. METHODS: In 2003, a questionnaire concerning peri-operative anaesthetic routines in elective, open colonic cancer resection was sent to the chief anaesthesiologist in 258......-operative fasting, thoracic epidurals and short-acting anaesthetics. However, premedication with longer-acting agents is still common. Avoidance of fluid overload has not yet found its way into daily practice. This may leave patients undergoing elective colonic surgery at risk of oversedation and excessive fluid...

  3. Peri-operative blood transfusion for resected colon cancer: Practice patterns and outcomes in a population-based study. (United States)

    Patel, Sunil V; Brennan, Kelly E; Nanji, Sulaiman; Karim, Safiya; Merchant, Shaila; Booth, Christopher M


    Literature suggests that peri-operative blood transfusion among patients with resected colon cancer may be associated with inferior long-term survival. The study objective was to characterize this association in our population. This is a retrospective cohort study using the population-based Ontario Cancer Registry (2002-2008). Pathology reports were obtained for a 25% random sample of all cases and constituted the study population. Log binomial regression was used to identify factors associated with transfusion. Cox proportional hazards model explored the association between transfusion and cancer specific survival (CSS) and overall survival (OS). The study population included 7198 patients: 18% stage I, 36% stage II, 40% stage III, and 6% stage IV. Twenty-eight percent of patients were transfused. Factors independently associated with transfusion included advanced age (pTransfusion was associated with inferior CSS (HR 1.51, 95% CI 1.38-1.65) and OS (HR 1.52, 95% CI 1.41-1.63), after adjusting for important confounders. Peri-operative transfusion rates among patients with colon cancer have decreased over time. Transfusion is associated with inferior long-term CSS and OS. Copyright © 2017 Elsevier Ltd. All rights reserved.

  4. Effect of different anesthesia methods on plasma neuropeptides levels during the peri-operative period in surgical patients with hypertension

    International Nuclear Information System (INIS)

    Li Hong; He Haomin; Tian Xiaoping


    Objective: To explore the effect of different anesthesia methods on the levels of plasma neuropeptides during the peri-operative period in patients with hypertension. Methods: Ninety hypertensive patients undergoing upper abdominal operations were randomly allocated to equal divided epidural anesthesia, general anesthesia and combined Groups. Plasma neuropeptide Y(NPY) concentrations were measured before anesthesia, at 15 min after anesthesia, 20 min after operation and 10 min after completion of the operation. Results: BP, HR and NPY were significantly changed in both E group and G group after anesthesia and operation (compared vs before anesthesia, p<0.01). BP, HR and NPY were significantly changed in C group after operation compared with those in both E and G group (p<0.05) . Conclusion: The combined anesthesia method is effective in inhibits the stress response during upper abdominal operation in the hypertensive patients

  5. Transient neonatal diabetes or neonatal hyperglycaemia: A case ...

    African Journals Online (AJOL)

    Transient neonatal diabetes and neonatal hyperglycaemia both present in the neonatal period with features of hyperglycaemia, dehydration and weight loss. Differentiating these conditions clinically is difficult. We describe the case of a 13 day old female whom we managed recently who could have had either condition.

  6. Five-year experience with the peri-operative goal directed management for surgical repair of traumatic aortic injury in the eastern province, Saudi Arabia

    Directory of Open Access Journals (Sweden)

    Haytham Z Al-Gameel


    Full Text Available Context: Traumatic aortic injury (TAI accounts for 1/3 of all trauma victims. Aim: We aimed to investigate the efficacy of the adopted standardized immediate pre-operative and intra-operative hemodynamic goal directed control, anesthetic technique and organs protection on the morbidity and mortality in patients presented with TAI. Settings and Design: An observational retrospective study at a single university teaching hospital. Materials and Methods: Following ethical approval, we recruited the data of 44 patients admitted to the King Fahd Hospital of the University, Al Khobar, Saudi Arabia, with formal confirmation of diagnosis of blunt TAI during a 5-year period from February 2008 to April 2013 from the hospital medical records. Statistical Analysis: descriptive analysis. Results: A total of 44 victims (41 men, median (range age 29 (22-34 years with TAI who underwent surgical repair were recruited. Median (range post-operative chest tube output was 700 (200-1100 ml necessitated transfusion in 5 (11.4% of cases. Post-operative complications included transient renal failure (13.6%, pneumonia (6.8%, acute lung injury/distress syndrome (20.5%, sepsis (4.5%, wound infection (47.7% and air leak (6.8%. No patient developed end stage renal failure or spinal cord injury. Median intensive care unit stay was 6 (4-30 days and in-hospital mortality was 9.1%. Conclusion: We found that the implementation of a standardized early goal directed hemodynamic control for the peri-operative management of patients with TAI reduces the post-operative morbidity and mortality after surgical repair.

  7. Use of peri-operative anti-epileptic drugs in patients with newly diagnosed high grade malignant glioma: a single center experience. (United States)

    Lwu, Shelly; Hamilton, Mark G; Forsyth, Peter A; Cairncross, J Gregory; Parney, Ian F


    An American Academy of Neurology practice parameter recommends that long-term prophylactic anti-epileptic drugs (AED) should not be routine in patients with newly diagnosed brain tumors. However, prospective multi-center North American data shows that most newly diagnosed glioma patients receive prophylactic AED. We examined our own peri-operative AED practice patterns in newly-diagnosed patients with malignant glioma to determine if we deviate from published guidelines. A retrospective chart review was performed in adult patients with newly diagnosed malignant gliomas undergoing surgery in southern Alberta between January 2003 and December 2005. Demographic information, AED use, seizure incidence, adverse effects, tumor size, and tumor location were recorded. Of 164 eligible patients, 54 (33%) presented with seizures and all received AED. Prophylactic AED were given to 44 patients (27%). Peri-operative seizures (within 1 week) occurred in two patients without (3%) and no patients with seizure prophylaxis. Adverse AED reactions and adverse effects attributable to seizures were both rare. Prophylactic AED were continued >1 week post-op in 30 patients (18%). Patients receiving prophylactic AED were more likely to have had tumors involving the temporal lobe than those who did not (50 vs. 20%; P < 0.01). Patients receiving peri-operative AED prophylaxis were common, had a trend to reduced peri-operative seizures, and had few adverse effects. However, most of these patients were maintained on prophylactic AED continued beyond the first peri-operative week, contradicting published guidelines. Increased awareness of practice guidelines may help modify AED prescription patterns in malignant glioma patients.

  8. Determinants of peri-operative blood transfusion in a contemporary series of open prostatectomy for benign prostate hyperplasia. (United States)

    Kyei, Mathew Y; Klufio, George O; Mensah, James E; Gepi-Attee, Samuel; Ampadu, Kwabena; Toboh, Bernard; Yeboah, Edward D


    The objective of this study was to determine the factors responsible for peri-operative blood transfusion in a contemporary series of open prostatectomy for benign prostate hyperplasia and thus offer a guide for blood product management for the procedure. This was a prospective study of 200 consecutive patients who underwent open prostatectomy for BPH from January 2010 to September 2013 at the Korle Bu Teaching Hospital, Accra. The data analyzed included the pre-operative blood haemoglobin level (Hb), presence of co-morbidities, the case type, indication for the surgery, ASA score, anaesthetic method used, systolic blood pressure, status of the operating surgeon, duration of surgery and the operative prostate weight. The transfusion of blood peri-operatively was also documented. The mean age of the patients was 69.1 years. Elective cases formed 83.5 % with refractory retention of urine being the commonest indication for surgery (68.0 %). The mean pre-operative Hb was 12.1 g/dl. Consultants performed 56.0 % of the prostatectomies. Transvesical approach was used in 90.0 % of the cases. The mean operative time was 101.3mins (range 35.0-240.0) with a mean operative prostate weight of 110.8 g (range 15-550 g). Most of the patients (82.0 %) had spinal anaesthesia. The blood transfusion rate was 23.5 %. The transfusion rate was significantly higher in patients with anaemia (p = .000), emergency cases (p = .000), the use of general anaesthesia (p = .002), a resident as the operating surgeons (p = .034), prostate weight >100 g (p = .000) and duration of surgery (p = .011). In a multivariable logistic regression analysis however only the pre-operative Hb (p = .000. OR 0.95, 95 % CI [0.035-0.257]) and the duration of surgery (p = .025, OR 1.021, 95 % CI [1.003-1.039]) could predict blood transfusion in open prostatectomy for BPH in this series. A 'group and save' policy should be the preferred blood ordering procedure for patients

  9. Influence of Peri-Operative Hypothermia on Surgical Site Infection in Prolonged Gastroenterological Surgery. (United States)

    Tsuchida, Toshie; Takesue, Yoshio; Ichiki, Kaoru; Uede, Takashi; Nakajima, Kazuhiko; Ikeuchi, Hiroki; Uchino, Motoi


    There have been several recent studies on the correlation between intra-operative hypothermia and the occurrence of surgical site infection (SSI). Differences in the depth and timing of hypothermia and the surgical procedure may have led to conflicting results. Patients undergoing gastroenterologic surgery with a duration of >3 h were analyzed. Hypothermia was defined as a core temperature <36°C and was classified as mild (35.5-35.9°C), moderate (35.0-35.4°C), or severe (<35.0°C). Hypothermia also was classified as early-nadir (<36°C within two h of anesthesia induction) and late-nadir (after that time). Risk factors for SSIs were analyzed according to these classifications. Among 1,409 patients, 528 (37.5%) had hypothermia, which was classified as mild in 358, moderate in 137, and severe in 33. Early-nadir and late-nadir hypothermia was found in 23.7% and 13.8%, respectively. There was no significant difference in the incidence of SSIs between patients with and without hypothermia (relative risk 1.00; 95% confidence interval [CI] 0.80-1.25; p = 0.997). However, there was a significantly greater incidence of SSIs in patients with severe hypothermia (33.3%) than in those with normothermia (19.2%; p = 0.045) or mild hypothermia (17.0%; p = 0.021). The incidence of SSIs also was significantly greater in patients with late-nadir than in those with early-nadir hypothermia (23.7% vs. 16.5%; p = 0.041). The incidence of organ/space SSIs was significantly greater in patients with late-nadir hypothermia (19.6%) than in patients with normothermia (12.7%; p = 0.012). In multivariable analysis, neither severe hypothermia (odds ratio 1.24; 95% CI 0.56-2.77] nor late-nadir hypothermia (OR 0.71; 95% CI 0.46-1.01) was an independent risk factor for SSIs. Severe and late-nadir hypothermia were associated with a greater incidence of SSIs and organ/space SSIs. However, neither of these patterns was identified as an independent risk factor for SSIs, possibly

  10. Differences between patients' and clinicians' research priorities from the Anaesthesia and Peri-operative Care Priority Setting Partnership. (United States)

    Boney, O; Nathanson, M H; Grocott, M P W; Metcalf, L


    The James Lind Alliance Anaesthesia and Peri-operative Care Priority Setting Partnership was a recent collaborative venture bringing approximately 2000 patients, carers and clinicians together to agree priorities for future research into anaesthesia and critical care. This secondary analysis compares the research priorities of 303 service users, 1068 clinicians and 325 clinicians with experience as service users. All three groups prioritised research to improve patient safety. Service users prioritised research about improving patient experience, whereas clinicians prioritised research about clinical effectiveness. Clinicians who had experience as service users consistently prioritised research more like clinicians than like service users. Individual research questions about patient experience were more popular with patients and carers than with clinicians in all but one case. We conclude that patients, carers and clinicians prioritise research questions differently. All groups prioritise research into patient safety, but service users also favour research into patient experience, whereas clinicians favour research into clinical effectiveness. © 2017 The Association of Anaesthetists of Great Britain and Ireland.

  11. Analysis of the impact of adherent perirenal fat on peri-operative outcomes of robotic partial nephrectomy. (United States)

    Khene, Zine-Eddine; Peyronnet, Benoit; Mathieu, Romain; Fardoun, Tarek; Verhoest, Grégory; Bensalah, Karim


    Adherent perirenal fat (APF) can be defined as inflammatory fat sticking to renal parenchyma, whose dissection is difficult and makes it troublesome to expose the tumour. Our objective was to evaluate the impact of APF on the technical difficulty of robot-assisted partial nephrectomy (RPN). We analysed data of 202 patients who underwent RPN for a small renal tumour. Patients were divided into two groups according to the presence of APF. Peri-operative data were compared between the two groups. Predictors of APF were evaluated by univariate and multivariate analysis. The validity of the MAP score (radiological scoring system) was also assessed. APF was observed in 80 patients (39.6 %). Tumour complexity and surgeon's experience were similar between both groups. Operative time was 40 min longer in the APF group (188.5 vs. 147.9 min, p < 0.0001). Blood loss was twice higher, and transfusions were more common in the APF group (694 vs. 330 ml, p < 0.0001 and 19 vs. 5.8 %, p = 0.003, respectively). APF was associated with an increased risk of conversion to open surgery (11.2 vs. 0 %, p = 0.0002) or radical nephrectomy (6.2 vs. 0.8 %, p = 0.03). In multivariate analysis, male gender (OR 13.2, p < 0.0001), obesity (OR 1.2, p = 0.007), hypertension (OR 3.7, p = 0.02), and MAP score (OR 3.3; p < 0.0001) were significant predictors of APF. During RPN, APF is associated with increased bleeding and a higher risk of conversion to open surgery and to radical nephrectomy. Male gender, hypertension, obesity, and MAP score are predictors of APF.

  12. Use and Effectiveness of Peri-Operative Cefotetan versus Cefazolin Plus Metronidazole for Prevention of Surgical Site Infection in Abdominal Surgery Patients. (United States)

    Danan, Eleanor; Smith, Janessa; Kruer, Rachel M; Avdic, Edina; Lipsett, Pamela; Curless, Melanie S; Jarrell, Andrew S


    Current practice guidelines for antimicrobial prophylaxis in surgery recommend a cephamycin or cefazolin plus metronidazole for various abdominal surgeries. In February 2016, cephamycin drug shortages resulted in a change in The Johns Hopkins Hospital's (JHH) recommendation for peri-operative antibiotic prophylaxis in abdominal surgeries from cefotetan to cefazolin plus metronidazole. The primary objective of this study was to quantify the percentage of abdominal surgeries adherent to JHH peri-operative antibiotic prophylaxis guidelines. A sub-group analysis investigated whether prophylaxis with cefazolin plus metronidazole was associated with a lower rate of surgical site infections (SSIs) versus cefotetan. This retrospective cohort study included adult inpatients who underwent an abdominal surgery at JHH in September 2015 (Study Period I: cefotetan) or February to March 2016 (Study Period II: cefazolin plus metronidazole). Two hundred abdominal surgery cases were included in the primary analysis. A subset of 156 surgical cases were included in the sub-group analysis. The overall adherence rate to JHH guidelines was 75% in Study Period I versus 17% in Study Period II (p operative administration time (87% vs. 23%, p site infections occurred in 14% (12/83) of surgeries with cefotetan versus 8.2% (6/73) with cefazolin plus metronidazole for prophylaxis (p = 0.19). Adherence to an institution-specific peri-operative antibiotic prophylaxis guideline for abdominal surgeries was limited primarily by the longer infusion time required for pre-operative metronidazole. A higher percentage of SSIs occurred among abdominal surgeries with cefotetan versus cefazolin plus metronidazole for prophylaxis.

  13. Comparison of robot-assisted and laparoscopic partial nephrectomy for complex renal tumours with a RENAL nephrometry score ≥7: peri-operative and oncological outcomes. (United States)

    Wang, Yubin; Ma, Xin; Huang, Qingbo; Du, Qingshan; Gong, Huijie; Shang, Jiwen; Zhang, Xu


    To evaluate the peri-operative, functional and oncological outcomes of robot-assisted partial nephrectomy (RAPN) and laparoscopic partial nephrectomy (LPN) for moderately or highly complex tumours (defined as RENAL nephrometry score ≥7). We retrospectively analysed the medical charts of 216 patients with complex tumours who underwent LPN (n = 135) or RAPN (n = 81) between 2008 and 2014. Peri-operative data, pathological variables, complications, functional and oncological outcomes were reviewed. Demographic characteristics were similar in the two groups. LPN was associated with a longer operating time (149.6 vs 135.6 min; P = 0.017) and greater estimated blood loss (220.8 vs 196.5 mL; P = 0.013). RAPN was associated with a higher direct cost. There were no differences in warm ischaemia time, transfusion rate, conversion rate, hospital stay, operative complications and estimated glomerular filtration rate change at 6 months after surgery. The mean follow-ups for LPN and RAPN were 31.4 and 16.5 months, respectively. The 3-year recurrence-free survival rate was 95.2% for LPN and 97.1% for RAPN (P = 0.71). In patients with complex tumours, RAPN and LPN provided acceptable and similar results in terms of peri-operative, functional and oncological outcomes. RAPN was superior to LPN in terms of estimated blood loss and operating time, and LPN was the more cost-effective approach. Both surgery techniques remain viable options in the management of complex tumours with RENAL scores ≥7. © 2015 The Authors BJU International © 2015 BJU International Published by John Wiley & Sons Ltd.

  14. Prevention of the onset of hyperglycaemia by extracts of Aloe ...

    African Journals Online (AJOL)


    The ability of a home-made aqueous extract of Aloe barbadensis to prevent the onset of alloxan- induced hyperglycaemia was examined and compared with that of a factory-produced gel. Three groups of animals were administered 200 mg/kg body weight of alloxan intraperitoneally. A fourth group of animals was left ...

  15. Prevention of the onset of hyperglycaemia by extracts of Aloe ...

    African Journals Online (AJOL)

    The ability of a home-made aqueous extract of Aloe barbadensis to prevent the onset of alloxaninduced hyperglycaemia was examined and compared with that of a factory-produced gel. Three groups of animals were administered 200 mg/kg body weight of alloxan intraperitoneally. A fourth group of animals was left ...

  16. Severe hyperglycaemia due to neonatal sepsis - A case report ...

    African Journals Online (AJOL)

    Neonatal sepsis is a clinical syndrome characterized by signs and symptoms of infection with or without accompanying bacteremia in the first month of life. The clinical signs of neonatal sepsis are neither specific nor uniform. Neonatal sepsis may present with fever, hypotonia, respiratory distress, apnea and hyperglycaemia.

  17. Effect of Aqueous Extract of Nutmeg on Hyperglycaemia ...

    African Journals Online (AJOL)


    Effect of Aqueous Extract of Nutmeg on. Hyperglycaemia, Hyperlipidaemia and Cardiac. Histology Associated with Isoproterenol-induced. Myocardial Infarction in Rats. Mohammed Abdul Kareem*, Gadhamsetty Saayi Krushna,. Shaik Althaf Hussain and Kodidhela Lakshmi Devi. Department of Biochemistry, S.K. University, ...

  18. Effect of crude garlic extract on nicotine induced hyperglycaemia ...

    African Journals Online (AJOL)

    The effect of curde garlic extract on nicotine induced hyperglycaemia and hyperlipidaemia has been studied in albino rats. Four groups of 6 rats each were used. A control group received saline, a second group received 1mg/kg nicotine i.p., the third group received 305 per kg body weight o acqueous garlic extract orally ...


    Directory of Open Access Journals (Sweden)

    Hema Divakar


    Full Text Available BACKGROUND The aim of the study is to determine the current practices in the medical college institutions pan India for testing for Hyperglycaemia in Pregnancy (HIP to detect gestational diabetes and highlight areas that need additional attention in order to ensure adherence to current national guidelines. MATERIALS AND METHODS Questionnaires were used to obtain information regarding the testing strategy for hyperglycaemia in pregnancy. The questionnaires were filled out by the teaching faculty of the OB/GYN departments of 47 medical college institutions in India. The perceptions regarding the prevalence of diabetes in pregnancy in India and the needs for capacity building were assessed. RESULTS Forty seven respondents answered the questionnaires. The majority of respondents (95.83% reported that all pregnant women were offered (universal testing for hyperglycaemia in pregnancy and 37.5% reported that women were screened both in early and midtrimester of pregnancy. Most reported that testing for HIP took place once at booking, irrespective of the gestational age (39.58%. Thirty three (70.21% respondents reported using the single-step nonfasting method to diagnose hyperglycaemia. Furthermore, 21.28% of respondents reported using a glucometer to determine the concentration of blood glucose in plasma, while 68.08% reported using a lab analyser. The instructions for the testing were offered by consultants and postgraduates in a vast majority of cases (87.5%. The staff communicated with the women in a significantly less number of cases (12.5%. 65.96% of respondents felt that all women readily agreed to follow this advice. The majority of respondents (89.35% reported having noticed an increase in the number of women with hyperglycaemia. Furthermore, 91% of all the respondents felt there was a need to train medical personnel to test and manage hyperglycaemia. CONCLUSION Our study confirms the continued wide variability in testing for HIP in India with

  20. Interaction between peri-operative blood transfusion, tidal volume, airway pressure and postoperative ARDS: an individual patient data meta-analysis. (United States)

    Serpa Neto, Ary; Juffermans, Nicole P; Hemmes, Sabrine N T; Barbas, Carmen S V; Beiderlinden, Martin; Biehl, Michelle; Fernandez-Bustamante, Ana; Futier, Emmanuel; Gajic, Ognjen; Jaber, Samir; Kozian, Alf; Licker, Marc; Lin, Wen-Qian; Memtsoudis, Stavros G; Miranda, Dinis Reis; Moine, Pierre; Paparella, Domenico; Ranieri, Marco; Scavonetto, Federica; Schilling, Thomas; Selmo, Gabriele; Severgnini, Paolo; Sprung, Juraj; Sundar, Sugantha; Talmor, Daniel; Treschan, Tanja; Unzueta, Carmen; Weingarten, Toby N; Wolthuis, Esther K; Wrigge, Hermann; de Abreu, Marcelo Gama; Pelosi, Paolo; Schultz, Marcus J


    Transfusion of blood products and mechanical ventilation with injurious settings are considered risk factors for postoperative lung injury in surgical Patients. A systematic review and individual patient data meta-analysis was done to determine the independent effects of peri-operative transfusion of blood products, intra-operative tidal volume and airway pressure in adult patients undergoing mechanical ventilation for general surgery, as well as their interactions on the occurrence of postoperative acute respiratory distress syndrome (ARDS). Observational studies and randomized trials were identified by a systematic search of MEDLINE, CINAHL, Web of Science, and CENTRAL and screened for inclusion into a meta-analysis. Individual patient data were obtained from the corresponding authors. Patients were stratified according to whether they received transfusion in the peri-operative period [red blood cell concentrates (RBC) and/or fresh frozen plasma (FFP)], tidal volume size [≤7 mL/kg predicted body weight (PBW), 7-10 and >10 mL/kg PBW] and airway pressure level used during surgery (≤15, 15-20 and >20 cmH 2 O). The primary outcome was development of postoperative ARDS. Seventeen investigations were included (3,659 patients). Postoperative ARDS occurred in 40 (7.2%) patients who received at least one blood product compared to 40 patients (2.5%) who did not [adjusted hazard ratio (HR), 2.32; 95% confidence interval (CI), 1.25-4.33; P=0.008]. Incidence of postoperative ARDS was highest in patients ventilated with tidal volumes of >10 mL/kg PBW and having airway pressures of >20 cmH 2 O receiving both RBC and FFP, and lowest in patients ventilated with tidal volume of ≤7 mL/kg PBW and having airway pressures of ≤15 cmH 2 O with no transfusion. There was a significant interaction between transfusion and airway pressure level (P=0.002) on the risk of postoperative ARDS. Peri-operative transfusion of blood products is associated with an increased risk of

  1. A comparison of intravenous ketoprofen versus pethidine on peri-operative analgesia and post-operative nausea and vomiting in paediatric vitreoretinal surgery.

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    Subramaniam R


    Full Text Available AIM: To compare the efficacy of ketoprofen and pethidine for peri-operative analgesia and post-operative nausea and vomiting in children undergoing vitreoretinal surgery and surgery for retinal detachment. MATERIAL AND METHODS: Children aged 7 to 16 years and ASA I status, undergoing vitreo-retinal surgery were randomly allocated to receive either ketoprofen 2mg/kg or pethidine 1mg/kg intravenously for peri-operative analgesia. In all patients, general anaesthesia was induced with thiopentone and intubation was facilitated with vecuronium bromide and maintained with 33% oxygen in nitrous oxide and isoflurane. Intra-operative and post-operative monitoring was done by an observer blinded to the technique. Intra-operative rescue analgesia was used if heart rate and/or blood pressure increased by 25% from pre-incision values. Post-operative pain and episodes of nausea and vomiting were evaluated at recovery (0 hour, 2, 6 and 24 hours intervals. Standard rescue analgesia and anti-emetic agents were administered if required. RESULTS: Eighty-six children were enrolled in the study. Forty-four received ketoprofen while 42 received pethidine. Intra-operative analgesia was comparable in both the groups and no significant difference was found in the requirement of intra-operative rescue analgesia, as well. Postoperatively 6/44 (13.6% children in ketoprofen group had pain at recovery compared to 17/42 (40.4% in pethidine group. Pain at 2, 6 and 24 hours, and postoperative analgesic requirement were not significantly different among the two groups. Post-operative nausea, vomiting, and antiemetic requirement were significantly less in the ketoprofen group at all time intervals. CONCLUSION: Ketoprofen is a satisfactory alternative analgesic to pethidine for vitreoretinal surgery and results in a lower incidence of postoperative nausea and vomiting.

  2. Prevalence of hyperglycaemia first detected during pregnancy and subsequent obstetric outcomes at St. Francis Hospital Nsambya. (United States)

    Nakabuye, Betty; Bahendeka, Silver; Byaruhanga, Romano


    Women with hyperglycaemia detected during pregnancy are at greater risk for adverse pregnancy outcomes. Data on hyperglycaemia in pregnancy in sub-Saharan Africa is scanty and varied depending on the populations studied and the methodologies used to define hyperglycaemia in pregnancy. With the recent 2013 World Health Organisation (WHO) diagnostic criteria and classification, there is yet no sufficient data on the prevalence of hyperglycaemia in sub-Saharan Africa. The objective was to determine the prevalence of Hyperglycaemia first detected during pregnancy and subsequent obstetric outcomes among patients attending antenatal care (ANC) at St. Francis Hospital Nsambya. A prospective cohort study. All women with no history of diabetes mellitus attending at or after 24 weeks gestation were eligible to participate in the study. Participants underwent a standard 75 g oral glucose tolerance test (OGTT) after an informed written consent. The primary outcome was diagnosis of hyperglycaemia. Enrolled participants were followed up to delivery to assess obstetric outcomes (secondary outcomes were birth weight, neonatal admission, maternal genital trauma, delivery mode, neonatal and maternal status at discharge). 251 women were screened between December 2013 and February 2014. The prevalence of hyperglycaemia first detected in pregnancy was 31.9%. We found 23.8 % of women with hyperglycaemia had no known risk factor. Macrosomia was the only obstetric outcome that was significantly associated with hyperglycaemia. The prevalence of hyperglycaemia first detected in pregnancy was high in the studied population. Clinicians, therefore, should become more vigilant to screen for the condition. Selective screening may miss 23.8% of pregnant women with hyperglycaemia. However the cost/benefit implications of screening strategy and the recent 2013 WHO diagnostic criteria need to be studied in our setting.

  3. Association of genetic variants with isolated fasting hyperglycaemia and isolated postprandial hyperglycaemia in a Han Chinese population.

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    Xiaomu Kong

    Full Text Available Though multiple single nucleotide polymorphisms (SNPs associated with type 2 diabetes have been identified, the genetic bases of isolated fasting hyperglycaemia (IFH and isolated postprandial hyperglycaemia (IPH were still unclear. In present study, we aimed to investigate the association of genome-wide association study-validated genetic variants and IFH or IPH in Han Chinese.We genotyped 27 validated SNPs in 6,663 unrelated individuals comprising 341 IFH, 865 IPH, 1,203 combined fasting hyperglycaemia and postprandial hyperglycaemia, and 4,254 normal glycaemic subjects of Han ancestry. The distributions of genotype frequencies of FTO, CDKAL1 and GCKR were significant different between individuals with IFH and those with IPH (SNP(ptrend : rs8050136(0.0024, rs9939609(0.0049, rs7756992(0.0122, rs780094(0.0037. Risk allele of FTO specifically increased the risk of IFH (rs8050136: OR 1.403 [95% CI 1.125-1.750], p = 0.0027; rs9939609: 1.398 [1.120-1.744], p = 0.0030. G allele of CDKAL1 specifically increased the risk of IPH (1.217 [1.092-1.355], p = 0.0004. G allele of GCKR increased the risk of IFH (1.167 [0.999-1.362], p = 0.0513, but decreased the risk of IPH (0.891 [0.801-0.991], p = 0.0331. In addition, TCF7L2 and KCNQ1 increased the risk of both IFH and IPH. When combined, each additional risk allele associated with IFH increased the risk for IFH by 1.246-fold (p<0.0001, while each additional risk allele associated with IPH increased the risk for IPH by 1.190-fold (p<0.0001.Our results indicate that genotype distributions of variants from FTO, GCKR, CDKAL1 were different between IPH and IFH in Han Chinese. Variants of genes modulating insulin sensitivity (FTO, GCKR contributed to the risk of IFH, while variants of genes related to beta cell function (CDKAL1 increase the risk of IPH.

  4. Pulsatile Hyperglycaemia Induces Vascular Oxidative Stress and GLUT 1 Expression More Potently than Sustained Hyperglycaemia in Rats on High Fat Diet

    DEFF Research Database (Denmark)

    Rakipovski, Gunaj; Lykkesfeldt, Jens; Raun, Kirsten


    expression of glucose transporter 1 (GLUT1), gp-91(PHOX) and super oxide dismutase (SOD), while only the PLG group showed increased accumulation of oxidative stress and oxidised low density lipoprotein (oxLDL) in aorta. Conclusion Pulsatile hyperglycaemia induced relatively higher levels of oxidative stress......Introduction Pulsatile hyperglycaemia resulting in oxidative stress may play an important role in the development of macrovascular complications. We investigated the effects of sustained vs. pulsatile hyperglycaemia in insulin resistant rats on markers of oxidative stress, enzyme expression...... and glucose metabolism in liver and aorta. We hypothesized that liver's ability to regulate the glucose homeostasis under varying states of hyperglycaemia may indirectly affect oxidative stress status in aorta despite the amount of glucose challenged with. Methods Animals were infused with sustained high (SHG...

  5. Moderate hyperglycaemia is associated with favourable outcome in acute lacunar stroke

    NARCIS (Netherlands)

    Uyttenboogaart, Maarten; Koch, Marcus W; Stewart, Roy E; Vroomen, Patrick C; Luijckx, Gert-Jan; De Keyser, Jacques

    Hyperglycaemia in acute ischaemic stroke is traditionally associated with a worsened outcome. However, it is unclear whether the impact of hyperglycaemia on stroke outcome is similar in lacunar and non-lacunar infarctions. The relation between serum glucose measured within 6 h after stroke onset and

  6. Peri-operative kidney injury and long-term chronic kidney disease following orthotopic heart transplantation in children. (United States)

    Hoskote, Aparna; Burch, Michael


    Significant advances in cardiac intensive care including extracorporeal life support have enabled children with complex congenital heart disease and end-stage heart failure to be supported while awaiting transplantation. With an increasing number of survivors after heart transplantation in children, the complications from long-term immunosuppression, including renal insufficiency, are becoming more apparent. Severe renal dysfunction after heart transplant is defined by a serum creatinine level >2.5 mg/dL (221 μmol/L), and/or need for dialysis or renal transplant. The degree of renal dysfunction is variable and is progressive over time. About 3-10 % of heart transplant recipients will go on to develop severe renal dysfunction within the first 10 years post-transplantation. Multiple risk factors for chronic kidney disease post-transplant have been identified, which include pre-transplant worsening renal function, recipient demographics and morbidity, peri-transplant haemodynamics and long-term exposure to calcineurin inhibitors. Renal insufficiency increases the risk of post-transplant morbidity and mortality. Hence, screening for renal dysfunction pre-, peri- and post-transplantation is important. Early and timely detection of renal insufficiency may help minimize renal insults, and allow prompt implementation of renoprotective strategies. Close monitoring and pre-emptive management of renal dysfunction is an integral aspect of peri-transplant and subsequent post-transplant long-term care.


    Sobel, Sandra I; Augustine, Marilyn; Donihi, Amy C; Reider, Jodie; Forte, Patrick; Korytkowski, Mary


    The number of people with diabetes using continuous subcutaneous insulin infusions (CSII) with an insulin pump has risen dramatically, creating new challenges when these patients are admitted to the hospital for surgical or other procedures. There is limited literature guiding CSII use during surgical procedures. The study was carried out in a large, urban, tertiary care hospital. We enrolled 49 patients using insulin pump therapy presenting for 57 elective surgeries. We developed a CSII peri-operative glycemic management protocol (PGMP) to standardize insulin pump management in patients admitted to a same-day surgery unit (SDSU). The purpose was evaluate the safety (% capillary blood glucose (CBG) operative steroid use on postoperative glycemic control. Overall, 63% of patients treated according to the CSII PGMP had a first postoperative CBG ≤200 mg/dL. There were no episodes of intra- or postoperative hypoglycemia. For patients treated with the CSII PGMP, the mean postoperative CBG was lower in patients with anticipated or actual surgical length ≤120 minutes (158.1 ± 53.9 vs. 216 ± 77.7 mg/dL, P<.01). No differences were observed with admission CBG, type of anesthesia, or steroid use. This study demonstrates that a CSII PGMP is both safe and effective for patients admitted for elective surgical procedures and provides an example of a standardized protocol for use in clinical practice.

  8. Deficiency of the oxygen sensor prolyl hydroxylase 1 attenuates hypercholesterolaemia, atherosclerosis, and hyperglycaemia

    NARCIS (Netherlands)

    Marsch, Elke; Demandt, Jasper A. F.; Theelen, Thomas L.; Tullemans, Bibian M. E.; Wouters, Kristiaan; Boon, Mariette R.; van Dijk, Theo H.; Gijbels, Marion J.; Dubois, Ludwig J.; Meex, Steven J. R.; Mazzone, Massimiliano; Hung, Gene; Fisher, Edward A.; Biessen, Erik A. L.; Daemen, Mat J. A. P.; Rensen, Patrick C. N.; Carmeliet, Peter; Groen, Albert K.; Sluimer, Judith C.


    AIMS: Normalization of hypercholesterolaemia, inflammation, hyperglycaemia, and obesity are main desired targets to prevent cardiovascular clinical events. Here we present a novel regulator of cholesterol metabolism, which simultaneously impacts on glucose intolerance and inflammation. METHODS AND

  9. Risk Factors for Fatal Hyperglycaemia Confirmed by Forensic Postmortem Examination - A Nationwide Cohort in Sweden.

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    Lotta Walz

    Full Text Available The aim of this study was to identify risk factors associated with confirmed fatal hyperglycaemia, which could predispose potentially preventable deaths in individuals on glucose lowering drugs.A retrospective register-based case-control study conducted on a nationwide cohort with individuals who died due to hyperglycaemia as determined by forensic postmortem examination, in Sweden August 2006 to December 2012. Vitreous glucose was used to diagnose hyperglycaemia postmortem. The forensic findings stored in the National Forensic Medicine Database were linked to nationwide registers. Cases that died due to confirmed hyperglycemia with dispensed glucose lowering drugs were identified and living controls with dispensed glucose lowering drugs were randomly selected in the Swedish prescribed drug register and matched on age and sex. Information on comorbidities, dispensed pharmaceuticals, clinical data and socioeconomic factors were obtained for cases and controls. Adjusted multiple logistic regression models were used to identify risk factors associated with fatal hyperglycaemia.During the study period 322 individuals, mostly males (79% with the mean age of 53.9 years (SD.± 14 died due to confirmed hyperglycaemia. Risk factors for fatal hyperglycaemia included; insulin treatment (OR = 4.40; 95%CI,1.96, 9.85, poor glycaemic control (OR = 2.00 95%CI,1.23, 3.27, inadequate refill-adherence before death (OR = 3.87; 95%CI,1.99, 7.53, microvascular disease (OR = 3.26; 95% CI, 1.84, 5.79, psychiatric illness (OR = 2.30; 95% CI,1.32, 4.01, substance abuse (OR = 8.85; 95%CI,2.34, 35.0 and/or living alone (OR = 2.25; 95%CI,1.21, 4.18.Our results demonstrate the importance of clinical attention to poor glycaemic control in subjects with psychosocial problems since it may indicate serious non-adherence, which consequently could lead to fatal hyperglycaemia.

  10. Hyperglycaemia and ketosis in a non-diabetic patient--an unusual cause of delayed recovery. (United States)

    Pawar, Sundeep T; Nath, Soumya S; Ansari, Farrukh


    We report a case of hyperglycaemia and ketosis developing in a non-diabetic patient who underwent a neurosurgical procedure under general anaesthesia. A 52-year-old non-diabetic female patient underwent excision of acoustic neuroma under general anaesthesia. Pancreatic function was not disturbed and she received a single dose of dexamethasone (8 mg) and paracetamol (1 g). Delayed recovery from anaesthesia occurred. On investigation, she was found to have hyperglycaemia and ketosis. She was further managed on the line of diabetic ketoacidosis. After 24 hours, when blood glucose had normalised and ketosis abated, she could be weaned from mechanical ventilation and extubated. The patient did not receive any drugs known to cause such a condition. To the best of our knowledge, hyperglycaemia and ketosis developing in a non-diabetic patient causing delayed recovery and extubation is here reported for the first time.

  11. Camel milk ameliorates hyperglycaemia and oxidative damage in type-1 diabetic experimental rats. (United States)

    Meena, Sunita; Rajput, Yudhishthir S; Pandey, Amit K; Sharma, Rajan; Singh, Raghvendar


    This study was designed to assess anti-diabetic potential of goat, camel, cow and buffalo milk in streptozotocin (STZ) induced type 1 diabetic albino wistar rats. A total of 48 rats were taken for the study where one group was kept as non-diabetic control group (8 rats) while others (40 rats) were made diabetic by STZ (50 mg/kg of body weight) injection. Among diabetic rats, a control group (8 rats) was kept and referred as diabetic control whereas other four groups (8 rats each) of diabetic rats were fed on 50 ml of goat or camel or cow or buffalo milk for 4 weeks. All the rats (non-diabetic and diabetic) were maintained on standard diet for four weeks. STZ administration resulted in enhancement of glucose, total cholesterol, triglyceride, low density lipoprotein, HbA1c and reduction in high density lipoprotein in plasma and lowering of antioxidative enzymes (catalase, glutathione peroxidase and superoxide dismutase) activities in pancreas, kidney, liver and RBCs, coupled with enhanced levels of TBARS and protein carbonyls in pancreas, kidney, liver and plasma. OGTT carried out at the end of 4 week milk feeding indicated that all milks helped in early maintenance of glucose level. All milks reduced atherogenic index. In camel milk fed diabetic group, insulin concentration enhanced to level noted for non-diabetic control while goat, cow and buffalo milk failed to restore insulin level. HbA1c level was also restored only in camel milk fed diabetic group. The level of antioxidative enzymes (catalase, GPx and SOD) in pancreas enhanced in all milk fed groups. Camel milk and to a reasonable extent goat milk reduced formation of TBARS and PCs in tissues and blood. It can be concluded that camel milk ameliorates hyperglycaemia and oxidative damage in type-1 diabetic experimental rats. Further, only camel milk completely ameliorated oxidative damage in pancreas and normalised insulin level.

  12. The effect of hyperglycaemia on in vitro cytokine production and macrophage infection with Mycobacterium tuberculosis

    NARCIS (Netherlands)

    Lachmandas, E.; Vrieling, F.; Wilson, L.G.; Joosten, S.A.; Netea, M.G.; Ottenhoff, T.H.; Crevel, R. van


    Type 2 diabetes mellitus is an established risk factor for tuberculosis but the underlying mechanisms are largely unknown. We examined the effects of hyperglycaemia, a hallmark of diabetes, on the cytokine response to and macrophage infection with Mycobacterium tuberculosis. Increasing in vitro

  13. Effects of oxidative stress on hyperglycaemia-induced brain malformations in a diabetes mouse model

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    Jin, Ya [Department of Pediatrics, The First Affiliated Hospital, Jinan University, Guangzhou 510630, China (China); Wang, Guang [Division of Histology & Embryology, Key Laboratory for Regenerative Medicine of the Ministry of Education, Medical College, Jinan University, Guangzhou 510632 (China); Han, Sha-Sha; He, Mei-Yao [Department of Pediatrics, The First Affiliated Hospital, Jinan University, Guangzhou 510630, China (China); Cheng, Xin; Ma, Zheng-Lai [Division of Histology & Embryology, Key Laboratory for Regenerative Medicine of the Ministry of Education, Medical College, Jinan University, Guangzhou 510632 (China); Wu, Xia [Department of Pediatrics, The First Affiliated Hospital, Jinan University, Guangzhou 510630, China (China); Yang, Xuesong, E-mail: [Division of Histology & Embryology, Key Laboratory for Regenerative Medicine of the Ministry of Education, Medical College, Jinan University, Guangzhou 510632 (China); Liu, Guo-Sheng, E-mail: [Department of Pediatrics, The First Affiliated Hospital, Jinan University, Guangzhou 510630, China (China)


    Pregestational diabetes mellitus (PGDM) enhances the risk of fetal neurodevelopmental defects. However, the mechanism of hyperglycaemia-induced neurodevelopmental defects is not fully understood. In this study, several typical neurodevelopmental defects were identified in the streptozotocin-induced diabetes mouse model. The neuron-specific class III beta-tubulin/forkhead box P1-labelled neuronal differentiation was suppressed and glial fibrillary acidic protein-labelled glial cell lineage differentiation was slightly promoted in pregestational diabetes mellitus (PGDM) mice. Various concentrations of glucose did not change the U87 cell viability, but glial cell line-derived neurotrophic factor expression was altered with varying glucose concentrations. Mouse maternal hyperglycaemia significantly increased Tunel{sup +} apoptosis but did not dramatically affect PCNA{sup +} cell proliferation in the process. To determine the cause of increased apoptosis, we determined the SOD activity, the expression of Nrf2 as well as its downstream anti-oxidative factors NQO1 and HO1, and found that all of them significantly increased in PGDM fetal brains compared with controls. However, Nrf2 expression in U87 cells was not significantly changed by different glucose concentrations. In mouse telencephalon, we observed the co-localization of Tuj-1 and Nrf2 expression in neurons, and down-regulating of Nrf2 in SH-SY5Y cells altered the viability of SH-SY5Y cells exposed to high glucose concentrations. Taken together, the data suggest that Nrf2-modulated antioxidant stress plays a crucial role in maternal hyperglycaemia-induced neurodevelopmental defects. - Highlights: • Typical neurodevelopmental defects could be observed in STZ-treated mouse fetuses. • Nrf2 played a crucial role in hyperglycaemia-induced brain malformations. • The effects of hyperglycaemia on neurons and glia cells were not same.

  14. Greater impairment of postprandial triacylglycerol than glucose response in metabolic syndrome subjects with fasting hyperglycaemia. (United States)

    Jackson, Kim G; Walden, Charlotte M; Murray, Peter; Smith, Adrian M; Minihane, Anne M; Lovegrove, Julie A; Williams, Christine M


    Studies have started to question whether a specific component or combinations of metabolic syndrome (MetS) components may be more important in relation to cardiovascular disease risk. Our aim was to examine the impact of the presence of raised fasting glucose as a MetS component on postprandial lipaemia. Men classified with the MetS underwent a sequential test meal investigation, in which blood samples were taken at regular intervals after a test breakfast (t=0 min) and lunch (t=330 min). Lipids, glucose and insulin were measured in the fasting and postprandial samples. MetS subjects with 3 or 4 components were subdivided into those without (n=34) and with (n=23) fasting hyperglycaemia (≥5.6 mmol/l), irrespective of the combination of components. Fasting lipids and insulin were similar in the two groups, with glucose significantly higher in the men with glucose as a MetS component (Ppostprandial triacylglycerol (TAG) response in men with fasting hyperglycaemia. Greater glucose AUC (Ppostprandial TAG and glucose response. Our data analysis has revealed a greater impairment of postprandial TAG than glucose response in MetS subjects with raised fasting glucose. The worsening of postprandial lipaemic control may contribute to the greater CVD risk reported in individuals with MetS component combinations which include hyperglycaemia. Copyright © 2013 Elsevier Inc. All rights reserved.

  15. Delayed onset of hyperglycaemia in a mouse model with impaired glucagon secretion demonstrates that dysregulated glucagon secretion promotes hyperglycaemia and type 2 diabetes

    DEFF Research Database (Denmark)

    Gustavsson, N; Seah, T; Lao, Y


    AIMS/HYPOTHESIS: Type 2 diabetes is caused by relative deficiency of insulin secretion and is associated with dysregulation of glucagon secretion during the late stage of diabetes development. Like insulin secretion from beta cells, glucagon secretion is dependent on calcium signals and a calcium...... sensing protein, synaptotagmin-7. In this study, we tested the relative contribution of dysregulated glucagon secretion and reduced insulin release in the development of hyperglycaemia and type 2 diabetes by using synaptotagmin-7 knockout (KO) mice, which exhibit glucose intolerance, reduced insulin...... secretion and nearly abolished Ca(2+)-stimulated glucagon secretion. METHODS: We fed the synaptotagmin-7 KO and control mice with a high-fat diet (HFD) for 14 weeks, and compared their body weight, glucose levels, glucose and insulin tolerance, and insulin and glucagon secretion. RESULTS: On the HFD...

  16. Hyperglycaemia Among Nigerian Infants Weighing Less Than 1,500 Grammes at Birth: A Retrospective Assessment of the Clinical Data

    Directory of Open Access Journals (Sweden)

    Onyiriuka Alphonsus N.


    Full Text Available Background and Aims: In very low birthweight (VLBW infants, birthweight < 1,500g, hyperglycaemia is associated with increased rates of mortality and morbidity. Our study aimed at determining the prevalence of hyperglycaemia among VLBW infants and describing their clinical characteristics. Methods: A retrospective chart review of all inborn VLBW infants was performed. Information obtained included birthweight, gestational age (best obstetric record, gender, and history of chorioamnionitis/maternal medical disorders, type and rates of intravenous fluid administration. Blood glucose level ≥ 7 mmol/L on at least two occasions defined hyperglycaemia. Results: Of the 279 blood glucose values, obtained from 93 infants, 91 (32.6%; 95% CI = 27.1% -38.1% were in the hyperglycaemic range, with the majority (61.5% occurring in the first 48 hours of life. The frequency of hyperglycaemia was significantly associated with a rate of infusion greater than 0.4g/kg/hour (Odds Ratio, OR = 3.76; 95% CI=1.58-8.94 and a positive history of maternal chorioamnionitis (OR = 3.04; 95%CI= 1.15-8.01. Conclusion: In the first 48 hours of life, hyperglycaemia co-existing with or complicating primary illnesses was common in VLBW infants who had dextrose infusion and a positive history of maternal chorioamnionitis

  17. Influence of diabetes and hyperglycaemia on infectious disease hospitalisation and outcome

    DEFF Research Database (Denmark)

    Benfield, Thomas; Jensen, J S; Nordestgaard, B G


    AIMS/HYPOTHESIS: Diabetes mellitus is believed to increase susceptibility to infectious diseases. The effects of hyperglycaemia per se on infectious disease risk are unknown and the influence of diabetes on infectious disease outcome is controversial. MATERIALS AND METHODS: We studied 10......,063 individuals from the Danish general population, who were participants in The Copenhagen City Heart Study, over a follow-up period of 7 years. Risk of hospitalisation caused by any infectious disease, and subsequent risk of disease progression to death were estimated by Cox proportional hazards regression...

  18. Non-insulin drugs to treat hyperglycaemia in type 1 diabetes mellitus

    DEFF Research Database (Denmark)

    Frandsen, Christian Seerup; Dejgaard, Thomas Fremming; Madsbad, Sten


    Insulin treatment of individuals with type 1 diabetes has shortcomings and many patients do not achieve glycaemic and metabolic targets. Consequently, the focus is on novel non-insulin therapeutic approaches that reduce hyperglycaemia and improve metabolic variables without increasing the risk...... with few participants; evidence for the efficacy of concomitant treatments is scarce and largely clinically insignificant. A subgroup of patients with type 1 diabetes for whom non-insulin antidiabetic drugs could significantly benefit glycaemic control cannot yet be defined, but we suggest that obese...

  19. Proposed mechanisms of Terminalia catappa in hyperglycaemia and associated diabetic complications. (United States)

    Behl, Tapan; Kotwani, Anita


    Terminalia catappa has shown potent antidiabetic activity in the past; however, the exact molecular mechanisms by which it acts have not been elucidated. This review aims at exploring several hypotheses which have been proposed to explain its mechanism of action, including reduction in oxidative stress, inflammation, angiogenesis, lipid profile correction and direct hypoglycaemic actions. A thorough review of all the articles, research as well as reviews, available regarding the concerned topic was performed. MEDLINE databases were searched using keywords (and their combinations), such as T. catappa, renin oxidative stress, inflammation, angiogenesis, diabetic retinopathy, α-glucosidase and α-amylase, among several others. English-language articles were preferably selected. Apart from metabolic dysfunctions, several hyperglycaemia-induced pathological conditions come into scene as the after-effects of diabetes. These mainly include inflammation, oxidative stress, angiogenesis and lipid profile alteration, which ultimately result in vascular endothelial dysfunction, hepatic steatosis, lipid peroxidation and apoptosis of endothelial, hepatic and neuronal cells. Terminalia catappa effectively attenuates the progression of diabetic retinopathy and shows significant hypoglycaemic actions. The mechanisms behind these effects were explained. Terminalia catappa may provide an effective natural product to treat hyperglycaemia and prevent subsequent diabetic complications. © 2016 Royal Pharmaceutical Society.

  20. Serum glucocorticoid inducible kinase (SGK)-1 protects endothelial cells against oxidative stress and apoptosis induced by hyperglycaemia. (United States)

    Ferrelli, Francesca; Pastore, Donatella; Capuani, Barbara; Lombardo, Marco F; Blot-Chabaud, Marcel; Coppola, Andrea; Basello, Katia; Galli, Angelica; Donadel, Giulia; Romano, Maria; Caratelli, Sara; Pacifici, Francesca; Arriga, Roberto; Di Daniele, Nicola; Sbraccia, Paolo; Sconocchia, Giuseppe; Bellia, Alfonso; Tesauro, Manfredi; Federici, Massimo; Della-Morte, David; Lauro, Davide


    Diabetic hyperglycaemia causes endothelial dysfunction mainly by impairing endothelial nitric oxide (NO) production. Moreover, hyperglycaemia activates several noxious cellular pathways including apoptosis, increase in reactive oxygen species (ROS) levels and diminishing Na(+)-K(+) ATPase activity which exacerbate vascular damage. Serum glucocorticoid kinase (SGK)-1, a member of the serine/threonine kinases, plays a pivotal role in regulating NO production through inducible NO synthase activation and other cellular mechanisms. Therefore, in this study, we aimed to investigate the protective role of SGK-1 against hyperglycaemia in human umbilical endothelial cells (HUVECs). We used retrovirus to infect HUVECs with either SGK-1, SGK-1Δ60 (lacking of the N-60 amino acids-increase SGK-1 activity) or SGK-1Δ60KD (kinase-dead constructs). We tested our hypothesis in vitro after high glucose and glucosamine incubation. Increase in SGK-1 expression and activity (SGK-1Δ60) resulted in higher production of NO, inhibition of ROS synthesis and lower apoptosis in endothelial cell after either hyperglycaemia or glucosamine treatments. Moreover, in this study, we showed increased GLUT-1 membrane translocation and Na(+)-K(+) ATPase activity in cell infected with SGK-1Δ60 construct. These results suggest that as in endothelial cells, an increased SGK-1 activity and expression reduces oxidative stress, improves cell survival and restores insulin-mediated NO production after different noxae stimuli. Therefore, SGK-1 may represent a specific target to further develop novel therapeutic options against diabetic vascular disease.

  1. Insulin administered by needle-free jet injection corrects marked hyperglycaemia faster in overweight or obese patients with diabetes

    NARCIS (Netherlands)

    Wit, H.M. de; Engwerda, E.E.C.; Tack, C.J.J.; Galan, B.E. de


    AIMS: To test whether jet injection of insulin resulted in faster correction of marked hyperglycaemia than when insulin is injected by a conventional pen in patients with diabetes. METHODS: Adult, overweight or obese (BMI >/=25 and

  2. Broccoli (Brassica oleracea) Reduces Oxidative Damage to Pancreatic Tissue and Combats Hyperglycaemia in Diabetic Rats. (United States)

    Suresh, Sithara; Waly, Mostafa Ibrahim; Rahman, Mohammad Shafiur; Guizani, Nejib; Al-Kindi, Mohamed Abdullah Badar; Al-Issaei, Halima Khalfan Ahmed; Al-Maskari, Sultan Nasser Mohd; Al-Ruqaishi, Bader Rashid Said; Al-Salami, Ahmed


    Oxidative stress plays a pivotal role in the development of diabetes and hyperglycaemia. The protective effects of natural extracts against diabetes are mainly dependent on their antioxidant and hypoglycaemic properties. Broccoli ( Brassica oleracea ) exerts beneficial health effects in several diseases including diabetes; however, the mechanism has not been elucidated yet. The present study was carried out to evaluate the potential hypoglycaemic and antioxidant properties of aqueous broccoli extracts (BEs) in diabetic rats. Streptozotocin (STZ) drug was used as a diabetogenic agent in a single intraperitoneal injection dose of 50 mg/kg body weight. The blood glucose level for each rat was measured twice a week. After 8 weeks, all animals were fasted overnight and sacrificed; pancreatic tissues were homogenized and used for measuring oxidative DNA damage, biochemical assessment of glutathione (GSH), and total antioxidant capacity (TAC) as well as histopathological examination for pancreatic tissues was examined. Diabetic rats showed significantly higher levels of DNA damage, GSH depletion, and impaired TAC levels in comparison to non-diabetics ( P <0.05). The treatment of diabetic rats with BE significantly reduced DNA damage and conserved GSH and TAC values ( P <0.01). BE attenuated pancreatic histopathological changes in diabetic rats. The results of this study indicated that BE reduced the STZ mediated hyperglycaemia and the STZ-induced oxidative injury to pancreas tissue. The used in vivo model confirmed the efficacy of BE as an anti-diabetic herbal medicine and provided insights into the capacity of BE to be used for phytoremediation purposes for human type 2 diabetes.

  3. Hyperglycaemia attenuates the gastrokinetic effect of erythromycin and affects the perception of postprandial hunger in normal subjects

    International Nuclear Information System (INIS)

    Jones, K.L.; Berry, M.; Kong, M.F.; Kwiatek, M.; Samsom, M.; Horowitz, M.; Royal Adelaide Hospital, SA


    Full text: Recent studies have demonstrated that acute changes in the blood glucose concentration may affect gastrointestinal motor function and the perception of sensations arising from the gastrointestinal tract. Erythromycin has been shown to accelerate gastric emptying in both normal subjects and patients with diabetes mellitus. The major aims of this study were to determine in normal subjects whether the effects of erythromycin on gastric emptying, and perceptions of hunger and fullness are modified by the blood glucose concentration. 10 normal subjects (aged 20-39 yr) underwent concurrent measurement of gastric emptying, blood glucose, hunger and fullness on four separate occasions: twice during euglycaemia (∼4 mmol/L) and twice during hyperglycaemia (∼15 mmol/L). Either erythromycin (3 mg/kg) or saline (0.9%) was administered intravenously immediately before ingestion of a radioisotopically labelled solid meal. Gastric emptying was slower (P<0.0001) during hyperglycaemia when compared to euglycaemia after both erythromycin and saline administration. Erythromycin accelerated the post-lag emptying rate during euglycaemia (P<0.05), but not hyperglycaemia. Hunger decreased (P<0.001) and fullness increased (P<0.001) after the meal Postprandial hunger was less (P<0.05) and fullness greater (P<0.05 during hyperglycaemia after saline infusion, but not after erythromycin. Hunger was greater after erythromycin when compared to saline during both hyperglycaemia and euglycaemia (P<0.05). In conclusion, at a blood glucose concentration of ∼15 mmol/L when compared to euglycaemia: (i) after administration of erythromycin (3 mg/kg IV) gastric emptying of a solid meal is much slower, (ii) the effect of erythromycin on gastric emptying of a solid meal is attenuated and (iii) the perception of postprandial hunger is reduced and that of fullness increased

  4. Physical activity, family history of diabetes and risk of developing hyperglycaemia and diabetes among adults in Mainland China. (United States)

    Xu, F; Wang, Y; Ware, R S; Tse, L Ah; Dunstan, D W; Liang, Y; Wang, Z; Hong, X; Owen, N


    To investigate the joint influence of physical activity and family history of diabetes on the subsequent risk of developing hyperglycaemia and Type 2 diabetes among Chinese adults. A prospective community-based cohort study was conducted among adults aged 35 years and older during 2004-2007 in Nanjing, China. Four communities (three urban and one rural) were randomly selected from 11 urban districts and two rural counties. Hyperglycaemia and Type 2 diabetes were defined using World Health Organization criteria based on fasting blood glucose concentration and physicians' diagnosis, respectively. Physical activity, parental diabetes history, and other important covariates were assessed at baseline and in the third-year follow-up survey. At study conclusion data were collected from 3031 participants (follow-up rate 81.3%). The 3-year cumulative incidence of hyperglycaemia and Type 2 diabetes was 6.2% and 2.4%, respectively. After adjustment for potential confounding variables, compared with those with positive family history and insufficient physical activity, the adjusted relative risk ratio (95% CI) of developing hyperglycaemia was 0.19 (0.02, 1.51) for participants with sufficient physical activity and a positive family history; 0.55 (0.31, 0.97) for participants with insufficient physical activity and a negative family history; and 0.36 (0.19, 0.70) for participants with sufficient physical activity but a negative family history. Participants who had a negative family history and insufficient physical activity were also less likely to develop Type 2 diabetes (RRR = 0.28; 0.14, 0.54), and participants with a negative family history and sufficient physical activity were the least likely to develop Type 2 diabetes (0.23; 0.10, 0.56). Sufficient physical activity and negative family history of diabetes may jointly reduce the risk of developing hyperglycaemia and Type 2 diabetes in Chinese adults. © 2011 The Authors. Diabetic Medicine © 2011 Diabetes UK.

  5. Computer simulations suggest that acute correction of hyperglycaemia with an insulin bolus protocol might be useful in brain FDG PET

    International Nuclear Information System (INIS)

    Buchert, R.; Brenner, W.; Apostolova, I.; Mester, J.; Clausen, M.; Santer, R.; Silverman, D.H.S.


    FDG PET in hyperglycaemic subjects often suffers from limited statistical image quality, which may hamper visual and quantitative evaluation. In our study the following insulin bolus protocol is proposed for acute correction of hyperglycaemia (> 7.0 mmol/l) in brain FDG PET. (i) Intravenous bolus injection of short-acting insulin, one I.E. for each 0.6 mmol/l blood glucose above 7.0. (ii) If 20 min after insulin administration plasma glucose is ≤ 7.0 mmol/l, proceed to (iii). If insulin has not taken sufficient effect step back to (i). Compute insulin dose with the updated blood glucose level. (iii) Wait further 20 min before injection of FDG. (iv) Continuous supervision of the patient during the whole scanning procedure. The potential of this protocol for improvement of image quality in brain FDG PET in hyperglycaemic subjects was evaluated by computer simulations within the Sokoloff model. A plausibility check of the prediction of the computer simulations on the magnitude of the effect that might be achieved by correction of hyperglycaemia was performed by retrospective evaluation of the relation between blood glucose level and brain FDG uptake in 89 subjects in whom FDG PET had been performed for diagnosis of Alzheimer's disease. The computer simulations suggested that acute correction of hyperglycaemia according to the proposed bolus insulin protocol might increase the FDG uptake of the brain by up to 80%. The magnitude of this effect was confirmed by the patient data. The proposed management protocol for acute correction of hyperglycaemia with insulin has the potential to significantly improve the statistical quality of brain FDG PET images. This should be confirmed in a prospective study in patients. (orig.)

  6. Computer simulations suggest that acute correction of hyperglycaemia with an insulin bolus protocol might be useful in brain FDG PET

    Energy Technology Data Exchange (ETDEWEB)

    Buchert, R.; Brenner, W.; Apostolova, I.; Mester, J.; Clausen, M. [University Medical Center Hamburg-Eppendorf (Germany). Dept. of Nuclear Medicine; Santer, R. [University Medical Center Hamburg-Eppendorf (Germany). Center for Gynaecology, Obstetrics and Paediatrics; Silverman, D.H.S. [David Geffen School of Medicine at UCLA, Los Angeles, CA (United States). Dept. of Molecular and Medical Pharmacology


    FDG PET in hyperglycaemic subjects often suffers from limited statistical image quality, which may hamper visual and quantitative evaluation. In our study the following insulin bolus protocol is proposed for acute correction of hyperglycaemia (> 7.0 mmol/l) in brain FDG PET. (i) Intravenous bolus injection of short-acting insulin, one I.E. for each 0.6 mmol/l blood glucose above 7.0. (ii) If 20 min after insulin administration plasma glucose is {<=} 7.0 mmol/l, proceed to (iii). If insulin has not taken sufficient effect step back to (i). Compute insulin dose with the updated blood glucose level. (iii) Wait further 20 min before injection of FDG. (iv) Continuous supervision of the patient during the whole scanning procedure. The potential of this protocol for improvement of image quality in brain FDG PET in hyperglycaemic subjects was evaluated by computer simulations within the Sokoloff model. A plausibility check of the prediction of the computer simulations on the magnitude of the effect that might be achieved by correction of hyperglycaemia was performed by retrospective evaluation of the relation between blood glucose level and brain FDG uptake in 89 subjects in whom FDG PET had been performed for diagnosis of Alzheimer's disease. The computer simulations suggested that acute correction of hyperglycaemia according to the proposed bolus insulin protocol might increase the FDG uptake of the brain by up to 80%. The magnitude of this effect was confirmed by the patient data. The proposed management protocol for acute correction of hyperglycaemia with insulin has the potential to significantly improve the statistical quality of brain FDG PET images. This should be confirmed in a prospective study in patients. (orig.)

  7. Protective Effect of Momordica charantia Fruit Extract on Hyperglycaemia-Induced Cardiac Fibrosis

    Directory of Open Access Journals (Sweden)

    Razif Abas


    Full Text Available In diabetes mellitus, cardiac fibrosis is characterized by increase in the deposition of collagen fibers. The present study aimed to observe the effect of Momordica charantia (MC fruit extract on hyperglycaemia-induced cardiac fibrosis. Diabetes was induced in the male Sprague-Dawley rats with a single intravenous injection of streptozotocin (STZ. Following 4 weeks of STZ induction, the rats were subdivided (n = 6 into control group (Ctrl, control group treated with MC (Ctrl-MC, diabetic untreated group (DM-Ctrl, diabetic group treated with MC (DM-MC, and diabetic group treated with 150 mg/kg of metformin (DM-Met. Administration of MC fruit extract (1.5 g/kg body weight in diabetic rats for 28 days showed significant increase in the body weight and decrease in the fasting blood glucose level. Significant increase in cardiac tissues superoxide dismutase (SOD, glutathione contents (GSH, and catalase (CAT was observed following MC treatment. Hydroxyproline content was significantly reduced and associated morphological damages reverted to normal. The decreased expression of type III and type IV collagens was observed under immunohistochemical staining. It is concluded that MC fruit extract possesses antihyperglycemic, antioxidative, and cardioprotective properties which may be beneficial in the treatment of diabetic cardiac fibrosis.

  8. Protective effect of Momordica charantia fruit extract on hyperglycaemia-induced cardiac fibrosis. (United States)

    Abas, Razif; Othman, Faizah; Thent, Zar Chi


    In diabetes mellitus, cardiac fibrosis is characterized by increase in the deposition of collagen fibers. The present study aimed to observe the effect of Momordica charantia (MC) fruit extract on hyperglycaemia-induced cardiac fibrosis. Diabetes was induced in the male Sprague-Dawley rats with a single intravenous injection of streptozotocin (STZ). Following 4 weeks of STZ induction, the rats were subdivided (n = 6) into control group (Ctrl), control group treated with MC (Ctrl-MC), diabetic untreated group (DM-Ctrl), diabetic group treated with MC (DM-MC), and diabetic group treated with 150 mg/kg of metformin (DM-Met). Administration of MC fruit extract (1.5 g/kg body weight) in diabetic rats for 28 days showed significant increase in the body weight and decrease in the fasting blood glucose level. Significant increase in cardiac tissues superoxide dismutase (SOD), glutathione contents (GSH), and catalase (CAT) was observed following MC treatment. Hydroxyproline content was significantly reduced and associated morphological damages reverted to normal. The decreased expression of type III and type IV collagens was observed under immunohistochemical staining. It is concluded that MC fruit extract possesses antihyperglycemic, antioxidative, and cardioprotective properties which may be beneficial in the treatment of diabetic cardiac fibrosis.

  9. Hyperglycaemia-induced resistance to Docetaxel is negated by metformin: a role for IGFBP-2. (United States)

    Biernacka, K M; Persad, R A; Bahl, A; Gillatt, D; Holly, J M P; Perks, C M


    The incidence of many common cancers varies between different populations and appears to be affected by a Western lifestyle. Highly proliferative malignant cells require sufficient levels of nutrients for their anabolic activity. Therefore, targeting genes and pathways involved in metabolic pathways could yield future therapeutics. A common pathway implicated in energetic and nutritional requirements of a cell is the LKB1/AMPK pathway. Metformin is a widely studied anti-diabetic drug, which improves glycaemia in patients with type 2 diabetes by targeting this pathway. We investigated the effect of metformin on prostate cancer cell lines and evaluated its mechanism of action using DU145, LNCaP, PC3 and VCaP prostate cancer cell lines. Trypan blue dye-exclusion assay was used to assess levels of cell death. Western immunoblotting was used to determine the abundance of proteins. Insulin-like growth factor-binding protein-2 (IGFBP-2) and AMPK genes were silenced using siRNA. Effects on cell morphology were visualised using microscopy. IGFBP-2 gene expression was assessed using real-time RT-PCR. With DU145 and LNCaP cells metformin alone induced cell death, but this was reduced in hyperglycaemic conditions. Hyperglycaemia also reduced the sensitivity to Docetaxel, but this was countered by co-treatment with metformin. LKB1 was required for the activation of AMPK but was not essential to mediate the induction of cell death. An alternative pathway by which metformin exerted its action was through downregulation of IGFBP-2 in DU145 and LNCaP cells, independently of AMPK. This finding could have important implications in relation to therapeutic strategies in prostate cancer patients presenting with diabetes. © 2017 The authors.

  10. The influence of induced hyperglycaemia on the characteristics of intestinal motility and bile kinetics in healthy men

    DEFF Research Database (Denmark)

    Oster-Jørgensen, E; Qvist, N; Pedersen, S A


    Simultaneous recording of duodenal motility and biliary scintigraphy by continuous infusion of 99mTc-dimethyl-iminodiacetic acid was performed in 16 healthy fasted men, of whom eight had an intravenous glucose bolus injection immediately after the passage of a duodenal phase III of the migrating...... to the gallbladder in the entire cycle was significantly higher in the subjects who received glucose, and in four subjects all the hepatic bile was diverted to the gallbladder. The results demonstrate that induced hyperglycaemia exerts a pronounced effect on gastrointestinal motility and bile kinetics. Available...

  11. The effect of hyperglycaemia on osseointegration: a review of animal models of diabetes mellitus and titanium implant placement. (United States)

    King, Shalinie; Klineberg, Iven; Levinger, Itamar; Brennan-Speranza, Tara C


    Patients with type 2 diabetes mellitus have a higher risk of dental and/or orthopaedic implant failure. However, the mechanism behind this phenomenon is unclear, and animal studies may prove useful in shedding light on the processes involved. This review considers the available literature on rat models of diabetes and titanium implantation. The process of osseointegration whereby direct contact is achieved between bone and an implant surface depends on healthy bone metabolism. Collective evidence suggests that hyperglycaemia adversely affects bone turnover and the quality of the organic matrix resulting in an overall deterioration in the quality, resilience and structure of the bone tissue. This in turn results in compromised osseointegration in patients receiving dental and orthopaedic implants. The incidence of diabetes mellitus (DM), which is a chronic metabolic disorder resulting in hyperglycaemia, is rising. Of particular significance is the rising incidence of adult onset type 2 diabetes mellitus (T2DM) in an ageing population. Understanding the effects of hyperglycaemia on osseointegration will enable clinicians to manage health outcomes for patients receiving implants. Much of our understanding of how hyperglycaemia affects osseointegration comes from animal studies. In this review, we critically analyse the current animal studies. Our review has found that most studies used a type 1 diabetes mellitus (T1DM) rodent model and looked at a young male population of rodents. The pathophysiology of T1DM is however very different to that of T2DM and is not representative of T2DM, the incidence of which is rising in the ageing adult population. Genetically modified rats have been used to model T2DM, but none of these studies have included female rats and the metabolic changes in bone for some of these models used are not adequately characterized. Therefore, the review suggests that the study population needs to be broadened to include both T1DM and T2DM models

  12. Early

    Directory of Open Access Journals (Sweden)

    Kamel Abd Elaziz Mohamed


    Conclusion: Early PDT is recommended for patients who require prolonged tracheal intubation in the ICU as outcomes like the duration of mechanical ventilation length of ICU stay and hospital stay were significantly shorter in early tracheostomy.

  13. Improving Prevention, Early Recognition and Management of Acute Kidney Injury after Major Surgery: Results of a Planning Meeting with Multidisciplinary Stakeholders

    Directory of Open Access Journals (Sweden)

    Matthew T James


    Full Text Available Purpose of review: Acute kidney injury (AKI is common after major surgery, and is associated with morbidity, mortality, increased length of hospital stay, and high health care costs. Although recent guidelines for AKI provide recommendations for identification of patients at risk, monitoring, diagnosis, and management of AKI, there is lack of understanding to guide successful implementation of these recommendations into clinical practice. Sources of information: We held a planning meeting with multidisciplinary stakeholders to identify barriers, facilitators, and strategies to implement recommendations for prevention, early identification, and management of AKI after major surgery. Barriers and facilitators to knowledge use for peri-operative AKI prevention and care were discussed. Findings: Stakeholders identified barriers in knowledge (how to identify high-risk patients, what criteria to use for diagnosis of AKI, attitudes (self-efficacy in preventive care and management of AKI, and behaviors (common use of diuretics, non-steroidal anti-inflammatory drugs, withholding of intravenous fluids, and competing time demands in peri-operative care. Educational, informatics, and organizational interventions were identified by stakeholders as potentially useful elements for future interventions for peri-operative AKI. Limitation: Meeting participants were from a single centre. Implications: The information and recommendations obtained from this stakeholder's meeting will be useful to design interventions to improve prevention and early care for AKI after major surgery.

  14. Diabetes treatments and risk of amputation, blindness, severe kidney failure, hyperglycaemia, and hypoglycaemia: open cohort study in primary care (United States)

    Coupland, Carol


    Objective To assess the risks of amputation, blindness, severe kidney failure, hyperglycaemia, and hypoglycaemia in patients with type 2 diabetes associated with prescribed diabetes drugs, particularly newer agents including gliptins or glitazones (thiazolidinediones). Design Open cohort study in primary care. Setting 1243 practices contributing data to the QResearch database in England. Participants 469 688 patients with type 2 diabetes aged 25-84 years between 1 April 2007 and 31 January 2015. Exposures Hypoglycaemic agents (glitazones, gliptins, metformin, sulphonylureas, insulin, and other) alone and in combination. Main outcome measures First recorded diagnoses of amputation, blindness, severe kidney failure, hyperglycaemia, and hypoglycaemia recorded on patients’ primary care, mortality, or hospital records. Cox models estimated hazard ratios for diabetes treatments adjusting for potential confounders. Results 21 308 (4.5%) and 32 533 (6.9%) patients received prescriptions for glitazones and gliptins during follow-up, respectively. Compared with non-use, glitazones were associated with a decreased risk of blindness (adjusted hazard ratio 0.71, 95% confidence interval 0.57 to 0.89; rate 14.4 per 10 000 person years of exposure) and an increased risk of hypoglycaemia (1.22, 1.10 to 1.37; 65.1); gliptins were associated with a decreased risk of hypoglycaemia (0.86, 0.77 to 0.96; 45.8). Although the numbers of patients prescribed gliptin monotherapy or glitazones monotherapy were relatively low, there were significantly increased risks of severe kidney failure compared with metformin monotherapy (adjusted hazard ratio 2.55, 95% confidence interval 1.13 to 5.74). We found significantly lower risks of hyperglycaemia among patients prescribed dual therapy involving metformin with either gliptins (0.78, 0.62 to 0.97) or glitazones (0.60, 0.45 to 0.80) compared with metformin monotherapy. Patients prescribed triple therapy with metformin

  15. Diabetic threesome (hyperglycaemia, renal function and nutrition) and advanced glycation end products: evidence for the multiple-hit agent? (United States)

    Kanková, Katerina


    Complex chemical processes termed non-enzymic glycation that operate in vivo and similar chemical interactions between sugars and proteins that occur during thermal processing of food (known as the Maillard reaction) are one of the interesting examples of a potentially-harmful interaction between nutrition and disease. Non-enzymic glycation comprises a series of reactions between sugars, alpha-oxoaldehydes and other sugar derivatives and amino groups of amino acids, peptides and proteins leading to the formation of heterogeneous moieties collectively termed advanced glycation end products (AGE). AGE possess a wide range of chemical and biological properties and play a role in diabetes-related pathology as well as in several other diseases. Diabetes is, nevertheless, of particular interest for several reasons: (1) chronic hyperglycaemia provides the substrates for extracellular glycation as well as intracellular glycation; (2) hyperglycaemia-induced oxidative stress accelerates AGE formation in the process of glycoxidation; (3) AGE-modified proteins are subject to rapid intracellular proteolytic degradation releasing free AGE adducts into the circulation where they can bind to several pro-inflammatory receptors, especially receptor of AGE; (4) kidneys, which are principally involved in the excretion of free AGE adducts, might be damaged by diabetic nephropathy, which further enhances AGE toxicity because of diminished AGE clearance. Increased dietary intake of AGE in highly-processed foods may represent an additional exogenous metabolic burden in addition to AGE already present endogenously in subjects with diabetes. Finally, inter-individual genetic and functional variability in genes encoding enzymes and receptors involved in either the formation or the degradation of AGE could have important pathogenic, nutrigenomic and nutrigenetic consequences.

  16. Adiposity and hyperglycaemia in pregnancy and related health outcomes in European ethnic minorities of Asian and African origin: a review

    Directory of Open Access Journals (Sweden)

    Anne Karen Jenum


    Full Text Available Background: Ethnic minorities in Europe have high susceptibility to type 2 diabetes (T2DM and, in some groups, also cardiovascular disease (CVD. Pregnancy can be considered a stress test that predicts future morbidity patterns in women and that affects future health of the child. Objective: To review ethnic differences in: 1 adiposity, hyperglycaemia, and pre-eclampsia during pregnancy; 2 future risk in the mother of obesity, T2DM and CVD; and 3 prenatal development and possible influences of maternal obesity, hyperglycaemia, and pre-eclampsia on offspring's future disease risk, as relevant for ethnic minorities in Europe of Asian and African origin. Design: Literature review. Results: Maternal health among ethnic minorities is still sparsely documented. Higher pre-pregnant body mass index (BMI is found in women of African and Middle Eastern descent, and lower BMI in women from East and South Asia compared with women from the majority population. Within study populations, risk of gestational diabetes mellitus (GDM is considerably higher in many minority groups, particularly South Asians, than in the majority population. This increased risk is apparent at lower BMI and younger ages. Women of African origin have higher risk of pre-eclampsia. A GDM pregnancy implies approximately seven-fold higher risk of T2DM than normal pregnancies, and both GDM and pre-eclampsia increase later risk of CVD. Asian neonates have lower birth weights, and mostly also African neonates. This may translate into increased risks of later obesity, T2DM, and CVD. Foetal overgrowth can promote the same conditions. Breastfeeding represents a possible strategy to reduce risk of T2DM in both the mother and the child. Conclusions: Ethnic minority women in Europe with Asian and African origin and their offspring seem to be at increased risk of T2DM and CVD, both currently and in the future. Pregnancy is an important window of opportunity for short and long-term disease prevention.

  17. Chronic liver disease and subchronic nephritis in a male warty chameleon (Furcifer verrucosus with transient hyperglycaemia – case report

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    Zdeněk Knotek


    Full Text Available A two-year old male warty chameleon (Furcifer verrucosus weighing 160 g was presented for veterinary examination following 4 weeks of decreased ability to catch insects with the tongue and difficulty in swallowing the prey. Non-invasive endoscopy did not reveal any macroscopic changes of the oral cavity mucosa or the cranial part of the esophagus. Dorsoventral and laterolateral plain and contrast radiographs revealed enlargement of the medial part of the liver without any visible abnormalities in the regions of the esophagus, stomach or small intestine. Abnormalities in the plasma chemistry profile included transient hyperglycaemia (52.68–57.18 mmol/l and hyperuricaemia (452.70–622.20 μmol/l. The chameleon was examined at 7, 20 and 22 weeks after initial examination. Its body weight decreased to 120 g. A blood profile revealed normoglycaemia (16.37–10.22 mmol/l and hyperphosphataemia (2.92–3.06 mmol/l at the last three examinations. The chameleon died suddenly 33 days after the final examination. Necropsy revealed the presence of a large liver cyst, filled with fluid. The liver had lost all of its normal structure. The kidneys showed a large area with fibrosis and multiple uric acid tophi. The post mortem findings were defined as liver with fatty degeneration and moderate fibrotic changes with large cyst, subchronic nephritis with uric acid tophi, and mineralization in the myocardium. This paper describes the first documented case of transient hyperglycaemia in a warty chameleon (Furcifer verrucosus associated with chronic liver disease and subchronic nephritis.

  18. Insulin administered by needle-free jet injection corrects marked hyperglycaemia faster in overweight or obese patients with diabetes. (United States)

    de Wit, H M; Engwerda, E E C; Tack, C J; de Galan, B E


    To test whether jet injection of insulin resulted in faster correction of marked hyperglycaemia than when insulin is injected by a conventional pen in patients with diabetes. Adult, overweight or obese (BMI ≥25 and ≤40 kg/m(2)) patients with type 1 diabetes (n = 10) or insulin-treated type 2 diabetes (n = 10) were enrolled in a randomized, controlled, crossover study. On two separate occasions, patients were instructed to reduce insulin dose(s) to achieve marked hyperglycaemia (18-23 mmol/l). Subsequently, insulin aspart was administered either by jet injection or by conventional pen, in a dose based on estimated individual insulin sensitivity. Pharmacodynamic and pharmacokinetic profiles were derived from plasma glucose and insulin levels, measured for 6 h after injection. After conventional injection, plasma glucose concentration dropped by ≥10 mmol/l after 192.5 ± 13.6 min. The jet injector advanced this time to 147.9 ± 14.4 min [difference 44.6 (95% confidence interval 4.3, 84.8); P = 0.03], except in 3 patients who failed to reach this endpoint. The time advantage exceeded 1.5 h in patients with a BMI above the median. Jet injection also reduced the hyperglycaemic burden during the first 2 h (2042 ± 37.2 vs 2168 ± 26.1 mmol/min; P = 0.01) and the time to peak insulin levels (40.5 ± 3.2 vs 76.8 ± 7.7 min; P overweight or obese patients with insulin-requiring diabetes. © 2015 John Wiley & Sons Ltd.

  19. Fever, hyperglycaemia and swallowing dysfunction management in acute stroke: A cluster randomised controlled trial of knowledge transfer

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    Quinn Clare


    Full Text Available Abstract Background Hyperglycaemia, fever, and swallowing dysfunction are poorly managed in the admission phase of acute stroke, and patient outcomes are compromised. Use of evidence-based guidelines could improve care but have not been effectively implemented. Our study aims to develop and trial an intervention based on multidisciplinary team-building to improve management of fever, hyperglycaemia, and swallowing dysfunction in patients following acute stroke. Methods and design Metropolitan acute stroke units (ASUs located in New South Wales, Australia will be stratified by service category (A or B and, within strata, by baseline patient recruitment numbers (high or low in this prospective, multicentre, single-blind, cluster randomised controlled trial (CRCT. ASUs then will be randomised independently to either intervention or control groups. ASUs allocated to the intervention group will receive: unit-based workshops to identify local barriers and enablers; a standardised core education program; evidence-based clinical treatment protocols; and ongoing engagement of local staff. Control group ASUs will receive only an abridged version of the National Clinical Guidelines for Acute Stroke Management. The following outcome measures will be collected at 90 days post-hospital admission: patient death, disability (modified Rankin Score; dependency (Barthel Index and Health Status (SF-36. Additional measures include: performance of swallowing screening within 24 hours of admission; glycaemic control and temperature control. Discussion This is a unique study of research transfer in acute stroke. Providing optimal inpatient care during the admission phase is essential if we are to combat the rising incidence of debilitating stroke. Our CRCT will also allow us to test interventions focussed on multidisciplinary ASU teams rather than individual disciplines, an imperative of modern hospital services. Trial Registration Australia New Zealand Clinical Trial

  20. Fever, hyperglycaemia and swallowing dysfunction management in acute stroke: a cluster randomised controlled trial of knowledge transfer. (United States)

    Middleton, Sandy; Levi, Christopher; Ward, Jeanette; Grimshaw, Jeremy; Griffiths, Rhonda; D'Este, Catherine; Dale, Simeon; Cheung, N Wah; Quinn, Clare; Evans, Malcolm; Cadilhac, Dominique


    Hyperglycaemia, fever, and swallowing dysfunction are poorly managed in the admission phase of acute stroke, and patient outcomes are compromised. Use of evidence-based guidelines could improve care but have not been effectively implemented. Our study aims to develop and trial an intervention based on multidisciplinary team-building to improve management of fever, hyperglycaemia, and swallowing dysfunction in patients following acute stroke. Metropolitan acute stroke units (ASUs) located in New South Wales, Australia will be stratified by service category (A or B) and, within strata, by baseline patient recruitment numbers (high or low) in this prospective, multicentre, single-blind, cluster randomised controlled trial (CRCT). ASUs then will be randomised independently to either intervention or control groups. ASUs allocated to the intervention group will receive: unit-based workshops to identify local barriers and enablers; a standardised core education program; evidence-based clinical treatment protocols; and ongoing engagement of local staff. Control group ASUs will receive only an abridged version of the National Clinical Guidelines for Acute Stroke Management. The following outcome measures will be collected at 90 days post-hospital admission: patient death, disability (modified Rankin Score); dependency (Barthel Index) and Health Status (SF-36). Additional measures include: performance of swallowing screening within 24 hours of admission; glycaemic control and temperature control. This is a unique study of research transfer in acute stroke. Providing optimal inpatient care during the admission phase is essential if we are to combat the rising incidence of debilitating stroke. Our CRCT will also allow us to test interventions focussed on multidisciplinary ASU teams rather than individual disciplines, an imperative of modern hospital services. Australia New Zealand Clinical Trial Registry (ANZCTR) No: ACTRN12608000563369.

  1. The influence of stress hyperglycaemia on the prognosis of patients with acute myocardial infarction and temporary electrical cardiac pacing

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    Stojković Aleksandar


    Full Text Available Introduction. Elevated glucose levels on admission in many emergency conditions, including acute myocardial infarction (AMI, have been identified as a predictor of hospital mortality. Objective. Since there are no data in the literature related to stress hyperglycaemia (SH in patients with both AIM and temporary electrical cardiac pacing, we aimed to investigate the influence of stress hyperglycaemia on the prognosis of patients with AMI and temporary electrical cardiac pacing. Methods. The prospective study included 79 patients with diagnosed AMI with ST-segment elevation (STEMI, admitted to the Coronary Care Unit of the Clinic for Cardiovascular Diseases, Clinical Centre Niš, from 2004 to 2007, who were indicated for temporary electrical cardiac pacing. The blood was sampled on admission for lab analysis, glucose levels were determined (as well as markers of myocardial necrosis - troponin I, CK-MB. Echocardiographic study was performed and ejection fraction was evaluated by using area length method. Results. The ROC analysis indicated that the best glycaemic level on admission, which could be used as a predictor of mortality, was 10.00 mmol/l, and the area under the curve was 0.82. In the group without SH, hospital mortality was 3-fold lower 11/48 (22.91% compared to the group with SH 19/31 (61.29%, p<0.0001. Patients with SH were more likely to have higher troponin levels, Killip >1, lower ejection fraction and heart rate, as well as systolic blood pressure. Conclusion. The best cut-off value for SH in patients with AMI (STEMI and temporary electrical cardiac pacing is 10 mmol/l (determined by ROC curve and may be used in risk stratification; patients with glucose levels <10 mmol/l on admission are at 3-fold lower risk compared to those with glucose levels >10 mml/l. Our results suggest that SH is a more reliable marker of poor outcome in AMI patients with temporary pace maker, without previously diagnosed DM.

  2. Dietary sweet potato (Ipomoea batatas L.) leaf extract attenuates hyperglycaemia by enhancing the secretion of glucagon-like peptide-1 (GLP-1). (United States)

    Nagamine, Rika; Ueno, Shiori; Tsubata, Masahito; Yamaguchi, Kazuya; Takagaki, Kinya; Hira, Tohru; Hara, Hiroshi; Tsuda, Takanori


    'Suioh', a sweet potato (Ipomoea batatas L.) cultivar developed in Japan, has edible leaves and stems. The sweet potato leaves contain polyphenols such as caffeoylquinic acid (CQA) derivatives. It has multiple biological functions and may help to regulate the blood glucose concentration. In this study, we first examined whether sweet potato leaf extract powder (SP) attenuated hyperglycaemia in type 2 diabetic mice. Administration of dietary SP for 5 weeks significantly lowered glycaemia in type 2 diabetic mice. Second, we conducted in vitro experiments, and found that SP and CQA derivatives significantly enhanced glucagon-like peptide-1 (GLP-1) secretion. Third, pre-administration of SP significantly stimulated GLP-1 secretion and was accompanied by enhanced insulin secretion in rats, which resulted in a reduced glycaemic response after glucose injection. These results indicate that oral SP attenuates postprandial hyperglycaemia, possibly through enhancement of GLP-1 secretion.

  3. Stress hyperglycaemia in critically ill patients: Potential role of incretin hormones; a preliminary study Hiperglucemia de estrés en el paciente crítico: papel potencial de las incretinas; estudio preliminar


    J. A. Llompart-Pou; A. G. Fernández-de-Castillo; B. Burguera; J. Pérez-Bárcena; P. Marsé; M. Rodríguez-Yago; A. Barceló; J. M.ª Raurich


    Background: Stress hyperglycaemia is common in the intensive care unit (ICU) setting and has been related to a worst outcome. Objective: The objective was to characterize the association of glucoregulatory hormones, mainly incretins, with the levels of glycaemia, and its relationship with outcome in ICU patients. Methods: We prospectively studied 60 patients. Stress hyperglycaemia was diagnosed when glycaemia was < 115 mg/dL. At ICU admission we determined glycaemia, insulin, glucagon, cortis...

  4. Combined effects of chronic hyperglycaemia and oral aluminium intoxication on testicular tissue and some male reproductive parameters in Wistar rats. (United States)

    Akinola, O B; Biliaminu, S A; Adedeji, O G; Oluwaseun, B S; Olawoyin, O M; Adelabu, T A


    Exposure to either environmental toxicants or chronic hyperglycaemia could impair male reproductive function. However, the extent to which exposure to such toxicants, in the presence of pre-existing metabolic dysfunction, could affect male reproduction is unclear. Streptozotocin-induced diabetic Wistar rats (12 weeks old) were exposed to oral aluminium chloride at 250 ppm for 30 days; followed by evaluation of caudal epididymal sperm count and motility, assay for serum follicle stimulating hormone (FSH), testosterone (T) and oestradiol; and assessment of testicular histology. Moreover, blood glucose was evaluated by the glucose oxidase method. In rats treated with streptozotocin (STZ) or aluminium (Al) alone, erosion of testicular parenchyma and stroma was observed. This effect was most severe in diabetic rats simultaneously exposed to Al; coupled with reduced caudal epididymal sperm count that was least in this (STZ+Al) group (18.75 × 10(6)  ml(-1) ) compared with controls (61.25 × 10(6)  ml(-1) ; P < 0.05), STZ group or Al group. Moreover, these reproductive perturbations (in the STZ+Al group) were associated with reduced sperm motility and significantly reduced serum FSH (P < 0.05); but elevated serum T and oestradiol (P < 0.05), compared with control. These suggest that diabetes-induced testicular lesion is exacerbated by simultaneous oral Al toxicity in Wistar rats. © 2015 Blackwell Verlag GmbH.

  5. Long Lasting Microvascular Tone Alteration in Rat Offspring Exposed In Utero to Maternal Hyperglycaemia.

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    Emilie Vessières

    Full Text Available Epidemiologic studies have demonstrated that cardiovascular risk is not only determined by conventional risk factors in adulthood, but also by early life events which may reprogram vascular function. To evaluate the effect of maternal diabetes on fetal programming of vascular tone in offspring and its evolution during adulthood, we investigated vascular reactivity of third order mesenteric arteries from diabetic mother offspring (DMO and control mother offspring (CMO aged 3 and 18 months. In arteries isolated from DMO the relaxation induced by prostacyclin analogues was reduced in both 3- and 18-month old animals although endothelium (acetylcholine-mediated relaxation was reduced in 18-month old DMO only. Endothelium-independent (sodium nitroprusside relaxation was not affected. Pressure-induced myogenic tone, which controls local blood flow, was reduced in 18-month old CMO compared to 3-month old CMO. Interestingly, myogenic tone was maintained at a high level in 18-month old DMO even though agonist-induced vasoconstriction was not altered. These perturbations, in 18-months old DMO rats, were associated with an increased pMLC/MLC, pPKA/PKA ratio and an activated RhoA protein. Thus, we highlighted perturbations in the reactivity of resistance mesenteric arteries in DMO, at as early as 3 months of age, followed by the maintenance of high myogenic tone in older rats. These modifications are in favour of excessive vasoconstrictor tone. These results evidenced a fetal programming of vascular functions of resistance arteries in adult rats exposed in utero to maternal diabetes, which could explain a re-setting of vascular functions and, at least in part, the occurrence of hypertension later in life.

  6. Are lipophilic beta-blockers preferable for peri-operative ...

    African Journals Online (AJOL)

    There is therefore doubt whether atenolol is the correct cardioprotective drug in the surgical setting. It is possible that some of the physiochemical properties of atenolol (hydrophilic and cardioselective) may decrease it's efficacy in comparison to its more lipophilic congeners (such as propranolol, metoprolol, bisoprolol and ...

  7. Abnormal peri-operative haemorrhage in asymptomatic patients is ...

    African Journals Online (AJOL)

    was found, according to the same battery of tests employed for pre-operative screening, in 49 of 1 872 patients who had undergone major surgical procedures ... which inadvertent contamination of the specimen with heparin is the single most common cause of prolonged activated partial thromboplastin time, with correction ...

  8. Prevention of wound sepsis in amputations by peri-operative ...

    African Journals Online (AJOL)

    as regards development of sepsis in wounds closed primarily or left open while under A-CA cover. In a series of 44 patients with lower limb ischaemia requiring amputation for major limb sepsis, the per- formance of a new antibiotic combination with B- lactamase-inhibiting properties, amoxycillin plus . c1avulanic acid ...

  9. Peri-operative Blood Transfusion in open Suprapubic Transvesical ...

    African Journals Online (AJOL)

    INTRODUCTION: Open simple prostatectomy is the most effective and the most durable method of controlling symptoms associated with benign prostatic hyperplasia, especially in sub- Saharan Africa, where TURP set and expertise are unavailable in most health institutions. The risk of perioperative heterologous blood ...

  10. Predictors of peri-operative risk acceptance by South African ...

    African Journals Online (AJOL)

    Gambling Task, widely regarded as an important assay of ability to learn and respond to feedback mixing gains and losses that differ in both magnitude and frequency, and the extent to which performance was degraded was correlated to pain intensity.32−35. With specific reference to treatment choices, Bono et al.

  11. Are lipophilic beta-blockers preferable for peri-operative ...

    African Journals Online (AJOL)


    coronary artery disease; and it has not been shown to significantly increase pulmonary oedema when administered following acute MI.1. Beta-blockers are protective against sudden arrhythmic death following MI.35-37 The latter accounts for between 22 and. 52% of post MI cardiac deaths.36 37 It is well recognised that the.

  12. Abnormal peri-operative haemorrhage in asymptomatic patients is ...

    African Journals Online (AJOL)

    Accordingly, we undertook two studies to detertnine whether it could be justified in patients without a history of abnormal bleeding. In the first of these, 45 of 159 patients were excluded because of aspirin ingestion and a further 3 because of positive bleeding history so that prothrombin time, activated partial thromboplastin ...

  13. Nutrition in peri-operative esophageal cancer management

    NARCIS (Netherlands)

    Steenhagen, E.; Vulpen, J.K. van; Hillegersberg, R. van; May, A.M.; Siersema, P.D.


    INTRODUCTION: Nutritional status and dietary intake are increasingly recognized as essential areas in esophageal cancer management. Nutritional management of esophageal cancer is a continuously evolving field and comprises an interesting area for scientific research. Areas covered: This review

  14. Acute severe depression following peri-operative ondansetron

    African Journals Online (AJOL)

    Anaesthesia with a propofol infusion and avoidance of serotonin antagonists provided a nausea-tree postoperative course without exacerbation of the depression disorder. S Afr Med J 1997; 87: 1013-1014. Ondansetron, a serotonin or 5-hydroxytryptamine-3 receptor. (5-HT3) antagonist, is often used as a potent anti-emetic.

  15. Peri-operative management for excision of plexiform ...

    African Journals Online (AJOL)

    Case report: A 28-year-old female weighing 78 kilograms presented at the University of Port Harcourt Teaching Hospital (UPTH) with a huge left thigh mass, nodules and brownish skin patches (café-au-lait spots) all over her body. Plexiform neurofibromatosis was diagnosed. The mass was subsequently excised under ...

  16. Effect of postprandial hyperglycaemia in non-invasive measurement of cerebral metabolic rate of glucose in non-diabetic subjects

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    Tsuchida, Tatsuro; Itoh, Harumi [Department of Radiology, Fukui Medical University, Matsuoka (Japan); Sadato, Norihiro; Nishizawa, Sadahiko; Yonekura, Yoshiharu [Biomedical Imaging Research Center, Fukui Medical University (Japan)


    The aim of this study was to determine the effect of postprandial hyperglycaemia (HG) on the non-invasive measurement of cerebral metabolic rate of glucose (CMRGlc). Five patients who had a meal within an hour before a fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET) examination were recruited in this study. They underwent intermittent arterial blood sampling (measured input function), and, based on this sampling, CMRGlc was calculated using an autoradiographic method (CMRGlc{sub real}). Simulated input functions were generated based on standardised input function, body surface area and net injected dose of FDG, and simulated CMRGlc (CMRGlc{sub sim}) was also calculated. Percent error of the area under the curve (AUC) between measured (AUC{sub real}) and simulated input function (AUC{sub IFsim}) and percent error between CMRGlc{sub real} and CMRGlc{sub sim} were calculated. These values were compared with those obtained from a previous study conducted under fasting conditions (F). The serum glucose level in the HG group was significantly higher than that in the F group (165{+-}69 vs 100{+-}9 mg/dl, P=0.0007). Percent errors of AUC and CMRGlc in grey matter and white matter in HG were significantly higher than those in F (12.9%{+-}1.3% vs 3.5%{+-}2.2% in AUC, P=0.0015; 18.2%{+-}2.2% vs 2.9%{+-}1.9% in CMRGlc in grey matter, P=0.0028; 24.0%{+-}4.6% vs 3.4%{+-}2.2% in CMRGlc in white matter, P=0.0028). It is concluded that a non-invasive method of measuring CMRGlc should be applied only in non-diabetic subjects under fasting conditions. (orig.)

  17. Assessment of screening practices for gestational hyperglycaemia in public health facilities: a descriptive study in Bangalore, India

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    Giridhara R. Babu


    Full Text Available Background. Screening and timely treatment of gestational hyperglycaemia (GH is proved to be beneficial and improves maternal and foetal health outcomes. To understand screening practices, we explored the knowledge and perceptions of doctors working in public health facilities in Bangalore, India. We also studied participation factors by examining whether undergoing glucose estimation tests affects morning sickness in pregnant women. Design and Methods. We aimed to understand the screening practices and knowledge of doctors. A semi-structured questionnaire was self-administered by the 50 participant doctors, selected from the sampling frame comprising of all the doctors working in public health facilities. We included 105 pregnant women for baseline assessment, in whom a well-structured questionnaire was used. Results. We reported that gestational diabetes mellitus (GDM screening was done in nearly all the health centres (96%. However, only 12% of the doctors could provide all components of GDM diagnosis and management correctly and 46% would diagnose by using a random blood glucose test. A majority (92% of the doctors had poor knowledge (68% about the cut-off values of glucose tests. More than 80% of pregnant women experienced some discomfort mostly due to rapid ingestion glucose in short span of time. Conclusions. Our study established that screening for GH is done in most public health facilities. Nonetheless, knowledge of doctors on the glucose tests and their interpretation needs improvement. Re-orientation trainings of the doctors can improve their knowledge and thereby can efficiently screen for GH. Further, adequate planning prior to the tests can aid successful completion of them.

  18. Categorisation of continuous exposure variables revisited. A response to the Hyperglycaemia and Adverse Pregnancy Outcome (HAPO Study

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    Henriksen Tore


    Full Text Available Abstract Background Although the general statistical advice is to keep continuous exposure variables as continuous in statistical analyses, categorisation is still a common approach in medical research. In a recent paper from the Hyperglycaemia and Adverse Pregnancy Outcome (HAPO Study, categorisation of body mass index (BMI was used when analysing the effect of BMI on adverse pregnancy outcomes. The lowest category, labelled "underweight", was used as the reference category. Methods The present paper gives a summary of reasons for categorisation and methodological drawbacks of this approach. We also discuss the choice of reference category and alternative analyses. We exemplify our arguments by a reanalysis of results from the HAPO paper. Results Categorisation of continuous exposure data results in loss of power and other methodological challenges. An unfortunate choice of reference category can give additional lack of precision and obscure the interpretation of risk estimates. A highlighted odds ratio (OR in the HAPO study is the OR for birth weight >90th percentile for women in the highest compared to the lowest BMI category ("obese class III" versus "underweight". This estimate was OR = 4.55 and OR = 3.52, with two different multiple logistic regression models. When using the "normal weight" category as the reference, our corresponding estimates were OR = 2.03 and OR = 1.62, respectively. Moreover, our choice of reference category also gave narrower confidence intervals. Summary Due to several methodological drawbacks, categorisation should be avoided. Modern statistical analyses should be used to analyse continuous exposure data, and to explore non-linear relations. If continuous data are categorised, special attention must be given to the choice of reference category.

  19. Diabetes in Danish bank voles (M. glareolus): survivorship, influence on weight, and evaluation of polydipsia as a screening tool for hyperglycaemia. (United States)

    Schønecker, Bryan; Freimanis, Tonny; Sørensen, Irene Vejgaard


    Previous studies have concluded that the development of polydipsia (PD, a daily water intake ≥ 21 ml) among captive Danish bank voles, is associated with the development of a type 1 diabetes (T1D), based on findings of hyperglycaemia, glucosuria, ketonuria/-emia, lipemia, destroyed beta cells, and presence of autoantibodies against GAD65, IA-2, and insulin. We retrospectively analysed data from two separate colonies of Danish bank voles in order to 1) estimate survivorship after onset of PD, 2) evaluate whether the weight of PD voles differed from non-PD voles, and, 3), evaluate a state of PD as a practical and non-invasive tool to screen for voles with a high probability of hypeglycaemia. In addition, we discuss regional differences related to the development of diabetes in Scandinavian bank voles and the relevance of the Ljungan virus as proposed etiological agent. We found that median survival after onset of PD is at least 91 days (lower/upper quartiles = 57/134 days) with a maximum recording of at least 404 days survivorship. The development of PD did not influence the weight of Danish bank voles. The measures of accuracy when using PD as predictor of hyperglycaemia, i.e. sensitivity, specificity, positive predictive value, and negative predictive value, equalled 69%, 97%, 89%, and 89%, respectively. The relatively long survival of Danish PD bank voles suggests potentials for this model in future studies of the long-term complications of diabetes, of which some observations are mentioned. Data also indicates that diabetes in Danish bank is not associated with a higher body weight. Finally, the method of using measurements of daily water intake to screen for voles with a high probability of hyperglycaemia constitutes a considerable refinement when compared to the usual, invasive, methods.

  20. High-polyphenol chocolate reduces endothelial dysfunction and oxidative stress during acute transient hyperglycaemia in Type 2 diabetes: a pilot randomized controlled trial. (United States)

    Mellor, D D; Madden, L A; Smith, K A; Kilpatrick, E S; Atkin, S L


    To investigate the effects of high-polyphenol chocolate upon endothelial function and oxidative stress in Type 2 diabetes mellitus during acute transient hyperglycaemia induced following a 75-g oral glucose challenge. Ten subjects with Type 2 diabetes underwent a double-blinded randomized controlled crossover study. A 75-g oral glucose load was used to induce hyperglycaemia, which was administered to participants 60 min after they had ingested either low (control) or high-polyphenol chocolate. Participants undertook testing at weekly intervals, following an initial cocoa-free period. Endothelial function was assessed by both functional [reactive hyperaemia peripheral artery tonometry (EndoPAT-2000) and serum markers (including intercellular adhesion molecule 1, P-selectin and P-selectin glycoprotein ligand 1]. Urinary 15-F2t-isoprostane adjusted for creatinine was used as an oxidative stress marker. Measurements were made at baseline and 2 h post-ingestion of the glucose load. Prior consumption of high-polyphenol chocolate before a glucose load improved endothelial function (1.7 ± 0.1 vs. 2.3 ± 0.1%, P = 0.01), whereas prior consumption of control chocolate resulted in a significant increase in intercellular adhesion molecule 1 (321.1 ± 7.6 vs. 373.6 ± 10.5 ng/ml, P = 0.04) and 15-F2t-isoprostane (116.8 ± 5.7 vs. 207.1 ± 5.7 mg/mol, P = 0.02). Analysis of percentage changes from baseline comparing control and high-polyphenol chocolate showed a significant improvement for high-polyphenol chocolate in both measures of endothelial function (P chocolate protected against acute hyperglycaemia-induced endothelial dysfunction and oxidative stress in individuals with Type 2 diabetes mellitus. © 2012 The Authors. Diabetic Medicine © 2012 Diabetes UK.

  1. The association of long-term glycaemic variability versus sustained chronic hyperglycaemia with heart rate-corrected QT interval in patients with type 2 diabetes.

    Directory of Open Access Journals (Sweden)

    Jian-Bin Su

    Full Text Available Prolonged heart rate-corrected QT(QTc interval is related to ventricular arrhythmia and cardiovascular mortality, with considerably high prevalence of type 2 diabetes. Additionally, long-term glycaemic variability could be a significant risk factor for diabetic complications in addition to chronic hyperglycaemia. We compared the associations of long-term glycaemic variability versus sustained chronic hyperglycaemia with the QTc interval among type 2 diabetes patients.In this cross-sectional study, 2904 type 2 diabetes patients were recruited who had undergone at least four fasting plasma glucose (FPG and 2-hour postprandial plasma glucose (PPG measurements (at least once for every 3 months, respectively during the preceding year. Long-term glycaemic variabilities of FPG and 2-hour PPG were assessed by their standard deviations (SD-FPG and SD-PPG, respectively, and chronic fasting and postprandial hyperglycaemia were assessed by their means (M-FPG and M-PPG, respectively. HbA1c was also determined upon enrolment to assess current overall glycaemic control. QTc interval was estimated from resting 12-lead electrocardiograms, and more than 440 ms was considered abnormally prolonged.Patients with prolonged QTc interval (≥440 ms had greater M-FPG, M-PPG, SD-PPG and HbA1c than those with normal QTc interval but comparable SD-FPG. QTc interval was correlated with M-FPG, M-PPG, SD-PPG and HbA1c (r = 0.133, 0.153, 0.245 and 0.207, respectively, p = 0.000 but not with SD-FPG (r = 0.024, p = 0.189. After adjusting for metabolic risk factors via multiple linear regression analysis, SD-PPG, M-PPG and HbA1c (t = 12.16, 2.69 and 10.16, respectively, p = 0.000 were the major independent contributors to the increased QTc interval. The proportion of prolonged QTc interval increased significantly from 10.9% to 14.2% to 26.6% for the first (T1 to second (T2 to third (T3 tertiles of SD-PPG. After adjusting via multiple logistic regression analysis, the odd ratios

  2. Loss of coupling between calcium influx, energy consumption and insulin secretion associated with development of hyperglycaemia in the UCD-T2DM rat model of type 2 diabetes. (United States)

    Rountree, A M; Reed, B J; Cummings, B P; Jung, S-R; Stanhope, K L; Graham, J L; Griffen, S C; Hull, R L; Havel, P J; Sweet, I R


    Previous studies on isolated islets have demonstrated tight coupling between calcium (Ca(2+)) influx and oxygen consumption rate (OCR) that is correlated with insulin secretion rate (ISR). To explain these observations, we have proposed a mechanism whereby the activation of a highly energetic process (Ca(2+)/metabolic coupling process [CMCP]) by Ca(2+) mediates the stimulation of ISR. The aim of the study was to test whether impairment of the CMCP could play a role in the development of type 2 diabetes. Glucose- and Ca(2+)-mediated changes in OCR and ISR in isolated islets were compared with the time course of changes of plasma insulin concentrations observed during the progression to hyperglycaemia in a rat model of type-2 diabetes (the University of California at Davis type 2 diabetes mellitus [UCD-T2DM] rat). Islets were isolated from UCD-T2DM rats before, 1 week, and 3 weeks after the onset of hyperglycaemia. Glucose stimulation of cytosolic Ca(2+) and OCR was similar for islets harvested before and 1 week after the onset of hyperglycaemia. In contrast, a loss of decrement in islet OCR and ISR in response to Ca(2+) channel blockade coincided with decreased fasting plasma insulin concentrations observed in rats 3 weeks after the onset of hyperglycaemia. These results suggest that phenotypic impairment of diabetic islets in the UCD-T2DM rat is downstream of Ca(2+) influx and involves unregulated stimulation of the CMCP. The continuously elevated levels of CMCP induced by chronic hyperglycaemia in these islets may mediate the loss of islet function.

  3. Critical potential of early cardiac surgery for infective endocarditis with cardio-embolic strokes. (United States)

    Suzuki, Makoto; Takanashi, Shuichiro; Ohshima, Yutaro; Nagatomo, Yuji; Seki, Atsushi; Takamisawa, Itaru; Tobaru, Tetsuya; Naito, Kazuhiro; Kin, Hajime; Umemura, Jun; Takayama, Morimasa; Sumiyoshi, Tetsuya; Tomoike, Hitonobu


    Early cardiac surgery may have a trade-off between stabilized hemodynamics with controlled infection and a risk of peri-operative death in patients with infective endocarditis (IE) complicated with cardio-embolic strokes. We retrospectively studied clinical characteristics and outcomes in 68 consecutive patients with IE (mean age, 58±3years, 62% male) who admitted in our institute during June 2013 and August 2015. Cardio-embolic strokes were noted in 37% of patients (n=25) with IE and overall in-hospital mortality was 4 times higher in IE with cardio-embolic strokes than IE with an absence of strokes (n=43) (20% vs. 4.7%, p=0.045). Bacteremia of Staphylococcus aureus (p=0.021) and a complication of cardio-embolic strokes (p=0.031) were independently associated with in-hospital death in those with IE. However, in-hospital mortality was quite low in 19 with early cardiac surgery compared with 6 with conventional treatment in those with cardio-embolic strokes (11% vs. 50%, p=0.035). Multivariate logistic analysis demonstrated that lack of early cardiac surgery (p=0.014), a complication of cerebral hemorrhage (p=0.002), and a presence of refractory heart failure (p=0.047) were independently associated with in-hospital death in those with IE complicated with cardio-embolic strokes. Early cardiac surgery may provide clinical advantages overcoming peri-operative risks in those with IE complicated with cardio-embolic strokes. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  4. Implementation of evidence-based treatment protocols to manage fever, hyperglycaemia, and swallowing dysfunction in acute stroke (QASC): a cluster randomised controlled trial. (United States)

    Middleton, Sandy; McElduff, Patrick; Ward, Jeanette; Grimshaw, Jeremy M; Dale, Simeon; D'Este, Catherine; Drury, Peta; Griffiths, Rhonda; Cheung, N Wah; Quinn, Clare; Evans, Malcolm; Cadilhac, Dominique; Levi, Christopher


    We assessed patient outcomes 90 days after hospital admission for stroke following a multidisciplinary intervention targeting evidence-based management of fever, hyperglycaemia, and swallowing dysfunction in acute stroke units (ASUs). In the Quality in Acute Stroke Care (QASC) study, a single-blind cluster randomised controlled trial, we randomised ASUs (clusters) in New South Wales, Australia, with immediate access to CT and on-site high dependency units, to intervention or control group. Patients were eligible if they spoke English, were aged 18 years or older, had had an ischaemic stroke or intracerebral haemorrhage, and presented within 48 h of onset of symptoms. Intervention ASUs received treatment protocols to manage fever, hyperglycaemia, and swallowing dysfunction with multidisciplinary team building workshops to address implementation barriers. Control ASUs received only an abridged version of existing guidelines. We recruited pre-intervention and post-intervention patient cohorts to compare 90-day death or dependency (modified Rankin scale [mRS] ≥2), functional dependency (Barthel index), and SF-36 physical and mental component summary scores. Research assistants, the statistician, and patients were masked to trial groups. All analyses were done by intention to treat. This trial is registered at the Australia New Zealand Clinical Trial Registry (ANZCTR), number ACTRN12608000563369. 19 ASUs were randomly assigned to intervention (n=10) or control (n=9). Of 6564 assessed for eligibility, 1696 patients' data were obtained (687 pre-intervention; 1009 post-intervention). Results showed that, irrespective of stroke severity, intervention ASU patients were significantly less likely to be dead or dependent (mRS ≥2) at 90 days than control ASU patients (236 [42%] of 558 patients in the intervention group vs 259 [58%] of 449 in the control group, p=0·002; number needed to treat 6·4; adjusted absolute difference 15·7% [95% CI 5·8-25·4]). They also had a

  5. Improvement of hyperglycaemia and metabolic syndromes in type 2 diabetic KKAy mice by oral treatment with [meso-tetrakis(4-sulfonatophenyl) porphyrinato]oxovanadium(IV)(4-) complex. (United States)

    Saha, Tapan Kumar; Yoshikawa, Yutaka; Sakurai, Hiromu


    Recently, we reported that [meso-tetrakis(4-sulfonatophenyl)porphyrinato]oxovanadium(IV)(4-), VO(tpps), shows in-vitro insulin-mimetic and in-vivo anti-diabetic activity in streptozotocin (STZ)-induced type 1 diabetic mice. This result prompted us to examine its ability in type 2 diabetic model KKA(y) mice with insulin resistance. We studied the in-vivo anti-diabetic activity of VO(tpps), compared with that of vanadium(IV) oxide sulfate, VS, as control. Both compounds were orally administered at doses of 5-10 mg (0.1-0.2 mmol) V/kg body weight to the KKA(y) mice for 28 days. VO(tpps) normalized the hyperglycaemia within 15 days, while VS lowered the blood glucose concentration only by a small degree. In addition, metabolic syndromes characterized by insulin and leptin resistance were significantly improved in VO(tpps)-treated KKA(y) mice compared with those treated with VS. The improvement in diabetes was validated by oral glucose tolerance test and decrease in HbA(1c) concentration. Based on these observations, VO(tpps) is proposed to be an orally active oxovanadium(IV)-porphyrin complex for treating not only type 2 diabetes but also metabolic syndromes in animals.

  6. How sensitive and specific is urinalysis 'dipstick' testing for detection of hyperglycaemia and ketosis? An audit of findings from coronial autopsies. (United States)

    Mitchell, Rebecca; Thomas, Sunethra Devika; Langlois, Neil E I


    Biochemical analysis of glucose and ketones in the vitreous humour obtained at post-mortem examination is representative of the levels in the blood prior to death. Elevated levels can be indicative of conditions including diabetic ketoacidosis, which can be a cause for unexpected death. A rapid screening test for such conditions can be performed during the autopsy through urinalysis using test strips (urine 'dipstick' testing). The aim of this study was to assess the utility of urinalysis testing for post-mortem detection of derangements of glucose and ketone levels. The results of vitreous biochemical analysis and urinalysis were collated from 188 forensic autopsy cases. A vitreous glucose result of above 10 mmol/L was regarded as high. When this was compared to urinalysis results it was found that any urinalysis result above negative had a sensitivity of 0.83 and a specificity of 0.93. A vitreous ketone level of above 5 mmol/L was regarded as significantly elevated; a urinalysis result above negative had a sensitivity of 1, but a specificity of 0.12. Urinalysis ('dipstick' testing) for glucose has a good sensitivity and specificity for high vitreous glucose levels, which are regarded as indicative of pathological hyperglycaemia during life. It was found that urine testing for ketones either has an excellent sensitivity with low specificity or a poor sensitivity with a good specificity; however, this finding has to be viewed in the context of uncertainty of the biochemical level of significant ketosis.

  7. GdCl3 reduces hyperglycaemia through Akt/FoxO1-induced suppression of hepatic gluconeogenesis in Type 2 diabetic mice. (United States)

    Wang, Qian; Wang, Ning; Dong, Mei; Chen, Fang; Li, Zhong; Chen, Yuanyuan


    GdCl3 (gadolinium chloride) has been shown to reduce blood glucose; however, the underlying mechanism remains unclear. Liver gluconeogenesis is an important pathway involved in the maintenance of glucose homoeostasis. The aim of the present study was to investigate the role of GdCl3 in hepatic gluconeogenesis and explore the precise molecular mechanism. Animals from a classical Type 2 diabetic mouse model, created by exposing C57BL/6J mice to a high-fat diet for 4 months, were treated with GdCl3 or saline. Body weight, blood glucose and insulin sensitivity were monitored. It was observed that GdCl3 significantly reduced blood glucose levels and improved insulin sensitivity. A pyruvate tolerance test showed further that GdCl3 suppressed gluconeogenesis in diabetic mice. In the livers of GdCl3-treated mice, the expression of Pepck (phosphoenolpyruvate carboxykinase) and G6pase (glucose-6-phosphatase), the key enzymes in gluconeogenesis, were dramatically reduced. Furthermore, experiments in hepatocarcinoma cells revealed that GdCl3 activated the Akt pathway to promote the phosphorylation of FoxO1 (forkhead box O1), leading to the suppression of gluconeogenesis by reducing the expression of PEPCK and G6Pase and resulting in decreased cellular production of glucose. Comparable results were observed in the livers of GdCl3-treated mice. In addition, we have shown that GdCl3 augmented the role of insulin to control hepatic glucose production. We conclude that GdCl3 reduces hyperglycaemia via the Akt/FoxO1-induced suppression of hepatic gluconeogenesis, both in Type 2 diabetic mice (in vivo) and in hepatocarcinoma cells (in vitro), suggesting that GdCl3 may be a potential therapeutic agent for diabetes.

  8. An audit of early complications of radical cystectomy using Clavien-Dindo classification

    Directory of Open Access Journals (Sweden)

    Nitesh Patidar


    Full Text Available Introduction: Despite the major improvements in surgical technique and perioperative care, radical cystectomy (RC remains a major operative procedure with a significant morbidity and mortality. The present study analyzes the early complications of RC and urinary diversion using a standardized reporting system. Materials and Methods: Modified Clavien-Dindo classification was used to retrospectively assess the peri-operative course of 212 patients who had RC with urinary diversion between October 2003 and October 2014 at a single institution. The indications for surgery were muscle invasive urothelial carcinoma, high-grade nonmuscle invasive bladder cancer (BC, and Bacillus Calmette-Guerin-resistant nonmuscle invasive BCs. Data on age, sex, comorbidities, smoking history, American Society of Anaesthesiologists score, and peri-operative complications (up to 90 days were captured. Statistical analysis was performed using SPSS 20.0 software (Chicago, USA. Results: The mean age was 56.15 ΁ 10.82. Orthotopic neobladder was created in 113 patients, ileal conduit in 88 patients, and cutaneous ureterostomy in 11 patients. A total of 292 complications were recorded in 136/212 patients. 242 complications (81.16% occurred in the first 30 days, with the remaining 50 complications (18.83% occurring thereafter. The rates for overall complication were 64.1%. The most common complications were hematologic (21.6%. Most of the complications were of Grade I and II (22.9% and 48.9%, respectively. Grade IIIa, IIIb, IVa, IVb, and V complications were observed in 10.2%, 8.9%, 3.4%, 2.7%, and 2.7% of the patients, respectively. Conclusions: RC and urinary diversion are associated with significant morbidity. This audit would help in setting a benchmark for further improvement in the outcome.

  9. Early Surrogate Markers of Treatment Activity: Where Are We Now? (United States)

    Klintman, Marie; Dowsett, Mitchell


    The assessment of new therapies in the adjuvant setting in early breast cancer requires large numbers of patients and many years of follow-up for results to be presented. Therefore, the neoadjuvant study setting, which allows for early prediction of treatment response in smaller patient sets, has become increasingly popular. Ki67 is the most commonly used and extensively studied intermediate biomarker of treatment activity and residual risk in neoadjuvant trials on endocrine therapy, new biological therapies, and chemotherapy. It is increasingly being used as a primary endpoint for new therapies particularly those added to endocrine therapy. The PeriOperative Endocrine Therapy for Individualizing Care (POETIC) trial, including more than 4000 postmenopausal, estrogen receptor (ER)-positive patients randomly assigned to receive 2 weeks of presurgical treatment with an aromatase inhibitor or no further treatment, is the largest window-of-opportunity trial conducted and is assessing the clinical utility of on-treatment Ki67 as a predictor of long-term outcome. For generalizability, Ki67 measurements in the POETIC and other trials need to use standard methodology. The International Working Group on Ki67 in Breast Cancer is conducting a series of studies to bring this to reality. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail:

  10. The pharmaco-economics of peri-operative beta-blocker and statin ...

    African Journals Online (AJOL)

    at 2 years.16.17 Because all drugs have potential adverse side- effects, we have attempted to determine the overall incidences of adverse cardiovascular outcomes potentially attributable to beta-blocker administration, including hypotension and bradycardia needing treatment, congestive heart failure, bronchospasm and ...

  11. Monitoring of peri-operative fluid administration by individualized goal-directed therapy

    DEFF Research Database (Denmark)

    Bundgaard-Nielsen, M; Holte, Kathrine; Secher, N H


    (n = 725) found a reduced hospital stay. Post-operative nausea and vomiting (PONV) and ileus were reduced in three studies and complications were reduced in four studies. Of the monitors that may be applied for goal-directed therapy, only oesophageal Doppler has been tested adequately; however......, several other options exist. CONCLUSION: Goal-directed therapy with the maximization of flow-related haemodynamic variables reduces hospital stay, PONV and complications, and facilitates faster gastrointestinal functional recovery. So far, oesophageal Doppler is recommended, but other monitors...

  12. Peri-operative concerns in a patient with thyroid storm secondary to molar pregnancy

    Directory of Open Access Journals (Sweden)

    Tanvir Samra


    Full Text Available Awareness of the presence of thyroid function abnormalities in patients with molar pregnancy is important for its prompt diagnosis and management. We report the development of thyroid storm in the immediate post-operative period in a 25-year-old female who underwent evacuation of her molar pregnancy under saddle spinal block after being controlled for her thyrotoxicosis with a combination of antithyroid drugs, iodine, steroids and adrenergic blocking agents. We advocate the use of esmolol infusions up to a maximum dose of 200 μg/kg/min for immediate haemodynamic management of the patient. Optimum time needed for stabilisation of the hyper metabolic state after initiation of antithyroid drugs is still not known and evacuation of molar pregnancy remains the only definitive management of the thyrotoxic state.

  13. Role of physiotherapy in peri-operative management in total knee and hip surgery. (United States)

    Lenssen, A F; de Bie, R A


    Knee osteoarthritis (OA) is often associated with pain, functional impairment and various degrees of disability. Physiotherapy in combination with both aerobic and strength training exercises have shown positive effects in both the pre-operative and post-operative period. At the initial stages of osteoarthritis, physical therapy and education can improve the functional outcome and the participation of patients in daily activities. In the case of OA progression and when an operation is the only effective treatment, physiotherapy is very useful in enhancing self-esteem and minimising depression and anxiety for the forthcoming surgery. Post-operative intense physical therapy and Continuous Passive Motion (CPM) application offer remarkable benefits in terms of faster recovery, shorter hospital stay and increase of range of motion. Furthermore, home-based excercises following discharge from the hospital should be encouraged in order to optimise the final result. Although the entire mechanism remains unclear, physical exercise protocols may be beneficial for patients and the health system alike.

  14. A review of the peri-operative management of paediatric burns ...

    African Journals Online (AJOL)

    temperature control, availability of consumables and staff experience.[3]. Although surgery for burns follows a standard procedure, it remains a high-risk procedure. This prospective study was designed to identify factors that could adversely affect surgical and anaesthetic outcomes. Ethical permission was granted by the ...

  15. Systematic review of peri-operative prognostic biomarkers in pancreatic ductal adenocarcinoma

    NARCIS (Netherlands)

    Petrushnko, W.; Gundara, J.S.; Reuver, P.R.; O'Grady, G.; Samra, J.S.; Mittal, A.


    BACKGROUND: Pancreatic ductal adenocarcinoma (PDAC) continues to be associated with a poor prognosis. This systematic review aimed to summarize the literature regarding potential prognostic biomarkers to facilitate validation studies and clinical application. METHODS: A systematic review was

  16. Improving peri-operative care using an anaesthesia information management system

    NARCIS (Netherlands)

    Kooij, F.O.


    This thesis investigates a reminder system and intends to form a proof of the concept that decision support, using patient and situation specific automated reminders, can actually improve patient outcome. The research in this thesis was planned and executed within the scope of a guideline

  17. Complications following an unnecessary peri-operative plasma transfusion and literature review

    Directory of Open Access Journals (Sweden)

    Jay S Raval


    Full Text Available Plasma is used to correct coagulopathies, but not all coagulation abnormalities are clinically significant enough to require correction before an invasive procedure. We report an 82-year-old female who, in response to a mildly prolonged INR of unknown etiology, was unnecessarily transfused with plasma in advance of elective surgery. The patient suffered a moderately severe transfusion reaction, including hives and voice hoarseness, which caused a 4-week delay in her surgery. This delay and adverse reaction could have been avoided had the principles of evidence based plasma therapy, which we herein review, been followed and if the etiology of the mildly elevated INR been investigated before the day of her surgery.

  18. Early blood glucose profile and neurodevelopmental outcome at two years in neonatal hypoxic-ischaemic encephalopathy

    LENUS (Irish Health Repository)

    Nadeem, Montasser


    Abstract Background To examine the blood glucose profile and the relationship between blood glucose levels and neurodevelopmental outcome in term infants with hypoxic-ischaemic encephalopathy. Methods Blood glucose values within 72 hours of birth were collected from 52 term infants with hypoxic-ischaemic encephalopathy. Hypoglycaemia [< 46.8 mg\\/dL (2.6 mmol\\/L)] and hyperglycaemia [> 150 mg\\/dL (8.3 mmol\\/L)] were correlated to neurodevelopmental outcome at 24 months of age. Results Four fifths of the 468 blood samples were in the normoglycaemic range (392\\/468:83.8%). Of the remaining 76 samples, 51.3% were in the hypoglycaemic range and (48.7%) were hyperglycaemic. A quarter of the hypoglycaemic samples (28.2%:11\\/39) and a third of the hyperglycaemic samples (32.4%:12\\/37) were recorded within the first 30 minutes of life. Mean (SD) blood glucose values did not differ between infants with normal and abnormal outcomes [4.89(2.28) mmol\\/L and 5.02(2.35) mmol\\/L, p value = 0.15] respectively. In term infants with hypoxic-ischaemic encephalopathy, early hypoglycaemia (between 0-6 hours of life) was associated with adverse outcome at 24 months of age [OR = 5.8, CI = 1.04-32)]. On multivariate analysis to adjust for grade of HIE this association was not statistically significant. Late hypoglycaemia (6-72 hours of life) was not associated with abnormal outcome [OR = 0.22, CI (0.04-1.14)]. The occurrence of hyperglycaemia was not associated with adverse outcome. Conclusion During the first 72 hours of life, blood glucose profile in infants with hypoxic-ischaemic encephalopathy varies widely despite a management protocol. Early hypoglycaemia (0-6 hours of life) was associated with severe HIE, and thereby; adverse outcome.

  19. Early blood glucose profile and neurodevelopmental outcome at two years in neonatal hypoxic-ischaemic encephalopathy.

    LENUS (Irish Health Repository)

    Nadeem, Montasser


    BACKGROUND: To examine the blood glucose profile and the relationship between blood glucose levels and neurodevelopmental outcome in term infants with hypoxic-ischaemic encephalopathy. METHODS: Blood glucose values within 72 hours of birth were collected from 52 term infants with hypoxic-ischaemic encephalopathy. Hypoglycaemia [< 46.8 mg\\/dL (2.6 mmol\\/L)] and hyperglycaemia [> 150 mg\\/dL (8.3 mmol\\/L)] were correlated to neurodevelopmental outcome at 24 months of age. RESULTS: Four fifths of the 468 blood samples were in the normoglycaemic range (392\\/468:83.8%). Of the remaining 76 samples, 51.3% were in the hypoglycaemic range and (48.7%) were hyperglycaemic. A quarter of the hypoglycaemic samples (28.2%:11\\/39) and a third of the hyperglycaemic samples (32.4%:12\\/37) were recorded within the first 30 minutes of life. Mean (SD) blood glucose values did not differ between infants with normal and abnormal outcomes [4.89(2.28) mmol\\/L and 5.02(2.35) mmol\\/L, p value = 0.15] respectively. In term infants with hypoxic-ischaemic encephalopathy, early hypoglycaemia (between 0-6 hours of life) was associated with adverse outcome at 24 months of age [OR = 5.8, CI = 1.04-32)]. On multivariate analysis to adjust for grade of HIE this association was not statistically significant. Late hypoglycaemia (6-72 hours of life) was not associated with abnormal outcome [OR = 0.22, CI (0.04-1.14)]. The occurrence of hyperglycaemia was not associated with adverse outcome. CONCLUSION: During the first 72 hours of life, blood glucose profile in infants with hypoxic-ischaemic encephalopathy varies widely despite a management protocol. Early hypoglycaemia (0-6 hours of life) was associated with severe HIE, and thereby; adverse outcome.

  20. Patent foramen ovale does not have a negative impact on early outcomes in patients undergoing liver transplantation. (United States)

    Alba, Ana Carolina; Verocai Flaman, F; Granton, J; Delgado, D H


    To identify the impact of the presence of patent foramen ovale (PFO) in patients undergoing liver transplantation. Twenty-seven pre-liver transplant patients who had a PFO (PFO group) were identified and compared with 61 patients without PFO (NoPFO group). Patients were matched according to age, gender and cause of liver disease. The diagnosis of PFO was made by transthoracic echocardiography prior to liver transplantation. Patient baseline characteristics and complications during the early post-transplant period were analyzed. The mean age in the PFO group was 47 ± 14 (range 18-68) yr and 50 ± 11 (range 12-65) yr in the NoPFO group. The PFO group had a mean model for end-stage liver disease (MELD) score of 15 ± 10 whereas in the NoPFO group the MELD score was 19 ± 10 (p = 0.08). There were non-significant differences in echocardiographic parameters between groups. Duration of mechanical ventilation and the incidence of neurological complications were similar. Thirty-day mortality rate was similar in both groups; only one patient in the NoPFO group died within the first 30 days post-transplantation. The presence of PFO in patients with end-stage liver disease undergoing liver transplantation does not appear to affect patient outcomes during the peri-operative period. © 2010 John Wiley & Sons A/S.

  1. Early detection of type 2 diabetes mellitus and screening for retinopathy are associated with reduced prevalence and severity of retinopathy. (United States)

    Olafsdottir, Eydis; Andersson, Dan K G; Dedorsson, Inger; Svärdsudd, Kurt; Jansson, Stefan P O; Stefánsson, Einar


    To explore whether the prevalence and severity of retinopathy differ in diabetes cohorts diagnosed through screening as compared with conventional health care. A total of 257 diabetes patients, 151 detected through screening and 106 through conventional clinical care, were included. Retinopathy was evaluated by fundus photography. The modified Airlie House adaptation of the Early Treatment Retinopathy Study protocol was used to grade the photographs. Averages of clinically collected fasting blood glucose (FBG), blood pressure and body mass index values were compiled from diabetes diagnosis until the eye examination. Blood chemistry, smoking habits and peripheral neuropathy were assessed at the time of the eye examination. Among the screening-detected patients, 22% had retinopathy as compared to 51% among those clinically detected (p retinopathy were more likely to have increased average FBG (OR 1.42, 95% CI 1.19-1.70 per mmol/l) and peripheral neuropathy (OR 2.75, 95% CI 1.40-5.43), but less likely to have screening-detected diabetes (OR 0.31, 95% CI 0.17-0.57). Similar results were found using increasing severity grade of retinopathy as outcome. The cumulative retinopathy prevalence for the screening-detected diabetes cohort as compared with the clinically diagnosed cohort was significantly lower from 10 years' follow-up and onwards (p = 0.0002). Among patients with screening-detected diabetes, the prevalence of retinopathy and increasing severity of retinopathy were significantly lower than among those who had their diabetes diagnosed through conventional care, even when other risk factors for retinopathy such as duration, hyperglycaemia and blood pressure were considered. Early detection of diabetes reduces prediagnostic time spent with hyperglycaemia. In combination with early and regular screening for retinopathy, more effective prevention against retinopathy can be provided. © 2016 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons

  2. Early metabolic defects in dexamethasone-exposed and undernourished intrauterine growth restricted rats.

    Directory of Open Access Journals (Sweden)

    Emmanuel Somm

    Full Text Available Poor fetal growth, also known as intrauterine growth restriction (IUGR, is a worldwide health concern. IUGR is commonly associated with both an increased risk in perinatal mortality and a higher prevalence of developing chronic metabolic diseases later in life. Obesity, type 2 diabetes or metabolic syndrome could result from noxious "metabolic programming." In order to better understand early alterations involved in metabolic programming, we modeled IUGR rat pups through either prenatal exposure to synthetic glucocorticoid (dams infused with dexamethasone 100 µg/kg/day, DEX or prenatal undernutrition (dams feeding restricted to 30% of ad libitum intake, UN. Physiological (glucose and insulin tolerance, morphometric (automated tissue image analysis and transcriptomic (quantitative PCR approaches were combined during early life of these IUGR pups with a special focus on their endocrine pancreas and adipose tissue development. In the absence of catch-up growth before weaning, DEX and UN IUGR pups both presented basal hyperglycaemia, decreased glucose tolerance, and pancreatic islet atrophy. Other early metabolic defects were model-specific: DEX pups presented decreased insulin sensitivity whereas UN pups exhibited lowered glucose-induced insulin secretion and more marked alterations in gene expression of pancreatic islet and adipose tissue development regulators. In conclusion, these results show that before any catch-up growth, IUGR rats present early physiologic, morphologic and transcriptomic defects, which can be considered as initial mechanistic basis of metabolic programming.

  3. Peri-Operative Management of Older Adults with Cancer—The Roles of the Surgeon and Geriatrician (United States)

    Parks, Ruth Mary; Rostoft, Siri; Ommundsen, Nina; Cheung, Kwok-Leung


    Optimal surgical management of older adults with cancer starts pre-operatively. The surgeon plays a key role in the appropriate selection of patients and procedures, optimisation of their functional status prior to surgery, and provision of more intensive care for those who are at high risk of post-operative complications. The literature, mainly based on retrospective, non-randomised studies, suggests that factors such as age, co-morbidities, pre-operative cognitive function and intensity of the surgical procedure all appear to contribute to the development of post-operative complications. Several studies have shown that a pre-operative geriatric assessment predicts post-operative mortality and morbidity as well as survival in older surgical cancer patients. Geriatricians are used to working in multidisciplinary teams that assess older patients and make individual treatment plans. However, the role of the geriatrician in the surgical oncology setting is not well established. A geriatrician could be a valuable contribution to the treatment team both in the pre-operative stage (patient assessment and pre-operative optimisation) and the post-operative stage (patient assessment and treatment of medical complications as well as discharge planning). PMID:26295261

  4. Tracheostomy: current practice on timing, correction of coagulation disorders and peri-operative management - a postal survey in the Netherlands

    NARCIS (Netherlands)

    Veelo, D. P.; Dongelmans, D. A.; Phoa, K. N.; Spronk, P. E.; Schultz, M. J.


    BACKGROUND: Several factors may delay tracheostomy. As many critically ill patients either suffer from coagulation abnormalities or are being treated with anticoagulants, fear of bleeding complications during the procedure may also delay tracheostomy. It is unknown whether such (usually mild)

  5. [Evaluation of changes made in the peri-operative care in patients submitted to elective abdominal surgery]. (United States)

    Walczewski, Mayra da Rosa Martins; Justino, Ariane Zanetta; Walczewski, Eduardo André Bracci; Coan, Tatiane


    To evaluate the results of the introduction of new measures to accelerate the postoperative recovery of patients undergoing elective abdominal surgery. We observed 162 patients and interviewed them on two distinct periods: the first between October to December 2009 (n = 81) comprised patients who underwent conventional perioperative monitoring (pre-intervention) and the second between March and May 2010 (n = 81), formed by a new group of patients, submitted to the new protocol of perioperative monitoring. Data collection in the two periods occurred without the knowledge of the professionals in the service. The variables were: indication for preoperative nutritional support, duration of fasting, post-operative volume of hydration, use of catheters and drains, length of stay and postoperative morbidity. when comparing the two periods we observed a decrease of 2.5 hours in the time of preoperative fasting (p = 0.0002) in the post-intervention group. As for the reintroduction of oral diet, there was no difference between the two periods (p = 0.0007). When considering the patients without postoperative complications, there was a significantly decreased length of stay (p = 0.001325). There was a reduction of approximately 50% in antibiotic use in the post-intervention group (p = 0.00001). The adoption of multidisciplinary perioperative measures is feasible within our reality, and although there was no statistically significant changes in the present study, it may improve morbidity and reduce length of stay in general surgery.

  6. Ultrasound guided rectus sheath blockade compared to peri-operative local anesthetic infiltration in infants undergoing supraumbilical pyloromyotomy


    Kumar, Anoop; Wilson, Graham A. M.; Engelhardt, Thomas E.


    Background: Provision of appropriate analgesia for supraumbilical pyloromyotomy in infants is limited by concerns about sensitivity to opioids and other medication groups, due to immature metabolism. Local anesthetic infiltration and ultrasound guided rectus sheath blockade are two techniques commonly employed to provide perioperative analgesia. The aim of this review was to compare the quality of post-operative analgesia afforded by these two techniques. Materials and Methods: A retrospectiv...

  7. Ultrasound guided rectus sheath blockade compared to peri-operative local anesthetic infiltration in infants undergoing supraumbilical pyloromyotomy. (United States)

    Kumar, Anoop; Wilson, Graham A M; Engelhardt, Thomas E


    Provision of appropriate analgesia for supraumbilical pyloromyotomy in infants is limited by concerns about sensitivity to opioids and other medication groups, due to immature metabolism. Local anesthetic infiltration and ultrasound guided rectus sheath blockade are two techniques commonly employed to provide perioperative analgesia. The aim of this review was to compare the quality of post-operative analgesia afforded by these two techniques. A retrospective chart analysis of hospital records of all patients who underwent supraumbilical pyloromyotomy at a tertiary pediatric hospital between March 2009 and February 2011. Analysis of the anesthetic technique employed and post-operative acetaminophen requirements were performed. Additional information as to time to first post-operative feed, any complications and time of discharge from the hospital were collected by reviewing the post-operative nursing notes. A total of 30 patients underwent supraumbilical pyloromyotomy during this period. A total of 18 received local anesthetic infiltration at the end of the procedure and 12 patients underwent ultrasound guided pre-incisional rectus sheath block for post-operative analgesia. Patients who had post-operative local anesthetic infiltration had a median (range) of 2 (1-3) doses of acetaminophen in the first 24 h. In the group of patients who received a rectus sheath block, the median (range) number of doses of acetaminophen in the first 24 h was also 2 (1-3). There were no differences in time to first feed and time to hospital discharge between the groups. The volume of local anesthetic administered was significantly smaller in the group receiving analgesia via rectus sheath block. Local anesthetic infiltration and pre-incisional ultrasound guided rectus sheath block provide similar degrees of post-operative analgesia. There were no differences between the two groups in time for first post-operative feed and time to hospital discharge.

  8. Ultrasound guided rectus sheath blockade compared to peri-operative local anesthetic infiltration in infants undergoing supraumbilical pyloromyotomy

    Directory of Open Access Journals (Sweden)

    Anoop Kumar


    Full Text Available Background: Provision of appropriate analgesia for supraumbilical pyloromyotomy in infants is limited by concerns about sensitivity to opioids and other medication groups, due to immature metabolism. Local anesthetic infiltration and ultrasound guided rectus sheath blockade are two techniques commonly employed to provide perioperative analgesia. The aim of this review was to compare the quality of post-operative analgesia afforded by these two techniques. Materials and Methods: A retrospective chart analysis of hospital records of all patients who underwent supraumbilical pyloromyotomy at a tertiary pediatric hospital between March 2009 and February 2011. Analysis of the anesthetic technique employed and post-operative acetaminophen requirements were performed. Additional information as to time to first post-operative feed, any complications and time of discharge from the hospital were collected by reviewing the post-operative nursing notes. Results: A total of 30 patients underwent supraumbilical pyloromyotomy during this period. A total of 18 received local anesthetic infiltration at the end of the procedure and 12 patients underwent ultrasound guided pre-incisional rectus sheath block for post-operative analgesia. Patients who had post-operative local anesthetic infiltration had a median (range of 2 (1-3 doses of acetaminophen in the first 24 h. In the group of patients who received a rectus sheath block, the median (range number of doses of acetaminophen in the first 24 h was also 2 (1-3. There were no differences in time to first feed and time to hospital discharge between the groups. The volume of local anesthetic administered was significantly smaller in the group receiving analgesia via rectus sheath block. Conclusion: Local anesthetic infiltration and pre-incisional ultrasound guided rectus sheath block provide similar degrees of post-operative analgesia. There were no differences between the two groups in time for first post-operative feed and time to hospital discharge.

  9. Trends in peri-operative performance status following resection of high grade glioma and brain metastases: The impact on survival. (United States)

    Patel, Chirag K; Vemaraju, Ravi; Glasbey, James; Shires, Joanne; Northmore, Tessa; Zaben, Malik; Hayhurst, Caroline


    Maximal surgical resection of high grade brain tumours is associated with improved overall survival (OS). It carries the risk of neurological deterioration leading to worsening performance status (PS), which may affect overall survival and preclude patients from adjuvant therapy. We aim to review the changes in performance status of patients undergoing resection of high grade tumours and metastases and the impact of changes on overall survival. A prospective study of the perioperative performance status of 75 patients who underwent primary resection of malignant primary brain tumour or solitary metastasis in a single centre. Data on patients' demographics, tumour histology and overall survival were also collected. WHO performance status was recorded pre-operatively and at intervals following surgery. Of the 75 patients (35 males, 40 females, median age 61 years at diagnosis), 50 had primary malignant brain tumours, 25 had metastasis. Although PS dropped at postoperative day 1 in 14 patients (18.7%), 28% improved by day 5 and there was significant improvement by day 14 (41%, p=0.02). The number of patients with PS 3 or worse changed from 4% pre-operatively (n=3) to 8% (n=6). Overall survival is better in those whose PS remained improved or unchanged at 2 weeks after surgery compared to those whose PS deteriorated; high grade glioma median survival 15.67 vs. 2.4 months (p=0.005) and metastasis median survival 8.53 vs.2.33 months (p=0.001). Our data demonstrates that although PS may deteriorate immediately after surgery, the majority of patients regain their baseline PS or improve by 2 weeks postoperatively; decisions on fitness for adjuvant treatment should therefore be delayed until then. In those patients whose PS declines following surgery overall survival is poor. Crown Copyright © 2017. Published by Elsevier B.V. All rights reserved.

  10. Patterns in current anaesthesiological peri-operative practice for colonic resections: a survey in five northern-European countries

    DEFF Research Database (Denmark)

    Hannemann, P; Lassen, K; Hausel, J


    clear liquids were permitted until 2-3 h before anaesthesia. Solid food was permitted up to 6-8 h prior to anaesthesia. In all countries more than 85% of the responders indicated that epidural anaesthesia was routinely used. Except for Denmark, long-acting benzodiazepines were still widely used. Short......-acting anaesthetics were used in all countries except Scotland where isoflurane is the anaesthetic of choice. With the exception of Denmark, intravenous fluids were used unrestrictedly. CONCLUSION: In northern Europe, most anaesthesiologists adhere to evidence-based optimal management strategies on pre......-operative fasting, thoracic epidurals and short-acting anaesthetics. However, premedication with longer-acting agents is still common. Avoidance of fluid overload has not yet found its way into daily practice. This may leave patients undergoing elective colonic surgery at risk of oversedation and excessive fluid...

  11. Patterns in current anaesthesiological peri-operative practice for colonic resections: a survey in five northern-European countries

    DEFF Research Database (Denmark)

    Hannemann, P; Lassen, K; Hausel, J


    BACKGROUND: For colorectal surgery, evidence suggests that optimal management includes: no pre-operative fasting, a thoracic epidural analgesia continued for 2 days post-operatively, and avoidance of fluid overload. In addition, no long-acting benzodiazepines on the day of surgery and use of short...... digestive surgical centres in Scotland, the Netherlands, Denmark, Sweden and Norway. RESULTS: The response rate was 74% (n = 191). Although periods of pre-operative fasting up to 48 h were reported, most (> 85%) responders in all countries declared to adhere to guidelines for pre-operative fasting and oral...... clear liquids were permitted until 2-3 h before anaesthesia. Solid food was permitted up to 6-8 h prior to anaesthesia. In all countries more than 85% of the responders indicated that epidural anaesthesia was routinely used. Except for Denmark, long-acting benzodiazepines were still widely used. Short...

  12. Peri-operative morbidity associated with radical cystectomy in a multicenter database of community and academic hospitals.

    Directory of Open Access Journals (Sweden)

    Luke T Lavallée

    Full Text Available OBJECTIVE: To characterize the frequency and timing of complications following radical cystectomy in a cohort of patients treated at community and academic hospitals. PATIENTS AND METHODS: Radical cystectomy patients captured from NSQIP hospitals from January 1 2006 to December 31 2012 were included. Baseline information and complications were abstracted by study surgical clinical reviewers through a validated process of medical record review and direct patient contact. We determined the incidence and timing of each complication and calculated their associations with patient and operative characteristics. RESULTS: 2303 radical cystectomy patients met inclusion criteria. 1115 (48% patients were over 70 years old and 1819 (79% were male. Median hospital stay was 8 days (IQR 7-13 days. 1273 (55.3% patients experienced at least 1 post-operative complication of which 191 (15.6% occurred after hospital discharge. The most common complication was blood transfusion (n = 875; 38.0%, followed by infectious complications with 218 (9.5% urinary tract infections, 193 (8.4% surgical site infections, and 223 (9.7% sepsis events. 73 (3.2% patients had fascial dehiscence, 82 (4.0% developed a deep vein thrombosis, and 67 (2.9% died. Factors independently associated with the occurrence of any post-operative complication included: age, female gender, ASA class, pre-operative sepsis, COPD, low serum albumin concentration, pre-operative radiotherapy, pre-operative transfusion >4 units, and operative time >6 hours (all p<0.05. CONCLUSION: Complications remain common following radical cystectomy and a considerable proportion occur after discharge from hospital. This study identifies risk factors for complications and quality improvement needs.

  13. Impact of the Antibiotic Stewardship Program on Prevention and Control of Surgical Site Infection during Peri-Operative Clean Surgery. (United States)

    Liu, Juyuan; Li, Na; Hao, Jinjuan; Li, Yanming; Liu, Anlei; Wu, Yinghong; Cai, Meng


    Surgical site infections (SSIs) are the leading cause of hospital-acquired infections and are associated with substantial healthcare costs, with increased morbidity and mortality. To investigate the effects of the antibiotic stewardship program on prevention and control of SSI during clean surgery, we investigated this situation in our institution. We performed a quasi-experimental study to compare the effect before and after the antibiotic stewardship program intervention. During the pre-intervention stage (January 1, 2010 through December 31, 2011), comprehensive surveillance was performed to determine the SSI baseline data. In the second stage (January 1, 2012 through December 31, 2016), an infectious diseases physician and an infection control practitioner identified the surgical patients daily and followed up on the duration of antimicrobial prophylaxis. From January 1, 2010 to December 31, 2016, 41,426 patients underwent clean surgeries in a grade III, class A hospital. The rate of prophylactic antibiotic use in the 41,426 clean surgeries was reduced from 82.9% to 28.0% after the interventions. The rate of antibiotic agents administered within 120 minutes of the first incision increased from 20.8% to 85.1%. The rate at which prophylactic antimicrobial agents were discontinued in the first 24 hours after surgery increased from 22.1% to 60.4%. Appropriate antibiotic selection increased from 37.0% to 93.6%. Prophylactic antibiotic re-dosing increased from 3.8% to 64.8%. The SSI rate decreased from 0.7% to 0.5% (p < 0.05). The pathogen detection rate increased from 16.7% up to 41.8% after intervention. The intensity of antibiotic consumption reduced from 74.9 defined daily doses (DDDs) per 100 bed-days to 34.2 DDDs per 100 bed-days after the interventions. Long-term and continuous antibiotic stewardship programs have important effects on the prevention and control of SSI during clean surgery.

  14. Effects of intra-operative fluoroscopic 3D-imaging on peri-operative imaging strategy in calcaneal fracture surgery

    NARCIS (Netherlands)

    M.S.H. Beerekamp (Suzan); Backes, M. (M.); N.W.L. Schep (Niels); D.T. Ubbink (Dirk); J.S.K. Luitse; T. Schepers (Tim); J.C. Goslings (Carel)


    textabstractIntroduction: Previous studies demonstrated that intra-operative fluoroscopic 3D-imaging (3D-imaging) in calcaneal fracture surgery is promising to prevent revision surgery and save costs. However, these studies limited their focus to corrections performed after 3D-imaging, thereby

  15. Peri-operative management of severe pre-eclampsia with kyphoscoliosis and poliomyelitis for emergency caesarean section

    Directory of Open Access Journals (Sweden)

    Anil K Bhiwal


    Full Text Available A 37 years old primigravida, 31 weeks gestation with severe preeclampsia [BP = 180/120 mm Hg] with severe kyphoscoliosis and polio affecting right lower limb was admitted in emergency with complaint of blurring of vision and pedal edema. An emergency caesarean section was conducted under general anaesthesia because of a failed spinal anaesthesia. Perioperative anaesthetic management and her postoperative course are discussed.

  16. Peri-operative cerebrospinal fluid leak during single-stage bone-anchored hearing aid implantation: case report. (United States)

    Dimbleby, G; Mitchell-Innes, A; Murphy, J


    A bone-anchored hearing aid uses the principle of bone conduction and osseointegration to transfer sound vibrations to a functioning inner ear. It consists of a permanent titanium implant, and removable abutment and sound processor. Informed consent requires discussion of the procedural benefits, alternatives and complications. The risks of bone-anchored hearing aid surgery include infection, soft tissue hypertrophy, skin graft or flap failure, osseointegration failure, and the need for further surgery. A case of cerebrospinal fluid leak in a patient undergoing bone-anchored hearing aid surgery is reported and discussed. Bone-anchored hearing aid surgery poses a risk of breaching the inner table of the temporal bone and dura, resulting in a cerebrospinal fluid leak; the risk of meningitis is rare but serious. The surgeon should discuss the possibility of cerebrospinal fluid leak when consenting patients. Pre-operative computerised tomography scanning should be considered in certain individuals to aid implant placement.

  17. Early outcomes of on-pump versus off-pump coronary artery bypass grafting. (United States)

    Hussain, Ghulam; Azam, Hammad; Baig, Mirza Ahmad Raza; Ahmad, Naseem


    To see the early post-operative outcomes of off-pump versus on-pump coronary artery bypass graft surgery. This retrospective analytical study was conducted at Ch. Pervaiz Elahi Institute of Cardiology Multan, Pakistan. Our Primary outcome variables were; necessity of inotropic support, nonfatal myocardial infarction, ICU stay, nonfatal stroke, new renal failure requiring dialysis and death within 30 days after operation. There were two groups of patients; Group-I (On-pump group) and Group-II (Off-pump Group). SPSS V17 was used for data analysis. Independent sample t-test and Mann Whitney U test were used to compare quantitative Variables. Chi-square test and Fisher's exact test were used to analyze qualitative variables. P-value ≤ 0.05 was considered significant. Three hundred patients were included in this study. There were no significant difference regarding risk factors except hyper-cholestrolemia which was high in off pump group (p-value 0.05). Angiographic and Echocardiographic characteristics e.g. preoperative ejection fraction, LV function grade and severity of CAD was same between the groups. Mortality risk scores and Priority status for surgery were also same. Regarding post-operative outcomes; Post-op CKMB Levels, need and duration of inotropic support, mechanical ventilation time and ICU stay was significantly less in Off-Pump group (p-value 0.001, pump CABG group (p-value 0.027). Incidence of post-op complications was not statistically different between the groups. At 30 days follow-up, Incidence of myocardial infarction, necessity and duration of inotropic support, ICU stay period and peri-operative bleeding were significantly less in off-pump group. The incidence of neurologic, pulmonary and renal complications was same between the off-pump and on-pump groups.

  18. Early multicentre experience of pre-pectoral implant based immediate breast reconstruction using Braxon®. (United States)

    Jafferbhoy, Sadaf; Chandarana, Mihir; Houlihan, Maria; Parmeshwar, Rishikesh; Narayanan, Sankaran; Soumian, Soni; Harries, Simon; Jones, Lucie; Clarke, Dayalan


    The last two decades have seen significant changes in surgical management of breast cancer. The offer of immediate breast reconstruction (IBR) following mastectomy is currently standard practice. Skin sparing and nipple sparing mastectomy with implant-based IBR have emerged as oncologically safe treatment options. Prepectoral implant placement and complete coverage of implant with acellular dermal matrix (ADM) eliminates the need to detach the muscle from underlying chest wall in contrast to the subpectoral technique. We report short-term outcomes of a multicentre study from the United Kingdom (UK) using Braxon ® in women having an IBR. A prospective study was conducted from December 2015 to October 2016 and included all patients from three breast units in the UK who underwent a mastectomy and an implant-based IBR using Braxon ® . The demographic details, co-morbidities, operative details, immediate and delayed complications were recorded. Specific complications recorded were infection, seroma, unplanned readmission and loss of implant. A comparison was made with complications reported in the National Mastectomy and Reconstruction Audit. Seventy-eight IBRs were included in the analysis with a median follow-up of 9.98 months. Mean age of the cohort was 50 years with a mean body mass index of 25.7 kg/m 2 . Mean implant volume was 365 cc. The inpatient hospital stay was 1.48 days. About 23% of patients had a seroma, 30% had erythema requiring antibiotics and the explant rate was 10.2 percent. Bilateral reconstructions were significantly associated with implant loss and peri-operative complications on univariate analysis. Our early experience with this novel prepectoral technique using Braxon ® has shown it to be an effective technique with complication rates comparable to subpectoral IBR. The advantages of prepectoral implant-based IBR are quicker postoperative recovery and short post-operative hospital stay. Long-term studies are required to assess rippling, post

  19. Early literacy

    DEFF Research Database (Denmark)

    Jensen, Anders Skriver


    This paper discusses findings from the Danish contribution to the EASE project, a European research project running from 2008 to 2010 on early literacy in relation to the transition from childcare to school. It explores a holistic, inclusive approach to early literacy that resists a narrow...... and schools. The paper also draws on Gee’s (2001, 2003, 2004, 2008) sociocultural approach to literacy, and Honneth’s (2003, 2006) concept of recognition. Emphasizing participation and recognition as key elements, it claims that stakeholders in early liter- acy must pay attention to how diverse early literacy...... opportunities empower children, especially when these opportunities are employed in a project-based learning environ- ment in which each child is able to contribute to the shared literacy events....

  20. Early Atomism

    Indian Academy of Sciences (India)

    was yet no experimental method for counting the num- ber of molecules in a given volume of gas which would allow direct verification of Avogadro's hypothesis. 6. Periodic Properties of Elements. By the early 19th century, about fifty elements had been discovered and their properties investigated. Based on these studies ...

  1. Early intervention

    African Journals Online (AJOL)

    family conflict.12 We also know that the effects of violence exposure are likely magnified in unstable ... and how chronic 'toxic stress' may lead to difficulties in self-regulation, poor control of emotions, and ... High levels of violence affect every family in South Africa. Exposure to violence starts early, in both the home.

  2. Early discontinuation

    DEFF Research Database (Denmark)

    Hansen, Dorte Gilså; Felde, Lina; Gichangi, Anthony


    Introduction Discontinuation of medical drug treatment is a serious problem in primary care. The need for a better understanding of the processes, including physician-specific mechanisms, is apparent. The aim of this study was to analyse the association between general practitioners' prescribing....... There was a positive association between the prevalence of prescribing for the specific drugs studied (antidepressants, antidiabetics, drugs against osteoporosis and lipid-lowering drugs) and early discontinuation (r = 0.29 -0.44), but not for anti-hypertensive drugs. The analysis of the association between prevalence...... of all drugs and drug-specific early discontinuation showed some degree of positive association - strongest for anti-hypertensive drugs (r = 0.62) and antidepressants (r = 0.43). Conclusion This study confirmed our hypothesis that general practitioners with high levels of prescribing attain higher rates...

  3. Sublobar resection versus lobectomy in Surgical Treatment of Elderly Patients with early-stage non-small cell lung cancer (STEPS): study protocol for a randomized controlled trial. (United States)

    Yang, Fan; Sui, Xizhao; Chen, Xiuyuan; Zhang, Lixue; Wang, Xun; Wang, Shaodong; Wang, Jun


    The appropriateness of lobectomy for all elderly patients is controversial. Meanwhile, sublobar resection is associated with reduced operative risk, better preservation of pulmonary function, and a better quality of life, constituting a potential alternative to standard lobectomy for elderly patients with early-stage non-small cell lung cancer (NSCLC). To date, no randomized trial comparing sublobar resection and lobectomy focusing on elderly patients has been reported. We hypothesized that for patients at least 70 years old with clinical stage T1N0M0 NSCLC, sublobar resection is non-inferior to lobectomy for 3-year disease-free survival (DFS). This is a prospective, randomized, controlled multicenter non-inferiority trial with two study arms: sublobar resection and lobectomy groups. Comprehensive geriatric assessments will be acquired for each patient. A total of 339 subjects will be enrolled on the basis of power calculations, and participants followed up every 6 months post-operation for 3 years. In case of relapse, survival follow-up will be continued until 5 years or death. Pulmonary function testing will be performed at 6, 12, and 36 months post-operation. The primary outcome is 3-year DFS; secondary endpoints include peri-operative complications and mortality, hospitalization time, post-operative ventilator time, overall survival, 3-year recurrence rates, post-operative pulmonary function, quality of life, geriatric assessment data, and 4-year mortality index. The present study is the only prospective, multicenter, randomized controlled trial comparing sublobar resection and lobectomy for elderly patients. The therapeutic outcomes of sublobar resection will be evaluated in comparison with lobectomy for elderly patients (≥70 years) with early-stage NSCLC. NCT02360761 : 01/24/2015 (

  4. Analysis of early effect of surgical treatment in patients with coronary heart disease complicated by moderate-to-severe ischemic mitral regurgitation

    Directory of Open Access Journals (Sweden)

    Jin WANG


    Full Text Available Objective To probe into the early effect of surgical treatment in coronary atherosclerotic heart disease (CAD patients with moderate-to-severe ischemic mitral regurgitation (IMR. Methods A total of 175 CAD patients with moderateto- severe IMR undergoing coronary artery bypass grafting (CABG from December 1999 to December 2010 were analyzed retrospectively. Based on the method applied during surgery, 108 patients were assigned to CABG group, undergoing CABG alone, and 67 to CABG+MVP/R group, undergoing CABG plus concomitant mitral valvuloplasty/repair (MVP/R. Differences between groups were compared in age, gender, numbers of the conduits, application of intra-aortic balloon pump (IABP and ventricular assist device (VAD, perioperative mortality, and other concomitant procedures (i.e. aortic valve replacement, resection of the heart wall aneurysm, repair of the septal defect repair. Differences within the groups were looked for in terms of left atrial diameter (LA, left ventricular ending diastolic diameter (LVEDD, left ventricular ejection fraction (LVEF, mitral regurgitation degree, systolic pulmonary artery pressure (sPAP, and cardiac function (NYHA classification, pre-operatively and post-operatively. Results  The differences between the groups showed no statistical significance in terms of age, gender, numbers of conduits, application of IABP and VAD, peri-operative mortality, and concomitant procedures (P > 0.05. LA, LVEDD, mitral regurgitation, sPAP, and cardiac function (NYHA classification after operation were improved obviously in both groups compared with that before operation (P 0.05. Conclusions The comprehensive and aggressive surgery did not result in more ideal early effect to CAD patients with moderate-to-severe IMR. Based on the total revascularization, we can choose simpler, safer, and more effective surgical methods.

  5. Moderately early (7-14 days) postnatal corticosteroids for preventing chronic lung disease in preterm infants. (United States)

    Halliday, H L; Ehrenkranz, R A; Doyle, L W


    Corticosteroids have been used late in the neonatal period to treat chronic lung disease (CLD) in preterm babies, and early to try to prevent it. CLD is likely to be the result of persisting inflammation in the lung and the use of powerful anti-inflammatory drugs like dexamethasone has some rationale. Early use tends to be associated with increased adverse effects so that studies of moderately early treatment (7-14 days postnatal) might have the dual benefits of fewer side effects and onset of action before chronic inflammation is established. To determine if moderately early (7-14 days) postnatal corticosteroid treatment vs control (placebo or nothing) is of benefit in the prevention and/or treatment of early chronic lung disease in the preterm infant. Randomised controlled trials of postnatal corticosteroid therapy were sought from the Oxford Database of Perinatal Trials, Cochrane Database of Controlled Trials, MEDLINE (1966 - October 2002), hand searching paediatric and perinatal journals, examining previous review articles and information received from practicing neonatologists. Authors of all studies were contacted, where possible, to confirm details of reported follow-up studies, or to obtain any information about long-term follow-up where none had been reported. Randomised controlled trials of postnatal corticosteroid treatment from 7-14 days of birth in high risk preterm infants were selected for this review. Data regarding clinical outcomes including mortality, CLD (including late rescue with corticosteroids, or need for home oxygen therapy), death or CLD, failure to extubate, complications during the primary hospitalisation (including infection, hyperglycaemia, hypertension, hypertrophic cardiomyopathy, pneumothorax, severe intraventricular haemorrhage (IVH), necrotizing enterocolitis (NEC), gastrointestinal bleeding, and severe retinopathy of prematurity (ROP)), and long term outcome (including blindness, deafness, cerebral palsy and major neurosensory

  6. Post-operative rounds by anaesthesiologists after hip fracture surgery

    DEFF Research Database (Denmark)

    Foss, N B; Christensen, D S; Krasheninnikoff, M


    Efforts to optimize the peri-operative care of hip fracture patients through multidisciplinary intervention have focused on orthopaedic-geriatric liaisons, which have not resulted in significant outcome changes. The early phase of rehabilitation could potentially be optimized through a multidisci......Efforts to optimize the peri-operative care of hip fracture patients through multidisciplinary intervention have focused on orthopaedic-geriatric liaisons, which have not resulted in significant outcome changes. The early phase of rehabilitation could potentially be optimized through...

  7. Early post-operative glucose levels are an independent risk factor for infection after peripheral vascular surgery. A retrospective study

    NARCIS (Netherlands)

    Vriesendorp, T. M.; Morélis, Q. J.; DeVries, J. H.; Legemate, D. A.; Hoekstra, J. B. L.


    Objective. To evaluate whether hyperglycaemia in the first 48 h after infrainguinal vascular surgery is a risk factor for postoperative infection, independent from factors associated with insulin resistance and surgical stress. Design. Retrospective cohort study. Patients and methods. Patients who

  8. Early or Premature Menopause (United States)

    ... email updates Enter email Submit Early or premature menopause Menopause that happens before age 40 is called ... What is the difference between early and premature menopause? Early or premature menopause happens when ovaries stop ...

  9. Early marriage and early motherhood in Nepal. (United States)

    Choe, Minja Kim; Thapa, Shyam; Mishra, Vinod


    This paper examines age patterns of first marriage and motherhood and covariates of early marriage, delayed consummation of marriage and early motherhood in Nepal using data from the 2000 Nepal Adolescent and Young Adult Survey (NAYA). Both unmarried and married male and female youths (age 14-22) were included in the survey. The analysis is based on 2800 urban youths and 5075 rural youths with complete information on the variables examined. Proportional hazard models are used to estimate covariates of early marriage and early motherhood, and logistic regression models are used to estimate covariates of delayed consummation of marriage. The results show that early marriage and early motherhood are quite common among Nepalese women, especially in rural areas. Early marriage is much less common among men. Delayed consummation of marriage is common among very young brides, especially in rural areas. The main covariates associated with early marriage and early motherhood are respondent's education, region of residence and ethnicity. The main covariates of delayed consummation of marriage are age at first marriage, region of residence and ethnicity. The study highlights the need to focus on less educated female youths in the Terai region in order to reduce the reproductive and child health risks associated with early marriage and early childbearing.

  10. Early hospital discharge and early puerperal complications. (United States)

    Ramírez-Villalobos, Dolores; Hernández-Garduño, Adolfo; Salinas, Aarón; González, Dolores; Walker, Dilys; Rojo-Herrera, Guadalupe; Hernández-Prado, Bernardo


    To evaluate the association between time of postpartum discharge and symptoms indicative of complications during the first postpartum week. Women with vaginal delivery at a Mexico City public hospital, without complications before the hospital discharge, were interviewed seven days after delivery. Time of postpartum discharge was classified as early (25 hours). The dependent variable was defined as the occurrence and severity of puerperal complication symptoms. Out of 303 women, 208 (68%) were discharged early. However, women with early discharge and satisfactory prenatal care had lower odds of presenting symptoms in early puerperium than women without early discharge and inadequate prenatal care (OR 0.36; 95% confidence intervals = 0.17-0.76). There was no association between early discharge and symptoms of complications during the first postpartum week; the odds of complications were lower for mothers with early discharge and satisfactory prenatal care.

  11. Study Protocol: The Norfolk Diabetes Prevention Study [NDPS]: a 46 month multi - centre, randomised, controlled parallel group trial of a lifestyle intervention [with or without additional support from lay lifestyle mentors with Type 2 diabetes] to prevent transition to Type 2 diabetes in high risk groups with non - diabetic hyperglycaemia, or impaired fasting glucose. (United States)

    Pascale, Melanie; Murray, Nikki; Bachmann, Max; Barton, Garry; Clark, Allan; Howe, Amanda; Greaves, Colin; Sampson, Mike


    This 7 year NIHR programme [2011-2018] tests the primary hypothesis that the NDPS diet and physical activity intervention will reduce the risk of transition to type 2 diabetes (T2DM) in groups at high risk of Type 2 diabetes. The NDPS programme recognizes the need to reduce intervention costs through group delivery and the use of lay mentors with T2DM, the realities of normal primary care, and the complexity of the current glycaemic categorisation of T2DM risk. NDPS identifies people at highest risk of T2DM on the databases of 135 general practices in the East of England for further screening with ab fasting plasma glucose and glycosylated haemoglobin [HbA1c]. Those with an elevated fasting plasma glucose [impaired fasting glucose or IFG] with or without an elevated HbA1c [non -diabetic hyperglycaemia; NDH] are randomised into three treatment arms: a control arm receiving no trial intervention, an arm receiving an intensive bespoke group-based diet and physical activity intervention, and an arm receiving the same intervention with enhanced support from people with T2DM trained as diabetes prevention mentors [DPM]. The primary end point is cumulative transition rates to T2DM between the two intervention groups, and between each intervention group and the control group at 46 months. Participants with screen detected T2DM are randomized into an equivalent prospective controlled trial with the same intervention and control arms with glycaemic control [HbA1c] at 46 months as the primary end point. Participants with NDH and a normal fasting plasma glucose are randomised into an equivalent prospective controlled intervention trial with follow up for 40 months. The intervention comprises six education sessions for the first 12 weeks and then up to 15 maintenance sessions until intervention end, all delivered in groups, with additional support from a DPM in one treatment arm. The NDPS programme reports in 2018 and will provide trial outcome data for a group delivered

  12. A randomised controlled trial of early insulin therapy in very low birth weight infants, "NIRTURE" (neonatal insulin replacement therapy in Europe

    Directory of Open Access Journals (Sweden)

    Cornette Luc


    Full Text Available Abstract Background Studies in adult intensive care have highlighted the importance of insulin and improved glucose control on survival, with 32% reduction in mortality, 22% reduction in intensive care stay and halving of the incidence of bacteraemia. Very low birth weight infants requiring intensive care also have relative insulin deficiency often leading to hyperglycaemia during the first week of life. The physiological influences on insulin secretion and sensitivity, and the potential importance of glucose control at this time are not well established. However there is increasing evidence that the early postnatal period is critical for pancreatic development. At this time a complex set of signals appears to influence pancreatic development and β cell survival. This has implications both in terms of acute glucose control but also relative insulin deficiency is likely to play a role in poor postnatal growth, which has been associated with later motor and cognitive impairment, and fewer β cells are linked to risk of type 2 diabetes later in life. Methods A multi-centre, randomised controlled trial of early insulin replacement in very low birth weight babies (VLBW, birth weight Trial Registration Current Controlled Trials ISRCTN78428828. EUDRACT Number 2004-002170-34

  13. Maintenance of hyperglycaemia does not improve perfomence in a ...

    African Journals Online (AJOL)

    ... in overall time (143:09±7:14 v. 142:23±7:16 min:s), mean power (275±39 v. 279±39 W) and heart rate (160±9 v. 158±11 beats.min-1). Conclusion. Time trial performance over 100 km is not improved by maintaining a hyperglycaemic (10 mmol.l-1) blood glucose concentration. South African Journal of Sports Medicine Vol.

  14. Effect Of Admission Hyperglycaemia On Short-Term Outcome In ...

    African Journals Online (AJOL)

    These findings are relevant in view of the potential benefit of maintaining euglycaemia in the course of stroke management. Introduction Il n\\'y a aucune étude prospective sur la relation entre l\\'hyperglycémie et l\\'évolution des accidents vasculaires cérébraux chez les nigérians. Objectif Le but de l\\'étude est d\\'apprécier ...

  15. Maintenance of hyperglycaemia does not improve performance in a ...

    African Journals Online (AJOL)

    . However, it was not until the 1980s that the performance benefits of CHO ingestion during prolonged ex- ercise were finally resolved. It has been shown by many studies that cycling endur- ance performance is enhanced when CHO is ...

  16. Risk Factors for Hyperglycaemia in Pregnancy in Tamil Nadu, India

    DEFF Research Database (Denmark)

    Nielsen, Karoline Kragelund; Damm, Peter; Kapur, Anil


    . Objective: The aims of this observational study were to examine the role of potential risk factors for HIP, and to investigate whether any single or accumulated risk factor(s) could be used to predict HIP among women attending GDM screening at three centres in urban, semi-urban and rural Tamil Nadu, India...... and a risk factor scoring variable was constructed. Results: HIP was prevalent in 18.9% of the study population (16.3% GDM; 2.6% DIP). Increasing age and BMI as well as having a mother only or both parents with diabetes were significant independent risk factors for HIP. Among women attending the rural health...

  17. Lixisenatide reduces postprandial hyperglycaemia via gastrostatic and insulinotropic effects. (United States)

    Becker, Reinhard H A; Stechl, Jens; Steinstraesser, Axel; Golor, Georg; Pellissier, Franck


    Lixisenatide is a once-daily, prandial, short-acting glucagon-like peptide-1 receptor agonist. Its main antidiabetic effect is to delay gastric emptying to control postprandial plasma glucose excursions. The dose-response relationship of the integrated insulinotropic and gastrostatic response to lixisenatide in healthy volunteers after a standardized liquid meal was investigated. Twenty healthy subjects received acetaminophen 1000 mg with a standardized liquid meal 60 min after a single subcutaneous injection of placebo or lixisenatide 2.5, 5, 10 or 20 µg in randomized order separated by a 2- to 7-day washout. Acetaminophen pharmacokinetics served as a surrogate to assess rate of gastric emptying. Postprandial plasma glucose, insulin, C-peptide and glucagon were assessed for 5 h after the meal test, and lixisenatide pharmacokinetics were determined for 6 h. After lixisenatide administration and prior to the standardized meal, insulin and C-peptide transiently increased, while fasting plasma glucose decreased in a dose-dependent manner. After the meal, postprandial plasma glucose, insulin and C-peptide were dose proportionally reduced with lixisenatide versus placebo for up to 6 h. Compared with placebo, glucagon levels were transiently lower after any lixisenatide dose, with more sustained reductions after the meal and no apparent dose-related trends. Acetaminophen absorption was significantly reduced and delayed compared with placebo for lixisenatide doses ≥5 µg and demonstrated dose-dependent slowing of gastric emptying. Lixisenatide displayed near dose-proportional exposure, with gastrointestinal events increasing with dose. Lixisenatide reduced fasting plasma glucose via stimulation of glucose-dependent insulin release and controlled postprandial plasma glucose by delaying gastric emptying, demonstrating it to be a valuable option for overall glycaemic control. © 2014 The Authors. Diabetes Metabolism Research and Reviews published by John Wiley & Sons, Ltd.

  18. Perioperative hyperglycaemia and its treatment in patients with diabetes mellitus

    NARCIS (Netherlands)

    Polderman, J.A.W.


    This dissertation is divided into two parts. In part 1, we have investigated whether we should monitor glucose in patients without diabetes, in order to diagnose ‘stress hyperglycaemia’. Two studies in this dissertation showed that it is not necessary to monitor glucose in patients undergoing

  19. Hyperglycaemia and diabetes impair gap junctional communication among astrocytes. (United States)

    Gandhi, Gautam K; Ball, Kelly K; Cruz, Nancy F; Dienel, Gerald A


    Sensory and cognitive impairments have been documented in diabetic humans and animals, but the pathophysiology of diabetes in the central nervous system is poorly understood. Because a high glucose level disrupts gap junctional communication in various cell types and astrocytes are extensively coupled by gap junctions to form large syncytia, the influence of experimental diabetes on gap junction channel-mediated dye transfer was assessed in astrocytes in tissue culture and in brain slices from diabetic rats. Astrocytes grown in 15-25 mmol/l glucose had a slow-onset, poorly reversible decrement in gap junctional communication compared with those grown in 5.5 mmol/l glucose. Astrocytes in brain slices from adult STZ (streptozotocin)-treated rats at 20-24 weeks after the onset of diabetes also exhibited reduced dye transfer. In cultured astrocytes grown in high glucose, increased oxidative stress preceded the decrement in dye transfer by several days, and gap junctional impairment was prevented, but not rescued, after its manifestation by compounds that can block or reduce oxidative stress. In sharp contrast with these findings, chaperone molecules known to facilitate protein folding could prevent and rescue gap junctional impairment, even in the presence of elevated glucose level and oxidative stress. Immunostaining of Cx (connexin) 43 and 30, but not Cx26, was altered by growth in high glucose. Disruption of astrocytic trafficking of metabolites and signalling molecules may alter interactions among astrocytes, neurons and endothelial cells and contribute to changes in brain function in diabetes. Involvement of the microvasculature may contribute to diabetic complications in the brain, the cardiovascular system and other organs.

  20. MRI in non ketotic hyperglycaemia with hemichorea hemiballismus syndrome

    Directory of Open Access Journals (Sweden)

    Vikas Bhatia


    Full Text Available Hemichorea hemiballismus is a rare manifestation seen in diabetic patients. MRI in these patients shows characteristic findings with T1w hyperintensity in striatum. We present a case of 60 year old female showing classical clinical and MRI features.

  1. A randomized clinical trial of a peri-operative behavioral intervention to improve physical activity adherence and functional outcomes following total knee replacement

    Directory of Open Access Journals (Sweden)

    Zheng Hua


    Full Text Available Abstract Background Total knee replacement (TKR is a common and effective surgical procedure to relieve advanced knee arthritis that persists despite comprehensive medical treatment. Although TKR has excellent technical outcomes, significant variation in patient-reported functional improvement post-TKR exists. Evidence suggests that consistent post-TKR exercise and physical activity is associated with functional gain, and that this relationship is influenced by emotional health. The increasing use of TKR in the aging US population makes it critical to find strategies that maximize functional outcomes. Methods/Design This randomized clinical trial (RCT will test the efficacy of a theory-based telephone-delivered Patient Self-Management Support intervention that seeks to enhance adherence to independent exercise and activity among post- TKR patients. The intervention consists of 12 sessions, which begin prior to surgery and continue for approximately 9 weeks post-TKR. The intervention condition will be compared to a usual care control condition using a randomized design and a probabilistic sample of men and women. Assessments are conducted at baseline, eight weeks, and six- and twelve- months. The project is being conducted at a large healthcare system in Massachusetts. The study was designed to provide greater than 80% power for detecting a difference of 4 points in physical function (SF36/Physical Component Score between conditions (standard deviation of 10 at six months with secondary outcomes collected at one year, assuming a loss to follow up rate of no more than 15%. Discussion As TKR use expands, it is important to develop methods to identify patients at risk for sub-optimal functional outcome and to effectively intervene with the goal of optimizing functional outcomes. If shown efficacious, this peri-TKR intervention has the potential to change the paradigm for successful post-TKR care. We hypothesize that Patient Self-Management Support to enhance adherence to independent activity and exercise will enhance uniform, optimal improvement in post-TKR function and patient autonomy, the ultimate goals of TKR. Trial Registration NCT00566826

  2. Changes in utilization and peri-operative outcomes of bariatric surgery in large U.S. hospital database, 2011-2014.

    Directory of Open Access Journals (Sweden)

    Lu Zhang

    Full Text Available With the epidemic of morbid obesity, bariatric surgery has been accepted as one of the most effective treatments of obesity.To investigate recent changes in the utilization of bariatric surgery, patients and hospital characteristics, and in-hospital complications in a nationwide hospital database in the United States.This is a secondary data analysis of the Premier Perspective database.ICD-9 codes were used to identify bariatric surgeries performed between 2011 and 2014. Descriptive statistics were computed and regression was used.A total of 74,774 bariatric procedures were identified from 436 hospitals between 2011 and 2014. During this time period, the proportion of gastric bypass (from 44.8% to 31.3%; P for trend < 0.0001 and gastric banding (from 22.8% to 5.2%; P for trend < 0.0001 decreased, while the proportion of sleeve gastrectomy (from 13.7% to 56.9%; P for trend < 0.0001 increased substantially. The proportion of bariatric surgery performed for outpatients decreased from 17.15% in 2011 to 8.11% in 2014 (P for trend < 0.0001. The majority of patients undergoing surgery were female (78.5%, white (65.6%, younger than 65 years (93.8%, and insured with managed care (53.6%. In-hospital mortality rate and length of hospital stay remained stable. The majority of surgeries were performed in high-volume (71.8% and urban (91.6% hospitals.Results based on our study sample indicated that the popularity of various bariatric surgery procedures changed significantly from 2011 to 2014. While the rates of in-hospital complications were stable, disparities in the use of bariatric surgery regarding gender, race, and insurance still exist.

  3. Tratamiento perioperatorio del paciente con antiagregación o anticoagulación Peri-operative management of patients with anti-platelet or anticoagulation treatment

    Directory of Open Access Journals (Sweden)

    Juan C Déaz M


    Full Text Available El tratamiento del paciente que recibe terapias que afectan la hemostasia normal (anticoagulantes y/o antiagregantes plaquetarios y que será sometido a un procedimiento quirúrgico, es uno de los retos que se presentan cada vez con mayor frecuencia en los servicios de cardiología. La toma de la mejor opción terapéutica en este grupo de pacientes requiere un profundo conocimiento sobre los riesgos de sangrado en caso de continuarse el tratamiento, frente a los riesgos de trombosis o embolismo en caso de suspenderlo. Por tradición, esa decisión se ha basado más en el temor al riesgo de sangrado, por lo cual en muchos casos se ha suspendido dicha terapia de manera innecesaria. En los últimos años, la aparición de la evidencia que indica que no sólo no es alto el riesgo de sangrado sino que además la continuación de estos medicamentos en muchos casos disminuye desenlaces adversos mayores, ha llevado a replantear esta conducta. En este artículo se revisará la evidencia actual existente al respecto y se suministrarán pautas que permitan la toma de una decisión adecuada.Treatment of patients receiving therapies that affect normal hemostasis (anticoagulants and / or anti-platelet aggregators and that will undergo surgery, is one of the challenges that arise with increasing frequency in the cardiology services. Making the best therapeutic option in these patients requires a thorough understanding of the risks of bleeding in case of continuing the treatment against the risks of thrombosis or embolism in case of stopping it. By tradition, this decision has been based more on fear to the risk of bleeding, whereby in many cases this therapy has been suspended unnecessarily. In recent years, the emergence of evidence indicates that the risk of bleeding is not high and that continuation of these drugs in many cases reduce major adverse outcomes. This has led to redefine this behavior. In this article we review the current evidence available on the subject and provide guidelines that allow making a right decision.

  4. Impact of single dose intravenous tranexamic acid on peri-operative blood transfusion requirements in burn patients: A prospective, randomized trial

    Directory of Open Access Journals (Sweden)

    Nidhi Bhatia


    Conclusions: Preoperative administration of a single dose of tranexamic acid significantly reduces blood loss during debridement of burn wounds and skin graft harvesting surgeries without increasing the risk of untoward side-effects or complications.

  5. Supplemental Peri-Operative Oxygen and Incision Site Infection after Surgery for Perforated Peptic Ulcer: A Randomized, Double-Blind Monocentric Trial. (United States)

    Schietroma, Mario; Cecilia, Emanuela Marina; De Santis, Giuseppe; Carlei, Francesco; Pessia, Beatrice; Amicucci, Gianfranco


    The clinical role of hyperoxia for preventing surgical site infection (SSI) remains uncertain because randomized controlled trials on this topic have reported disparate results. One of the principal reasons for this outcome may be that prior trials have entered heterogeneous populations of patients and a variety of procedures. The aim of our study was to assess the influence of hyperoxygenation on SSI using a homogeneous study population. From January 2004 to April 2013, we studied, in a randomized trial, 239 patients, who underwent open surgery for perforated peptic ulcer (PPU). The surgical procedure was performed through an upper abdominal midline incision, and closure of PPU was achieved by suture alone or in combination with an omental patch. Patients were assigned randomly to an oxygen/air mixture with a fraction of inspired oxygen (FiO2) of 30% (n = 120) or 80% (n = 119). Administration was commenced after induction of anesthesia and maintained for 6 hours after surgery. The overall incision infection rate was 38.4% (92 of 239): 61 patients (50.8%) had an infection in the 30% FiO2 group and 31 (26%) in the 80% FiO2 group (p operative SSI, should be considered part of ongoing quality improvement activities related to surgical care, with few risks to the patient and little associated cost.

  6. Surgical site infections following operative management of cervical spondylotic myelopathy: prevalence, predictors of occurence, and influence on peri-operative outcomes. (United States)

    Jalai, C M; Worley, N; Poorman, G W; Cruz, D L; Vira, S; Passias, P G


    Studies have examined infection rates following spine surgery and their relationship to post-operative complications and increased length of stay. Few studies, however, have investigated predictors of infection, specifically in the setting of operative intervention for cervical spondylotic myelopathy (CSM). This study aims to identify the incidence and factors predictive of infection amongst this cohort. This study performed a retrospective review of the prospectively collected American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. Patients included those treated surgically for CSM (ICD-9 code 721.1) from 2010 to 2012. Patient demographics and surgical data were collected with outcome variables including the occurrence of one of the following surgical site infections (SSIs) within 30 days of index operation: superficial SSI, deep incisional SSI, and organ/space SSI. 3057 patients were included in this analysis. Overall infection rate was 1.15 % (35/3057), of which 54.3 % (19/35) were superficial SSIs, 28.6 % (10/35) were deep incisional SSI, and 20 % (7/35) were peri-spinal SSI. Logistic regression revealed factors associated with SSI included: higher BMI [OR 1.162 (CI 1.269-1.064), p = 0.001] and operative time ≥208 min [OR 4.769 (CI 20.220-1.125), p = 0.034]. The overall SSI rate for the examined CSM cohort was 1.15 %. This study identified increased BMI and operative time ≥208 min as predictors of infection in surgical CSM patients. This information should be carefully considered in delivering patient education and future efforts to optimize risk in CSM patients indicated for surgical intervention.

  7. Robotic assisted radical prostatectomy accelerates postoperative stress recovery: Final results of a contemporary prospective study assessing pathophysiology of cortisol peri-operative kinetics in prostate cancer surgery

    Directory of Open Access Journals (Sweden)

    Antonio B. Porcaro


    Conclusion: Our study shows that PCa surgery immediately (POD 0 triggers the stress system which respond by overproduction of cortisol which induces the negative feedback mechanism that starts on POD 1, is still ongoing on POD 5, but is completely settled on POD 45. Moreover, after surgical trauma, our study gives evidence that the RARP procedure associates with stress recovery faster than RRP. Further confirmatory studies are required.

  8. Peri-operative alemtuzumab (Campath-1H) and plasmapheresis for high-PRA positive lymphocyte crossmatch heart transplant: a strategy to shorten left ventricular assist device support. (United States)

    Lick, Scott D; Vaidya, Smita; Kollar, Andras C; Boor, Paul J; Vertrees, Roger A


    Patients on a left ventricular assist device (LVAD) often have a high level of panel-reactive antibodies (PRA). Conventional therapy is to await a heart from a negative prospective-crossmatch donor. We transplanted three high-PRA patients with non-crossmatched hearts, using intra- and post-operative plasmapheresis and long-term T-/B-/plasma-cell therapy with alemtuzumab. Three highly sensitized patients (70%, 94% and 96% T-PRA; 63%, 24% and 73% B-PRA) were transplanted after 29, 187 and 94 days LVAD support. The first patient (Case 1) had an erroneous prospective negative crossmatch (due to an outside laboratory's use of the wrong patient's serum) with immediate allograft dysfunction. The correct serum showed a strongly positive crossmatch; plasmapheresis followed by alemtuzumab (20 mg intravenously) shortly after arrival in the ICU resulted in rapid hemodynamic improvement. Encouraged by this success, the next two patients (Cases 2 and 3) underwent LVAD explant and heart transplant with the next available ABO-identical, non-crossmatched donors, using plasmapheresis on bypass immediately before heart implant and alemtuzumab 20 mg intravenously upon ICU arrival, with uneventful courses. All three patients had positive retrospective T- and B-cell crossmatches. Maintenance immunosuppression consisted of cyclosporine and routine prednisone taper, with plasmapheresis as needed (Patient 1, x10; Patient 2, x5) based on diastolic dysfunction. Mycophenolate mofetil was started as a third agent several months post-transplant. Patients are presently New York Heart Association (NYHA) Class I at 26, 16 and 13 months post-transplant. In this small series with follow-up, immediate antibody removal with plasmapheresis, combined with alemtuzumab, a long-acting antibody to CD52 (expressed on T, B and some plasma cells), appears effective in allowing transplantation in sensitized, positive crossmatch recipients. Expanded use of this strategy could shorten LVAD support in many sensitized patients.

  9. Local anaesthetic infiltration for peri-operative pain control in total hip and knee replacement: systematic review and meta-analyses of short- and long-term effectiveness. (United States)

    Marques, Elsa M R; Jones, Hayley E; Elvers, Karen T; Pyke, Mark; Blom, Ashley W; Beswick, Andrew D


    Surgical pain is managed with multi-modal anaesthesia in total hip replacement (THR) and total knee replacement (TKR). It is unclear whether including local anaesthetic infiltration before wound closure provides additional pain control. We performed a systematic review of randomised controlled trials of local anaesthetic infiltration in patients receiving THR or TKR. We searched MEDLINE, Embase and Cochrane CENTRAL to December 2012. Two reviewers screened abstracts, extracted data, and contacted authors for unpublished outcomes and data. Outcomes collected were post-operative pain at rest and during activity after 24 and 48 hours, opioid requirement, mobilisation, hospital stay and complications. When feasible, we estimated pooled treatment effects using random effects meta-analyses. In 13 studies including 909 patients undergoing THR, patients receiving local anaesthetic infiltration experienced a greater reduction in pain at 24 hours at rest by standardised mean difference (SMD) -0.61 (95% CI -1.05, -0.16; p = 0.008) and by SMD -0.43 (95% CI -0.78 -0.09; p = 0.014) at 48 hours during activity.In TKR, diverse multi-modal regimens were reported. In 23 studies including 1439 patients undergoing TKR, local anaesthetic infiltration reduced pain on average by SMD -0.40 (95% CI -0.58, -0.22; p SMD -0.27 (95% CI -0.50, -0.05; p = 0.018) at 48 hours during activity, compared with patients receiving no infiltration or placebo. There was evidence of a larger reduction in studies delivering additional local anaesthetic after wound closure. There was no evidence of pain control additional to that provided by femoral nerve block.Patients receiving local anaesthetic infiltration spent on average an estimated 0.83 (95% CI 1.54, 0.12; p = 0.022) and 0.87 (95% CI 1.62, 0.11; p = 0.025) fewer days in hospital after THR and TKR respectively, had reduced opioid consumption, earlier mobilisation, and lower incidence of vomiting.Few studies reported long-term outcomes. Local anaesthetic infiltration is effective in reducing short-term pain and hospital stay in patients receiving THR and TKR. Studies should assess whether local anaesthetic infiltration can prevent long-term pain. Enhanced pain control with additional analgesia through a catheter should be weighed against a possible infection risk.

  10. Novel utilization of 3D technology and the hybrid operating theatre: Peri-operative assessment of posterior sterno-clavicular dislocation using cone beam CT

    Energy Technology Data Exchange (ETDEWEB)

    Crowhurst, James A; Campbell, Douglas; Whitby, Mark; Pathmanathan, Pavthrun [The Prince Charles Hospital, Rode Road, Chermside, Queensland (Australia)


    A patient with a medial and posterior dislocation of the right sterno-clavicular (SC) joint and displacement of the trachea and brachiocephalic artery by the medial head of the clavicle underwent general anaesthetic in the operating theatre for an open reduction procedure. The surgeon initially attempted a closed reduction, but this required imaging to check SC alignment. The patient was transferred to an adjacent hybrid operating theatre for imaging. Cone beam computed tomography (CBCT) was performed, which successfully demonstrated a significant reduction in the dislocation of the SC joint. The trachea and brachiocephalic artery were no longer compressed or displaced. This case study demonstrates an alternative to the patient being transferred to the medical imaging department for multi-slice CT. It also describes a novel use of the hybrid operating theatre and its CBCT capabilities.

  11. Guideline for Early Interventions (United States)


    RTO-MP-HFM-134 6 - 1 Guideline for Early Interventions Maaike de Vries Impact Foundation, Dutch Knowledge & Advice Centre for Post...assistance, also referred to as ‘ early interventions ’ or ‘debriefing’, is offered following shocking events. These may be large scale disasters or...calamities, but also military deployment and individual incidents. During the last years, the demand for early interventions has been increasing

  12. Early intervention in psychosis

    DEFF Research Database (Denmark)

    Csillag, Claudio; Nordentoft, Merete; Mizuno, Masafumi


    AIM: Early intervention in psychosis (EIP) is a well-established approach with the intention of early detection and treatment of psychotic disorders. Its clinical and economic benefits are well documented. This paper presents basic aspects of EIP services, discusses challenges to their implementa......AIM: Early intervention in psychosis (EIP) is a well-established approach with the intention of early detection and treatment of psychotic disorders. Its clinical and economic benefits are well documented. This paper presents basic aspects of EIP services, discusses challenges...

  13. Multifactorial intervention to prevent cardiovascular disease in patients with early rheumatoid arthritis

    DEFF Research Database (Denmark)

    Svensson, Annemarie Lyng; Christensen, Robin; Persson, Frederik


    rheumatological nurse-administered set-up of behaviour modification and pharmacological therapy targeting (1) hyperlipidaemia, (2) hypertension, (3) hyperglycaemia and (4) microalbuminuria (intervention group). ETHICS AND DISSEMINATION: This protocol is approved by the local ethics committee (DK-S-2014007...

  14. Maternal early warning systems. (United States)

    Friedman, Alexander M


    This article reviews evidence and recommendations for maternal early warning systems designed to reduce severe maternal morbidity and mortality. The clinical rationale for these systems is discussed as is research literature on early warning systems from other fields. Copyright © 2015 Elsevier Inc. All rights reserved.

  15. Early College High Schools (United States)

    Dessoff, Alan


    For at-risk students who stand little chance of going to college, or even finishing high school, a growing number of districts have found a solution: Give them an early start in college while they still are in high school. The early college high school (ECHS) movement that began with funding from the Bill and Melinda Gates Foundation 10 years ago…

  16. Early rehabilitation after stroke. (United States)

    Bernhardt, Julie; Godecke, Erin; Johnson, Liam; Langhorne, Peter


    Early rehabilitation is recommended in many guidelines, with limited evidence to guide practice. Brain neurobiology suggests that early training, at the right dose, will aid recovery. In this review, we highlight recent trials of early mobilization, aphasia, dysphagia and upper limb treatment in which intervention is commenced within 7 days of stroke and discuss future research directions. Trials in this early time window are few. Although the seminal AVERT trial suggests that a cautious approach is necessary immediately (stroke, early mobility training and mobilization appear well tolerated, with few reasons to delay initiating some rehabilitation within the first week. The results of large clinical trials of early aphasia therapy are on the horizon, and examples of targeted upper limb treatments with better patient selection are emerging. Early rehabilitation trials are complex, particularly those that intervene across acute and rehabilitation care settings, but these trials are important if we are to optimize recovery potential in the critical window for repair. Concerted efforts to standardize 'early' recruitment, appropriately stratify participants and implement longer term follow-up is needed. Trial standards are improving. New recommendations from a recent Stroke Recovery and Rehabilitation Roundtable will help drive new research.

  17. [Metabolic side effects of risperidone in early onset schizophrenia]. (United States)

    Goeb, J-L; Marco, S; Duhamel, A; Kechid, G; Bordet, R; Thomas, P; Delion, P; Jardri, R


    Atypical antipsychotics have a favourable risk/benefit profile in early onset schizophrenia (EOS). However, despite increasing use of psychotropic medication in children and adolescents, their endocrine and metabolic side-effects (weight gain, obesity, and related metabolic abnormalities such as hyperglycaemia and dyslipidemia) are of particular concern, especially within this paediatric population that appears to be at greater risk as compared with adults for antipsychotic-induced metabolic adverse effects. In addition to medication, many factors contribute to weigh gain in psychiatric patients, including sedentary lifestyle and poor diet. Excessive weigh gain has several deleterious effects in psychiatric patients, including stigmatization and further social withdrawal, and non compliance with medication. Furthermore, excessive corpulence may evolve to a metabolic syndrome with a high-risk state for future cardiovascular morbidity and mortality in adult age. Because youths are still developing at the time of psychotropic drug exposure, in a context of physiological changes in hormonal and endocrines levels and body composition, most reference values need to be adjusted for gender, age and growth charts. Hence, sex- and age-adjusted BMI percentiles and BMI Z scores are crucial to assess weight gain in children and adolescents. Obesity thresholds have been proposed to define "at risk" categories of patients. In recently issued guidelines, thresholds for antipsychotic-induced weight gain in adults have been set at a 5% increase or one point increase in BMI unit. To date, no definition has reached a consensus in childhood and adolescence. However, some at risk states requiring action are proposed in literature: more than 5% increase in weight within a three-month period; more than half a point increase in BMI Z score; between 85th and 95th BMI percentile plus one adverse health consequence (i.e. hyperglycaemia, dyslipidemia, hyperinsulinemia, hypertension, or

  18. Selective Endothelin-1 Receptor type-A Inhibition in Cardiac Surgery Subjects with Pre-Existing LV Dysfunction: Influence on Early Post-Operative Hemodynamics (United States)

    Toole, John M.; Ikonomidis, John S.; Szeto, Wilson Y.; Zellner, James L.; Mulcahy, John; Deardorff, Rachael L.; Spinale, Francis G.


    Background and Objective A robust release of endothelin-1-1 (ET) with subsequent ETA subtype receptor (ET-AR) activation occurs in patients following cardiac surgery requiring cardiopulmonary bypass (CPB). Increased ET-AR activation has been identified in patients with poor LV function (reduced ejection fraction; EF). Accordingly, this study tested the hypothesis that a selective ET-AR antagonist (ET-ARA) administered peri-operatively would favorably affect post-CPB hemodynamic profiles in patients with a pre-existing poor LVEF. Methods and Results Patients (n=29; 66±2 yrs) with a reduced LVEF (37±2%) were prospectively randomized, in a blinded fashion, at the time of elective coronary revascularization and/or valve replacement requiring CPB, to infusion of the highly-selective and potent ET-ARA, sitaxsentan at 1 or 2 mg/kg (IV bolus; n=9, 10 respectively) or vehicle (saline; n=10). Infusion of the ET-ARA/vehicle was performed immediately prior to separation from CPB and again at 12 hrs post-CPB. ET and hemodynamic measurements were performed at baseline, at separation from CPB (Time 0) and at 0.5, 6, 12, 24 hrs post-CPB. Baseline plasma ET (4.0±0.3 fmol/mL) was identical across all 3 groups, but when compared to pre-operative, baseline values obtained from age matched subjects with a normal LVEF (n=37;LVEF>50%), were significantly increased (2.9±0.2 fmol/mL, pTime 0, SVR changed in an equivalent fashion in the post-CPB period, but a significant ET-ARA effect was observed for PVR (ANOVA; p<0.05). For example at 24 hrs post-CPB, PVR increased by 40 d.scm-5 in the vehicle group, but directionally decreased by over 40 d·s·cm-5 in the 2 mg/kg ETARA group (p<0.05). Total adverse events were equivalently distributed across the ET-ARA/placebo groups. Conclusions These unique findings demonstrated that infusion of an ET-ARA in high risk cardiac surgery patients was not associated with significant hemodynamic compromise. Moreover, ET-ARA favorably affected PVR in the

  19. Early discharge following birth

    DEFF Research Database (Denmark)

    Nilsson, Ingrid M. S.; Kronborg, Hanne; Knight, Christopher H.


    of discharge after birth. Results In total 34% mothers were discharged within 12 hours (very early) and 25% between 13 and 50 hours (early), respectively. Vaginal birth and multiparity were the most influential predictors, as Caesarean section compared to vaginal birth had an OR of 0.35 (CI 0....... Smoking, favourable social support and breastfeeding knowledge were significantly associated with discharge within 12 hours. Finally time of discharge varied significantly according to region and time of day of birth. Conclusions Parity and birth related factors were the strongest predictors of early...

  20. Early Option Exercise

    DEFF Research Database (Denmark)

    Heje Pedersen, Lasse; Jensen, Mads Vestergaard

    A classic result by Merton (1973) is that, except just before expiration or dividend payments, one should never exercise a call option and never convert a convertible bond. We show theoretically that this result is overturned when investors face frictions. Early option exercise can be optimal when...... it reduces short-sale costs, transaction costs, or funding costs. We provide consistent empirical evidence, documenting billions of dollars of early exercise for options and convertible bonds using unique data on actual exercise decisions and frictions. Our model can explain as much as 98% of early exercises...

  1. Early Option Exercise

    DEFF Research Database (Denmark)

    Jensen, Mads Vestergaard; Heje Pedersen, Lasse


    A classic result by Merton (1973) is that, except just before expiration or dividend payments, one should never exercise a call option and never convert a convertible bond. We show theoretically that this result is overturned when investors face frictions. Early option exercise can be optimal when...... it reduces short-sale costs, transaction costs, or funding costs. We provide consistent empirical evidence, documenting billions of dollars of early exercise for options and convertible bonds using unique data on actual exercise decisions and frictions. Our model can explain as much as 98% of early exercises...

  2. Early Head Start Evaluation (United States)

    U.S. Department of Health & Human Services — Longitudinal information from an evaluation where children were randomly assigned to Early Head Start or community services as usual;direct assessments and...

  3. Earth's early biosphere (United States)

    Des Marais, D. J.


    Understanding our own early biosphere is essential to our search for life elsewhere, because life arose on Earth very early and rocky planets shared similar early histories. The biosphere arose before 3.8 Ga ago, was exclusively unicellular and was dominated by hyperthermophiles that utilized chemical sources of energy and employed a range of metabolic pathways for CO2 assimilation. Photosynthesis also arose very early. Oxygenic photosynthesis arose later but still prior to 2.7 Ga. The transition toward the modern global environment was paced by a decline in volcanic and hydrothermal activity. These developments allowed atmospheric O2 levels to increase. The O2 increase created new niches for aerobic life, most notably the more advanced Eukarya that eventually spawned the megascopic fauna and flora of our modern biosphere.

  4. Guideline for Early Interventions

    National Research Council Canada - National Science Library

    Vries, de, Maaike


    .... During the last years, the demand for early interventions has been increasing. International literature has shown that the psychosocial effects of disaster and military deployment may last for years...

  5. Cancer treatment - early menopause (United States)

    Premature menopause; Ovarian insufficiency - cancer ... Cancer treatments that can cause early menopause include: Surgery. Having both ovaries removed causes menopause to happen right away. If you are age 50 or younger, your provider may ...

  6. Q fever - early (United States)

    ... spread by domestic and wild animals and ticks. Causes Q fever is caused by the bacteria Coxiella burnetii , which ... Prevention Pasteurization of milk destroys the bacteria that cause early Q fever. Domestic animals should be inspected for signs of ...

  7. Early Life Stages (United States)

    Childhood should be viewed as a sequence of lifestages, from birth through infancy and adolescence. When assessing early life risks, consideration is given to risks resulting from fetal exposure via the pregnant mother, as well as postnatal exposures.

  8. Early Prediction of Preeclampsia

    Directory of Open Access Journals (Sweden)

    Leona C. Poon


    Full Text Available Effective screening for the development of early onset preeclampsia (PE can be provided in the first-trimester of pregnancy. Screening by a combination of maternal risk factors, uterine artery Doppler, mean arterial pressure, maternal serum pregnancy-associated plasma protein-A, and placental growth factor can identify about 95% of cases of early onset PE for a false-positive rate of 10%.

  9. Embracing early literacy indicators

    DEFF Research Database (Denmark)

    Broström, Stig; Hansen, Ole Henrik; Jensen, Anders Skriver


    Abstract til paper om early literacy indikatorer. Det paper abstractet er knyttet til var en del af et inviteret, selvorganiseret symposium som afrapporterede EASE-projektet ( på OMEP's 26. verdenskongres.......Abstract til paper om early literacy indikatorer. Det paper abstractet er knyttet til var en del af et inviteret, selvorganiseret symposium som afrapporterede EASE-projektet ( på OMEP's 26. verdenskongres....

  10. Who Gets Early Tracheostomy? (United States)

    Shaw, Joshua J.


    BACKGROUND: Although the benefits of early tracheostomy in patients dependent on ventilators are well established, the reasons for variation in time from intubation to tracheostomy remain unclear. We identified clinical and demographic disparities in time to tracheostomy. METHODS: We performed a level 3 retrospective prognostic study by querying the University HealthSystem Consortium (2007-2010) for adult patients receiving a tracheostomy after initial intubation. Time to tracheostomy was designated early ( 10 days). Cohorts were stratified by time to tracheostomy and compared using univariate tests of association and multivariable adjusted models. RESULTS: A total of 49,191 patients underwent tracheostomy after initial intubation: 42% early (n = 21,029) and 58% late (n = 28,162). On both univariate and multivariable analyses, women, blacks, Hispanics, and patients receiving Medicaid were less likely to receive an early tracheostomy. Patients in the early group also experienced lower rates of mortality (OR, 0.84; 95% CI, 0.79-0.88). CONCLUSIONS: Early tracheostomy was associated with increased survival. Yet, there were still significant disparities in time to tracheostomy according to sex, race, and type of insurance. Application of evidence-based algorithms for tracheostomy may reduce unequal treatment and improve overall mortality rates. Additional research into this apparent bias in referral/rendering of tracheostomy is needed. PMID:26313324

  11. Early cosmology constrained

    Energy Technology Data Exchange (ETDEWEB)

    Verde, Licia; Jimenez, Raul [Institute of Cosmos Sciences, University of Barcelona, IEEC-UB, Martí Franquès, 1, E08028 Barcelona (Spain); Bellini, Emilio [University of Oxford, Denys Wilkinson Building, Keble Road, Oxford, OX1 3RH (United Kingdom); Pigozzo, Cassio [Instituto de Física, Universidade Federal da Bahia, Salvador, BA (Brazil); Heavens, Alan F., E-mail:, E-mail:, E-mail:, E-mail:, E-mail: [Imperial Centre for Inference and Cosmology (ICIC), Imperial College, Blackett Laboratory, Prince Consort Road, London SW7 2AZ (United Kingdom)


    We investigate our knowledge of early universe cosmology by exploring how much additional energy density can be placed in different components beyond those in the ΛCDM model. To do this we use a method to separate early- and late-universe information enclosed in observational data, thus markedly reducing the model-dependency of the conclusions. We find that the 95% credibility regions for extra energy components of the early universe at recombination are: non-accelerating additional fluid density parameter Ω{sub MR} < 0.006 and extra radiation parameterised as extra effective neutrino species 2.3 < N {sub eff} < 3.2 when imposing flatness. Our constraints thus show that even when analyzing the data in this largely model-independent way, the possibility of hiding extra energy components beyond ΛCDM in the early universe is seriously constrained by current observations. We also find that the standard ruler, the sound horizon at radiation drag, can be well determined in a way that does not depend on late-time Universe assumptions, but depends strongly on early-time physics and in particular on additional components that behave like radiation. We find that the standard ruler length determined in this way is r {sub s} = 147.4 ± 0.7 Mpc if the radiation and neutrino components are standard, but the uncertainty increases by an order of magnitude when non-standard dark radiation components are allowed, to r {sub s} = 150 ± 5 Mpc.

  12. Early knee osteoarthritis. (United States)

    Favero, Marta; Ramonda, Roberta; Goldring, Mary B; Goldring, Steven R; Punzi, Leonardo


    Concepts regarding osteoarthritis, the most common joint disease, have dramatically changed in the past decade thanks to the development of new imaging techniques and the widespread use of arthroscopy that permits direct visualisation of intra-articular tissues and structure. MRI and ultrasound allow the early detection of pre-radiographic structural changes not only in the peri-articular bone but also in the cartilage, menisci, synovial membrane, ligaments and fat pad. The significance of MRI findings such as cartilage defects, bone marrow lesions, synovial inflammation/effusions and meniscal tears in patients without radiographic signs of osteoarthritis is not fully understood. Nevertheless, early joint tissue changes are associated with symptoms and, in some cases, with progression of disease. In this short review, we discuss the emerging concept of early osteoarthritis localised to the knee based on recently updated knowledge. We highlight the need for a new definition of early osteoarthritis that will permit the identification of patients at high risk of osteoarthritis progression and to initiate early treatment interventions.

  13. Early Dementia Screening

    Directory of Open Access Journals (Sweden)

    Peter K. Panegyres


    Full Text Available As the population of the world increases, there will be larger numbers of people with dementia and an emerging need for prompt diagnosis and treatment. Early dementia screening is the process by which a patient who might be in the prodromal phases of a dementing illness is determined as having, or not having, the hallmarks of a neurodegenerative condition. The concepts of mild cognitive impairment, or mild neurocognitive disorder, are useful in analyzing the patient in the prodromal phase of a dementing disease; however, the transformation to dementia may be as low as 10% per annum. The search for early dementia requires a comprehensive clinical evaluation, cognitive assessment, determination of functional status, corroborative history and imaging (including MRI, FDG-PET and maybe amyloid PET, cerebrospinal fluid (CSF examination assaying Aβ1–42, T-τ and P-τ might also be helpful. Primary care physicians are fundamental in the screening process and are vital in initiating specialist investigation and treatment. Early dementia screening is especially important in an age where there is a search for disease modifying therapies, where there is mounting evidence that treatment, if given early, might influence the natural history—hence the need for cost-effective screening measures for early dementia.

  14. Early diagnosis of early stage lung cancer

    Directory of Open Access Journals (Sweden)

    Andrej Debeljak


    Full Text Available Background: For the detection of premalignant changes of bronchial mucosa and early stages of lung cancer frequent chest X-ray, spiral low dose computed tomography, fluorescence bronchoscopy, sputum cytology (also with automated systems with genetic and molecular changes in the sputum cells and bronchial mucosa were used. These screening methods of the high-risk groups for lung cancer achieved: earlier diagnosis of lung cancer in lower stage, higher operability, longer 5-year survival, but without mortality reduction.Conclusions: In the clinical practice we can examine higher risk groups for lung cancer in randomised control trials with multimodality approach: frequent chest low-dose fast spiral computed tomography, sputum cytology with genetic and molecular examinations and fluorescence bronchoscopy. Smoking cessation remains the best means to achieve mortality reduction from lung cancer.

  15. Early intervention as a catalyst for effective early childhood ...

    African Journals Online (AJOL)

    Early childhood intervention is an essential contributor and catalyst for the development of a culture of positive attitudes towards children with disabilities in a country like Ghana. Intervention could begin at the early years or early childhood education level. Does early intervention make a difference in the lives of children ...

  16. Early anaerobic metabolisms

    DEFF Research Database (Denmark)

    Canfield, Donald Eugene; Rosing, Minik T; Bjerrum, Christian


    probably driven by the cycling of H2 and Fe2+ through primary production conducted by anoxygenic phototrophs. Interesting and dynamic ecosystems would have also been driven by the microbial cycling of sulphur and nitrogen species, but their activity levels were probably not so great. Despite the diversity......Before the advent of oxygenic photosynthesis, the biosphere was driven by anaerobic metabolisms. We catalogue and quantify the source strengths of the most probable electron donors and electron acceptors that would have been available to fuel early-Earth ecosystems. The most active ecosystems were...... of potential early ecosystems, rates of primary production in the early-Earth anaerobic biosphere were probably well below those rates observed in the marine environment. We shift our attention to the Earth environment at 3.8Gyr ago, where the earliest marine sediments are preserved. We calculate, consistent...

  17. Early Islamic Syria

    DEFF Research Database (Denmark)

    Walmsley, Alan

    After more than a century of neglect, a profound revolution is occurring in the way archaeology addresses and interprets developments in the social history of early Islamic Syria-Palestine. This concise book offers an innovative assessment of social and economic developments in Syria......-Palestine shortly before, and in the two centuries after, the Islamic expansion (the later sixth to the early ninth century AD), drawing on a wide range of new evidence from recent archaeological work. Alan Walmsley challenges conventional explanations for social change with the arrival of Islam, arguing...... for considerable cultural and economic continuity rather than devastation and unrelenting decline. Much new, and increasingly non-elite, architectural evidence and an ever-growing corpus of material culture indicate that Syria-Palestine entered a new age of social richness in the early Islamic period, even...

  18. Early detection of psychosis

    DEFF Research Database (Denmark)

    Larsen, T. K.; Melle, I.; Auestad, B.


    Background During the last decades we have seen a new focus on early treatment of psychosis. Several reviews have shown that duration of untreated psychosis (DUP) is correlated to better outcome. However, it is still unknown whether early treatment will lead to a better long-term outcome....... This study reports the effects of reducing DUP on 5-year course and outcome.Method During 1997â€"2000 a total of 281 consecutive patients aged >17 years with first episode non-affective psychosis were recruited, of which 192 participated in the 5-year follow-up. A comprehensive early detection (ED) programme...... with public information campaigns and low-threshold psychosis detection teams was established in one healthcare area (ED-area), but not in a comparable area (no-ED area). Both areas ran equivalent treatment programmes during the first 2 years and need-adapted treatment thereafter.Results At the start...

  19. Early life vaccination

    DEFF Research Database (Denmark)

    Nazerai, Loulieta; Bassi, Maria Rosaria; Uddbäck, Ida Elin Maria


    Intracellular pathogens represent a serious threat during early life. Importantly, even though the immune system of newborns may be characterized as developmentally immature, with a propensity to develop Th2 immunity, significant CD8+ T-cell responses may still be elicited in the context of optimal...... the first period of life and provide a pertinent alternative in infant vaccinology. To address this, infant mice were vaccinated with three different adenoviral vectors and the CD8+ T-cell response after early life vaccination was explored. We assessed the frequency, polyfunctionality and in vivo...... cytotoxicity of the elicited memory CD8+ T cells, as well as the potential of these cells to respond to secondary infections and confer protection. We further tested the impact of maternal immunity against our replication-deficient adenoviral vector during early life vaccination. Overall, our results indicate...

  20. [Early orthodontic treatment]. (United States)

    Boute, S; Kleutghen, J


    Several preventive procedures are recommended for the interception of early malocclusion. Therefore some important characteristics of normal dental development are mentioned. This preventive approach is focused around selected topics as forced bite, midline diastema and retarded eruption. This influence of functional disturbances on dentofacial morphology is discussed. An overview of possible therapy by the general dentist is presented for problems, aroused by thumb- and fingersucking, agenesis of upper lateral and mandibular second premolars as well as early loss of deciduous molars. Finally, the possible indications for serial extractions are examined.

  1. Early College Entrance in Australia (United States)

    Jung, Jae Yup; Young, Marie; Gross, Miraca U. M.


    Early college entry is an educational intervention that is being increasingly used in Australia. Following a review of the current Australian literature on early college entry, an overview is provided of the characteristics of, and the procedures associated with, one formal Australian early college entry program (the Early Admission for…

  2. Early modern natural history

    Indian Academy of Sciences (India)

    Early modern natural history: Contributions from the Americas and India. Rajesh Kochhar. Perspectives Volume 37 Issue ... Keywords. India; medical botany; natural history; scientific botany; the Americas. Author Affiliations. Rajesh Kochhar1. Indian Institute of Science Education and Research, Mohali 140 306 Punjab, India ...

  3. Characteristics of early psychosis

    NARCIS (Netherlands)

    Schothorst, P.F.; Emck, C.; van Engeland, H.


    There is little research on characteristics related to course and prognosis of early-onset psychosis. The present article aims to advance our knowledge of this disorder for the purpose of proper diagnosis and treatment. It focuses on premorbid and prodromal characteristics, treatment history,

  4. Prenatal depression: Early intervention. (United States)

    Anderson, Cheryl A; Lieser, Carol


    Frequently undiagnosed and untreated, prenatal depression affects approximately one in four childbearing women. Screening and appropriate management is essential to prevent adverse consequences to both the woman and her unborn infant. Early conversations between the woman and her nurse practitioner are essential to making medical management decisions.

  5. Teaching polymorphism early

    DEFF Research Database (Denmark)


    Is it possible to teach dynamic polymorphism early? What techniques could facilitate teaching it in Java. This panel will bring together people who have considered this question and attempted to implement it in various ways, some more completely than others. It will also give participants...

  6. Early practice: neurotology. (United States)

    Breen, Joseph T; Vrabec, Jeffrey T


    Besides technical and surgical proficiency, some of the most important skills for a young Neurotologist to refine include communication and critical thinking abilities. This Early Practice article provides perspectives on common challenges and career development from a current Neurotology fellow and his mentor. Copyright © 2015 Elsevier Inc. All rights reserved.

  7. (Reconceptualizing Early Childhood Education)?

    African Journals Online (AJOL)

    As she looks back on her past experiences of depression, working in a revolutionary psychiatric clinic, experiencing a near catatonic state, and an action research study of women in early childhood education at the precipice of an immanent plane, the reader is led on their own journey to consider deeply the differences ...

  8. Early Childhood Trauma (United States)

    National Child Traumatic Stress Network, 2010


    Early childhood trauma generally refers to the traumatic experiences that occur to children aged 0-6. Because infants' and young children's reactions may be different from older children's, and because they may not be able to verbalize their reactions to threatening or dangerous events, many people assume that young age protects children from the…

  9. Early childhood aggression

    NARCIS (Netherlands)

    Alink, Lenneke Rosalie Agnes


    In this thesis the development, stability, and correlates of early childhood aggression were investigated. The normative development was examined in a general population sample using questionnaires completed by the parents of 12-, 24-, and 36-month-old children and again one year later. Results

  10. Music in Early Childhood. (United States)

    Feierabend, John


    Argues that music activities in early childhood education foster a variety of developmental skills. Analyzes Howard Gardner's theory of multiple intelligences, contending that music intelligence is a separate intelligence. Provides ways to identify and promote musical intelligence. Suggests methods for encouraging musical development. Using songs…

  11. Introduction to "Early psychosis

    DEFF Research Database (Denmark)

    McGorry, Patrick; Nordentoft, Merete; Simonsen, Erik


    warrants careful analysis. The Third International Early Psychosis Conference proved to be a watershed and was the largest and most vibrant meeting to that point. This preface aims to set the scene for a selection of contributions, derived from the array of new evidence reported in Copenhagen, and recently...

  12. Early Developments, 2002. (United States)

    Winton, Pam, Ed.; Buysse, Virginia, Ed.


    This document consists of the three 2002 issues of a journal reporting new research in early child development conducted by the Frank Porter Graham Child Development Center (FPG) at the University of North Carolina at Chapel Hill. Articles in the Winter 2002 issue highlight some current work at FPG on factors that enhance or inhibit social and…

  13. Early prenatal syphilis

    Directory of Open Access Journals (Sweden)

    Santosh Rathod


    Full Text Available Syphilis in pregnancy still remains a challenge despite the availability of adequate diagnostic tests for serological screening and penicillin therapy. We report a case of 2 month old female infant who presented with runny nose, papulosquamous lesions over both palms and soles and perianal erosions since 1 month after birth. Cutaneous examination revealed moist eroded areas in the perianal region and fine scaly lesions over palms and soles. Radiograph of both upper limbs and limbs revealed early periosteal changes in lower end of humerus and lower end of tibia. Diagnosis of early pre-natal syphilis was confirmed by Child′s Serum Rapid Plasma Reagin Antibody test [S.RPR] being positive with 1:64 dilution while that of mother was 1:8.

  14. Earthquake Early Warning Systems


    Pei-Yang Lin


    Because of Taiwan’s unique geographical environment, earthquake disasters occur frequently in Taiwan. The Central Weather Bureau collated earthquake data from between 1901 and 2006 (Central Weather Bureau, 2007) and found that 97 earthquakes had occurred, of which, 52 resulted in casualties. The 921 Chichi Earthquake had the most profound impact. Because earthquakes have instant destructive power and current scientific technologies cannot provide precise early warnings in advance, earthquake ...

  15. Early Permian bipedal reptile. (United States)

    Berman, D S; Reisz, R R; Scott, D; Henrici, A C; Sumida, S S; Martens, T


    A 290-million-year-old reptilian skeleton from the Lower Permian (Asselian) of Germany provides evidence of abilities for cursorial bipedal locomotion, employing a parasagittal digitigrade posture. The skeleton is of a small bolosaurid, Eudibamus cursoris, gen. et sp. nov. and confirms the widespread distribution of Bolosauridae across Laurasia during this early stage of amniote evolution. E. cursoris is the oldest known representative of Parareptilia, a major clade of reptiles.

  16. Hands of early primates. (United States)

    Boyer, Doug M; Yapuncich, Gabriel S; Chester, Stephen G B; Bloch, Jonathan I; Godinot, Marc


    Questions surrounding the origin and early evolution of primates continue to be the subject of debate. Though anatomy of the skull and inferred dietary shifts are often the focus, detailed studies of postcrania and inferred locomotor capabilities can also provide crucial data that advance understanding of transitions in early primate evolution. In particular, the hand skeleton includes characteristics thought to reflect foraging, locomotion, and posture. Here we review what is known about the early evolution of primate hands from a comparative perspective that incorporates data from the fossil record. Additionally, we provide new comparative data and documentation of skeletal morphology for Paleogene plesiadapiforms, notharctines, cercamoniines, adapines, and omomyiforms. Finally, we discuss implications of these data for understanding locomotor transitions during the origin and early evolutionary history of primates. Known plesiadapiform species cannot be differentiated from extant primates based on either intrinsic hand proportions or hand-to-body size proportions. Nonetheless, the presence of claws and a different metacarpophalangeal [corrected] joint form in plesiadapiforms indicate different grasping mechanics. Notharctines and cercamoniines have intrinsic hand proportions with extremely elongated proximal phalanges and digit rays relative to metacarpals, resembling tarsiers and galagos. But their hand-to-body size proportions are typical of many extant primates (unlike those of tarsiers, and possibly Teilhardina, which have extremely large hands). Non-adapine adapiforms and omomyids exhibit additional carpal features suggesting more limited dorsiflexion, greater ulnar deviation, and a more habitually divergent pollex than observed plesiadapiforms. Together, features differentiating adapiforms and omomyiforms from plesiadapiforms indicate increased reliance on vertical prehensile-clinging and grasp-leaping, possibly in combination with predatory behaviors in

  17. Early Building Design

    DEFF Research Database (Denmark)

    Østergård, Torben; Jensen, Rasmus Lund; Maagaard, Steffen


    Highlights •Development of a design methodology that can handle the vast design space in early building design. •A global design space is modelled from extensive Monte Carlo simulations. •Sensitivity analysis methods applied to guide decision-makers. •Interactive visualizations help the multi......-actor design team explore thousands of building performance simulations. •Metamodels are used to run additional simulations and demonstrate the holistic consequences of input changes....

  18. Coaching in Early Mathematics. (United States)

    Germeroth, Carrie; Sarama, Julie


    Falling scores in math have prompted a renewed interest in math instruction at early ages. By their own admission, early childhood educators are generally underprepared and not always comfortable teaching math. Professional development (PD) in early mathematics is widely considered a main way to increase teachers' skills and efficacy (e.g., Guskey, 2000; Hyson & Woods, 2014; Munby, Russell, & Martin, 2001; Piasta, Logan, Pelatti, Capps, & Petrill, 2015; Richardson & Placier, 2001; Sarama, Clements, Wolfe, & Spitler, 2016; Sarama & DiBiase, 2004; Zaslow, 2014). However, it has been documented that stand-alone PD is not as effective in changing practice (e.g., Biancarosa & Bryk, 2011; Garet et al., 2008; Guskey, 2000; Hyson & Woods, 2014; Institute of Medicine and National Research Council, 2015; Joyce & Showers, 2002; Zaslow, 2014). Site-embedded ongoing support in the form of coaching or mentoring has been shown to be critical for successful implementation (Neuman & Cunningham, 2009; Powell, Diamond, Burchinal, & Koehler, 2010). In this chapter, we describe coaching models and abstract characteristics of effective coaching from the research. With this background, we provide an in-depth view of the coaching aspect of two large empirical studies in early mathematics. We introduce the theoretical framework from which the coaching models for these projects were developed and describe the research on which they were based. We then summarize how the planned models were instantiated and challenges to their implementation within each project. In the final section, we summarize what we have learned and described implications and challenges for the field. © 2017 Elsevier Inc. All rights reserved.

  19. Early anaerobic metabolisms (United States)

    Canfield, Don E; Rosing, Minik T; Bjerrum, Christian


    Before the advent of oxygenic photosynthesis, the biosphere was driven by anaerobic metabolisms. We catalogue and quantify the source strengths of the most probable electron donors and electron acceptors that would have been available to fuel early-Earth ecosystems. The most active ecosystems were probably driven by the cycling of H2 and Fe2+ through primary production conducted by anoxygenic phototrophs. Interesting and dynamic ecosystems would have also been driven by the microbial cycling of sulphur and nitrogen species, but their activity levels were probably not so great. Despite the diversity of potential early ecosystems, rates of primary production in the early-Earth anaerobic biosphere were probably well below those rates observed in the marine environment. We shift our attention to the Earth environment at 3.8 Gyr ago, where the earliest marine sediments are preserved. We calculate, consistent with the carbon isotope record and other considerations of the carbon cycle, that marine rates of primary production at this time were probably an order of magnitude (or more) less than today. We conclude that the flux of reduced species to the Earth surface at this time may have been sufficient to drive anaerobic ecosystems of sufficient activity to be consistent with the carbon isotope record. Conversely, an ecosystem based on oxygenic photosynthesis was also possible with complete removal of the oxygen by reaction with reduced species from the mantle. PMID:17008221

  20. Early intervention for psychosis (United States)

    Marshall, Max; Rathbone, John


    Background Proponents of early intervention have argued that outcomes might be improved if more therapeutic efforts were focused on the early stages of schizophrenia or on people with prodromal symptoms. Early intervention in schizophrenia has two elements that are distinct from standard care: early detection, and phase-specific treatment (phase-specific treatment is a psychological, social or physical treatment developed, or modified, specifically for use with people at an early stage of the illness). Early detection and phase-specific treatment may both be offered as supplements to standard care, or may be provided through a specialised early intervention team. Early intervention is now well established as a therapeutic approach in America, Europe and Australasia. Objectives To evaluate the effects of: (a) early detection; (b) phase-specific treatments; and (c) specialised early intervention teams in the treatment of people with prodromal symptoms or first-episode psychosis. Search methods We searched the Cochrane Schizophrenia Group Trials Register (March 2009), inspected reference lists of all identified trials and reviews and contacted experts in the field. Selection criteria We included all randomised controlled trials (RCTs) designed to prevent progression to psychosis in people showing prodromal symptoms, or to improve outcome for people with first-episode psychosis. Eligible interventions, alone and in combination, included: early detection, phase-specific treatments, and care from specialised early intervention teams. We accepted cluster-randomised trials but excluded non-randomised trials. Data collection and analysis We reliably selected studies, quality rated them and extracted data. For dichotomous data, we estimated relative risks (RR), with the 95% confidence intervals (CI). Where possible, we calculated the number needed to treat/harm statistic (NNT/H) and used intention-to-treat analysis (ITT). Main results Studies were diverse, mostly small

  1. Infusing Early Childhood Mental Health into Early Intervention Services (United States)

    Grabert, John C.


    This article describes the process of enhancing early childhood mental health awareness and skills in non-mental health staff. The author describes a pilot training model, conducted the U.S. Army's Early Intervention Services, that involved: (a) increasing early childhood mental health knowledge through reflective readings, (b) enhancing…

  2. Developmental Milestones of Early Literacy (United States)

    ... Size Email Print Share Developmental Milestones of Early Literacy Page Content ​In the spirit of making both ... at the well-defined developmental milestones of early literacy. Younger Than 6 Months: Never Too Young Unlike ...

  3. Early Life Exposures and Cancer (United States)

    Early-life events and exposures have important consequences for cancer development later in life, however, epidemiological studies of early-life factors and cancer development later in life have had significant methodological challenges.

  4. Early Onset Werner Syndrome

    Directory of Open Access Journals (Sweden)

    Berna İmge Aydoğan


    Full Text Available Werner syndrome (WS is a rare autosomal recessive adult-onset progeroid disorder characterized by the early onset of aged-appearance and age-related metabolic disorders. Symptoms of premature aging usually first develop in the second-third decades of life. We report a 27-year-old female who was admitted to our clinic at the age of eighteen with hyperglycemia. She was diagnosed with diabetes and type 4 dyslipidemia at the age of seven. In her family history, her parents were first cousins and she had three healthy brothers. On her first physical examination; she had bird-like face appearance, global hair loss, beaked nose, short stature and she was overweight. She had global hair loss with gray and thin hair. Hoarseness of voice and hyperkeratosis of skin were observed. She had bilateral cataracts and moderate sensorineural hearing loss. On psychiatric examination, borderline mental retardation was detected. She had severe insulin resistance and hypertriglyceridemia despite levothyroxine, gemfibrozil, omega-3 and intensive insulin treatment. Routine lipid apheresis was performed to lower the triglyceride levels reaching 5256 mg/dL. She also had focal segmental glomerulosclerosis, hepatosteatosis, osteoporosis and epilepsy. Disease was accompanied by several congenital deformities, such as Rathke’s cleft cyst, angiomyolipoma and femoral neck hypoplasia. WS is a rare genetic disorder characterized by multiple endocrine manifestations as well as soft tissue changes. We present a case of early disturbances that were diagnosed before typical clinical signs and symptoms. We propose that WS should be kept in mind when type 2 diabetes and hyperlipidemia are diagnosed early in childhood. Turk Jem 2015; 19: 99-104

  5. Crowdsourced earthquake early warning (United States)

    Minson, Sarah E.; Brooks, Benjamin A.; Glennie, Craig L.; Murray, Jessica R.; Langbein, John O.; Owen, Susan E.; Heaton, Thomas H.; Iannucci, Robert A.; Hauser, Darren L.


    Earthquake early warning (EEW) can reduce harm to people and infrastructure from earthquakes and tsunamis, but it has not been implemented in most high earthquake-risk regions because of prohibitive cost. Common consumer devices such as smartphones contain low-cost versions of the sensors used in EEW. Although less accurate than scientific-grade instruments, these sensors are globally ubiquitous. Through controlled tests of consumer devices, simulation of an Mw (moment magnitude) 7 earthquake on California’s Hayward fault, and real data from the Mw 9 Tohoku-oki earthquake, we demonstrate that EEW could be achieved via crowdsourcing.

  6. Early solar physics

    CERN Document Server

    Meadows, A J


    Early Solar Physics reviews developments in solar physics, particularly the advent of solar spectroscopy and the discovery of relationships between the various layers of the solar atmosphere and between the different forms of solar activity. Topics covered include solar observations during 1843; chemical analysis of the solar atmosphere; the spectrum of a solar prominence; and the solar eclipse of December 12, 1871. Spectroscopic observations of the sun are also presented. This book is comprised of 30 chapters and begins with an overview of ideas about the sun in the mid-nineteenth century, fo

  7. Early Childhood Workforce Index, 2016 (United States)

    Whitebook, Marcy; McLean, Caitlin; Austin, Lea J. E.


    The State of the Early Childhood Workforce (SECW) Initiative is a groundbreaking multi-year project to shine a steady spotlight on the nation's early childhood workforce. The SECW Initiative is designed to challenge entrenched ideas and policies that maintain an inequitable and inadequate status quo for early educators and for the children and…

  8. Early Intervention: A Global Perspective. (United States)

    Blackman, James A.


    The recognition of the importance of brain development in the early years of life has led to expanded early intervention programs for very young children with or at risk for developmental disabilities. A biological basis for early intervention is explored, and brain plasticity is discussed. (Contains references.) (Author/CR)

  9. The Effectiveness of Early Intervention. (United States)

    Guralnick, Michael J., Ed.

    This book reviews research on the effectiveness of early intervention for children with disabilities or who are at risk. Program factors for children at risk and with disabilities, the effects of early intervention on different types of disabilities, and the outcomes of early intervention are explored. Chapters include: "Second-Generation Research…

  10. Value-Added Early Learning (United States)

    Dichter, Harriet


    Elected state leaders often prioritize economic prosperity and competitiveness, which provides an important opportunity too rarely taken for investing in early education. In 2003, Pennsylvania recognized the connection between early education and the economy, and smartly embraced early learning as part of its economic prosperity and…

  11. The Perils of Early Motherhood. (United States)

    Sawhill, Isabel V.


    Suggests that preventing early childbearing among those who are still young and unmarried is likely to yield significant social benefits, including the restoration of marriage, discussing whether marriage is the solution to the problem of early motherhood. Explains the need for strong efforts to prevent early childbearing, examining teen pregnancy…

  12. Sonority and early words

    DEFF Research Database (Denmark)

    Kjærbæk, Laila; Boeg Thomsen, Ditte; Lambertsen, Claus


    Syllables play an important role in children’s early language acquisition, and children appear to rely on clear syllabic structures as a key to word acquisition (Vihman 1996; Oller 2000). However, not all languages present children with equally clear cues to syllabic structure, and since the spec......Syllables play an important role in children’s early language acquisition, and children appear to rely on clear syllabic structures as a key to word acquisition (Vihman 1996; Oller 2000). However, not all languages present children with equally clear cues to syllabic structure, and since...... acquisition therefore presents us with the opportunity to examine how children respond to the task of word learning when the input language offers less clear cues to syllabic structure than usually seen. To investigate the sound structure in Danish children’s lexical development, we need a model of syllable......-29 months. For the two children, the phonetic structure of the first ten words to occur is compared with that of the last ten words to occur before 30 months of age, and with that of ten words in between. Measures related to the sonority envelope, viz. sonority types and in particular sonority rises...

  13. Improving early seizure detection. (United States)

    Jouny, Christophe C; Franaszczuk, Piotr J; Bergey, Gregory K


    Over the last decade, the search for a method able to reliably predict seizures hours in advance has been largely replaced by the more realistic goal of very early detection of seizure onset, which would allow therapeutic or warning devices to be triggered prior to the onset of disabling clinical symptoms. We explore in this article the steps along the pathway from data acquisition to closed-loop applications that can and should be considered to design the most efficient early seizure detection. Microelectrodes, high-frequency oscillations, high sampling rate, high-density arrays, and modern analysis techniques are all elements of the recording and detection process that in combination with modeling studies can provide new insights into the dynamics of seizure onsets. Each of these steps needs to be considered if detection devices that will favorably impact the quality of life of patients are to be implemented. This article is part of a Supplemental Special Issue entitled The Future of Automated Seizure Detection and Prediction. Copyright © 2011 Elsevier Inc. All rights reserved.

  14. Early-Onset Dementia

    DEFF Research Database (Denmark)

    Konijnenberg, Elles; Fereshtehnejad, Seyed-Mohammad; Kate, Mara Ten


    BACKGROUND: Early-onset dementia (EOD) is a rare condition, with an often atypical clinical presentation, and it may therefore be challenging to diagnose. Specialized memory clinics vary in the type of patients seen, diagnostic procedures applied, and the pharmacological treatment given. The aim...... of this study was to investigate quality-of-care indicators in subjects with EOD from 3 tertiary memory clinics in 3 European countries. METHODS: We included 1325 newly diagnosed EOD patients, ages 65 years or younger, between January 1, 2007 and December 31, 2013, from the Danish Dementia Registry...... (Rigshospitalet, Copenhagen), the Swedish Dementia Registry ("SveDem", Karolinska University Hospital, Stockholm), and the Amsterdam Dementia Cohort (VU University Medical Center). RESULTS: The frequency of EOD among all dementia patients was significantly lower in Copenhagen (410, 20%) and Stockholm (284, 21...

  15. Manipulating early pig embryos. (United States)

    Niemann, H; Reichelt, B


    On the basis of established surgical procedures for embryo recovery and transfer, the early pig embryo can be subjected to various manipulations aimed at a long-term preservation of genetic material, the generation of identical multiplets, the early determination of sex or the alteration of the genetic make-up. Most of these procedures are still at an experimental stage and despite recent considerable progress are far from practical application. Normal piglets have been obtained after cryopreservation of pig blastocysts hatched in vitro, whereas all attempts to freeze embryos with intact zona pellucida have been unsuccessful. Pig embryos at the morula and blastocyst stage can be bisected microsurgically and the resulting demi-embryos possess a high developmental potential in vitro, whereas their development in vivo is impaired. Pregnancy rates are similar (80%) but litter size is reduced compared with intact embryos and twinning rate is approximately 2%. Pig blastomeres isolated from embryos up to the 16-cell stage can be grown in culture and result in normal blastocysts. Normal piglets have been born upon transfer of blastocysts derived from isolated eight-cell blastomeres, clearly underlining the totipotency of this developmental stage. Upon nuclear transfer the developmental capacity of reconstituted pig embryos is low and culture. Sex determination can be achieved either by separation of X and Y chromosome bearing spermatozoa by flow cytometry or by analysing the expression of the HY antigen in pig embryos from the eight-cell to morula stage. Microinjection of foreign DNA has been successfully used to alter growth and development of transgenic pigs, and to produce foreign proteins in the mammary gland or in the bloodstream, indicating that pigs can be used as donors for valuable human pharmaceutical proteins. Another promising area of gene transfer is the increase of disease resistance in transgenic lines of pigs. Approximately 30% of pig spermatozoa bind

  16. Consequences of early childbearing. (United States)

    Monroy De Velasco, A


    By 2000, developing countries will have an estimated 1 billion adolescents who are physically old enough to reproduce themselves but far too young to be responsible, healthy parents of healthy children. Governments must become involved in the issues surrounding adolescent pregnancy and both custom and the laws must change to reflect the needs of young people. The consequences of early childbearing are felt by society as well as the families directly affected. The incidence of births to very young women, both married and unmarried is growing; each year approximately 13 million children are born to young mothers. The percentage of live births to mothers under the age of 20 ranges from 20% in some African and Caribbean countries, to 10-15% in many Latin American countries, 5-10% in Asia, and 1% in Japan. Increased out-of-wedlock adolescent pregnancy is due to many factors: earlier sexual maturity from better childhood health and nutrition, a trend toward later marriage, increased opportunity for opposite sex interaction in schools and in the labor force, and rapid urbanization which weakens traditional family structures and social and cultural controls. Early childbirth is especially dangerous for adolescents and their infants. Compared to women between the ages of 20-35, pregnant women under 20 are at a greater risk for death and disease including bleeding during pregnancy, toxemia, hemorrhage, prolonged and difficult labor, severe anemia, and disability. Life-long social and economic disadvantages may be a consequence of teenage birth. Educational and career opportunities may be limited, as may be opportunities for marriage. Teen mothers tend to have larger completed family sizes, shorter birth intervals resulting in both poorer health status for the family, and a more severe level of poverty. The children also suffer; teens mothers have a higher incidence of low birth weight infants which is associated with birth injuries, serious childhood illness, and mental and

  17. Asceticism and Early Christian Lifestyle


    Salminen, Joona


    This dissertation explores early Christian asceticism. The study consists of introduction and five articles examining ascetic ideals and practices in early Christianity and analysing the question of early Christian lifestyle within the context of city life in Late Antiquity, with particular emphasis on Clement of Alexandria. The dissertation also clarifies the role of Clement and his work Paedagogus practical instructions in the development of Christian asceticism. The introductory article o...

  18. Peer Bullying During Early Childhood


    Hatice UYSAL; Çağlayan DİNÇER


    Peer bullying during early childhood is discussed along with the literature reviewed in this article with the purpose of drawing attention to peer bullying during early childhood and its significance, and contributing to studies which are few in number in Turkey. Peer bullying during early childhood was considered with its definition and types, people who play key roles in peer bullying, factors (gender, age, parents, and friendship) that relate to peer bullying, and what should be done befor...

  19. [The early diagnosis of spondyloarthritis]. (United States)

    Novak, Srdan


    The most frequent early symptoms of spondyloarthritides are inflammatory back pain and asymetric peripheral arthritis. Currently the mean delay between the onset of first symptoms and diagnosing ankylosing spondylitis which is the frequent type of spondyloarthritis is over 5 years. The availability of effective therapies makes an early diagnosis mandatory. The clinical symptoms of inflammatory back pain, active inflamation on MR, and positivity for HLA-B27 are the most important parameters for an early diagnosis of spondyloarthritis, especially in combination. Moreover, the combination of clinical and laboratory parameters is necessary for the early diagnosis.

  20. 75 FR 20830 - Early Learning (United States)


    ... innovative and successful approaches to improving early learning outcomes for children, birth through third... in ``listen'' mode only. Assistance to Individuals With Disabilities at the Public Meetings: The...

  1. Early Identification of Reading Difficulties

    DEFF Research Database (Denmark)

    Poulsen, Mads; Nielsen, Anne-Mette Veber; Juul, Holger


    them. The present study compared the accuracy of early screening before the onset of formal reading instruction with late screening six months into the first year of instruction. The study followed 164 Danish students from the end of Grade 0 to the end of Grade 2. Early screening included measures......Early screening for reading difficulties before the onset of instruction is desirable because it allows intervention that is targeted at prevention rather than remediation of reading difficulties. However, early screening may be too inaccurate to effectively allocate resources to those who need...

  2. Early diagnosis of leptospirosis

    Directory of Open Access Journals (Sweden)

    Andrea Babic-Erceg


    Full Text Available A 25-years old man from Zagreb, Croatia, was admitted to the University Hospital for Infectious Diseases four days after the onset of symptoms such as fever, intense pain in the calves and anuria. The patient owned a rabbit and, before the onset of the disease, repaired some rubber pipes damaged by rodents. At admission, he had a severe clinical picture with fever, hypotension, jaundice, immobility, and pain in leg muscles. Treatment with ceftriaxone was initiated in combination with volume restitution. Renal failure soon ensued. Consequently continuous venovenous hemodiaphiltration therapy was performed. Due to acute respiratory distress syndrome, the patient was mechanically ventilated. The patient’s condition gradually improved and he recovered fully from multi-organ failure. Diagnosis was confirmed by a microscopic agglutination test (MAT covering 15 leptospira serovars and real-time polymerase-chain reaction (PCR. The first serum sample taken on day 6 tested negative for leptospira, while PCR showed positive results for leptospiral DNA. The second serum sample taken on day 13 tested positive for serovar Canicola serogroup Canicola, serovar Patoc, serovar Grippotyphosa serogroup Grippotyphosa and serovar Tarassovi serogroup Tarassovi (titre 4000, 4000, 1000 and 2000, respectively, while PCR was negative. This report highlights the benefits of combining MAT and PCR methods in early diagnosis of leptospirosis.

  3. Early History of Titan (United States)

    Castillo-Rogez, J. C.; Matson, D. L.; Johnson, T. V.; Atreya, S.; Lunine, J. I.


    We revisit models for the early history of Titan. Our models start a few My after the production of calcium- aluminum inclusions (CAIs), consistent with the dates required by our thermophysical-dynamical modeling of Saturn's medium-sized satellites. Depending on the time of formation with respect to CAIs, the accretion time scale, and the available accretional energy, models of Titan's interior after accretion are partially to fully differentiated. At one extreme of the models, Titan accretes incorporating a minimal amount of heat. This results in a relatively cold core that, over the long term, heats up and overturns, consistent with previous models of Titan. At the other extreme, accretional heat and heat fom the decay of short-lived radiogenic isotopes results in quick and complete differentiation. In this model there is no core overturn, and conditions soon develop for silicate serpentinization, and hydrothermal activity starts. We identify the periods during which conditions are suitable for hydrothermal geochemistry leading to the production of molecular nitrogen from ammonia decomposition and methane from the Fischer-Tropsch reaction. Key questions include the availability of suitable metal catalysts and/or clay minerals, storage of the reactants and products in the interior of Titan, and mechanisms by which they are released to the atmosphere. Acknowledgements: This work was carried out at the Jet Propulsion Laboratory-California Institute of Technology, under contract to NASA.


    Energy Technology Data Exchange (ETDEWEB)

    John S. Abughazaleh; Mushtaq Ahmed; Ashok Anand; John H. Anderson; Charles Benham; Fred D. Brent; Thomas E. Chance; William K. Davis; Raymond F. Drnevich; Larry Hall; Ming He; Stephen A. Lang; David Mintner; Wendy Moore; Jimmy O. Ong; George Potoczniak; Adela G. Sanchez; Charles H. Schrader; Lalit S. Shah; Kalapi D. Sheth; Phil J. Shires; Rae Song


    The overall objective of this project is the three-phase development of an Early Entrance Coproduction Plant (EECP) that produces at least one product from at least two of the following three categories: Electric power (or heat); Fuels; and Chemicals. The objective is to have these products produced by technologies capable of using synthesis gas derived from coal and/or some other carbonaceous feedstock, such as petroleum coke. The objective of Phase I was to determine the feasibility and define the concept for the EECP located at a specific site and to develop a Research, Development, and Testing (RD and T) Plan for implementation in Phase II. This objective has now been accomplished. A specific site, Motiva Refinery in Port Arthur, Texas, has been selected as the location best suited for the EECP. The accomplishments of Phase I are discussed in detail in this Phase I Concept Report. A RD and T Plan and a preliminary project financing plan have been developed and are submitted separately from this report.

  5. Early Attachment Relationships and the Early Childhood Curriculum (United States)

    Cortazar, Alejandra; Herreros, Francisca


    This article explores the relationship between attachment theory and the early childhood curriculum. During the first years of life children develop early attachment relationships with their primary caregivers. These attachment relationships, either secure or insecure, will shape children's socio-emotional development. In the USA, the predominant…

  6. Is credit for early action credible early action?

    International Nuclear Information System (INIS)

    Rolfe, C.; Michaelowa, A.; Dutschke, M.


    Credit for early action as a tool for greenhouse gas emissions reduction is compared with various market instruments as a means of narrowing the gap between projected emissions and those of the Kyoto Protocol. Market instruments work by creating a market price for emissions and use the market to encourage reductions at the lowest price, which is done by placing limits on greenhouse gas emissions and allowing the market to decide where reductions occur, or by imposing a carbon tax or emissions charge. While they can be applied within a sector, they are usually used to encourage reductions throughout the economy or across large sectors. Credit for early action also creates an incentive for emissions reductions throughout the economy or at least across many sectors. Credit for early action tools do not work by either imposing a carbon tax or emissions charge or placing limits on emissions, rather they promise that entities that take action against greenhouse gases prior to the imposition of a carbon tax or emissions limits will receive a credit against future taxes or limits. An overview is provided of the Kyoto Protocol and the rationale for taking early action, and a review is included of the theory and specific proposals for market instruments and credit for early action. A comparative analysis is provided of these approaches by examining their relative efficiency, environmental effectiveness, and impacts on the redistribution of wealth. Credit for early action is viewed as problematic on a number of counts and is seen as an interim strategy for imposition while political support for market instruments develop. The environmental effectiveness of credit for early action is very difficult to predict, and credit for early action programs do not yield the lowest cost emissions reductions. Credit for early action programs will not achieve compliance with the Kyoto Protocol at the lowest cost, and credits for early action will increase the compliance costs for those who

  7. Early tetrapod relationships revisited. (United States)

    Ruta, Marcello; Coates, Michael I; Quicke, Donald L J


    In an attempt to investigate differences between the most widely discussed hypotheses of early tetrapod relationships, we assembled a new data matrix including 90 taxa coded for 319 cranial and postcranial characters. We have incorporated, where possible, original observations of numerous taxa spread throughout the major tetrapod clades. A stem-based (total-group) definition of Tetrapoda is preferred over apomorphy- and node-based (crown-group) definitions. This definition is operational, since it is based on a formal character analysis. A PAUP* search using a recently implemented version of the parsimony ratchet method yields 64 shortest trees. Differences between these trees concern: (1) the internal relationships of aïstopods, the three selected species of which form a trichotomy; (2) the internal relationships of embolomeres, with Archeria crassidisca and Pholiderpeton scut collapsed in a trichotomy with a clade formed by Anthracosaurus russelli and Pholiderpeton attheyi; (3) the internal relationships of derived dissorophoids, with four amphibamid species forming an unresolved node with a clade consisting of micromelerpetontids and branchiosaurids and a clade consisting of albanerpetontids plus basal crown-group lissamphibians; (4) the position of albenerpetontids and Eocaecilia micropoda, which form an unresolved node with a trichotomy subtending Karaurus sharovi, Valdotriton gracilis and Triadobatrachus massinoti; (5) the branching pattern of derived diplocaulid nectrideans, with Batrachiderpeton reticulatum and Diceratosaurus brevirostris collapsed in a trichotomy with a clade formed by Diplocaulus magnicornis and Diploceraspis burkei. The results of the original parsimony run--as well as those retrieved from several other treatments of the data set (e.g. exclusion of postcranial and lower jaw data; character reweighting; reverse weighting)--indicate a deep split of early tetrapods between lissamphibian- and amniote-related taxa. Colosteids, Crassigyrinus

  8. Early onset sebaceous carcinoma

    Directory of Open Access Journals (Sweden)

    Kaltreider Sara A


    Full Text Available Abstract Background Ocular sebaceous carcinoma can masquerade as benign lesions resulting in delay of diagnosis. Early recognition is even more difficult in young patients where the disease rarely occurs. Here, we provide a clinicopathological correlation of ocular sebaceous carcinoma in a young individual lacking history of hereditary cancer or immunosuppression. Findings A detailed histopathological study including p53 DNA sequencing was performed on an aggressive sebaceous carcinoma presenting in a healthy 32 year-old Caucasian woman. She had no history of retinoblastoma, evidence for a hereditary cancer syndrome, or radiation therapy. However, she potentially was at risk for excessive UV light exposure. A detailed review of the literature is also provided. A moderately well differentiated sebaceous carcinoma was established histopathologically arising from the meibomian gland of the upper eyelid. In most areas, the cytoplasm contained small but distinct Oil-red-O positive vacuoles. Direct sequencing of p53 identified a G:C→A:T mutation at a dipyrimidine site. The mutation results in substitution of arginine for the highly conserved glycine at residue 199 located at the p53 dimer-dimer interface. Energy minimization structural modeling predicts that G199R will neutralize negative charges contributed by nearby inter- and intramonomeric glutamate residues. Discussion This study points to the importance of recognizing that sebaceous carcinoma can occur in young patients with no evidence for hereditary cancer risk or radiation therapy. The G199R substitution is anticipated to alter the stability of the p53 tetrameric complex. The role of UV light in the etiology of sebaceous carcinoma deserves further study. Our findings, taken together with those of others, suggest that different environmental factors could lead to the development of sebaceous carcinoma in different patients.

  9. Family Influences on Early Development. (United States)

    Silber, Sharon


    The article reviews the literature concerning family influences on early childhood development. Implications of this literature for intervention planning with high risk children and families are suggested. Topics covered include the early parent-child relationship, disciplinary strategies, stimulation, parental instruction and expectations, the…

  10. Early Intervention in Bipolar Disorder. (United States)

    Vieta, Eduard; Salagre, Estela; Grande, Iria; Carvalho, André F; Fernandes, Brisa S; Berk, Michael; Birmaher, Boris; Tohen, Mauricio; Suppes, Trisha


    Bipolar disorder is a recurrent disorder that affects more than 1% of the world population and usually has its onset during youth. Its chronic course is associated with high rates of morbidity and mortality, making bipolar disorder one of the main causes of disability among young and working-age people. The implementation of early intervention strategies may help to change the outcome of the illness and avert potentially irreversible harm to patients with bipolar disorder, as early phases may be more responsive to treatment and may need less aggressive therapies. Early intervention in bipolar disorder is gaining momentum. Current evidence emerging from longitudinal studies indicates that parental early-onset bipolar disorder is the most consistent risk factor for bipolar disorder. Longitudinal studies also indicate that a full-blown manic episode is often preceded by a variety of prodromal symptoms, particularly subsyndromal manic symptoms, therefore supporting the existence of an at-risk state in bipolar disorder that could be targeted through early intervention. There are also identifiable risk factors that influence the course of bipolar disorder, some of them potentially modifiable. Valid biomarkers or diagnosis tools to help clinicians identify individuals at high risk of conversion to bipolar disorder are still lacking, although there are some promising early results. Pending more solid evidence on the best treatment strategy in early phases of bipolar disorder, physicians should carefully weigh the risks and benefits of each intervention. Further studies will provide the evidence needed to finish shaping the concept of early intervention.

  11. Cell Analysis and Early Diagnostics

    NARCIS (Netherlands)

    Subramaniam, Vinod; Jones, Val


    In an era of aging populations and rising health-care costs, the shift of medical paradigms towards rapid, accurate, early diagnoses of diseases is inevitable. In addition to further development of ultrasensitive in vitro tests, the focus of attention in both diagnostics and the early drug discovery

  12. Promoting Health in Early Childhood (United States)

    Rossin-Slater, Maya


    Children who are healthy early in life--from conception to age five--not only grow up to be healthier adults, they are also better educated, earn more, and contribute more to the economy. The United States lags behind other advanced countries in early childhood health, threatening both the health of future generations and the nation's long-term…

  13. Early intervention services in psychosis

    DEFF Research Database (Denmark)

    Csillag, Claudio; Nordentoft, Merete; Mizuno, Masafumi


    AIM: Early intervention (EI) in psychosis is a comprehensive and evidence-based approach aimed at detection and treatment of psychotic symptoms in their early stages. This paper presents core features and noteworthy aspects of the evidence basis and limitations of EI, the importance of programme...

  14. Early Childhood Inclusion in Spain (United States)

    Giné, Climent; Balcells-Balcells, Anna; Cañadas, Margarita; Paniagua, Gema


    This article describes early childhood inclusion in educational settings in Spain. First, we address the legislative framework of preschool education in Spain and offer a brief analysis of some relevant issues, including the current situation of early childhood education and inclusion at this stage. Second, current policies and practices relating…

  15. Early Childhood Special Education Research. (United States)

    Wolery, Mark; Bailey, Donald B., Jr.


    The written testimony of the authors before the President's Commission on Excellence in Special Education in April, 2002, identifies five areas of needed effort in early childhood special education research: (1) early identification and eligibility; (2) services; (3) outcomes; (4) infrastructure; and (5) the research funding process. Specific…

  16. Early determinants of mental health

    NARCIS (Netherlands)

    Räikkönen, Katri; Pesonen, Anu-Katriina; Roseboom, Tessa J.; Eriksson, Johan G.


    Environmental adversities in pre- and early postnatal life may have life-long consequences. Based upon a series of epidemiological and clinical studies and natural experiments, this review describes how the early life environment may affect psychological functions and mental disorders later in life.

  17. Early experience and brain development. (United States)

    Bick, Johanna; Nelson, Charles A


    Healthy brain development takes place within the context of individual experience. Here, we describe how certain early experiences are necessary for typical brain development. We present evidence from multiple studies showing that severe early life neglect leads to alterations in brain development, which compromises emotional, behavioral, and cognitive functioning. We also show how early intervention can reverse some of the deleterious effects of neglect on brain development. We conclude by emphasizing that early interventions that start at the earliest possible point in human development are most likely to support maximal recovery from early adverse experiences. WIREs Cogn Sci 2017, 8:e1387. doi: 10.1002/wcs.1387 For further resources related to this article, please visit the WIREs website. © 2016 Wiley Periodicals, Inc.

  18. Early osteoarthritis of the knee. (United States)

    Madry, Henning; Kon, Elizaveta; Condello, Vincenzo; Peretti, Giuseppe M; Steinwachs, Matthias; Seil, Romain; Berruto, Massimo; Engebretsen, Lars; Filardo, Giuseppe; Angele, Peter


    There is an increasing awareness on the importance in identifying early phases of the degenerative processes in knee osteoarthritis (OA), the crucial period of the disease when there might still be the possibility to initiate treatments preventing its progression. Early OA may show a diffuse and ill-defined involvement, but also originate in the cartilage surrounding a focal lesion, thus necessitating a separate assessment of these two entities. Early OA can be considered to include a maximal involvement of 50 % of the cartilage thickness based on the macroscopic ICRS classification, reflecting an OARSI grade 4. The purpose of this paper was to provide an updated review of the current status of the diagnosis and definition of early knee OA, including the clinical, radiographical, histological, MRI, and arthroscopic definitions and biomarkers. Based on current evidence, practical classification criteria are presented. As new insights and technologies become available, they will further evolve to better define and treat early knee OA.

  19. Early diagnosis and early intervention in cerebral palsy

    Directory of Open Access Journals (Sweden)

    Mijna eHadders-Algra


    Full Text Available This paper reviews the opportunities and challenges for early diagnosis and early intervention in cerebral palsy (CP. CP describes a group of disorders of the development of movement and posture, causing activity limitation, that are attributed to disturbances that occurred in the fetal or infant brain. Therefore the paper starts with a summary of relevant information from developmental neuroscience. Most lesions underlying CP occur in the second half of gestation, when developmental activity in the brain reaches its summit. Variations in timing of the damage not only result in different lesions, but also in different neuroplastic reactions and different associated neuropathologies. This turns CP into a heterogeneous entity. This may mean that the best early diagnostics and the best intervention methods may differ for various subgroups of children with CP. Next, the paper addresses possibilities for early diagnosis. It discusses the predictive value of neuromotor and neurological exams, neuro-imaging techniques and neurophysiological assessments. Prediction is best when complementary techniques are used in longitudinal series. Possibilities for early prediction of CP differ for infants admitted to neonatal intensive care and other infants. In the former group best prediction is achieved with the combination of neuro-imaging and the assessment of general movements, in the latter group best prediction is based on carefully documented milestones and neurological assessment. The last part reviews early intervention in infants developing CP. Most knowledge on early intervention is based on studies in high risk infants without CP. In these infants early intervention programs promote cognitive development until preschool age; motor development profits less. The few studies on early intervention in infants developing CP suggest that programs that stimulate all aspects of infant development by means of family coaching are most promising. More research is


    Energy Technology Data Exchange (ETDEWEB)

    David Storm; Govanon Nongbri; Steve Decanio; Ming He; Lalit Shah; Charles Schrader; Earl Berry; Peter Ricci; Belma Demirel; Charles Benham; Mark Bohn


    The overall objective of this project is the three phase development of an Early Entrance Coproduction Plant (EECP) which uses petroleum coke to produce at least one product from at least two of the following three categories: (1) electric power (or heat), (2) fuels, and (3) chemicals using ChevronTexaco's proprietary gasification technology. The objective of Phase I is to determine the feasibility and define the concept for the EECP located at a specific site; develop a Research, Development, and Testing (RD&T) Plan to mitigate technical risks and barriers; and prepare a Preliminary Project Financing Plan. The objective of Phase II is to implement the work as outlined in the Phase I RD&T Plan to enhance the development and commercial acceptance of coproduction technology. The objective of Phase III is to develop an engineering design package and a financing and testing plan for an EECP located at a specific site. The project's intended result is to provide the necessary technical, economic, and environmental information needed by industry to move the EECP forward to detailed design, construction, and operation. The partners in this project are Texaco Energy Systems LLC or TES (a subsidiary of ChevronTexaco), General Electric (GE), Praxair, and Kellogg Brown & Root (KBR) in addition to the U.S. Department of Energy (DOE). TES is providing gasification technology and Fischer-Tropsch (F-T) technology developed by Rentech, Inc., GE is providing combustion turbine technology, Praxair is providing air separation technology, and KBR is providing engineering. During Phase I, a design basis for the Fischer-Tropsch Synthesis section was developed based on limited experience with the specified feed gas and operating conditions. The objective of this Task in Phase II RD&T work was to confirm the performance of the F-T reactor at the set design conditions. Although much of the research, development, and testing work were done by TES outside of this project, several


    Energy Technology Data Exchange (ETDEWEB)

    John Anderson; Charles Schrader


    In 1999, the U. S. Department of Energy (DOE) awarded a Cooperative Agreement to Texaco Energy Systems Inc. to provide a preliminary engineering design of an Early Entrance Coproduction Plant (EECP). Since the award, continuous and diligent work has been undertaken to achieve the design of an economical facility that makes strides toward attaining the goal of DOE's Vision 21 Program. The objective of the EECP is to convert coal and/or petroleum coke to power while coproducing transportation fuels, chemicals, and useful utilities such as steam. This objective is being pursued in a three-phase effort through the partnership of the DOE with prime contractor Texaco Energy Systems, LLC. (TES), the successor to Texaco Energy Systems, Inc. The key subcontractors to TES include General Electric (GE), Praxair, and Kellogg Brown and Root. ChevronTexaco provided gasification technology and Rentech Inc.'s Fischer-Tropsch (F-T) technology that has been developed for non-natural gas sources. GE provided gas turbine technology for the combustion of low energy content gas. Praxair provided air separation technology and KBR provided engineering to integrate the facility. A conceptual design was completed in Phase I and the report was accepted by the DOE in May 2001. The Phase I work identified risks and critical research, development, and testing that would improve the probability of technical success of the EECP. The objective of Phase II was to mitigate the risks by executing research, development, and testing. Results from the Phase II work are the subject of this report. As the work of Phase II concluded, it became evident that sufficient, but not necessarily complete, technical information and data would be available to begin Phase III - Preliminary Engineering Design. Work in Phase II requires additional technical development work to correctly apply technology at a specific site. The project's intended result is to provide the necessary technical, economic, and

  2. Early Notification Monitoring System

    International Nuclear Information System (INIS)

    Lulic, S.


    Nuclear accidents are unexpected events characterized by losing of control over the sources of radiation. This may, directly or indirectly, create a danger to human life, health or property. In certain nuclear accidents, such dangers may be of a limited scope, which means that they constitute a threat only to those persons who work directly with the sources of radiation, or the equipment that comprises such sources, and their immediate working environment. Under certain conditions, as a consequence of major nuclear accidents, the broader population and considerable property might be endangered as well. The way in which nuclear accidents with the sources of ionizing radiation may occur, the intensity of doses that may exist in the radiation source environment, the nature and quantities of radioactive materials which might spread in the environment, the level of radiation exposure of the staff and the population due to a nuclear accident - all these may be considerably different in case of a nuclear accident with different radiation sources. Depending on the category of nuclear accident, major environmental pollutant releases are possible in such situations. The proposal for the establishment of a network of early notification monitors in the Republic of Croatia leans upon: a description of similar networks in Europe, the experience gathered during previous work with the existing monitors on the territory of the Republic of Slovenia, and direct experience of the three continuous radiological monitors established on the territory of the Republic of Croatia ('Rudjer Boskovic' Institute, Sljeme-Puntijarka and Velebit-Pljesivica). In this moment there are eight monitors MFM-202 installed on the territory of the Republic of Croatia, which are used to measure the dose rate. The position of eight monitors MFM-202 on the territory of the Republic of Croatia is displayed in MAP 1. Respecting the existing network of eight monitors MFM-202 for dose rate measuring (MAP 1), their

  3. From Early Intervention to Early Childhood Programs: Timeline for Early Successful Transitions (TEST) (United States)

    Brandes, Joyce A.; Ormsbee, Christine K.; Haring, Kathryn A.


    More than one million transitions between early intervention services and early childhood programs are facilitated annually for youngsters with special needs. To be successful, these transitions require planning and ongoing communication between all parties. This article substantiates the need for a timeline/checklist and provides a model of…

  4. What Works Clearinghouse Quick Review: "Early College, Early Success: Early College High School Initiative Impact Study" (United States)

    What Works Clearinghouse, 2013


    The study examined in this quick review concerns whether attending Early College High Schools increased postsecondary outcomes. This study is a randomized experiment examining the impact of Early Colleges on a number of outcomes. The study had relatively low attrition rates (approximately 7% in the intervention group and 13% in the comparison…

  5. Early Mobilization: Changing the Mindset. (United States)

    Castro, Emily; Turcinovic, Michael; Platz, John; Law, Isabel


    Staff in the surgical intensive care unit (SICU) had several concerns about mobilizing patients receiving mechanical ventilation. To assess and improve the mindset of SICU staff toward early mobilization of patients receiving mechanical ventilation before, 6 months after, and 1 year after implementation of early mobilization. The Plan-Do-Study-Act model was used to guide the planning, implementation, evaluation, and interventions to change the mindset and practice of SICU staff in mobilizing patients receiving mechanical ventilation. Interventions to overcome barriers to early mobilization included interdisciplinary collaboration, multimodal education, and operational changes. The mindset of the SICU staff toward early mobilization of patients receiving mechanical ventilation was assessed by using a survey questionnaire distributed 2 weeks before, 6 months after, and 1 year after implementation of early mobilization. The median score on 6 of 7 survey questions changed significantly from before, to 6 months after, to 1 year after implementation, indicating a change in the mindset of SICU staff toward early mobilization of patients receiving mechanical ventilation. The SICU staff agreed that most patients receiving mechanical ventilation are able to get out of bed safely with coordination among personnel and that early mobilization of intubated patients decreases length of stay and decreases occurrence of ventilator-associated pneumonia, deep vein thrombosis, and skin breakdown. SICU interdisciplinary team collaboration, multimodal education, and operational support contribute to removing staff bias against mobilizing patients receiving mechanical ventilation. ©2015 American Association of Critical-Care Nurses.

  6. Early Signs and Early Behavioral Intervention of Challenging Behavior

    NARCIS (Netherlands)

    Lang, R.B.; Sigafoos, J.; Meer, L. van der; O'Reilly, M.F.; Lancioni, G.E.; Didden, H.C.M.; Hastings, R.; Rojahn, J.


    This chapter summarizes research on the emergence of challenging behavior and early behavioral intervention for the treatment of challenging behavior in young children with Intellectual Disability (ID). Biological and learning theories related to the emergence of challenging behavior and risk


    Energy Technology Data Exchange (ETDEWEB)

    John Anderson; Mark Anselmo; Earl Berry; Mark Bohn; Roko Bujas; Ming He; Ken Kwik; Charles H. Schrader; Lalit Shah; Dennis Slater; Donald Todd; Don Wall


    The overall objective of this project is the three phase development of an Early Entrance Coproduction Plant (EECP) which uses petroleum coke to produce at least one product from at least two of the following three categories: (1) electric power (or heat), (2) fuels, and (3) chemicals using ChevronTexaco's proprietary gasification technology. The objective of Phase I is to determine the feasibility and define the concept for the EECP located at a specific site; develop a Research, Development, and Testing (RD&T) Plan to mitigate technical risks and barriers; and prepare a Preliminary Project Financing Plan. The objective of Phase II is to implement the work as outlined in the Phase I RD&T Plan to enhance the development and commercial acceptance of coproduction technology. The objective of Phase III is to develop an engineering design package and a financing and testing plan for an EECP located at a specific site. The project's intended result is to provide the necessary technical, economic, and environmental information needed by industry to move the EECP forward to detailed design, construction, and operation. The partners in this project are Texaco Energy Systems LLC (TES), a subsidiary of ChevronTexaco, General Electric (GE), Praxair, and Kellogg Brown & Root (KBR) in addition to the U.S. Department of Energy (DOE). TES is providing gasification technology and Fischer-Tropsch (F-T) technology developed by Rentech, Inc. GE is providing combustion turbine technology, Praxair is providing air separation technology, and KBR is providing engineering. Each of the EECP subsystems were assessed for technical risks and barriers. A plan was identified to mitigate the identified risks (Phase II RD&T Plan, October 2000). The RD&T Plan identified catalyst/wax separation as a potential technical and economic risk. To mitigate risks to the proposed EECP, Phase II RD&T included tests of an alternative (to Rentech's Dynamic Settler) primary catalyst


    Energy Technology Data Exchange (ETDEWEB)

    Fred D. Brent; Lalit Shah; Earl Berry; Charles H. Schrader; John Anderson; Ming He; James F. Stevens; Centha A. Davis; Michael Henley; Jerome Mayer; Harry Tsang; Jimell Erwin; Jennifer Adams; Michael Tillman; Chris Taylor; Marjan J. Roos; Robert F. Earhart


    The overall objective of this project is the three phase development of an Early Entrance Coproduction Plant (EECP) which uses petroleum coke to produce at least one product from at least two of the following three categories: (1) electric power (or heat), (2) fuels, and (3) chemicals using ChevronTexaco's proprietary gasification technology. The objective of Phase I is to determine the feasibility and define the concept for the EECP located at a specific site; develop a Research, Development, and Testing (RD&T) Plan to mitigate technical risks and barriers; and prepare a Preliminary Project Financing Plan. The objective of Phase II is to implement the work as outlined in the Phase I RD&T Plan to enhance the development and commercial acceptance of coproduction technology. The objective of Phase III is to develop an engineering design package and a financing and testing plan for an EECP located at a specific site. The project's intended result is to provide the necessary technical, economic, and environmental information needed by industry to move the EECP forward to detailed design, construction, and operation. The partners in this project are Texaco Energy Systems LLC or TES (a subsidiary of ChevronTexaco), General Electric (GE), Praxair, and Kellogg Brown & Root (KBR) in addition to the U.S. Department of Energy (DOE). TES is providing gasification technology and Fischer-Tropsch (F-T) technology developed by Rentech, GE is providing combustion turbine technology, Praxair is providing air separation technology, and KBR is providing engineering. Each of the EECP subsystems was assessed for technical risks and barriers. A plan was developed to mitigate the identified risks (Phase II RD&T Plan, October 2000). The potential technical and economic risks to the EECP from Task 2.5 can be mitigated by demonstrating that the end-use products derived from the upgrading of the F-T synthesis total liquid product can meet or exceed current specifications for the

  9. Early vision and visual attention

    Directory of Open Access Journals (Sweden)

    Gvozdenović Vasilije P.


    Full Text Available The question whether visual perception is spontaneous, sudden or is running through several phases, mediated by higher cognitive processes, was raised ever since the early work of Gestalt psychologists. In the early 1980s, Treisman proposed the feature integration theory of attention (FIT, based on the findings of neuroscience. Soon after publishing her theory a new scientific approach appeared investigating several visual perception phenomena. The most widely researched were the key constructs of FIT, like types of visual search and the role of the attention. The following review describes the main studies of early vision and visual attention.

  10. Early eruption of permanent canines

    Directory of Open Access Journals (Sweden)

    S Madhu


    Full Text Available Systemic and local factors can modify the eruption time of teeth. Generalized eruption time changes could be due to some systemic diseases like hyperthyroidism, hypophosphatasia, precocious puberty, Proteus syndrome, etc. Localized early eruption of permanent teeth could be due to early extraction of deciduous teeth. Presented here is an extremely rare case of early eruption of permanent canines in a 7-year old female child. Though the number of such cases is very limited, the clinician should poses adequate knowledge and keeps an open eye to identify such cases.

  11. Early onset type 2 diabetes

    DEFF Research Database (Denmark)

    Bo, A; Thomsen, R W; Nielsen, J S


    AIM: To examine the association between early onset of type 2 diabetes (DM) and clinical and behavioural risk factors for later diabetes complications. METHODS: We conducted a cross-sectional study of 5115 persons with incident type 2 DM enrolled during 2010-2015 in the Danish Centre for Strategic...... Research in Type 2 Diabetes-cohort. We compared risk factors at time of diagnosis among those diagnosed at ≤45 years (early-onset) with diagnosis age 46-55, 56-65 (average-onset = reference), 66-75, and >75 years (late-onset). Prevalence ratios (PRs) were computed using Poisson regression. RESULTS: Poor...... was more frequent and meeting physical activity recommendations less likely in persons with early-onset type 2 DM. CONCLUSIONS: We found a clear age-gradient, with increasing prevalence of clinical and behavioural risk factors the younger the onset age of type 2 DM. Younger persons with early-onset type 2...

  12. Early Retiree Reinsurance Program Reports (United States)

    U.S. Department of Health & Human Services — The Early Retiree Reinsurance Program (ERRP) was established by section 1102 of the Patient Protection and Affordable Care Act (the Affordable Care Act) enacted on...

  13. Effects of Early Sun Exposure (United States)

    ... It can lead to: Skin changes. Some skin cells with melanin can form a clump. This creates freckles and moles. Over time, these can develop cancer. Early aging. Time spent in the sun makes your skin ...


    National Aeronautics and Space Administration — This volume contains the results of the early cruise images of the Stardust Navigation Camera. These images are of no clear scientific or engineering use. They were...


    Energy Technology Data Exchange (ETDEWEB)

    Fred D. Brent; Lalit Shah; Earl Berry; Charles H. Schrader; John Anderson; J. Erwin; Matthew G. Banks; Terry L. Ullman


    The overall objective of this project is the three phase development of an Early Entrance Coproduction Plant (EECP) which uses petroleum coke to produce at least one product from at least two of the following three categories: (1) electric power (or heat), (2) fuels, and (3) chemicals using ChevronTexaco's proprietary gasification technology. The objective of Phase I is to determine the feasibility and define the concept for the EECP located at a specific site; develop a Research, Development, and Testing (RD&T) Plan to mitigate technical risks and barriers; and prepare a Preliminary Project Financing Plan. The objective of Phase II is to implement the work as outlined in the Phase I RD&T Plan to enhance the development and commercial acceptance of coproduction technology. The objective of Phase III is to develop an engineering design package and a financing and testing plan for an EECP located at a specific site. The project's intended result is to provide the necessary technical, economic, and environmental information needed by industry to move the EECP forward to detailed design, construction, and operation. The partners in this project are Texaco Energy Systems LLC or TES (a subsidiary of ChevronTexaco), General Electric (GE), Praxair, and Kellogg Brown & Root (KBR) in addition to the U.S. Department of Energy (DOE). TES is providing gasification technology and Fischer-Tropsch (F-T) technology developed by Rentech, GE is providing combustion turbine technology, Praxair is providing air separation technology, and KBR is providing engineering. Each of the EECP subsystems was assessed for technical risks and barriers. A plan was developed to mitigate the identified risks (Phase II RD&T Plan, October 2000). Phase II RD&T Task 2.6 identified as potential technical risks to the EECP the fuel/engine performance and emissions of the F-T diesel fuel products. Hydrotreating the neat F-T diesel product reduces potentially reactive olefins, oxygenates, and acids

  16. NASA Early Career Fellowship Program (United States)

    Smith, H. D.


    The Early Career Fellowship program was established in 2005 to facilitate the integration of outstanding early career planetary science researchers into established research funding programs by providing tools and experience useful to maintain a successful research program. Executing a successful research program requires a few key elements such as: successful proposal writing; adequate (paid) research time; management of a laboratory; collaboration and networking; frequent and high-quality publications; and adequate start-up equipment funds. These elements may be particularly critical for early career researchers searching for a tenure- track or equivalent position. The Early Career Fellowship program recognizes the importance of these skills and provides extra funding and resources to begin a successful research program. For consideration into The Early Career Fellowship program, the candidate needs to be the P. I. or Science P.I. of a funded research proposal from one of the participating R&A program areas, be within 7 years of earning a PhD, hold a non-tenure track position, and indicate the early career candidacy when submitting the research proposal. If the research proposal is funded and the discipline scientist nominates the candidate as an early career fellow, the candidate is then considered a Fellow and eligible to propose for Step 2. Upon obtaining a tenure-track equivalent position the Fellow submits a Step 2 proposal for up to one hundred thousand dollars in start-up funds. Start-up funds may be used for salary; undergraduate and/or graduate research assistants; supplies and instrument upgrades; travel to conferences, meetings, and advisory groups; time and travel for learning new skills; publication page charges; books and journal subscriptions; computer time and/or specialized software; and other justified research-specific needs. The early career fellowship program provides resources that a more established scientist would have acquired allowing

  17. Early diagnosis of breast cancer

    International Nuclear Information System (INIS)

    Semiglazov, V.F.


    Modern data are presentd on epidemology etiopathogensis and statistics of breast cancer. Home and international clinical and histological classifications is given. Much attention is paid to the methods for early diagnosis of pretumor diseases and breast cancer: clinical roentgenomammography, thrmography and computerized tomomammography. The role of self-examination in cancer early detection has been analyzed. Special attention is paid to system of detection of minimal and unpalpable form of breast cancer, screening of these tumors. 113 refs.; 60 figs.; 6 tabs

  18. Epigenetics of Early Child Development

    Directory of Open Access Journals (Sweden)

    Chris eMurgatroyd


    Full Text Available Comprehensive clinical studies show that adverse conditions in early life can severely impact the developing brain and increase vulnerability to mood disorders later in life. During early postnatal life the brain exhibits high plasticity which allows environmental signals to alter the trajectories of rapidly developing circuits. Adversity in early life is able to shape the experience-dependent maturation of stress-regulating pathways underlying emotional functions and endocrine responses to stress, such as the hypothalamo-pituitary-adrenal (HPA system, leading to long-lasting altered stress responsivity during adulthood.To date, the study of gene-environment interactions in the human population has been dominated by epidemiology. However, recent research in the neuroscience field is now advancing clinical studies by addressing specifically the mechanisms by which gene-environment interactions can predispose individuals towards psychopathology. To this end, appropriate animal models are being developed in which early environmental factors can be manipulated in a controlled manner. Here we will review recent studies performed with the common aim of understanding the effects of the early environment in shaping brain development and discuss the newly developing role of epigenetic mechanisms in translating early life conditions into long-lasting changes in gene expression underpinning brain functions. Particularly, we argue that epigenetic mechanisms can mediate the gene-environment dialogue in early life and give rise to persistent epigenetic programming of adult physiology and dysfunction eventually resulting in disease. Understanding how early life experiences can give raise to lasting epigenetic memories conferring increased risk for mental disorders, how they are maintained and how they could be reversed, is increasingly becoming a focus of modern psychiatry and should pave new guidelines for timely therapeutic interventions.

  19. [Autism: An early neurodevelopmental disorder]. (United States)

    Bonnet-Brilhault, F


    With approximately 67 million individuals affected worldwide, autism spectrum disorder (ASD) is the fastest growing neurodevelopmental disorder (United Nations, 2011), with a prevalence estimated to be 1/100. In France ASD affects approximately 600,000 individuals (from childhood to adulthood, half of whom are also mentally retarded), who thus have a major handicap in communication and in adapting to daily life, which leads autism to be recognized as a national public health priority. ASD is a neurodevelopmental disorder that affects several domains (i.e., socio-emotional, language, sensori-motor, executive functioning). These disorders are expressed early in life with an age of onset around 18 months. Despite evidence suggesting a strong genetic link with ASD, the genetic determinant remains unclear. The clinical picture is characterized by impairments in social interaction and communication and the presence of restrictive and repetitive behaviors (DSM-5, ICD-10). However, in addition to these two main dimensions there is significant comorbidity between ASD and other neurodevelopmental disorders such as attention deficit hyperactivity disorder or with genetic and medical conditions. One of the diagnostic features of ASD is its early emergence: symptoms must begin in early childhood for a diagnosis to be given. Due to brain plasticity, early interventions are essential to facilitate clinical improvement. Therefore, general practitioners and pediatricians are on the front line to detect early signs of ASD and to guide both medical explorations and early rehabilitation. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  20. The early evolution of rhynchosaurs

    Directory of Open Access Journals (Sweden)

    Martin Daniel Ezcurra


    Full Text Available The rhynchosaurian archosauromorphs are an important and diverse group of fossil tetrapods that first appeared during the Early Triassic and probably became extinct during the early Late Triassic (early Norian. Here, the early evolution of rhynchosaurs during the Early and early Middle Triassic (Induan−Anisian: 252.2−242 Mya is reviewed based on new anatomical observations and the implications of these observations for the taxonomy, phylogenetic relationships and macroevolutionary history of the group. A quantitative phylogenetic analysis recovered a paraphyletic genus Rhynchosaurus, with Rhynchosaurus brodiei more closely related to hyperodapedontines than to Rhynchosaurus articeps. Therefore, a new genus is erected, resulting in the new combination Langeronyx brodiei. A body size analysis found two independent increases in size in the evolutionary history of rhynchosaurs, one among stenaulorhynchines and the other in the hyperodapedontine lineage. Maximum likelihood fitting of phenotypic evolution models to body size data found ambiguous results, with body size evolution potentially interpreted as either fitting either a non-directional Brownian motion model or a stasis model. A Dispersal−Extinction−Cladogenesis analysis reconstructed the areas that are now South Africa and Europe as the ancestral areas of Rhynchosauria and Rhynchosauridae, respectively. The reconstruction of dispersal events between geographic areas that are broadly separated paleolatitudinally implies that barriers to the dispersal of rhynchosaurs from either side of the paleo-Equator during the Middle Triassic were either absent or permeable.

  1. Manuseio peri-operatório do paciente em uso de amiodarona Manoseo peri-operatorio del paciente en uso de amiodarona Peri-operative management of amiodarone patients

    Directory of Open Access Journals (Sweden)

    Gilson Ramos


    Full Text Available JUSTIFICATIVA E OBJETIVOS: A amiodarona é um antidisrítmico bastante eficaz e indicado no tratamento de disritmias ventriculares e supraventriculares, motivo pelo qual vem sendo extensamente administrada na prática clínica. Entretanto, seu uso crônico pode estar associado com sérios efeitos colaterais, que podem ser agravados por atos anestésico-cirúrgicos, aumentando o risco dos procedimentos. O presente estudo objetiva revisar os principais efeitos da amiodarona e associá-los à prática clínica do anestesiologista. CONTEÚDO: Tratou-se das principais propriedades da amiodarona, seu uso clínico, bem como os mais importantes efeitos adversos que podem aumentar o risco cirúrgico dos pacientes em uso desse antidisrítmico. CONCLUSÕES: A amiodarona, apesar de habitualmente segura e eficiente, pode apresentar efeitos adversos exacerbados, notadamente para o aparelho cardiovascular, durante procedimentos anestésico-cirúrgicos. Isso se deve possivelmente às interações entre esse fármaco e agentes anestésicos, associados principalmente à anestesia geral. Há relatos de bradicardias graves e resistentes à terapêutica, bem como bloqueio atrioventricular (BAV em graus variados. O paciente deve ser rigorosamente monitorizado, especialmente nos procedimentos de grande porte, e o anestesiologista deve estar amparado no peri-operatório com drogas vasoativas (isoproterenol e marcapasso cardíaco artificial temporário, que podem ser fundamentais durante o procedimento.JUSTIFICATIVA Y OBJETIVOS: La amiodarona es un antidisrítmico bastante eficaz y indicado en el tratamiento de disritmias ventriculares y supraventriculares, motivo por el cual viene siendo extensamente administrada en la práctica clínica. Entretanto, su uso crónico puede estar asociado con serios efectos colaterales, que pueden ser agravados por actos anestésico-cirúgicos, aumentando el riesgo de los procedimientos. El presente estudio objetiva revisar los principales efectos de la amiodarona y asociarlos a la práctica clínica del anestesista. CONTENIDO: Se trató de las principales propiedades de la amiodarona, su uso clínico, bien como los más importantes efectos adversos que pueden aumentar el riesgo quirúrgico de los pacientes en uso de este antidisrítmico. CONCLUSIONES: La amiodarona, a pesar de habitualmente segura y eficiente, puede presentar efectos adversos exacerbados, especialmente para el aparato cardiovascular, durante procedimientos anestésico-cirúgicos. Esto se debe posiblemente a las interacciones entre ese fármaco y agentes anestésicos, asociados principalmente a la anestesia general. Hay relatos de bradicárdias graves y resistentes a la terapéutica, bien como bloqueo atrioventricular (BAV en grados variados. El paciente debe ser rigurosamente monitorizado, especialmente en los procedimientos de grande porte, y el anestesista debe estar amparado en el peri-operatorio con drogas vasoactivas (isoproterenol y marcapaso cardíaco artificial temporario, que pueden ser fundamentales durante el procedimiento.BACKGROUND AND OBJECTIVES: Amiodarone is quite an effective anti-arrhythmic drug indicated for controlling ventricular and supra-ventricular arrhythmias, and it is being widely administered in clinical practice. However, its chronic use may be associated to severe side effects which may be worsened by anesthetic-surgical acts, thus increasing the risk of such procedures. This study aimed at reviewing major amiodarone effects and relating them to anesthetic procedures. CONTENTS: The study covers major amiodarone properties, its clinical use, as well as major adverse effects, which may increase patient's surgical risk. CONCLUSIONS: Amiodarone, although normally safe and effective, may present adverse effects, especially on cardiovascular system, during anesthetic-surgical procedures. This is possibly due to interactions between this drug and anesthetic agents mainly related to general anesthesia. There are reports on severe, treatment - resistant bradycardias as well as on different degrees of atrioventricular block (AVB. Patients should be carefully monitored, especially during major procedures, and vasoactive drugs (isoproterenol and temporary artificial pacemaker, should be available because they may be critical during the adverse effects treatment.

  2. A comparison of the incidence of hypercapnea in non-obese and morbidly obese peri-operative patients using the SenTec transcutaneous pCO(2) monitor. (United States)

    Soto, Roy G; Davis, Maurice; Faulkner, Michael J


    Obese patients are at increased risk for hypoventilation, leading to hypercapnea and acidosis. The primary objective of this study was to compare the incidence of perioperative hypercapnea in non-obese and morbidly obese patients using the SenTec transcutaneous PCO2 (tcPCO2) monitor. 10 morbidly obese subjects (BMI > 40 kg/m(2)) undergoing laparoscopic bariatric surgery, and 10 non-obese subjects (BMI TcPCO2 and SpO2 were monitored continuously intraoperatively, and during the first 24 h postoperatively. Opiate consumption, respiratory rate (RR), and pain scores were collected from postanesthesia care unit (PACU) and ward nursing notes. RR, SpO2, and tcPCO2 did not differ significantly between groups during PACU or ward time periods. End-tidal CO2 (EtCO2) values were similar between groups during the intraoperative period, but tcPCO2 was significantly higher in the obese group at specific time points, and trended towards being higher throughout the case. Our study did not show significant tcPCO2 differences between non-obese and obese post-surgical patients, however, it did allow for continuous, trendable, nonobtrusive monitoring throughout the perioperative period. As V/Q mismatch increases with the PaCO2/EtCO2 gradient, and this effect is most pronounced in morbidly obese patients, tcPCO2 monitoring may prove to be a useful additional monitor in these patients during the intraoperative period.

  3. Perspective: How to evaluate studies on peri-operative nutrition? Considerations about the definition of optimal nutrition for patients and its key role in the comparison of the results of studies on nutritional intervention

    NARCIS (Netherlands)

    Sauerwein, H. P.; Strack van Schijndel, R. J. M.


    Different nutritional outcome studies on the same subject can have vast differences in composition of the chosen food without justification, suggesting that the composition of "optimal" nutrition in patients is not known or that optimal nutrition does not exist. The result will be negative studies

  4. Peri-operative troponin monitoring using a prototype high-sensitivity cardiac troponin I (hs-cTnI) assay: comparisons with hs-cTnT and contemporary cTnI assays.

    LENUS (Irish Health Repository)

    Lee, Graham R


    Non-cardiac surgery is associated with major vascular complications and higher incidences of elevated plasma troponin (cTn) concentration. Goal-directed therapy (GDT) is a stroke volume (SV)-guided approach to intravenous (IV) fluid therapy that improves tissue perfusion, oxygenation and reduces post-operative complications. In patients undergoing major gastro-intestinal surgery, we compared high sensitive and contemporary troponin assays and correlated results with patient outcome.

  5. If You're Concerned - Act Early (United States)

    ... Materials Multimedia & Tools Videos Widgets and Buttons Families Early Intervention Information by State Healthcare Providers Autism Case Training ... younger than 3 years old, contact your local early intervention system . Find your state’s early intervention contact information ...

  6. Early Learner Engagement in the Clinical Workplace

    NARCIS (Netherlands)

    Chen, H.C.


    Introduction Recent calls for medical education reform advocate for the integration of knowledge with clinical experience through early clinical immersion. Yet, early learners rarely are invited to participate in workplace activities and early clinical experiences remain largely observational.

  7. Routine Early Angioplasty after Fibrinolysis

    DEFF Research Database (Denmark)

    Wang, Zhipeng; Liang, Bo; Mei, Qibing


    patients in the group that underwent routine early PCI than in the group that received standard treatment received clopidogrel (Ppatients who undergo PCI, as well as in those who do not, is well established,1...... with early beta-blocker therapy is taken into consideration.3 The overall benefit of clopidogrel and beta-blocker therapy could have influenced the outcome in patients who underwent early PCI. These facts leave the conclusion of the TRANSFER-AMI trial still highly uncertain.......To the Editor: Cantor et al. report that there is a significantly reduced rate of ischemic complications among patients with myocardial infarction with ST-segment elevation who are transferred for PCI within 6 hours after fibrinolysis. However, Table 2 of the article shows that significantly more...

  8. Early Literacy and Early Numeracy: The Value of Including Early Literacy Skills in the Prediction of Numeracy Development (United States)

    Purpura, David J.; Hume, Laura E.; Sims, Darcey M.; Lonigan, Cristopher J.


    The purpose of this study was to examine whether early literacy skills uniquely predict early numeracy skills development. During the first year of the study, 69 3- to 5-year-old preschoolers were assessed on the Preschool Early Numeracy Skills (PENS) test and the Test of Preschool Early Literacy Skills (TOPEL). Participants were assessed again a…


    Directory of Open Access Journals (Sweden)

    Marco Aurelio SANTO

    Full Text Available ContextBariatric surgery has proven to be the most effective method of treating severe obesity. Nevertheless, the acceptance of bariatric surgery is still questioned. The surgical complications observed in the early postoperative period following surgeries performed to treat severe obesity are similar to those associated with other major surgeries of the gastrointestinal tract. However, given the more frequent occurrence of medical comorbidities, these patients require special attention in the early postoperative follow-up. Early diagnosis and appropriate treatment of these complications are directly associated with a greater probability of control.MethodThe medical records of 538 morbidly obese patients who underwent surgical treatment (Roux-en-Y gastric bypass surgery were reviewed. Ninety-three (17.2% patients were male and 445 (82.8% were female. The ages of the patients ranged from 18 to 70 years (average = 46, and their body mass indices ranged from 34.6 to 77 kg/m2.ResultsEarly complications occurred in 9.6% and were distributed as follows: 2.6% presented bleeding, intestinal obstruction occurred in 1.1%, peritoneal infections occurred in 3.2%, and 2.2% developed abdominal wall infections that required hospitalization. Three (0.5% patients experienced pulmonary thromboembolism. The mortality rate was 0,55%.ConclusionThe incidence of early complications was low. The diagnosis of these complications was mostly clinical, based on the presence of signs and symptoms. The value of the clinical signs and early treatment, specially in cases of sepsis, were essential to the favorable surgical outcome. The mortality was mainly related to thromboembolism and advanced age, over 65 years.

  10. Protocols for early audiology intervention services: Views from early ...

    African Journals Online (AJOL)

    Objectives. To identify the protocols and practices for audiology early intervention (EI) in Gauteng government hospitals, and determine whether these protocols comply with the principles for effective EI in audiology. Methods and materials. Self-administered questionnaires were hand-delivered and distributed to ...

  11. Early assembly of cellular life. (United States)

    Trevors, J T


    Popular hypotheses that attempt to explain the origin of prebiotic molecules and cellular life capable of growth and division are not always agreed upon. In this manuscript, information on early bacterial life on Earth is examined using information from several disciplines. For example, knowledge can be integrated from physics, thermodynamics, planetary sciences, geology, biogeochemistry, lipid chemistry, primordial cell structures, cell and molecular biology, microbiology, metabolism and genetics. The origin of life also required a combination of elements, compounds and environmental physical-chemical conditions that allowed cells to assemble in less than a billion years. This may have been widespread in the subsurface of the early Earth located at microscopic physical domains.

  12. Shocks in the Early Universe. (United States)

    Pen, Ue-Li; Turok, Neil


    We point out a surprising consequence of the usually assumed initial conditions for cosmological perturbations. Namely, a spectrum of Gaussian, linear, adiabatic, scalar, growing mode perturbations not only creates acoustic oscillations of the kind observed on very large scales today, it also leads to the production of shocks in the radiation fluid of the very early Universe. Shocks cause departures from local thermal equilibrium as well as create vorticity and gravitational waves. For a scale-invariant spectrum and standard model physics, shocks form for temperatures 1  GeVUniverse as early as 10^{-30}  sec after the big bang.

  13. Istanbul Earthquake Early Warning System (United States)

    Alcik, H.; Mert, A.; Ozel, O.; Erdik, M.


    As part of the preparations for the future earthquake in Istanbul a Rapid Response and Early Warning system in the metropolitan area is in operation. For the Early Warning system ten strong motion stations were installed as close as possible to the fault zone. Continuous on-line data from these stations via digital radio modem provide early warning for potentially disastrous earthquakes. Considering the complexity of fault rupture and the short fault distances involved, a simple and robust Early Warning algorithm, based on the exceedance of specified threshold time domain amplitude levels is implemented. The band-pass filtered accelerations and the cumulative absolute velocity (CAV) are compared with specified threshold levels. When any acceleration or CAV (on any channel) in a given station exceeds specific threshold values it is considered a vote. Whenever we have 2 station votes within selectable time interval, after the first vote, the first alarm is declared. In order to specify the appropriate threshold levels a data set of near field strong ground motions records form Turkey and the world has been analyzed. Correlations among these thresholds in terms of the epicenter distance the magnitude of the earthquake have been studied. The encrypted early warning signals will be communicated to the respective end users. Depending on the location of the earthquake (initiation of fault rupture) and the recipient facility the alarm time can be as high as about 8s. The first users of the early warning signal will be the Istanbul gas company (IGDAS) and the metro line using the immersed tube tunnel (MARMARAY). Other prospective users are power plants and power distribution systems, nuclear research facilities, critical chemical factories, petroleum facilities and high-rise buildings. In this study, different algorithms based on PGA, CAV and various definitions of instrumental intensity will be discussed and triggering threshold levels of these parameters will be studied

  14. Electromigration early resistance increase measurements

    NARCIS (Netherlands)

    Niehof, J.; Flinn, P.A.; Maloney, T.J.


    An early resistance change measurement set-up, using an AC bridge technique, has been developed, and measurements have been performed. Large sample-to-sample variations occur. The characteristic time for the resistance change curve is shorter for resistance increase (under current stress) than for

  15. Early Learning Theories Made Visible (United States)

    Beloglovsky, Miriam; Daly, Lisa


    Go beyond reading about early learning theories and see what they look like in action in modern programs and teacher practices. With classroom vignettes and colorful photographs, this book makes the works of Jean Piaget, Erik Erikson, Lev Vygotsky, Abraham Maslow, John Dewey, Howard Gardner, and Louise Derman-Sparks visible, accessible, and easier…

  16. Physical Education in Early Childhood (United States)

    Stork, Steve; Sanders, Stephen W.


    This article examines the incidence and quality of physical activity instruction during early childhood. Although the positive effect of physical activity on the cognitive, social, and physical development of young children is generally acknowledged, there is little emphasis nationally on ensuring appropriate physical educational experiences…

  17. Reduplication Facilitates Early Word Segmentation (United States)

    Ota, Mitsuhiko; Skarabela, Barbora


    This study explores the possibility that early word segmentation is aided by infants' tendency to segment words with repeated syllables ("reduplication"). Twenty-four nine-month-olds were familiarized with passages containing one novel reduplicated word and one novel non-reduplicated word. Their central fixation times in response to…

  18. Early-delayed radiation rhombencephalopathy

    International Nuclear Information System (INIS)

    Nightingale, S.; Dawes, P.J.D.K.; Cartlidge, N.E.F.; Newcastle upon Tyne Univ.


    A 37-year-old woman developed an early-delayed rhombencephalopathy 7 weeks after completing a course of radiotherapy to a glomus jugulare tumour. The clinical features, comprising nystagmus, skew strabismus, unilateral facial weakness, dysarthria and ataxia, are compared with four previously reported patients with this syndrome. (author)

  19. Early warning network of Slovenia

    International Nuclear Information System (INIS)

    Three subnetworks: EIS NEK, RAMS, and ROS form the basis of the Slovenian early warning network, named ROSS, which is under construction. Its aim is to detect any domestic or foreign incident where radioactive material was spread into environment. The system is planned to be completed in five years. (author)

  20. Boys' Bodies in Early Childhood (United States)

    Drummond, Murray


    This paper is based on qualitative research data from a project investigating early childhood boys' constructions of masculinities in relation to sport, health and the body. The focus group data, with 33 boys, has been collected in each of the boys' first three years at school. It is part of the data that will be collected over eight years with…

  1. Early stage fuel cell funding

    International Nuclear Information System (INIS)

    Bergeron, C.


    'Full text:' Early stage venture funding requires an in depth understanding of both current and future markets as well as the key technical hurdles that need to be overcome for new technology to commercialize into successful products for mass markets. As the leading fuel cell and hydrogen investor, Chrysalix continuously reviews global trends and new technologies, evaluates them with industry leaders worldwide and tries to match them up with the best possible management teams when selecting its early stage investments. Chrysalix Energy Limited Partnership is an early-stage venture capital firm focusing on fuel cell and related fueling technology companies and is a private equity joint venture between Ballard Power Systems, BASF Venture Capital, The BOC Group, The Boeing Company, Duke Energy, Mitsubishi Corporation and Shell Hydrogen. Operating independently, Chrysalix offers a unique value proposition to its clients throughout the business planning, start-up and operations phases of development. Chrysalix provides early-stage funding to new companies as well as management assistance, technological knowledge, organized networking with industry players and experience in the management of intellectual property. (author)

  2. Defeating cancer with early detection

    CERN Multimedia


    A meeting of scientists and industry experts will hold an open review of the Three Dimension Complete Body Screening System (3D-CBS) on the 1st of July 2003. This new imaging technlogy is potentially powerful and safe enough to offer routine screening of healthy patients for early signs of cancer (1 page).

  3. The Early-Decision Racket. (United States)

    Fallows, James


    Discusses why early-decision programs have added an "insane intensity to middle-class obsessions about college." Asserts that they distort the admissions process, rewarding the richest students from the most exclusive high schools and penalizing nearly everyone else, but that the incentives for many colleges and students are "as irresistible as…

  4. Physics of the early universe

    International Nuclear Information System (INIS)

    Klinkhamer, F.R.


    In this thesis, the author has assembled his papers on elementary particle physics which are of importance for studying cosmology viz. the physics of the early universe. A rather detailed introduction reviewing basic principles and current trends in the relation particle physics/cosmology precedes the papers. (Auth.)

  5. Management of early pregnancy loss

    NARCIS (Netherlands)

    Graziosi, G. C. M.; Mol, B. W.; Ankum, W. M.; Bruinse, H. W.


    Objectives: In order to assess the available evidence on the management of early pregnancy loss, we performed a meta-analysis on the subject. Methods: MEDLINE and EMBASE were searched for randomized studies reporting on the effectiveness of expectant management, misoprostol treatment or curettage.

  6. Early Childhood Inclusion in Australia (United States)

    Kemp, Coral R.


    From the introduction of early intervention services in Australian in the mid-1970s, the families of children with intellectual and multiple disabilities have been encouraged to enroll their children in local preschools and childcare centers. Children with disabilities have also accessed a range of alternatives to full inclusion, such as reverse…

  7. Early management of acute pancreatitis

    NARCIS (Netherlands)

    Schepers, Nicolien J.; Besselink, Marc G. H.; van Santvoort, Hjalmar C.; Bakker, Olaf J.; Bruno, Marco J.


    Acute pancreatitis is the most common gastro-intestinal indication for acute hospitalization and its incidence continues to rise. In severe pancreatitis, morbidity and mortality remains high and is mainly driven by organ failure and infectious complications. Early management strategies should aim to

  8. Uganda Early Generation Seed Study

    NARCIS (Netherlands)

    Mastenbroek, A.; Ntare, Bonny


    One of the major bottlenecks limiting farmers’ access to good quality seed for food crops in Uganda is the shortage of early generation seed (EGS - breeder and foundation) to produce sufficient quantities of certified and/or quality declared) to satisfy the needs of farmers. A national study was

  9. Early Signs of Entrepreneurial Giftedness (United States)

    Shavinina, Larisa V.


    Although successful entrepreneurship is important for the economic prosperity of any society, one should acknowledge that entrepreneurial giftedness is terra incognita from a research viewpoint. This article analyzes early manifestations of entrepreneurial giftedness in the cases of Richard Branson, Michael Dell, and Bill Gates and thus opens a…

  10. Early-delayed radiation rhombencephalopathy

    Energy Technology Data Exchange (ETDEWEB)

    Nightingale, S.; Dawes, P.J.D.K.; Cartlidge, N.E.F. (Royal Victoria Infirmary, Newcastle upon Tyne (UK); Newcastle upon Tyne Univ. (UK). Newcastle General Hospital)


    A 37-year-old woman developed an early-delayed rhombencephalopathy 7 weeks after completing a course of radiotherapy to a glomus jugulare tumour. The clinical features, comprising nystagmus, skew strabismus, unilateral facial weakness, dysarthria and ataxia, are compared with four previously reported patients with this syndrome.

  11. Early Childhood Intervention in China (United States)

    Zheng, Yuzhu; Maude, Susan P.; Brotherson, Mary Jane


    With rapid economic development and increasing awareness of the importance of early childhood intervention (ECI), China is re-examining its social and educational practices for young children with disabilities. This re-examination may have a significant impact on young children with disabilities in China. It may also set an example for other…

  12. Early Children's Literature and Aging (United States)

    McGuire, Sandra L.


    Increased longevity is a worldwide phenomenon placing emphasis on the need for preparation for life's later years. Today's children will be the older adults of tomorrow. A resource that can help to educate them about aging and prepare them for the long life ahead is early children's literature (Preschool-Primary). This literature can provide…

  13. Famines in Africa: is early warning early enough?

    Directory of Open Access Journals (Sweden)

    Jeeyon Janet Kim


    Full Text Available Following the second Sahelian famine in 1984–1985, major investments were made to establish Early Warning Systems. These systems help to ensure that timely warnings and vulnerability information are available to decision makers to anticipate and avert food crises. In the recent crisis in the Horn of Africa, alarming levels of acute malnutrition were documented from March 2010, and by August 2010, an impending food crisis was forecast. Despite these measures, the situation remained unrecognised, and further deteriorated causing malnutrition levels to grow in severity and scope. By the time the United Nations officially declared famine on 20 July 2011, and the humanitarian community sluggishly went into response mode, levels of malnutrition and mortality exceeded catastrophic levels. At this time, an estimated 11 million people were in desperate and immediate need for food. With warnings of food crises in the Sahel, South Sudan, and forecast of the drought returning to the Horn, there is an immediate need to institutionalize change in the health response during humanitarian emergencies. Early warning systems are only effective if they trigger an early response.

  14. Pompe Disease: Early Diagnosis and Early Treatment Make a Difference

    Directory of Open Access Journals (Sweden)

    Yin-Hsiu Chien


    Full Text Available Pompe disease (glycogen storage disease type II or acid maltase deficiency is a lysosomal disorder in which acid α-glucosidase (GAA deficiencies lead to intralysosomal accumulation of glycogen in all tissues; most notably in skeletal muscles. Both the patient's age at the onset of Pompe disease symptoms and the rate of deterioration caused by the disease can vary considerably. In classical infant-onset Pompe disease (IOPD, symptoms start very early in life, and death occurs soon afterward if the disease remains untreated. In later-onset Pompe disease, symptoms are slower to appear, and patients often progress to wheelchair confinement and eventual respiratory failure. A diagnosis can be made by screening for GAA in dried blood samples, followed either by GAA assessment in lymphocytes or in fibroblasts or by the genetic analysis of mutations. Treatment by enzyme replacement therapy (ERT with alglucosidase alfa was approved for human use in 2006. In classical IOPD, treatment significantly lengthens survival and improves motor development and cardiac function. The sooner ERT begins, the better are the results. Newborn screening aims to take advantage of different technologies for diagnosing and treating newborns early on and it yields better outcomes. However, newborns diagnosed early and other long-term survivors may encounter fresh problems, making up a new phenotype of IOPD patients. Further modifications of the treatment, such as a decrease in immune responses to ERT, a higher dosage, a better uptake formulation, and gene therapy delivered locally or systemically are being explored.

  15. Hyperglycaemia modifies energy metabolism and reactive oxygen species formation in endothelial cells in vitro. (United States)

    Dymkowska, Dorota; Drabarek, Beata; Podszywałow-Bartnicka, Paulina; Szczepanowska, Joanna; Zabłocki, Krzysztof


    There is significant evidence for an involvement of reactive oxygen species (ROS) in the pathogenesis of diabetic vascular complications through many metabolic and structural derangements. However, despite the advanced knowledge on the crucial role of ROS in cardiovascular damage, their intracellular source in endothelial cells exposed to high concentrations of glucose has not been precisely defined. Moreover, the molecular mechanism of action of elevated glucose on mitochondria has not been fully elucidated. The main aim of this study was to describe changes in the mitochondrial metabolism of human umbilical vein endothelial cells (HUVECs) treated with high glucose concentrations and to indicate the actual source of ROS in these cells. HUVECs exposed to 30 mM glucose exhibited an increased content of vascular adhesive molecule-1 (VCAM-1) and an excessive ROS production. Faster oxygen consumption and increased abundance of selected respiratory complexes coexist with slightly declined mitochondrial membrane potential and substantially elevated amount of uncoupling protein-2 (UCP2). Inhibition of NADPH oxidase (NOX) and modification of mitochondrial ROS generation with a mitochondrial uncoupler or respiratory chain inhibitors allowed concluding that the major source of ROS in HUVECs exposed to hyperglycaemic conditions is NOX. The mitochondrial respiratory chain seems not to participate in this phenomenon. Copyright © 2013 Elsevier Inc. All rights reserved.

  16. Andrographolide reorganise hyperglycaemia and distorted antioxidant profile in streptozotocin-induced diabetic rats. (United States)

    Naik, Ramavat Ravindhar; Munipally, Praveen Kumar; Nagaraju, Turlapati


    Diabetes mellitus (DM) is a constant and illimitable metabolic disorder that can happen even at a young age due to the virtual absence of naturally acting insulin, which uptakes and accumulates glucose; thereby reduce the use of glucose. In the present study, we evaluated the neuroprotective efficacy of andrographolide on streptozotocin (STZ) induced diabetic Sprague dawley rats. Diabetes was induced by intraperitonial injection of STZ (45 mg/kg B.W) in Sprague dawley rats. Andrographolide (2.5 mg/kg B.W) was administered orally to diabetic rats and Glibenclamide (25mg/kg B.W) as control for 30 days to assess its effects on blood glucose, insulin, insulin resistance and antioxidant profiles such as superoxide dismutase, catalase, glutathione peroxidase, reduced glutathione and lipid peroxidation in various regions of brain namely hypothalamus, cerebellum, hippocampus and brain cerebral cortex. Oral supplementation of andrographolide extensively diminished the blood glucose levels than diabetic control. There was noteworthy reduction in the CAT, SOD and GPx activities in the hippocampus, hypothalamus and cerebral cortex cerebellum of the DM rat brain. However, andrographolide supplementation drastically reverses the CAT, GPx and SOD back to normal levels. In conclusion, the results revealed that andrographolide shown beneficial potentiality against neuropathy in STZ induced diabetic rats. Copyright© Bentham Science Publishers; For any queries, please email at

  17. Hyperglycaemia as a determinant of cognitive decline in patients with type 1 diabetes

    NARCIS (Netherlands)

    Wessels, A.M.; Scheltens, P.; Barkhof, F.; Heine, R.J.


    Individuals with type 1 diabetes show mild performance deficits in a range of neuropsychological tests compared to healthy controls, but the mechanisms underlying this cognitive deterioration are still poorly understood. Basically, two diabetes-related mechanisms can be postulated: recurrent severe


    Studies of diabetes mellitus in the streptozotocin rat model suggest that sexual dysfunctions may result from diabetes-induced alterations of the neuroendocrine-reproductive tract axis. Our investigation was performed to better define the effects of short-term hyperglycemia on ra...

  19. Control of hyperglycaemia in paediatric intensive care (CHiP: study protocol

    Directory of Open Access Journals (Sweden)

    Percy Deborah


    Full Text Available Abstract Background There is increasing evidence that tight blood glucose (BG control improves outcomes in critically ill adults. Children show similar hyperglycaemic responses to surgery or critical illness. However it is not known whether tight control will benefit children given maturational differences and different disease spectrum. Methods/Design The study is an randomised open trial with two parallel groups to assess whether, for children undergoing intensive care in the UK aged ≤ 16 years who are ventilated, have an arterial line in-situ and are receiving vasoactive support following injury, major surgery or in association with critical illness in whom it is anticipated such treatment will be required to continue for at least 12 hours, tight control will increase the numbers of days alive and free of mechanical ventilation at 30 days, and lead to improvement in a range of complications associated with intensive care treatment and be cost effective. Children in the tight control group will receive insulin by intravenous infusion titrated to maintain BG between 4 and 7.0 mmol/l. Children in the control group will be treated according to a standard current approach to BG management. Children will be followed up to determine vital status and healthcare resources usage between discharge and 12 months post-randomisation. Information regarding overall health status, global neurological outcome, attention and behavioural status will be sought from a subgroup with traumatic brain injury (TBI. A difference of 2 days in the number of ventilator-free days within the first 30 days post-randomisation is considered clinically important. Conservatively assuming a standard deviation of a week across both trial arms, a type I error of 1% (2-sided test, and allowing for non-compliance, a total sample size of 1000 patients would have 90% power to detect this difference. To detect effect differences between cardiac and non-cardiac patients, a target sample size of 1500 is required. An economic evaluation will assess whether the costs of achieving tight BG control are justified by subsequent reductions in hospitalisation costs. Discussion The relevance of tight glycaemic control in this population needs to be assessed formally before being accepted into standard practice. Trial Registration Current Controlled Trials ISRCTN61735247

  20. Management of Hyperglycaemia by Ethyl Acetate Extract of Balanites aegyptiaca (Desert Date). (United States)

    Al-Malki, Abdulrahman L; Barbour, Elie K; Abulnaja, Kalid O; Moselhy, Said S


    Reactive oxygen species play a significant role in the pathogenesis of retinopathy in diabetes patients. The current study aimed to assess the effect of ethyl acetate extract (EAE) from Balanites aegyptiaca (10, 25 or 50 mg/kg b.w.) in experimental diabetic rats. To achieve this aim, five groups of male rats were included: control, diabetic, and diabetic rats treated with 10, 25, and 50 µg/kg b.w. of EAE for eight weeks. Our results suggests a protective role of EAE against oxidative stress induced by streptozocine. EAE treatment produced a reduction in blood glucose levels, HbA1c, malondialdehyde and vascular endothelial growth factor (VEGF) in diabetic retina (p < 0.001), as well as an enhancement in antioxidant capacity against streptozocine-induced oxidative stress. Tumor necrosis factor alpha (TNF-α), interleukin (IL-1β) and vascular endothelial growth factor (VEGF) were significantly reduced in diabetic rats treated with EAE, compared with untreated diabetic rats. Analysis of EAE by GC-MS indicated the presence of β-sistosterol. Overall, EAE modulates oxidative stress induced by streptozocine and enhances antioxidant activity, which may provide additional endothelial protection in retina of diabetic rats. These results hold great promise in the management of diabetic complications.

  1. Acupuncture attenuates hyperglycaemia and improves ovarian function in female rats subjected to continuous light exposure. (United States)

    Kang, Xuezhi; Jia, Lina; Li, Yaming; Zhang, Xu


    Exposure to unnatural light cycles is increasingly associated with obesity and the metabolic syndrome. The purpose of this study was to examine the effects of electroacupuncture (EA) on glucose metabolism and ovarian function in female rats subjected to long-term continuous light exposure. Female Sprague-Dawley rats (n=24) were divided into three experimental groups: an LD group that was maintained under a normal light-dark cycle (healthy control); an LL group that was exposed to continuous light for 21 weeks but remained untreated; and an LL+EA group that received EA at ST36 and SP6 during weeks 17 to 21 of continuous light exposure. Oestrous cycles of female rats kept in a continuously lit environment for 21 weeks were disordered and polycystic ovarian syndrome (PCOS)-like changes occurred, accompanied by increased fasting blood glucose (6.23±0.33 vs 5.27±0.40 mmol/L in week 17, p=0.015) and reduced fasting levels of serum testosterone (0.07±0.018 vs 0.12±0.058 ng/L, p=0.043) and insulin (0.89±0.20 vs 1.43±0.46 ng/L, p=0.006). After 5 weeks of EA treatment at ST36 and SP6, ovarian cycle disruption was mitigated and blood glucose levels showed a gradual decline (5.18±0.37 vs 5.80±0.55 mmol/L, p=0.017; and 5.73±0.31 vs 6.62±0.13 mmol/L, p=0.004; in the fourth and fifth weeks of EA treatment, respectively). EA also attenuated the reductions otherwise seen in serum insulin and testosterone levels. Prolonged exposure to light can lead to a decline in ovarian and pancreatic function. EA at ST36 and SP6 may reduce abnormally elevated blood glucose levels and improve ovarian and pancreatic hormone levels. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  2. Markers of autophagy are adapted to hyperglycaemia in skeletal muscle in type 2 diabetes

    DEFF Research Database (Denmark)

    Sørensen, Rikke Kruse; Vind, Birgitte F; Petersson, Stine J


    AIMS/HYPOTHESIS: Autophagy is a catabolic process that maintains cellular homeostasis by degradation of protein aggregates and selective removal of damaged organelles, e.g. mitochondria (mitophagy). Insulin resistance in skeletal muscle has been linked to mitochondrial dysfunction and altered...... protein metabolism. Here, we investigated whether abnormalities in autophagy are present in human muscle in obesity and type 2 diabetes. METHODS: Using a case-control design, skeletal muscle biopsies obtained in the basal and insulin-stimulated states from patients with type 2 diabetes during both...... of forkhead box O3A (FOXO3A) were similar among the groups. Insulin reduced lipidation of microtubule-associated protein light chain 3 (LC3)B-I to LC3B-II, a marker of autophagosome formation, with no effect on p62/sequestosome 1 (SQSTM1) content in muscle of lean and obese individuals. In diabetic patients...

  3. Refractory hyperglycaemia induced by glucose-insulin-potassium infusion in acute myocardial infarction

    NARCIS (Netherlands)

    Svilaas, Tone; van der Horst, I.C.C.; Nijsten, M.W.N.; Zijlstra, F.


    Background. Recent randomised clinical trials have not confirmed the beneficial effects of glucose-insulin-potassium (GIK) infusion observed in experimental models of myocardial ischaemia and infarction. Methods. We investigated glucose levels and insulin dose in 107 patients treated with

  4. The risk of postpartum maternal hyperglycaemia in women with gestational diabetes is reduced by breastfeeding

    LENUS (Irish Health Repository)

    O'Reilly, MW


    Background and aims: Gestational diabetes (GDM) is associated with adverse fetal and maternal outcomes. It identifies women at risk of pre-diabetes, type 2 diabetes (T2DM) and cardiovascular risk in later life. Recent studies have suggested that breastfeeding may confer a beneficial effect on postpartum maternal glucose tolerance in both women with GDM and normal glucose tolerance (NGT) in pregnancy.\\r\

  5. A patient with hyperglycaemia and normal HbA Ic due to impaired glycation

    NARCIS (Netherlands)

    Diekman, M. J. M.; Salden, H. J. M.; DeVries, J. H.


    A diabetic Caucasian woman presented with discrepantly low HbA Ic values compared with her glycaemia. High-performance liquid chromatography (HPLC) analysis disclosed 80% HbA and 20% HbI Philadelphia (I6alpha2 lys --> glut). The calculated glycosylation gap from the fructosamine level was 1.2%. The

  6. Targeting hyperglycaemia with either metformin or repaglinide in non-obese patients with type 2 diabetes

    DEFF Research Database (Denmark)

    Lund, S S; Tarnow, L; Stehouwer, C D A


    were not significantly different between treatments. However, body weight, waist circumference, fasting serum levels of insulin and C-peptide were lower and less number of patients experienced hypoglycaemia during treatment with metformin vs. repaglinide. Both drugs were well tolerated. CONCLUSIONS......AIM: Metformin is the 'drug-of-first-choice' in obese patients with type 2 diabetes mellitus (T2DM) due to its antihyperglycaemic and cardiovascular protective potentials. In non-obese patients with T2DM, insulin secretagogues are empirically used as first choice. In this investigator-initiated......-obese (body mass index

  7. A patient treated with olanzapine developing diabetes de novo : proposal for hyperglycaemia screening

    NARCIS (Netherlands)

    Duiverman, M. L.; Cohen, D.; van Oven, W.; Nieboer, P.


    We report a patient with schizophrenia who developed diabetes mellitus during treatment with olanzapine. The case confirms the pattern of atypical antipsychotic-related diabetic emergencies: rapid onset in relatively young patients, often with severe glucose derangements and serious complications.

  8. Osteoporosis and its association with non-gonadal hormones involved in hypertension, adiposity and hyperglycaemia. (United States)

    Poudyal, Hemant; Brown, Lindsay


    Osteoporosis is a high-prevalence disease, particularly in developed countries, and results in high costs both to the individual and to society through associated fragility fractures. There is an urgent need for identification of novel drug targets and development of new anti-osteoporotic agents. Between 30 and 80% of osteoporotic fractures cannot be prevented despite current treatments achieving relative fracture risk reduction of up to 20%, 50%, and 70% for non-vertebral, hip and spine fractures, respectively. Traditionally, the decline in gonadal hormones has been studied as the sole hormonal determinant for the loss of bone mineral density in osteoporosis. However, recent studies have identified receptors for numerous non-gonadal hormones such as PTH, angiotensin II, leptin, adiponectin, insulin and insulin-like growth factor-1 on the osteoblast lineage cells that directly regulate bone turnover. These hormones are also involved in the pathogenesis of metabolic syndrome risk factors, particularly hypertension, type-II diabetes and obesity. By activating their respective receptors on osteoblastic lineage cells, these hormones appear to act through a common mechanism by down-regulating receptors for activation of nuclear factor kappa B ligand (RANKL) and up-regulating osteoprotegerin (OPG) with inverse responses for adiponectin. Receptors for amylin, gastric inhibitory polypeptide and ghrelin and have also been identified on the osteoblast lineage cells although the roles of these receptors in bone turnover are controversial or poorly studied. Moreover, bone turnover may be independently regulated by modulation of osteoclast-osteoblast function and bone marrow adiposity. Leptin appears to be the only hormone that is a known regulator of both bone mineralisation and bone adiposity.

  9. Proteomics of early zebrafish embryos

    Directory of Open Access Journals (Sweden)

    Heisenberg Carl-Philipp


    Full Text Available Abstract Background Zebrafish (D. rerio has become a powerful and widely used model system for the analysis of vertebrate embryogenesis and organ development. While genetic methods are readily available in zebrafish, protocols for two dimensional (2D gel electrophoresis and proteomics have yet to be developed. Results As a prerequisite to carry out proteomic experiments with early zebrafish embryos, we developed a method to efficiently remove the yolk from large batches of embryos. This method enabled high resolution 2D gel electrophoresis and improved Western blotting considerably. Here, we provide detailed protocols for proteomics in zebrafish from sample preparation to mass spectrometry (MS, including a comparison of databases for MS identification of zebrafish proteins. Conclusion The provided protocols for proteomic analysis of early embryos enable research to be taken in novel directions in embryogenesis.

  10. Early stages of Ostwald ripening (United States)

    Shneidman, Vitaly A.


    The Becker-Döring (BD) nucleation equation is known to predict a narrow double-exponential front (DEF) in the distribution of growing particles over sizes, which is due to early transient effects. When mass conservation is included, nucleation is eventually exhausted while independent growth is replaced by ripening. Despite the enormous difference in the associated time scales, and the resulting demand on numerics, within the generalized BD model the early DEF is shown to be crucial for the selection of the unique self-similar Lifshitz-Slyozov-Wagner asymptotic regime. Being preserved till the latest stages of growth, the DEF provides a universal part of the initial conditions for the ripening problem, regardless of the mass exchange mechanism between the nucleus and the matrix.

  11. Nanotechnology for Early Cancer Detection

    Directory of Open Access Journals (Sweden)

    Joon Won Park


    Full Text Available Vast numbers of studies and developments in the nanotechnology area have been conducted and many nanomaterials have been utilized to detect cancers at early stages. Nanomaterials have unique physical, optical and electrical properties that have proven to be very useful in sensing. Quantum dots, gold nanoparticles, magnetic nanoparticles, carbon nanotubes, gold nanowires and many other materials have been developed over the years, alongside the discovery of a wide range of biomarkers to lower the detection limit of cancer biomarkers. Proteins, antibody fragments, DNA fragments, and RNA fragments are the base of cancer biomarkers and have been used as targets in cancer detection and monitoring. It is highly anticipated that in the near future, we might be able to detect cancer at a very early stage, providing a much higher chance of treatment.

  12. [Early diagnosis of periodontal disease]. (United States)

    Sicilia, A M; Cobo Plana, J; López Arranz, J S; Ainamo, J


    Early diagnosis is necessary if the prevalence of periodontal disease is to be brought under control. For periodontal screening in dental practice we propose to employ the C.P.I.T.N. system, combined with examination of two or four dental bite-wing radiographs. Both of these procedures can be accurately applied in general dental practice conditions. The screening is not time consuming and can yield very important diagnostic data.

  13. Supporting Families through Early Intervention

    Directory of Open Access Journals (Sweden)

    Roy McConkey


    Full Text Available Internationally early intervention programmes for infants and preschoolers with disabilities have proved to be remarkably successful. In many countries, they began with teachers for visually impaired or hearing impaired children visiting the family home to teach parents how they could overcome the child's impairments. The logic of early intervention was inequitable. For example, the sooner children with visual impairments learnt to be independently mobile, then the greater their potential to learn and to kad an ordinary life. In time, this philosophy was extended to children with neurological and developmental delays, such as mental retardation, although success could be variable. In part, many different factors contributed to this variability: the form the interventions took, the extent of family involvement in the intervention and the lack of sensitivity of the measures used to assess a child's progress, to name but three. Perhaps the most extensive and intensive Early intervention schemes have been in the United States with their Head Start programmes. They were aimed at promoting the educational potential of preschoolers from deprived socio - economic backgrounds. Although the first phase of programmes had varying success, those in the second phase yielded impressive results which were mainly attributed to a greater focus on parental participation and links forged with the school system. Recently in developing countries, priority has been given to establishing early intervention as a means of creating new styles of family-based and community-based service in these countries in contrast to the hospital or institutional-services that were a legacy from a previous generation. Although formal evaluations are largely lacking, informal reports have been broadly enthusiastic. In sum, early intervention is no longer a new approach to developmental disabilities. It is an approach of proven effectiveness with children who have different impairments

  14. Planck early results. VII. The Early Release Compact Source Catalogue

    DEFF Research Database (Denmark)

    Ade, P. A. R.; Aghanim, N.; Arnaud, M.


    the different techniques, an implementation of the PowellSnakes source extraction technique was used at the five frequencies between 30 and 143 GHz while the SExtractor technique was used between 217 and 857GHz. The 10σ photometric flux density limit of the catalogue at |b| > 30 is 0.49, 1.0, 0.67, 0.5, 0.33, 0....... In addition, two early release catalogs that contain 915 cold molecular cloud core candidates and 189 SZ cluster candidates that have been generated using multifrequency algorithms are presented. The entire source list, with more than 15 000 unique sources, is ripe for follow-up characterisation with Herschel...

  15. Early rehabilitation and participation in focus

    DEFF Research Database (Denmark)

    Pallesen, Hanne; Buhl, Inge; Roenn-Smidt, Helle


    Early neurorehabilitation is an interdisciplinary field. Thus, in order to eliminate unnecessary barriers for individuals with severe acquired brain injury in early rehabilitation, we need rehabilitation science that supports both quantitative and qualitative research methods. Participation can...

  16. Genetics Home Reference: early-onset glaucoma (United States)

    ... Home Health Conditions Early-onset glaucoma Early-onset glaucoma Printable PDF Open All Close All Enable Javascript to view the expand/collapse boxes. Description Glaucoma is a group of eye disorders in which ...

  17. Early detection of first-episode psychosis

    DEFF Research Database (Denmark)

    Larsen, Tor K; Melle, Ingrid; Auestad, Bjørn


    Early intervention is assumed to improve outcome in first-episode psychosis, but this has not been proven.......Early intervention is assumed to improve outcome in first-episode psychosis, but this has not been proven....

  18. Early Identification of Psychosis: A Primer


    Early Psychosis Initiative of British Columbia


    This document is an educational resource concerning the early identification of psychosis. Primary topics addressed include: an outline of the importance of early intervention; signs and symptoms of psychosis; and strategies for recognizing psychosis.  

  19. Peering Into an Early Galaxy (United States)

    Kohler, Susanna


    Thirteen billion years ago, early galaxies ionized the gas around them, producing some of the first light that brought our universe out of its dark ages. Now the Atacama Large Millimeter/submillimeter Array (ALMA) has provided one of the first detailed looks into the interior of one of these early, distant galaxies.Sources of LightArtists illustration of the reionization of the universe (time progresses left to right), in which ionized bubbles that form around the first sources of light eventually overlap to form the fully ionized universe we observe today. [Avi Loeb/Scientific American]For the first roughly hundred million years of its existence, our universe expanded in relative darkness there were no sources of light at that time besides the cosmic microwave background. But as mass started to condense to form the first objects, these objects eventually shone as the earliest luminous sources, contributing to the reionization of the universe.To learn about the early production of light in the universe, our best bet is to study in detail the earliest luminous sources stars, galaxies, or quasars that we can hunt down. One ideal target is the galaxy COSMOS Redshift 7, known as CR7 for short.Targeting CR7CR7 is one of the oldest, most distant galaxies known, lying at a redshift of z 6.6. Its discovery in 2015 and subsequent observations of bright, ultraviolet-emitting clumps within it have led to broad speculation about the source of its emission. Does this galaxy host an active nucleus? Or could it perhaps contain the long-theorized first generation of stars, metal-free Population III stars?To determine the nature of CR7 and the other early galaxies that contributed to reionization, we need to explore their gas and dust in detail a daunting task for such distant sources! Conveniently, this is a challenge that is now made possible by ALMAs incredible capabilities. In a new publication led by Jorryt Matthee (Leiden University, the Netherlands), a team of scientists now

  20. Restraint Effects in Early Age Concrete Structures


    Al-Gburi, Majid


    One of the widespread issues in concrete structures is cracks occurring at early age. Cracks that appear in the young concrete may cause early start of corrosion of rebars or early penetration of harmful liquids or gases into the concrete body. These situations could result in reduced service life and in significantly increased maintenance cost of structures. Therefore it is important for construction companies to avoid these cracks.Volumetric deformations in early age concrete are caused by ...

  1. Early diagnosis of the Spondyloarthropathies

    International Nuclear Information System (INIS)

    Gonzalez Naranjo, Luis Alonso; Londono, John D; Valle, Rafael Raul


    Spondyloarthropathies are a cluster of chronic inflammatory diseases that primarily include ankylosing spondylitis, reactive arthritis, psoriatic arthritis; arthritis associated with inflammatory bowel diseases and undifferentiated spondyloarthropathies. The most common subgroups of spondyloarthropathies are ankylosing spondylitis and undifferentiated spondyloarthropathy. The diagnosis of ankylosing spondylitis is mainly based on unequivocal radiographic sacroiliitis of at least grade 2 bilaterally or grade 3 unilaterally. How ever, in the early phase of disease, conventional radiographs are often too insensitive to show sacroiliitis and it usually takes several years for definite radiographic sacroiliitis to evolve. Thus, the diagnosis of ankylosing spondylitis is a commonly delayed by 8 to 11 years after the onset of symptoms. As a result, diagnosing axial spondyloarthropathy in the absence of radiographic sacroiliitis is very difficult to rheumatologists. In the early phase of disease, HLA B27 test and magnetic resonance imaging of sacroiliac joints may be helpful to the early diagnosis. In the presence of chronic low back pain the probability of axial spondyloarthropathy is about 5% and is about 14% if the back pain is inflammatory. The presence of = 3 features of spondyloarthropathy (heel pain, uveitis, dactylitis, positive family history, alternating buttock pain, psoriasis, inflammatory bowel disease, asymmetrical arthritis, positive response to anti-inflammatory drugs) increase the probability of axial spondyloarthropathy to 90%. Both, the positive HLA B27 and magnetic resonance imaging with signs of sacroiliitis increase the probability of spondyloarthropathy, particularly in patients without spondyloarthropathies features or with only 1 or 2 features. Since ankylosing spondylitis in association with psoriasis and inflammatory bowel disease is often HLA B27 negative, this test is of limited value under theses circumstances. Is important to consider that

  2. Early School Leaving in Scandinavia

    DEFF Research Database (Denmark)

    Jakobsen, Vibeke; Bäckman, Olof; Lorentzen, Thomas


    The article explores the extent to which the organization of vocational tracks in upper secondary school affects the labour market risks associated with early school exit. The Nordic countries share many features, but the upper secondary school systems differ significantly in how their vocational...... tracks are organized. Denmark and Norway have dual vocational tracks, that is, they combine school-based education and workplace apprenticeships, whereas in Finland and Sweden they are primarily school based. We analyse administrative longitudinal data from the mid-1990s to the mid-2000s in the four...

  3. Early detection of congenital syphilis

    Directory of Open Access Journals (Sweden)

    Nagalakshmi Chowdhary


    Full Text Available Late congenital syphilis is a very rare clinical entity, and its early diagnosis and treatment is essential. Dental findings often provide valuable evidence for the diagnosis of late congenital syphilis. It occurs due to the transmission of the disease from an infected mother to her fetus through placenta. This long forgotten disease continues to effect pregnant women resulting in perinatal morbidity and mortality. Congenital syphilis is a preventable disease, and its presence reflects a failure of prenatal care delivery system, as well as syphilis control programs. We are reporting a case of late congenital syphilis with only Hutchinson′s teeth.

  4. Excess Early Mortality in Schizophrenia

    DEFF Research Database (Denmark)

    Laursen, Thomas Munk; Nordentoft, Merete; Mortensen, Preben Bo


    Schizophrenia is often referred to as one of the most severe mental disorders, primarily because of the very high mortality rates of those with the disorder. This article reviews the literature on excess early mortality in persons with schizophrenia and suggests reasons for the high mortality...... as well as possible ways to reduce it. Persons with schizophrenia have an exceptionally short life expectancy. High mortality is found in all age groups, resulting in a life expectancy of approximately 20 years below that of the general population. Evidence suggests that persons with schizophrenia may...

  5. Early Detection of Ovarian Cancer

    Directory of Open Access Journals (Sweden)

    Donna Badgwell


    Full Text Available Despite advances in therapy, ovarian cancer remains the most deadly of the gynecological cancers. Less than 30% of women with advanced stage disease survive long-term. When diagnosed in stage I, up to 90% of patients can be cured with conventional surgery and chemotherapy. At present, only 25% of ovarian cancers are detected in stage I due, in part, to the absence of specific symptoms and to lack of an effective screening strategy. Early detection of ovarian cancer might significantly improve the overall survival rate of women with ovarian cancer if 1 most cancers are clonal and unifocal, arising in the ovary rather than in the peritoneum, 2 metastatic disease results from progression of clinically detectable stage I lesions, and 3 cancers remain localized for a sufficient interval to permit cost-effective screening. Given the prevalence of ovarian cancer, strategies for early detection must have high sensitivity for early stage disease (> 75%, but must have extremely high specificity (99.6% to attain a positive predictive value of at least 10%. Transvaginal sonography (TVS, serum markers and a combination of the two modalities have been evaluated for early detection of ovarian cancer. Among the serum markers, CA125 has received the most attention, but lacks the sensitivity or specificity to function alone as a screening test. Greater specificity can be achieved by combining CA125 and TVS and/or by monitoring CA125 over time. Two stage screening strategies promise to be cost effective, where abnormal serum assays prompt TVS to detect lesions that require laparotomy. Accrual has been completed for a 200,000 woman trial in the United Kingdom that will test the ability of a rising CA125 to trigger TVS and subsequent exploratory surgery. Given the heterogeneity of ovarian cancer, it is unlikely that any single marker will be sufficiently sensitive to provide an effective initial screen. Sensitivity of serum assays might be enhanced by utilizing a

  6. Early management of acute pancreatitis. (United States)

    Schepers, Nicolien J; Besselink, Marc G H; van Santvoort, Hjalmar C; Bakker, Olaf J; Bruno, Marco J


    Acute pancreatitis is the most common gastro-intestinal indication for acute hospitalization and its incidence continues to rise. In severe pancreatitis, morbidity and mortality remains high and is mainly driven by organ failure and infectious complications. Early management strategies should aim to prevent or treat organ failure and to reduce infectious complications. This review addresses the management of acute pancreatitis in the first hours to days after onset of symptoms, including fluid therapy, nutrition and endoscopic retrograde cholangiography. This review also discusses the recently revised Atlanta classification which provides new uniform terminology, thereby facilitating communication regarding severity and complications of pancreatitis. Copyright © 2013 Elsevier Ltd. All rights reserved.

  7. Early detection of contagious diseases (United States)

    Colston, Jr., Billy W.; Milanovich, Fred P [Lafayette, CA; Estacio, Pedro [Mission San Jose, CA; Chang, John [Walnut Creek, CA


    This invention provides an electronic proximity apparatus and a surveillance method using such an apparatus for alerting individuals that are exposed to a contagious disease. When a person becomes symptomatic and is diagnosed as positive for a given contagious agent, individuals that have recently maintained a threshold proximity with respect to an infected individual are notified and advised to seek immediate medial care. Treatment of individuals in the very early phases of infection (pre-symptomatic) significantly reduces contagiousness of the infected population first exposed to the contagious disease, thus preventing spread of the disease throughout the general population.

  8. Early outcome of mitral valve replacement through right anterolateral thoracotomy versus standard median sternotomy

    Directory of Open Access Journals (Sweden)

    Heemel Saha


    Full Text Available This study was aimed to compare the peri-operative outcomes among the mitral valve replace-ment using anterolateral thoracotomy (n=17 and standard median sternotomy (n=17 in a single surgeons practice. The mean age was 24.1 ± 5.3 years in Group I and 41.0 ± 11.5 years in Group II. Female was predominant in Group I. Total operative time and bypass time were significant in both the study groups. Incision scar was not visible in females in Group I but full incision scar was visible in Group II in sitting posture. In Group I patients, majority (52.9% patients needed short duration of ICU stay in comparison to Group II, and the difference was statistically significant (p<0.05 between the two groups. During discharge, 94.1% wound was well healed in Group I and 70.6% in Group II. Wound dehiscence was nil in Group I, but 23.5% patients developed dehiscence in Group II. However, only 5.9% patient developed unstable sternum in Group II. Cosmetic mitral valve replacement can be done safely through anterolateral thoracotomy and it is cost effective especially for the developing countries.

  9. Early Childhood Inclusion in the United Kingdom (United States)

    Blackburn, Carolyn


    A policy-to-practice paper is presented of early childhood inclusion in England. The article aims to report the benefits of early intervention services and early childhood inclusion for children with special educational needs and disabilities (SEND), document the chronology of policy development, and discuss research evidence about…

  10. Ethics dilemmas of early detection of obesity

    DEFF Research Database (Denmark)

    Vallgårda, Signild


    Aim: To discuss the ethics dilemmas of the early detection of overweight and obesity. Methods: Analysis of the ethical aspects of early detection. Results: The early detection of overweight and obesity entails a number of ethical dilemmas because it may both be helpful and harmful. It may help...

  11. Early Learning and Educational Technology Policy Brief (United States)

    Lee, Joan


    Recognizing the growth of technology use in early learning settings, the U.S. Department of Education and U.S. Department of Health and Human Services collaborated in the development of the "Early Learning and Educational Technology Policy Brief" to promote developmentally appropriate use of technology in homes and early learning…

  12. Early identification and intervention in cerebral palsy

    DEFF Research Database (Denmark)

    Herskind, Anna; Greisen, Gorm; Nielsen, Jens Bo


    Infants with possible cerebral palsy (CP) are commonly assumed to benefit from early diagnosis and early intervention, but substantial evidence for this is lacking. There is no consensus in the literature on a definition of 'early', but this review focuses on interventions initiated within...

  13. Early identification systems for emerging foodborne hazards

    NARCIS (Netherlands)

    Marvin, H.J.P.; Kleter, G.A.; Pradini, A.; Dekkers, S.; Bolton, D.J.


    This paper provides a non-exhausting overview of early warning systems for emerging foodborne hazards that are operating in the various places in the world. Special attention is given to endpoint-focussed early warning systems (i.e. ECDC, ISIS and GPHIN) and hazard-focussed early warning systems

  14. Perceived Stress and Canadian Early Childcare Educators (United States)

    Wagner, Shannon L.; Forer, Barry; Cepeda, Ivan L.; Goelman, Hillel; Maggi, Stefania; D'Angiulli, Amedeo; Wessel, Julie; Hertzman, Clyde; Grunau, Ruth E.


    Background: Occupational stress for early childcare educators is an area of apparent understudy in the literature. The present study attempted to address this gap and provide some updated data regarding the experiences of this occupational group. Methods: Early childhood workers across a variety of early childhood education settings (N = 69)…

  15. Early Smoking, Education, and Labor Market Performance

    NARCIS (Netherlands)

    Palali, Ali


    This study investigates the effects of early smoking on educational attainment and labor market performance. The results show that early smoking adversely affects educational attainment and initial labor market performance, but only for males. The effect of early smoking on initial labor market

  16. Learning and inclusion in the Early Years


    Blamires, M.; Estrada, C.


    This paper considers inclusion in the early years from the perspective of a social model of learning articulated by Wenger (1998). This model is used to highlight key areas of teaching and learning in the early years that enhance participation and achievement. Implications for change in early years settings are considered alongside some priorities for professional development.

  17. Early infection and prognosis after acute stroke

    DEFF Research Database (Denmark)

    Kammersgaard, L P; Jørgensen, H S; Reith, J


    Infection is a frequent complication in the early course of acute stroke and may adversely affect stroke outcome. In the present study, we investigate early infection developing in patients within 3 days of admission to the hospital and its independent relation to recovery and stroke outcome....... In addition, we identify predictors for early infections, infection subtypes, and their relation to initial stroke severity....

  18. Early occurring and continuing effects

    International Nuclear Information System (INIS)

    Scott, B.R.; Hahn, F.F.


    This chapter deals with health-risk estimates for early and continuing effects of exposure to ionizing radiations that could be associated with light water nuclear power plants accidents. Early and continuing effects considered are nonneoplastic diseases and symptoms that normally occur soon after radiation exposure, but may also occur after years have passed. They are generally associated with relatively high (greater than 1 Gy) doses. For most of the effects considered, there is a practical dose threshold. Organs of primary interest, because of their high sensitivity or the likelihood of receiving a large radiation dose, are bone marrow, gastrointestinal tract, thyroid glands, lungs, skin, gonads, and eyes. In utero exposure of the fetus is also considered. New data and modeling techniques available since publication of the Reactor Safety Study (WASH 1400, 1975) were used along with data cited in the Study to develop improved health-risk models for morbidity and mortality. The new models are applicable to a broader range of accident scenarios, provide a more detailed treatment of dose protraction effects, and include morbidity effects not considered in the Reactor Safety Study. 115 references, 20 figures, 19 tables

  19. Early history of scapular fractures. (United States)

    Bartoníček, Jan; Kozánek, Michal; Jupiter, Jesse B


    The first to use the term Scapula was Vesalius (1514-1564) and thus it has remained ever since. Probably the oldest injured scapula, from 250 million years ago, was described by Chinese authors of a skeletal examination of a fossilised remains of a dinosaur Yangchuanosaurus hepingensis. In humans, the oldest known scapular fractures date back to the prehistoric and early historic times. In ancient times, a fracture of acromion was described in the treatises of Hippocrates. Early modern history of the treatment of scapular fractures is closely interlinked with the history of the French surgery. The first to point out the existence of these fractures were Petit, Du Verney and Desault in the 18th century. The first study devoted solely to scapular fractures was published by Traugott Karl August Vogt in 1799. Thomas Callaway published in 1849 an extensive dissertation on injuries to the shoulder girdle, in which he discussed a number of cases known at that time. The first radiograph of a scapular fracture was published by Petty in 1907. Mayo Robson (1884), Lambotte (1913) and Lane (1914) were pioneers in the surgical treatment of these fractures, followed in 1923 by the French surgeons Lenormat, Dujarrier and Basset. The first internal fixation of the glenoid fossa, including a radiograph, was published by Fischer in 1939.

  20. [Early diagnosis of ectopic pregnancy]. (United States)

    Belics, Zoran; Gérecz, Balázs; Csákány, M György


    Ectopic pregnancy is a high-risk condition that occurs in 2% of reported pregnancies. This percentage is fivefold higher than that registered in the 1970s. Since 1970 there has been a two-fold increase in the ratio of ectopic pregnancies to all reported pregnancies in Hungary and in 2012 7.4 ectopic pregnancies per thousand registered pregnancies were reported. Recently, the majority (80%) of cases can be diagnosed in early stage, and the related mortality objectively decreased in the past few decades to 3.8/10,000 ectopic pregnancies. If a woman with positive pregnancy test has abdominal pain and/or vaginal bleeding the physician should perform a work-up to safely exclude the possibility of ectopic pregnancy. The basis of diagnosis is ultrasonography, especially vaginal ultrasound examination and measurement of the β-subunit of human chorionic gonadotropin. The ultrasound diagnosis is based on the visualization of an ectopic mass rather than the inability to visualize an intrauterine pregnancy. In some questionable cases the diagnostic uterine curettage or laparoscopy may be useful. The actuality of this topic is justified by practical difficulties in obtaining correct diagnosis, especially in the early gestational time.

  1. Mechanical Valve Replacement: Early Results

    Directory of Open Access Journals (Sweden)

    Habib Cakir


    Full Text Available Aim: Valve diseases in developing countries like Turkey which often occur as a complication of rheumatic fever are a serious disease. Surgical treatment of valve diseases should be done before irreversible damage to the myocardium occurred. In this study, we aimed to present the early results of mechanical valve replacement operations. Method: A hundred patients with mechanical valve replacement surgery were retrospectively evaluated in Seyhan Application Center attached to our clinic between July 2007 and August 2011. Results: Fifty patients were male and 50 were women. The mean age of patients was 47.88 (18-78. Isolated aortic valve replacement (AVR was performed to 23 patients, isolated mitral valve replacement (MVR was 32, double valve replacement (AVR + MVR was 12, MVR + aortic valve valvuloplasty was 1, AVR + mitral kommissurotomi was 1, AVR + coronary artery bypass graft surgery (CABG was 17, MVR + CABG was 8, MVR + atrial septal defect closure was 2 and Bentall procedure.was 4 patients. In addition, ablation procedure was performed to 5 patients intraoperatively because of preoperative atrial fibrillation. Two patients (2 % died in early postoperative period. Conclusion: Mechanical prosthetic valves are used for surgical treatment of valve disease with low mortality and morbidity in a large group of patients like women that not to think to get pregnant, non advanced age group and patients have less risky for anticoagulation drug in our clinic. [Cukurova Med J 2012; 37(1.000: 49-54

  2. EGU's Early Career Scientists Network (United States)

    Roberts Artal, L.; Rietbroek, R.


    The EGU encourages early career scientists (ECS) to become involved in interdisciplinary research in the Earth, planetary and space sciences, through sessions, social events and short courses at the annual General Assembly in April and throughout the year. Through division-level representatives, all ECS members can have direct input into matters of the division. A Union-wide representative, who sits on the EGU Council, ensures that ECS are heard at a higher level in the Union too. After a brief introduction as to how the network is organised and structured, this presentation will discuss how EGU ECS activities have been tailored to the needs of ECS members and how those needs have been identified. Reaching and communicating opportunities to ECS remains an ongoing challenge; they will be discussed in this presentation too, as well as some thoughts on how to make them more effective. Finally, the service offered to EGU ECS members would certainly benefit from building links and collaboration with other early career networks in the geosciences. This presentation will outline some of our efforts in that direction and the challenges that remain.

  3. Recent Coverage of Early Childhood Education Approaches in Open Access Early Childhood Journals (United States)

    Keskin, Burhanettin


    A content analysis of the coverage of the major approaches to early childhood education in the early childhood research journals, published between 2010 and 2014, that are early childhood research oriented and have free online access were investigated. Among 21 journals in early childhood education, two journals were selected for the content…

  4. Overview of Play: Its Uses and Importance in Early Intervention/Early Childhood Special Education (United States)

    Lifter, Karin; Foster-Sanda, Suzanne; Arzamarski, Caley; Briesch, Jacquelyn; McClure, Ellen


    Play is a natural activity of early childhood, which has great relevance to the fields of early intervention, early childhood special education, and early childhood education. Within these fields, ongoing tensions persist in how play is described and used. These tensions compromise activities of assessment, intervention, and curriculum development…

  5. Ultrasonographic findings of early abortion: suggested predictors

    International Nuclear Information System (INIS)

    Jun, Soon Ae; Ahn, Myoung Ock; Cha, Kwang Yul; Lee, Young Doo


    To investigate predictable ultrasonographic findings of early abortion. To investigate objective rules for the screening of abortion. Ultrasonographic examination of 111 early pregnancies between the sixth and ninth week in women who had regular 28 day menstrual cycles was performed. Ultrasonographic measurements of the gestational sac, crown rump length and fetal heart rate were performed using a linear array real time transducer with doppler ultrasonogram. All measurements of 17 early abortions were compared to those of 94 normal pregnancies. Most of early aborted pregnancies were classified correctly by discriminant analysis with G-SAC and CRL (G-SAC=0.5 CRL + 15, sensitivity 76.5%, specificity 96.8%). With the addition of FHR, 94.1% of early abortions could be predicted. In conclusion, ultrasonographic findings of early intrauterine growth retardation, small gestational sac and bradycardia can be predictable signs suggestive of poor prognosis of early pregnancies

  6. Atypical manifestations of early syphilis

    Directory of Open Access Journals (Sweden)

    R V Koranne


    Full Text Available A study of 36 untreated patients with early syphilis revealed atypical variations namely; long incubation period of 101 days in I patient, more than 3 chancres in 1, undermined margin of the chancre along with tenderness in 1 and moderate to severe tenderness of the ulcers in 2 cases. In 3 patients there was no indurations of the ulcers. Three patients with primary syphilis had unilateral lymphadenitis, and in I case the lymph nodes were not only tender but showed tendency towardsmatingawell. Insecondarysyphilis, 11 out of 16 patients having condylomata lata had no other muco-cutaneous lesions. Concomitant presence of other venereal disease to account for the atypical manifestations was discounted- by appropriate laboratory tests, response to therapeutic agents and follow up.

  7. LEP vacuum chamber, early prototype

    CERN Multimedia

    CERN PhotoLab


    The structure of LEP, with long bending magnets and little access to the vacuum chamber between them, required distributed pumping. This is an early prototype for the LEP vacuum chamber, made from extruded aluminium. The main opening is for the beam. The small channel to the right is for cooling water, to carry away the heat deposited by the synchroton radiation from the beam. The 4 slots in the channel to the left house the strip-shaped ion-getter pumps (see 7810255). The ion-getter pumps depended on the magnetic field of the bending magnets, too low at injection energy for the pumps to function well. Also, a different design was required outside the bending magnets. This design was therefore abandoned, in favour of a thermal getter pump (see 8301153 and 8305170).

  8. Early Earthquakes of the Americas (United States)

    Ni, James


    Robert Kovach's second book looks at the interplay of earthquake and volcanic events, archeology, and history in the Americas. Throughout history, major earthquakes have caused the deaths of millions of people and have damaged countless cities. Earthquakes undoubtedly damaged prehistoric cities in the Americas, and evidence of these events could be preserved in archeological records. Kovach asks, Did indigenous native cultures-Indians of the Pacific Northwest, Aztecs, Mayas, and Incas-document their natural history? Some events have been explicitly documented, for example, in Mayan codices, but many may have been recorded as myth and legend. Kovach's discussions of how early cultures dealt with fearful events such as earthquakes and volcanic eruptions are colorful, informative, and entertaining, and include, for example, a depiction of how the Maya would talk to maize plants in their fields during earthquakes to reassure them.

  9. Galaxies in the Early Universe

    DEFF Research Database (Denmark)

    Krogager, Jens-Kristian

    Understanding how galaxies evolved from the early Universe through cosmic time is a fundamental part of modern astrophysics. In order to study this evolution it is important to sample the galaxies at various times in a consistent way through time. In regular luminosity selected samples, our...... analyses are biased towards the brightest galaxies at all times (as these are easier to observe and identify). A complementary method relies on the absorption imprint from neutral gas in galaxies, the so-called damped Ly absorbers (DLAs) seen towards distant bright objects. This thesis seeks to understand...... how the absorption selected galaxies relate to the emission selected galaxies by identifying the faint glow from the absorbing galaxies at redshift z 2. In Chapters 2 and 3, the emission properties of DLAs are studied in detail using state-of-the-art instrumentation. The specific DLA studied...

  10. Early laparotomy after lung transplantation

    DEFF Research Database (Denmark)

    Bredahl, Pia; Zemtsovski, Mikhail; Perch, Michael


    BACKGROUND: Gastrointestinal complications after lung transplantation have been reported with incidence rates ranging from 3% to 51%, but the reasons are poorly understood. We aimed to investigate the correlations between pulmonary diseases leading to lung transplantation and early gastrointestinal...... complications requiring laparotomy after transplantation with outcomes for patients at increased risk. METHODS: In this study we performed a retrospective analysis of data of patients who underwent lung transplantation at our institution from 2004 to 2012. The study period was limited to the first 90 days after...... transplantation. RESULTS: Lung transplantation was performed in 258 patients, including 51 patients with α1-anti-trypsin deficiency (A1AD). Seventy-eight patients (30%) had an X-ray of the abdomen, and 23 patients (9%) required laparotomy during the first 90 days after transplantation. Patients with A1AD...

  11. Chandra Early Type Galaxy Atals (United States)

    Kim, Dong-Woo; Anderson, Craig; Burke, Douglas J.; Fabbiano, Giuseppina; Fruscione, Antonella; Lauer, Jennifer; McCollough, Michael; Morgan, Douglas; Mossman, Amy; O'Sullivan, Ewan; Paggi, Alessandro; Vrtilek, Saeqa Dil; Trinchieri, Ginevra


    The hot gas in early type galaxies (ETGs) plays a crucial role in understanding their formation and evolution. As the hot gas is often extended to the outskirts beyond the optical size, the large scale structural features identified by Chandra (including jets, cavities, cold fronts, filaments and tails) point to key evolutionary mechanisms, e.g., AGN feedback, merging history, accretion, stripping and star formation and its quenching. We have systematically analyzed the archival Chandra data of ~100 ETGs to study the hot ISM. We produce the uniformly derived data products with spatially resolved spectral information and will make them accessible via a public web site. With 2D spectral infomation, we further discuss gas morphology, scaling relations, X-ray based mass profiles and their implications related to various physical mechanisms (e.g., stellar and AGN feedback).

  12. Physics of the early universe

    International Nuclear Information System (INIS)

    Brandenberger, R.H.


    When studying the evolution of the very early universe it is necessary to use a description of matter which is appropriate at very high energies, namely in terms of quantum fields. In such models there may be a period during which the ratio of pressure and energy density is - 1, an equation of state which leads to an exponential expansion of the universe (inflation). There may also arise stable topological defects similar to vortex lines in condensed matter physics. These defects (cosmic strings) form seeds about which gas can accrete to form galaxies and clusters of galaxies. The author reviews inflation and cosmic strings, emphasizing their role in generating the energy density perturbations which are required in order to explain the existence of structures in the universe

  13. LHCb Early Career Scientist Awards

    CERN Multimedia

    Patrick Koppenburg for the LHCb Collaboration


    On 15 September 2016, the LHCb collaboration awarded the first set of prizes for outstanding contributions of early career scientists.   From left to right: Guy Wilkinson (LHCb spokesperson), Sascha Stahl, Kevin Dungs, Tim Head, Roel Aaij, Conor Fitzpatrick, Claire Prouvé, Patrick Koppenburg (chair of committee) and Sean Benson. Twenty-five nominations were submitted and considered by the committee, and 5 prizes were awarded to teams or individuals for works that had a significant impact within the last year. The awardees are: Roel Aaij, Sean Benson, Conor Fitzpatrick, Rosen Matev and Sascha Stahl for having implemented and commissioned the revolutionary changes to the LHC Run-2 high-level-trigger, including the first widespread deployment of real-time analysis techniques in High Energy Physics;   Kevin Dungs and Tim Head for having launched the Starterkit initiative, a new style of software tutorials based on modern programming methods. “Starterkit is a group of ph...

  14. Acute leukemia in early childhood

    Directory of Open Access Journals (Sweden)

    M. Emerenciano


    Full Text Available Acute leukemia in early childhood is biologically and clinically distinct. The particular characteristics of this malignancy diagnosed during the first months of life have provided remarkable insights into the etiology of the disease. The pro-B, CD10 negative immunophenotype is typically found in infant acute leukemia, and the most common genetic alterations are the rearrangements of the MLL gene. In addition, the TEL/AML1 fusion gene is most frequently found in children older than 24 months. A molecular study on a Brazilian cohort (age range 0-23 months has detected TEL/AML1+ve (N = 9, E2A/PBX1+ve (N = 4, PML/RARA+ve (N = 4, and AML1/ETO+ve (N = 2 cases. Undoubtedly, the great majority of genetic events occurring in these patients arise prenatally. The environmental exposure to damaging agents that give rise to genetic changes prenatally may be accurately determined in infants since the window of exposure is limited and known. Several studies have shown maternal exposures that may give rise to leukemogenic changes. The Brazilian Collaborative Study Group of Infant Acute Leukemia has found that mothers exposed to dipyrone, pesticides and hormones had an increased chance to give birth to babies with infant acute leukemia [OR = 1.48 (95%CI = 1.05-2.07, OR = 2.27 (95%CI = 1.56-3.31 and OR = 9.08 (95%CI = 2.95-27.96], respectively. This review aims to summarize recent clues that have facilitated the elucidation of the biology of early childhood leukemias, with emphasis on infant acute leukemia in the Brazilian population.

  15. The early Earth atmosphere and early life catalysts. (United States)

    Ramírez Jiménez, Sandra Ignacia


    Homochirality is a property of living systems on Earth. The time, the place, and the way in which it appeared are uncertain. In a prebiotic scenario two situations are of interest: either an initial small bias for handedness of some biomolecules arouse and progressed with life, or an initial slight excess led to the actual complete dominance of the known chiral molecules. A definitive answer can probably never be given, neither from the fields of physics and chemistry nor biology. Some arguments can be advanced to understand if homochirality is necessary for the initiation of a prebiotic homochiral polymer chemistry, if this homochirality is suggesting a unique origin of life, or if a chiral template such as a mineral surface is always required to result in an enantiomeric excess. A general description of the early Earth scenario will be presented in this chapter, followed by a general description of some clays, and their role as substrates to allow the concentration and amplification of some of the building blocks of life.

  16. Early innovation - NRX and NRU

    International Nuclear Information System (INIS)

    Collins, J.H.


    Innovation has been an integral part of the entire histories of both the NRX and NRU reactors, their systems and the programs conducted in them. I have chosen to emphasize the period of the first decade of NRX operation because it was such a time of discovery. What might be considered obvious today was unknown then. It was at the end of this period that NRU's operation began. This is not a technical paper nor is it intended to be. Rather, it is my version of an oral history of the time recorded from my memory of events or from information told to me by others. The basic facts have been verified through reference to Dr. D.A. Keys' excellent reports and the other progress reports of the time. Some of my old colleagues might have chosen different examples. I do believe that what is included is a reasonable cross-section of examples of early innovation. To help orient those who are not familiar with NRX and NRU and perhaps jog the memories of others, appended are a cutaway view and simple cross-section of each reactor as well as a schematic view of the uranium fuel rod originally used in NRX. With the startup of NRX in 1947 Canada became a major player on the world's nuclear stage. Much work had been done before this date. There was early research by Canadian scientists such as Dr. G.C. Laurence at NRC. As part of the war effort, through the collaborative efforts with our allies led by the U.K. and the U.S. the program to build NRX evolved. At the time the primary purpose of the reactor was to produce Plutonium-239 and Uranium-233. ZEEP was the first reactor to operate outside the U.S. as a step in the development of NRX. The Canadian nuclear industry owes much to those who contributed to the design and building of NRX. They did an outstanding job. A reactor that was built with war in mind was so astonishingly flexible that it became one of the world's renowned contributors to the peaceful uses of nuclear energy

  17. Early childhood programs and the education system. (United States)

    Beach, Jane; Bertrand, Jane


    Policy makers, advocates and experts agree that the current delivery of early childhood development programs is fragmented. Many point to the education system as a better alternative for a more coherent approach that has the necessary infrastructure in place in communities, and is well placed to meet the needs of all young children and their families. In other jurisdictions, early childhood development programs have moved into education. In Canada, provincial and local school authorities are taking on more early childhood programs.


    Directory of Open Access Journals (Sweden)

    V. O. Mager


    Full Text Available Radical cystectomy (RCE is associated with a considerable number of early postoperative complications as before. Based on 10 years’ experience, this paper demonstrates the frequency (33.9 % and types of early complications following RCE, as well as postoperative mortality (5.5 % and its resulting causes. Although postoperative mortality is relatively low today, the frequency of early postoperative complications remains high as before.

  19. Timely Healthcare Checkup Catches Melanoma Early (United States)

    ... Skin Cancer" Articles Skin Cancer Can Strike Anyone / Skin Cancer: Biology, Risk Factors & Treatment / Timely Healthcare Checkup Catches Melanoma Early / NIH Research to Results / Skin and Sun – ...

  20. Genetics of Severe Early Onset Epilepsies (United States)


    Epilepsy; Epileptic Encephalopathy; Ohtahara Syndrome; Infantile Spasms; Dravet Syndrome; Malignant Migrating Partial Epilepsy of Infancy; Early Myoclonic Epileptic Encephalopathy; PCDH19-related Epilepsy and Related Conditions

  1. Cerebellar ataxia of early onset

    International Nuclear Information System (INIS)

    Yamashita, Sumimasa; Miyake, Shota; Yamada, Michiko; Iwamoto, Hiroko; Yamada, Kazuhiko.


    Eight cases of childhood cerebellar ataxia were reported. All these cases showed chronic cerebellar ataxia with early onset, and the other diseases of cerebellum such as infections, neoplasms and storage diseases were excluded by clinical symptoms and laboratory findings including blood counts, blood chemistry, lactate, pyruvate, ceruloplasmine, urinalysis, serum immunoglobulins, amino acid analysis in blood and urine, CSF analysis, leukocyte lysosomal enzymes, MCV, EMG, EEG and brain X-CT. Two pairs of siblings were included in this study. The clinical diagnosis were cerebellar type (5), spinocerebellar type (1), one Marinesco-Sjoegren syndrome and undetermined type (1). The age of onset was 1 to 5 years. The chief complaint was motor developmental delay in 6 cases; among them 5 patients could walk alone at the ages of 2 to 3 years'. Mental retardation was observed in 7 cases and epilepsy in 2. TRH was effective in 5 cases. The MRI study revealed that the area of medial sagittal slice of the cerebellum was reduced significantly in all cases and also that of pons was reduced in 5 cases. Different from typical adult onset spinocerebellar degenerations, most of the present cases have achieved slow developmental milestones and the clinical course was not progressive. Genetic factors are suspected in the pathogenesis of this disease in some cases. (author)

  2. Cosmology and the early universe (United States)

    Joshi, Abhigna


    In the beginning the universe was in a hot dense state nearly 13.8 billion years ago. The thermal history of the universe was traced back to an era when the temperature was about 1012K. At this early time, the universe was filled with particles-mostly photons and leptons- whose interactions are hopefully weak enough to allow this medium to be treated as a more or less ideal gas. However, if we look back a little further, into the first 0.0001 second of cosmic history when the temperature was above 1012K. At such temperatures, there will be present in thermal equilibrium copious numbers of strongly interacting particles-mostly masons and baryons-with a mean interparticle distance less than a Compton wavelength. These particles will be in a state of continual mutual interaction, and cannot reasonably be expected to obey any simple equation of state. The inflationary epoch lasted from 10-36seconds after the Big Bang to sometime between 10-33and 10-32seconds. Matter and energy created in this time. Right after that space expanded exponentially with enormous rate of 74.3 +/-2.1Km per second per Mpc. Undergraduate student and researcher of the string theory, quantum gravity, cosmology and quantum biology.

  3. Casebooks in Early Modern England: (United States)

    Kassell, Lauren


    summary Casebooks are the richest sources that we have for encounters between early modern medical practitioners and their patients. This article compares astrological and medical records across two centuries, focused on England, and charts developments in the ways in which practitioners kept records and reflected on their practices. Astrologers had a long history of working from particular moments, stellar configurations, and events to general rules. These practices required systematic notation. Physicians increasingly modeled themselves on Hippocrates, recording details of cases as the basis for reasoned expositions of the histories of disease. Medical records, as other scholars have demonstrated, shaped the production of medical knowledge. Instead, this article focuses on the nature of casebooks as artifacts of the medical encounter. It establishes that casebooks were serial records of practice, akin to diaries, testimonials, and registers; identifies extant English casebooks and the practices that led to their production and preservation; and concludes that the processes of writing, ordering, and preserving medical records are as important for understanding the medical encounter as the records themselves. PMID:25557513

  4. Early vision and focal attention (United States)

    Julesz, Bela


    At the thirty-year anniversary of the introduction of the technique of computer-generated random-dot stereograms and random-dot cinematograms into psychology, the impact of the technique on brain research and on the study of artificial intelligence is reviewed. The main finding-that stereoscopic depth perception (stereopsis), motion perception, and preattentive texture discrimination are basically bottom-up processes, which occur without the help of the top-down processes of cognition and semantic memory-greatly simplifies the study of these processes of early vision and permits the linking of human perception with monkey neurophysiology. Particularly interesting are the unexpected findings that stereopsis (assumed to be local) is a global process, while texture discrimination (assumed to be a global process, governed by statistics) is local, based on some conspicuous local features (textons). It is shown that the top-down process of "shape (depth) from shading" does not affect stereopsis, and some of the models of machine vision are evaluated. The asymmetry effect of human texture discrimination is discussed, together with recent nonlinear spatial filter models and a novel extension of the texton theory that can cope with the asymmetry problem. This didactic review attempts to introduce the physicist to the field of psychobiology and its problems-including metascientific problems of brain research, problems of scientific creativity, the state of artificial intelligence research (including connectionist neural networks) aimed at modeling brain activity, and the fundamental role of focal attention in mental events.

  5. Women, motherhood and early childhood

    DEFF Research Database (Denmark)

    Ravnbøl, Camilla Ida

    This paper explores the question of how Roma women’s situation influences Roma children’s survival, growth and development in the early years. It focuses specifically on the barriers and opportunities for action that Roma women experience and how these influence their possibilities to engage in e...... an assessment of the mothers’ capacity to internalize and act upon advice. It is argued that supporting Roma women’s access to human rights is likely to have positive outcomes for the women and their families, especially the young children...... in efforts for their young children. The paper adopts the perspective that in poor and socially excluded Roma communities, young children’s survival, growth and development cannot be addressed effectively if the rights of women are overlooked. Roma women navigate in contexts where they, as women, experience...... multiple barriers to their agency in particular due to multiple forms of discrimination and living in poverty on the margins of society. In such contexts of disempowerment, programme responses are likely to meet with limited success if they seek to teach mothers about child care and rearing, without...

  6. Hepatic vein and inferior vena caval thrombus extending into the right atrium: A rare complication of amoebic liver abscess

    International Nuclear Information System (INIS)

    Rehman, S.; Alvi, A.R.


    Amoebic liver abscess is an endemic in developing countries but few cases of associated vascular complications have been reported. The authors report a very rare vascular complication of hepatic veins and inferior vena caval (IVC) thrombosis extending into the right atrium in a young male with large amoebic liver abscess. Optimal result was achieved with early diagnosis on CT scan, percutaneous drainage of abscess, intravenous metronidazole, peri-operative anticoagulation, sternotomy and thrombectomy. (author)

  7. From early wireless to Everest. (United States)

    Allen, A


    Medical information has been transmitted using wireless technologies for almost 80 years. A "wired wireless" electronic stethoscope was developed by the U.S. Army Signal Corps in the early 1920's, for potential use in ship-to-shore transmission of cardiac sounds. [Winters SR. Diagnosis by wireless. Scientific American June 11, 1921, p. 465] Today, wireless is used in a wide range of medical applications and at sites from transoceanic air flights to offshore oil platforms to Mt. Everest. 'Wireless LANs' are often used in medical environments. Typically, nurses and physicians in a hospital or clinic use hand-held "wireless thin client" pen computers that exchange patient information and images with the hospital server. Numerous companies, such as Fujitsu (article below) and Cruise Technologies ( manufacture handheld pen-entry computers. One company, LXE, integrates radio-frequency (RF) enhanced hand-held computers specifically designed for production use within a wireless LAN ( Other companies (Proxim, Symbol, and others) supply the wireless RF LAN infrastructure for the enterprise. Unfortunately, there have been problems with widespread deployment of wireless LANs. Perhaps the biggest impediment has been the lack of standards. Although an international standard (IEEE 802.11) was adopted in 1997, most wireless LAN products still are not compatible with the equipment of competing companies. A problem with the current standard for LAN adapters is that throughput is limited to 3 Mbps--compared to at least 10 Mbps, and often 100 Mbps, in a hard-wired Ethernet LAN. An II Mbps standard is due out in the next year or so, but it will be at least 2 years before standards-compliant products are available. This story profiles some of the ways that wireless is being used to overcome gaps in terrestrial and within-enterprise communication.

  8. The Early History of Life (United States)

    Nisbet, E. G.; Fowler, C. M. R.


    The youth of the Earth is strange to us. Many of the most fundamental constraints on life may have been different, especially the oxidation state of the surface. Should we suddenly land on its Hadean or early Archean surface by some sci-fi accident, we would not recognize our home. Above, the sky may have been green or some other unworldly color, and above that the weak young Sun might have been unrecognizable to someone trying to identify it from its spectrum. Below, seismology would show a hot, comparatively low-viscosity interior, possibly with a magma ocean in the deeper part of the upper mantle (Drake and Righter, 2002; Nisbet and Walker, 1982), and a core that, though present, was perhaps rather smaller than today. The continents may have been small islands in an icy sea, mostly frozen with some leads of open water, ( Sleep et al., 2001). Into these icy oceans, huge protruding Hawaii-like volcanoes would have poured out vast far-spreading floods of komatiite lavas in immense eruptions that may have created sudden local hypercane storms to disrupt the nearby icebergs. And meteorites would rain down.Or perhaps it was not so strange, nor so violent. The child is father to the man; young Earth was mother to Old Earth. Earth had hydrogen, silicate rock below and on the surface abundant carbon, which her ancient self retains today. Moreover, Earth was oxygen-rich, as today. Today, a tiny part of the oxygen is free, as air; then the oxygen would have been in the mantle while the surface oxygen was used to handcuff the hydrogen as dihydrogen monoxide. Oxygen dihydride is dense, unlikely to fly off to space, and at the poles, rock-forming. Of all the geochemical features that make Earth unique, the initial degassing (Genesis 2 : b) and then the sustained presence of liquid water is the defining oddity of this planet. Early Earth probably also kept much of its carbon, nitrogen, and sulfur as oxide or hydride. And, after the most cataclysmic events had passed, ˜4.5 Ga

  9. Early adolescent music preferences and minor delinquency

    NARCIS (Netherlands)

    ter Bogt, T.F.M.; Keijsers, L.G.M.T.; Meeus, W.H.J.


    Objectives: To test Music Marker Theory (MMT) positing that early adolescents’ preferences for nonmainstream types of popular music indicate concurrent and later minor delinquency. Methods: MMT was tested in a 4-year longitudinal study (n = 309). Results: The results showed that early fans of

  10. Legitimacy and the Value of Early Customers

    NARCIS (Netherlands)

    Wang, Tang; Song, Michael; Zhao, Y. Lisa


    To overcome resource constraints and achieve exponential growth, a new venture must rely on early customers of its products to communicate value and commitment to others. For this reason, founders of new ventures focus more on early customers as a key element of their founding strategy than on other

  11. Good practices in early childhood education:

    DEFF Research Database (Denmark)

    Sanders, Lise; Gregoriadis, Athanasis; Zachopoulou, Evridiki

    Good practices in early childhood education er en undersøgelse fortaget efter Early Childhood Environmental Rating Scale - R (ECERS-R). I undersøgelsen deltog Akademikere, pædagoger og kommunalt personale fra de 6 partnerlande bestående af Grækenland, Portugal, Finland, Danmark, Rumænien og Cypern...

  12. Early life factors and adult mammographic density

    NARCIS (Netherlands)

    Lokate, M.; Duijnhoven, van F.J.B.; Berg, van den S.W.; Peeters, P.H.; Gils, van C.H.


    Purpose Early life factors have shown to be related to breast cancer risk. The pathophysiological link could be mammographic density, a strong risk factor for breast cancer. Mammary gland development already starts in utero and early life factors might affect the number of mammary cells at risk. In

  13. Early detection of COPD in general practice

    DEFF Research Database (Denmark)

    Ulrik, Charlotte Suppli; Løkke, Anders; Dahl, Ronald


    Early detection enables the possibility for interventions to reduce the future burden of COPD. The Danish National Board of Health recommends that individuals >35 years with tobacco/occupational exposure, and at least 1 respiratory symptom should be offered a spirometry to facilitate early...

  14. Gene expression in early stage cervical cancer

    NARCIS (Netherlands)

    Biewenga, Petra; Buist, Marrije R.; Moerland, Perry D.; van Thernaat, Emiel Ver Loren; van Kampen, Antoine H. C.; ten Kate, Fiebo J. W.; Baas, Frank


    Objective. Pelvic lymph node metastases are the main prognostic factor for survival in early stage cervical cancer, yet accurate detection methods before surgery are lacking. In this study, we examined whether gene expression profiling can predict the presence of lymph node metastasis in early stage

  15. Challenges and limitations in early intervention

    NARCIS (Netherlands)

    Hadders-Algra, Mijna

    Research over the past three decades has shown that early intervention in infants biologically at risk of developmental disorders, irrespective of the presence of a brain lesion, is associated with improved cognitive development in early childhood without affecting motor development. However, at

  16. The Democratic Theory of the Early Marx

    NARCIS (Netherlands)

    Raekstad, P.


    This article presents a novel reading of Marx’s early, pre-1844, democratic theory, and its connection with his early views on alienation. It argues, contra established readings, that Marx had a properly developed theory of alienation prior to his famous Economic and Philosophical Manuscripts of

  17. Early Stuttering, Temperament and Anxiety: Two Hypotheses (United States)

    Kefalianos, Elaina; Onslow, Mark; Block, Susan; Menzies, Ross; Reilly, Sheena


    Purpose: The topic of temperament and early stuttering and the extent to which it involves anxiety is theoretically and clinically relevant. The topic can contribute to theory development and clinical practices with early stuttering. Method: We present a review of the empirical literature for this area with a view to determining which of two…

  18. The EHDI and Early Intervention Connection (United States)

    Nelson, Lauri; Bradham, Tamala S.; Houston, K. Todd


    State coordinators of early hearing detection and intervention (EHDI) programs completed a strengths, weaknesses, opportunities, and threats, or SWOT, analysis that examined 12 areas within state EHDI programs. For the early intervention focus question, 48 coordinators listed 273 items, and themes were identified within each SWOT category. A…

  19. Redox fluctuations in the Early Ordovician oceans

    DEFF Research Database (Denmark)

    D'Arcy, Joan Mary; Gilleaudeau, Geoffrey Jon; Peralta, Silvio


    δ53Cr values of limestones and dolostones from an Early Ordovician marine carbonate platform (Cerro La Silla section of the Precordillera, San Juan, Argentina). An increasing number of studies support the hypothesis that the Early Ordovician oceans were stratified with respect to oxygen...

  20. Early Sport Specialization: A Psychological Perspective (United States)

    Gould, Daniel


    Specializing too early in life can lead to emotional stress, loss of motivation, and burnout, but the research is inadequate to resolve the question of whether early specialization or diversification is more beneficial from a psychological perspective. Nevertheless, some best practices are recommended based on the known benefits and detriments.…

  1. Early Care in Children with Neurodevelopmental Disorders (United States)

    Ponce-Meza, Jacqueline


    The article analyzes the importance of early care in child development, guiding a neuropsychological perspective of development. The early care model seeks to refer to the set of interventions aimed at children and their work in conjunction with a multidisciplinary team. It presents recommendations for the implementation of programs that allow…

  2. Early Years Students' Relationships with Mathematics (United States)

    Takeuchi, Miwa Aoki; Towers, Jo; Plosz, Jennifer


    Early years mathematics experiences have been shown to be a significant predictor for students' school readiness and future mathematics achievement. Previous research also indicates an important connection between emotion and mathematics learning. How do students in early years education in Alberta describe their emotional relationship with…

  3. Early-stage mantle cell lymphoma

    DEFF Research Database (Denmark)

    Dabaja, B S; Zelenetz, A D; Ng, A K


    Background: Mantle cell lymphoma (MCL) rarely presents as early-stage disease, but clinical observations suggest that patients who present with early-stage disease may have better outcomes than those with advanced-stage disease. Patients and methods: In this 13-institution study, we examined...

  4. Orphans in mediterranean antiquity and early Christianity ...

    African Journals Online (AJOL)

    ... in age at first marriage for men and women) that contributed to the high incidence of orphans in antiquity. Part 3 surveys the recognition of orphans' vulnerability in ancient Babylon, ancient Israel and early Judaism, ancient Greece, and imperial Rome. Part 4 discusses the treatment of orphans in early Christianity, focusing ...

  5. Early Childhood Math: Make It Manipulative! (United States)

    Stone, Janet I.


    Maintains that early childhood teachers should provide young children with creative, stimulating, and manipulative (hands-on) experiences rather than workbook pages in early mathematics programs. Presents reasons and corresponding counterpositions for using workbooks and suggests sample activities which teachers can use to make mathematics more…

  6. Early Childhood Education: History, Theory, and Practice (United States)

    Morgan, Harry


    In this book, the author covers the history, theory, and practices that influence early childhood education along with an emphasis on infant and toddler care and education. He also presents a comparison of the conflict between education planners who support early childhood studies and state school systems whose cost-saving measures are dismantling…

  7. Understanding the Early Years (UEY) Initiative (United States)

    Human Resources and Social Development Canada, 2007


    Internal Audit Services conducted an Early Implementation Review of the Understanding the Early Years (UEY) Initiative in 2006-07. This review is intended to provide assurance to senior management that program delivery has been established appropriately in order to meet its objectives and highlight any areas that require focused management…

  8. Pretend Play in the Early Childhood Classroom (United States)

    McEntire, Nancy


    This article presents and summarizes recent resources related to pretend play in the early childhood classroom. These include "Contemporary Perspectives on Play in Early Childhood Education" by Olivia N. Sarachoe and Bernard Spodek; "Dramatic Play: Bring It Back" by Tammy Benson; and "The Importance of Being Playful" by Elena Bodrova and Deborah…

  9. Transforming early childhood education for sustainable development

    African Journals Online (AJOL)

    This paper examined the ways in which early childhood education needs to be transformed for sustainable development. These ways include teaching children environmental security through play, personal hygiene, appropriate waste use and disposal, and nature awareness. It was recommended that early childhood ...

  10. [Treatment of early stage Hodgkin disease

    DEFF Research Database (Denmark)

    Specht, Lena; Carde, P.; Mauch, P.


    indicate that we still do not definitively know whether or not the early addition of prophylactic chemotherapy improves survival. Arguments in favour of early chemotherapy are: that laparotomy may be avoided, that radiation fields and doses may perhaps be reduced, and that the stress of experiencing...

  11. REVIEW ARTICLE Conjugated Hyperbilirubinaemia in Early Infancy ...

    African Journals Online (AJOL)

    REVIEW ARTICLE Conjugated Hyperbilirubinaemia in Early Infancy. AOK Johnson. Abstract. Conjugated hyperbilirubinaemia exists when the conjugated serum bilirubin level is more than 2 mg/dl or more than 20 per cent of the total serum bilirubin. It is always pathological in early infancy. The causes are many and diverse ...

  12. Early detection of COPD in general practice

    DEFF Research Database (Denmark)

    Ulrik, Charlotte Suppli; Løkke, Anders; Dahl, Ronald


    Early detection enables the possibility for interventions to reduce the future burden of COPD. The Danish National Board of Health recommends that individuals >35 years with tobacco/occupational exposure, and at least 1 respiratory symptom should be offered a spirometry to facilitate early detect...

  13. New treatment of early fetal chylothorax

    DEFF Research Database (Denmark)

    Nygaard, Ulrikka; Sundberg, Karin; Nielsen, Henriette Svarre


    OBJECTIVE: To evaluate OK-432, a preparation of Streptococcus pyogenes, in the treatment of early fetal chylothorax. METHODS: A prospective study of all fetuses (n=7) with persistent early chylothorax (gestational ages 16-21 weeks) referred to the tertiary center of fetal medicine in Denmark...

  14. The early novels of Ngugi Wa Thiongo

    African Journals Online (AJOL)



    May 6, 2006 ... As a writer, therefore, Ngugi is not satisfied with the surface appearance of society and individuals, rather he is ..... keeps pace with the trends of the early to mid 20 th. Century among ..... 8 We note here though that the fashion in name change was also a pan-Africanist gesture during the late pre- and early ...

  15. Evolution of the early Antarctic ice ages

    NARCIS (Netherlands)

    Liebrand, Diederik; de Bakker, Anouk T M|info:eu-repo/dai/nl/371573734; Beddow, Helen M; Wilson, Paul A; Bohaty, Steven M; Ruessink, Gerben|info:eu-repo/dai/nl/169093360; Pälike, Heiko; Batenburg, Sietske J; Hilgen, Frederik J|info:eu-repo/dai/nl/102639876; Hodell, David A; Huck, Claire E; Kroon, Dick; Raffi, Isabella; Saes, Mischa J M; van Dijk, Arnold E|info:eu-repo/dai/nl/341412082; Lourens, Lucas J|info:eu-repo/dai/nl/125023103


    Understanding the stability of the early Antarctic ice cap in the geological past is of societal interest because present-day atmospheric CO2 concentrations have reached values comparable to those estimated for the Oligocene and the Early Miocene epochs. Here we analyze a new high-resolution

  16. Early Risers. What Works Clearinghouse Intervention Report (United States)

    What Works Clearinghouse, 2012


    "Early Risers" is a multi-year prevention program for elementary school children demonstrating early aggressive and disruptive behavior. The intervention model includes two child-focused components and two parent/family components. The Child Skills component is designed to teach skills that enhance children's emotional and behavioral…

  17. The Starting Early Starting Smart Story. (United States)

    Casey Family Programs, Seattle, WA.

    Starting Early Starting Smart (SESS) is an early childhood public/private initiative designed to identify new, empirical knowledge about the effectiveness of integrating substance abuse prevention, addictions treatment, and mental health services with primary health care and childcare service settings (e.g., Head Start, day care, preschool) to…

  18. The Early Rehabilitation Barthel Index (ERBI). (United States)

    Rollnik, J D


    An extended version of the Barthel index, the so-called "Early Rehabilitation Barthel Index", or ERBI, is widely used in German early neurological rehabilitation centres and even was used in defining early rehabilitation procedures in the German DRG system. It contains highly relevant items like mechanical ventilation, tracheostomy, or dysphagia. This study presents an English version of the ERBI and examines its validity and reliability. Two samples of early neurological rehabilitation patients have been analyzed. In one sample (n=1,669), measures of morbidity and length of stay (LOS) have been compared between certain ERBI categories. In a second sample (n=273), inter-rater reliability (nurses vs. physicians) has been examined. Patients with low ERBI had a significantly longer LOS than those with high ERBI values (pscale to assess early neurological rehabilitation patients. © Georg Thieme Verlag KG Stuttgart · New York.

  19. Screening of colorectal early cancer by radiology

    International Nuclear Information System (INIS)

    Matsukawa, M.; Usui, Y.; Kobayashi, S.


    The incidence of colorectal cancer has been gradually increasing in Japan, and if the present rate of increase is maintained it has been estimated that it will become the most common of all malignant neoplasms by the year 2000. It has been proved that colorectal cancer can be completely cured, if it is treated in its early phase. Early cancer of the large bowel is defined as a cancer which is limited to the mucosal membrane or submucosal layer, regardless of lymph node and distant metastases. Detection of early cancer improves the overall curability of colorectal cancer. The greatest number of early cancers of the large bowel are polypoid lesions in their macroscopic form, and depressed lesions are rarely encountered. Accordingly, the first step in the detection of early cancer starts with the screening of polypoid lesion by radiology and endoscopy. This paper is concerned with diagnostic accuracy of radiology in the screening of colorectal cancer with endoscopic correlation

  20. Long-term Consequences of Early Parenthood

    DEFF Research Database (Denmark)

    Johansen, Eva Rye; Nielsen, Helena Skyt; Verner, Mette

    Having children at an early age is known to be associated with unfavorable economic outcomes, such as lower education, employment and earnings. In this paper, we study the long-term consequences of early parenthood for mothers and fathers. Our study is based on rich register-based data that......, importantly, merges all childbirths to the children’s mothers and fathers, allowing us to study the consequences of early parenthood for both parents. We perform a sibling fixed effects analysis in order to account for unobserved family attributes that are possibly correlated with early parenthood...... (and to lesser extent employment), as fathers appear to support the family, especially when early parenthood is combined with cohabitation with the mother and the child. Heterogeneous effects reveal that individuals with a more favorable socioeconomic background are affected more severely than...

  1. Sophisticated digestive systems in early arthropods. (United States)

    Vannier, Jean; Liu, Jianni; Lerosey-Aubril, Rudy; Vinther, Jakob; Daley, Allison C


    Understanding the way in which animals diversified and radiated during their early evolutionary history remains one of the most captivating of scientific challenges. Integral to this is the 'Cambrian explosion', which records the rapid emergence of most animal phyla, and for which the triggering and accelerating factors, whether environmental or biological, are still unclear. Here we describe exceptionally well-preserved complex digestive organs in early arthropods from the early Cambrian of China and Greenland with functional similarities to certain modern crustaceans and trace these structures through the early evolutionary lineage of fossil arthropods. These digestive structures are assumed to have allowed for more efficient digestion and metabolism, promoting carnivory and macrophagy in early arthropods via predation or scavenging. This key innovation may have been of critical importance in the radiation and ecological success of Arthropoda, which has been the most diverse and abundant invertebrate phylum since the Cambrian.

  2. Early Childhood Educators' Perceived and Actual Metalinguistic Knowledge, Beliefs and Enacted Practice about Teaching Early Reading (United States)

    Hammond, Lorraine


    Results of influential reports on early literacy have drawn attention to the need for early childhood educators to take up a more explicit, teacher-directed approach to beginning reading. Positive classroom results however are in part dependent upon teacher knowledge and this study investigated the relationship between early childhood educators'…

  3. The Association between Early Conduct Problems and Early Marijuana Use in College Students (United States)

    Falls, Benjamin J.; Wish, Eric D.; Garnier, Laura M.; Caldeira, Kimberly M.; O'Grady, Kevin E.; Vincent, Kathryn B.; Arria, Amelia M.


    Early conduct problems have been linked to early marijuana use in adolescence. The present study examines this association in a sample of 1,076 college students that was divided into three groups: (1) early marijuana users (began marijuana use prior to age 15; N = 126), (2) late marijuana users (began marijuana use at or after age 15; N = 607),…

  4. Evolution of Early Cenozoic marine temperatures (United States)

    Zachos, James C.; Stott, Lowell D.; Lohmann, Kyger C.


    The equator to high southern latitude sea surface and vertical temperature gradients are reconstructed from oxygen isotope values of planktonic and benthic foraminifers for the following five time intervals: late Paleocene, early Eocene, early middle Eocene, late Eocene, and early Oligocene. Paleotemperatures are calculated using standard oxygen isotope/temperature equations with adjustments to account for (1) variations in sea water δ18O related to changes in global ice volume over time and (2) latitudinal gradients in surface water δ18O. These reconstructions indicate that sea-surface temperatures (SST) of the Southern Oceans in the early Eocene were as high as 15°C, whereas temperatures during the late Paleocene and early middle Eocene reached maximum levels of 10°-12°C. By the late Eocene and early Oligocene high latitude SST had declined to 6 and 4°C, respectively. For most of the early Paleogene, low latitude sub-tropical temperatures remained constant and well within the range of Holocene temperatures (24°ndash;25°C) but by the late Eocene and early Oligocene declined to values in the range of 18° to 22°C. The late Paleogene apparent decline in tropical temperatures, however, might be artificial because of dissolution of near-surface foraminifera tests which biased sediment assemblages toward deeper-dwelling foraminifera. Moreover, according to recent plate reconstructions, it appears that the majority of sites upon which the late Eocene and early Oligocene tropical temperatures were previously established were located either in or near regions likely to have been influenced by upwelling. Global deepwater temperature on average paralleled southern ocean SST for most of the Paleogene. We speculate based on the overall timing and character of marine sea surface temperature variation during the Paleogene that some combination of both higher levels of greenhouse gases and increased heat transport was responsible for the exceptional high-latitude warmth

  5. Early markers of adult obesity: a review (United States)

    Brisbois, T D; Farmer, A P; McCargar, L J


    Summary The purpose of this review was to evaluate factors in early childhood (≤5 years of age) that are the most significant predictors of the development of obesity in adulthood. Factors of interest included exposures/insults in the prenatal period, infancy and early childhood, as well as other socio-demographic variables such as socioeconomic status (SES) or birth place that could impact all three time periods. An extensive electronic and systematic search initially resulted in 8,880 citations, after duplicates were removed. Specific inclusion and exclusion criteria were set, and following two screening processes, 135 studies were retained for detailed abstraction and analysis. A total of 42 variables were associated with obesity in adulthood; however, of these, only seven variables may be considered as potential early markers of obesity based on the reported associations. Possible early markers of obesity included maternal smoking and maternal weight gain during pregnancy. Probable early markers of obesity included maternal body mass index, childhood growth patterns (early rapid growth and early adiposity rebound), childhood obesity and father's employment (a proxy measure for SES in many studies). Health promotion programmes/agencies should consider these factors as reasonable targets to reduce the risk of adult obesity. PMID:22171945

  6. Early Feeding After a Total Abdominal Hysterectomy

    Directory of Open Access Journals (Sweden)

    Mary Flesher


    Full Text Available Background: Oral fluids and food are traditionally introduced slowly after total abdominal hysterectomy (TAH. This descriptive study examined the effect and tolerance of early oral intake following this surgery. Methods: A retrospective chart review was conducted on 164 patients who had been on a clinical pathway following TAH. Comparisons in initiation of fluids and foods, and gastrointestinal effects were made between the early fed group (n=82 and the traditionally fed group (n=82. Results: Both groups had the similar gastrointestinal symptoms postoperatively, but the early fed group had an earlier bowel movement. The early fed group had a statistically significant shorter length of stay. Similar usage of anti-nausea medication and pain medication usage was noted between the two groups, except for a lower usage of Tylenol #3 (acetaminophen with codeine in the early fed group. Conclusions: This study found that early feeding could be tolerated well in TAH patients, with statistically significant improvements in usage of some pain medication and length of stay were noted in the early fed group.

  7. Very early and early systemic sclerosis in the Spanish scleroderma Registry (RESCLE) cohort. (United States)

    Trapiella-Martínez, Luis; Díaz-López, José Bernardino; Caminal-Montero, Luis; Tolosa-Vilella, Carles; Guillén-Del Castillo, Alfredo; Colunga-Argüelles, Dolores; Rubio-Rivas, Manuel; Iniesta-Arandia, Nerea; Castillo-Palma, María Jesús; Sáez-Comet, Luis; Egurbide-Arberas, María Victoria; Ortego-Centeno, Norberto; Freire, Mayka; Vargas-Hitos, Jose Antonio; Ríos-Blanco, Juan José; Todolí-Parra, Jose Antonio; Rodríguez-Carballeira, Mónica; Marín-Ballvé, Adela; Chamorro-Fernández, Antonio Javier; Pla-Salas, Xavier; Madroñero-Vuelta, Ana Belén; Ruiz-Muñóz, Manuel; Fonollosa-Pla, Vicent; Simeón-Aznar, Carmen Pilar


    According to the existence of subclinical organ involvement pre-scleroderma should be divided into two subsets: very early and early disease. Pre-scleroderma patients included in the Spanish Scleroderma Registry (RESCLE) Cohort were reclassified into subsets. Differences were evaluated and the risk of progression to definite systemic sclerosis was estimated. The characteristics of very early and early SSc patients were compared. A logistic regression model was used to determine the risk factors of progression. 1632 patients were included, 36 (2.2%) in the very early subset and 111 (6.8%) in the early subset. There were no differences in sex, age at disease onset, duration of Raynaud's phenomenon, antinuclear antibodies or capillaroscopic findings. Three (8.3%) very early SSc patients evolved to definite SSc, 2 (5.6%) of them meeting the ACR/EULAR 2013 criteria, unlike 31 (28%) early SSc patients, 20 (24%) of them meeting the criteria (p=0.034). Digestive involvement was an independent risk factor of progression (OR 17; 95% CI, 6.1-47.2). The classification of early forms of scleroderma identifies patients with different prognostic risk of progression. The evolution to definite SSc is more frequent in early than in very early SSc patients. Digestive involvement is a risk factor of progression. An active assessment of organ damage in preclinical stages allows a correct classification and risk stratification, with implications for monitoring and treatment. Copyright © 2017 Elsevier B.V. All rights reserved.

  8. [Early detection and prevention of dementia]. (United States)

    Urakami, Katsuya


    Dementia is about 15% aged 65 and over people now, and is regarded as the common disease. Early symptoms, such as forgetfulness, tend to be overlooked. Alzheimer type dementia is now possible to treat with medication. Therefore, early diagnosis and early treatment are required. Prevention of dementia is also expected and dementia checkup attracts attention. Although there was little data with high evidence, I introduced some reports about dementia prevention including our data. Dementia prevention is an important issue and establishment of evidence is desired in the near future.

  9. International Orders in the Early Modern World

    DEFF Research Database (Denmark)

    . Focusing on a crucial period of global history that has been neglected in the field of International Relations, the book reveals profound differences between the early modern era and the more familiar colonial conquests of the second half of the nineteenth century. It will be interest to students...... and scholars of international relations, international relations theory, international history, early modern history and sociology.......This book challenges the Eurocentric foundations of modern International Relations scholarship. Its primary empirical focus is the early modern era, when European primacy had yet to develop in many parts of the globe. It presents a series of regional case studies from experts on East Asia...

  10. The determinants of early retirement in Switzerland


    Dorn, David; Sousa-Poza, Alfonso


    In the past decade, Switzerland has experienced a large increase in the number of individuals going into early retirement. This paper examines the determinants of such early retirement using data from the newly implemented social-security module of the 2002 Swiss Labor Force Survey. In the sixteen-month period from January 2001 to April 2002, more than 36,000 older individuals, representing 8% of all workers within nine years of legal retirement age, became early retirees. One of the most imp...

  11. Diagnosis of early stomach cancer (Lecture)

    International Nuclear Information System (INIS)

    Vinner, M.G.


    Problems concerning diagnosis of early stomach cancer using X-ray and endoscopic investigation techniques are stated. Classification of early stomach cancer suggested by the Japan Endoscopy Society and division system of early stomach cancer into two main foms: depth (erosive-ulcerous) one and elevated (polypoid) one-is presented X-ray and endoscopic investigation techniques are shown to be high efficiency concerning revealingation of stomach mucous variations using biopsy, which allow to determine for certain whother the process is benign or malignant one


    Directory of Open Access Journals (Sweden)

    Pradeep Kumar Mishra


    Full Text Available In the 21st century, technology serves to reinforce the educational bedrock of any country. Technology has revolutionized the teaching learning process by integrating different source of knowledge - clearly visible from primary to post-tertiary level. This paper examines the introduction of ICT in early childhood years centred on the relationship of ICT with the cognitive, emotional and social development of children. The paper discusses various aspects of the ongoing debate around ICT usage in the early years and tries to answer some of the relevant issues namely, the rationale for early introduction of ICT, the perceived risks and benefits involved in its usage, the role of the parents, and fostering appropriate application of ICT in the early childhood classrooms.

  13. Early adolescent music preferences and minor delinquency. (United States)

    Ter Bogt, Tom F M; Keijsers, Loes; Meeus, Wim H J


    To test Music Marker Theory (MMT) positing that early adolescents' preferences for nonmainstream types of popular music indicate concurrent and later minor delinquency. MMT was tested in a 4-year longitudinal study (n = 309). The results showed that early fans of different types of rock (eg, rock, heavy metal, gothic, punk), African American music (rhythm and blues, hip-hop), and electronic dance music (trance, techno/hardhouse) showed elevated minor delinquency concurrently and longitudinally. Preferring conventional pop (chart pop) or highbrow music (classic music, jazz), in contrast, was not related to or was negatively related to minor delinquency. Early music preferences emerged as more powerful indicators of later delinquency rather than early delinquency, indicating that music choice is a strong marker of later problem behavior. The mechanisms through which music preferences are linked to minor delinquency are discussed within the framework of MMT.

  14. Alchemy--A History of Early Technology. (United States)

    Pollard, A. M.


    Reviews the history of alchemy including personalities and methods. Discusses the philosophy associated with various early chemists and alchemists. Attempts to show that it was not unreasonable for ancient alchemists to believe in the possibility of transmutation. (CW)

  15. Kidney Disease: Early Detection and Treatment (United States)

    ... Bar Home Current Issue Past Issues Special Section Kidney Disease: Early Detection and Treatment Past Issues / Winter 2008 ... called a "urine albumin-to-creatinine ratio." Treating Kidney Disease Kidney disease is usually a progressive disease, which ...

  16. Early medieval touchstones from Sowinki, Greater Poland

    Czech Academy of Sciences Publication Activity Database

    Ježek, Martin; Krzyszowski, A.; Zavřel, J.


    Roč. 91, 1-2 (2013), s. 177-186 ISSN 0016-8874 Institutional support: RVO:67985912 Keywords : Early Middle Ages * graveyards * touchstones * metals * electron microscopy * social structure Subject RIV: AC - Archeology, Anthropology, Ethnology

  17. 75 FR 24450 - Early Retiree Reinsurance Program (United States)


    ... comments in the CMS drop slots located in the main lobby of the building. A stamp- in clock is available... regulatory terminology and concepts should be the same or similar between the RDS Program and the Early...

  18. [Colorectal cancer: prevention and early detection]. (United States)

    Kolligs, Frank Thomas


    Colorectal cancer is one of the leading causes of cancer associated morbidity and mortality. Main risk factors include advanced age, affected family members, male sex and lifestyle factors. The development of early adenoma to invasive cancer requires 10 and more years. Therefore, prevention via colonoscopy with polypectomy and early detection of asymptomatic stages is possible. Colonoscopy is a diagnostic and therapeutic tool with the highest sensitivity for precancerous lesions and early cancers of the colon. New fecal immunological tests reveal a higher sensitivity for advanced adenoma and cancer than guaiac based hemoccult tests while maintaining a high specificity. Molecular stool and blood tests are promising new developments. However, similar to virtual colonoscopy and colon capsule endoscopy, they have so far not been established as routine instruments for prevention and early detection of colorectal cancer. © Georg Thieme Verlag KG Stuttgart · New York.

  19. Business Case for Early Childhood Investments (United States)

    America's Promise Alliance (NJ1), 2011


    America's Promise's ReadyNation initiative has released this brief, which "makes the case" to business leaders on why investing in early childhood should be important to them. The brief includes "how-to" tips, helpful statistics and more.

  20. AOSSM Early Sport Specialization Consensus Statement (United States)

    LaPrade, Robert F.; Agel, Julie; Baker, Joseph; Brenner, Joel S.; Cordasco, Frank A.; Côté, Jean; Engebretsen, Lars; Feeley, Brian T.; Gould, Daniel; Hainline, Brian; Hewett, Timothy E.; Jayanthi, Neeru; Kocher, Mininder S.; Myer, Gregory D.; Nissen, Carl W.; Philippon, Marc J.; Provencher, Matthew T.


    Background: Early sport specialization is not a requirement for success at the highest levels of competition and is believed to be unhealthy physically and mentally for young athletes. It also discourages unstructured free play, which has many benefits. Purpose: To review the available evidence on early sports specialization and identify areas where scientific data are lacking. Study Design: Think tank, roundtable discussion. Results: The primary outcome of this think tank was that there is no evidence that young children will benefit from early sport specialization in the majority of sports. They are subject to overuse injury and burnout from concentrated activity. Early multisport participation will not deter young athletes from long-term competitive athletic success. Conclusion: Youth advocates, parents, clinicians, and coaches need to work together with the sport governing bodies to ensure healthy environments for play and competition that do not create long-term health issues yet support athletic competition at the highest level desired. PMID:27169132

  1. Early infarct detection assistance through image colourisation

    International Nuclear Information System (INIS)

    Sim, K.S.; Tan, T.L.; Ong, M.K.; Tan, C.K.; Hamid, R.A.


    Early infarct detection on brain images is difficult due to their subtle signs. However, early detection on infarct sign can provide early treatment to preserve other healthy brain tissues. In this project, a technique is proposed to enhance the interpretation of computer tomography (CT) brain images to improve the detection of brain infarct. The proposed method stretches the contrast of the CT brain image based on Hounsfield units and applies colourisation to the contrast-stretched image to improve the observation of the CT brain image by eye sight. A test was conducted in a private university in order to evaluate the proposed method. The results show that the detection of early infarct, carried by the students was improved by 5% with the help of the proposed method. (author)

  2. Exploring Equity in Early Postsecondary Education (United States)

    Fox, Heather L.; Zamani-Gallaher, Eboni M.


    This chapter examines how postsecondary practitioners are encouraged to work collaboratively with child welfare agencies and other community-based organizations to identify and implement culturally responsive supports for former foster youth to promote early academic achievement.

  3. Early Extracorporeal Detoxification after Cardiosurgical Interventions

    Directory of Open Access Journals (Sweden)

    G. P. Plotnikov


    Full Text Available Objective: to substantiate a need for early use of extracorporeal homeostatic correction techniques during cardiosurgical intensive care. Subjects and methods: A non-randomized study was conducted in 63 cardiosurgical patients with postoperatively evolving multiple organ dysfunction. The clinical efficiency and economic expediency of the early initiation of homeostatic correction were estimated by continuous low-flow venovenous hemofiltration on a Prisma apparatus. Results. The study has demonstrated the advantages of early (within the 36-hour postoperative period initiation of a procedure by the time of organ dysfunction recovery, the length of stay on a resuscitation bed, and pharmacoeconomic indices. Conclusion. The early (at the stage of dysfunction, until hemostasis becomes stable and in the absence of drainage volume losses initiation of hemofiltration in the development of multiple organ dysfunction after surgical interventions has been clinically and economically warranted. Key words: extracorporeal homeostatic correction, multiple organ dysfunction, cardiac surgery.

  4. Current early diagnostic biomarkers of prostate cancer

    Directory of Open Access Journals (Sweden)

    Min Qu


    Full Text Available Prostate cancer (PCa has become to have the highest incidence and the second mortality rate in western countries, affecting men's health to a large extent. Although prostate-specific antigen (PSA was discovered to help diagnose the cancer in an early stage for decades, its specificity is relative low, resulting in unnecessary biopsy for healthy people and over-treatment for patients. Thus, it is imperative to identify more and more effective biomarkers for early diagnosis of PCa in order to distinguish patients from healthy populations, which helps guide an early treatment to lower disease-related mortality by noninvasive or minimal invasive approaches. This review generally describes the current early diagnostic biomarkers of PCa in addition to PSA and summarizes the advantages and disadvantages of these biomarkers.

  5. Fact Sheet: Early Warning Signs of Psychosis (United States)

    ... items) Share Fact Sheet: Early Warning Signs of Psychosis Download PDF Download ePub Order a free hardcopy ... show changes in his or her behaviors before psychosis develops. The list below includes several warning signs ...

  6. Early and Periodic Screening, Diagnosis and Treatment (United States)

    U.S. Department of Health & Human Services — The Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit provides comprehensive and preventive health care services for children under age 21 who...

  7. Brain mechanisms in early language acquisition. (United States)

    Kuhl, Patricia K


    The last decade has produced an explosion in neuroscience research examining young children's early processing of language. Noninvasive, safe functional brain measurements have now been proven feasible for use with children starting at birth. The phonetic level of language is especially accessible to experimental studies that document the innate state and the effect of learning on the brain. The neural signatures of learning at the phonetic level can be documented at a remarkably early point in development. Continuity in linguistic development from infants' earliest brain responses to phonetic stimuli is reflected in their language and prereading abilities in the second, third, and fifth year of life, a finding with theoretical and clinical impact. There is evidence that early mastery of the phonetic units of language requires learning in a social context. Neuroscience on early language learning is beginning to reveal the multiple brain systems that underlie the human language faculty. 2010 Elsevier Inc. All rights reserved.

  8. Illinois Early Learning Project Tip Sheets: Social and Emotional Development. (United States)


    The Illinois Early Learning Project (IEL) is funded by the Illinois State Board of Education to provide information resources on early learning and training related to implementing the Illinois Early Learning Standards for parents and for early childhood personnel in all settings. The IEL tip sheets offer suggestions to parents and early childhood…

  9. The need to better classify and diagnose early and very early rheumatoid arthritis. (United States)

    Zeidler, Henning


    Early rheumatoid arthritis (RA) and very early RA are major targets of research and clinical practice. Remission has become a realistic goal in the management of RA, particularly in early disease. The 2010 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) RA classification criteria, the EULAR treatment recommendations for RA, and the EULAR recommendations for the management of early arthritis focus on early disease and translate the knowledge related to early RA into classification and management. Nevertheless, there is a need for further improvement and progress. Results from 6 recent studies are summarized, evaluating the performance of the 2010 ACR/EULAR RA classification criteria. The data show a significant risk of misclassification, and highlight that overdiagnosis and underdiagnosis may become important issues if the criteria recommend synthetic and biological disease-modifying antirheumatic drugs. Therefore, some considerations are presented on how the current problems and limitations could be overcome in clinical practice and future research. A consensus is needed to better define the early phase of RA and differentiate from other early arthritis. The possible effect of misclassification on spontaneous and drug-induced remission of early and very early RA awaits further elucidation. Such research will eventually lead to more reliable diagnostic and classification criteria for new-onset RA.

  10. Sterile neutrinos in the early universe

    Energy Technology Data Exchange (ETDEWEB)

    Malaney, R.A. (Lawrence Livermore National Lab., CA (USA)); Fuller, G.M. (California Univ., San Diego, La Jolla, CA (USA). Dept. of Physics)


    We discuss the role played by right-handed sterile neutrinos in the early universe. We show how well known {sup 4}He constraint on the number of relativistic degrees of freedom at early times limits the equilibration of the right handed neutrino sea with the background plasma. We discuss how this allows interesting constraints to be placed on neutrino properties. In particular, a new limit on the Dirac mass of the neutrino is presented. 12 refs.

  11. Early x-ray diagnosis of coxarthrosis

    Energy Technology Data Exchange (ETDEWEB)

    Lingg, G.; Nebel, G.

    Radiological and pathological comparisons on specimen of femur head and neck at autopsy have shown a statistical relationship between osteophytosis of the femoral head and ulcerations of the joint cartilage. Especially, there are highly significant relationships between the length of osteophytes and the diameter of the ulcera. The 'plaque'-sign is shown to be a very sensitive indicator of early arthrosis. So there exist semiquantitative parameters for the X-ray diagnosis of early coxarthrosis.

  12. Transitional Thermal Creep of Early Age Concrete

    DEFF Research Database (Denmark)

    Hauggaard-Nielsen, Anders Boe; Damkilde, Lars; Freiesleben Hansen, Per


    Couplings between creep of hardened concrete and temperature/water effects are well-known. Both the level and the gradients in time of temperature or water content influence the creep properties. In early age concrete the internal drying and the heat development due to hydration increase the effe...... of experimental results for creep of early age and hardened concrete either at different constant temperature levels or for varuing temperature histories illustrate the model....

  13. Early X-ray diagnosis of coxarthrosis

    International Nuclear Information System (INIS)

    Lingg, G.; Nebel, G.


    Radiological and pathological comparisons on specimen of femurhead and neck at autopsy have shown a statistical relationship between osteophytosis of the femoral head and ulcerations of the joint cartilage. Especially there are highly significant relationships between the length of osteophytes and the diameter of the ulcera. The 'plaque'-sign shows to be a very sensitive indicator of early arthrosis. So there exist semiquantitative parameters for the X-ray diagnosis of early coxarthrosis. (orig.) [de

  14. Early detection of COPD in general practice

    DEFF Research Database (Denmark)

    Ulrik, Charlotte Suppli; Løkke, Anders; Dahl, Ronald


    Early detection enables the possibility for interventions to reduce the future burden of COPD. The Danish National Board of Health recommends that individuals >35 years with tobacco/occupational exposure, and at least 1 respiratory symptom should be offered a spirometry to facilitate early...... detection of COPD. The aim, therefore, was to provide evidence for the feasibility and impact of doing spirometry in this target population....

  15. Supersymmetry: Early Roots That Did Not Grow

    Directory of Open Access Journals (Sweden)

    Cecilia Jarlskog


    Full Text Available This paper is about early roots of supersymmetry, as found in the literature from 1940s and early 1950s. There were models where the power of “partners” in alleviating divergences in quantum field theory was recognized. However, other currently known remarkable features of supersymmetry, such as its role in the extension of the Poincaré group, were not known. There were, of course, no supersymmetric nonabelian quantum field theories in those days.

  16. The SuperNova Early Warning System


    Scholberg, K.


    A core collapse in the Milky Way will produce an enormous burst of neutrinos in detectors world-wide. Such a burst has the potential to provide an early warning of a supernova's appearance. I will describe the nature of the signal, the sensitivity of current detectors, and SNEWS, the SuperNova Early Warning System, a network designed to alert astronomers as soon as possible after the detected neutrino signal.

  17. Occlusion Issues in Early Renaissance Art


    Barbara Gillam


    Early Renaissance painters innovatively attempted to depict realistic three-dimensional scenes. A major problem was to produce the impression of overlap for surfaces that occlude one another in the scene but are adjoined in the picture plane. Much has been written about perspective in art but little about occlusion. Here I examine some of the strategies for depicting occlusion used by early Renaissance painters in relation to ecological considerations and perceptual research. Perceived surfac...

  18. AOSSM Early Sport Specialization Consensus Statement


    LaPrade, Robert F.; Agel, Julie; Baker, Joseph; Brenner, Joel S.; Cordasco, Frank A.; Côté, Jean; Engebretsen, Lars; Feeley, Brian T.; Gould, Daniel; Hainline, Brian; Hewett, Timothy E.; Jayanthi, Neeru; Kocher, Mininder S.; Myer, Gregory D.; Nissen, Carl W.


    © 2016 The Author(s). This is an Open Access article. Background: Early sport specialization is not a requirement for success at the highest levels of competition and is believed to be unhealthy physically and mentally for young athletes. It also discourages unstructured free play, which has many benefits. Purpose: To review the available evidence on early sports specialization and identify areas where scientific data are lacking. Study Design: Think tank, roundtable discussion...

  19. Early development of the aplacophoran mollusc Chaetoderma

    DEFF Research Database (Denmark)

    Nielsen, Claus; Haszprunar, Gerhard; Ruthensteiner, Bernhard


    The early development of the trochophore larva of the aplacophoran Chaetoderma nitidulum (Mollusca: Caudofoveata = Chaetodermomorpha) is described using scanning and transmission electron microscopy and using fluorescence staining and confocal laser scanning microscopy of the muscle system. The m...... of the early anlagen of the circular body wall muscles does not show the anterior-posterior mode of formation that is typical for annelids, thus strengthening the hypothesis of a non-segmented ancestry of Mollusca....

  20. Music as therapy in early history. (United States)

    Thaut, Michael H


    The notion of music as therapy is based on ancient cross-cultural beliefs that music can have a "healing" effect on mind and body. Explanations for the therapeutic mechanisms in music have almost always included cultural and social science-based causalities about the uses and functions of music in society. However, it is also important to note that the view of music as "therapy" was also always strongly influenced by the view and understanding of the concepts and causes of disease. Magical/mystical concepts of illness and "rational" medicine probably lived side by side for thousands of years. Not until the late-nineteenth and early-twentieth centuries were the scientific foundations of medicine established, which allowed the foundations of music in therapy to progress from no science to soft science and most recently to actual brain science. Evidence for "early music therapy" will be discussed in four broad historical-cultural divisions: preliterate cultures; early civilizations in Mesopotamia, Egypt, Israel; Greek Antiquity; Middle Ages, Renaissance, and Baroque. In reviewing "early music therapy" practice, from mostly unknown periods of early history (using preliterate cultures as a window) to increasingly better documented times, including preserved notation samples of actual "healing" music, five theories and applications of early music therapy can be differentiated. © 2015 Elsevier B.V. All rights reserved.

  1. CT findings of early acute cerebral infarction

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Tae Hoon; Choi, Woo Suk; Ryu, Kyung Nam [Kyung Hee University Hospital, Seoul (Korea, Republic of)


    The CT findings of the acute cerebral infarction are well known. However the CT findings of early stroke within 24 hours of the onset have not been sufficiently reported. The purpose of this study is to evaluate early acute cerebral infarction on CT within 24 hours after ictus. The early and accurate CT diagnosis could lead to the appropriate therapy and improved outcome of the patients. Authors retrospectively analyzed 16 patients with early acute cerebral infarction. Acute cerebral infarction was confirmed by follow-up CT in 11 patients, SPECT in 4 patients, and MRI in 1 patient. The CT findings of early acute cerebral infarction include effacement of cortical sulci or cistern (n = 16, 100%), hyperattenuation of MCA (n = 3), obscuration of lentiform nucleus (n = 6), loss of insular ribbon (n = 6) and subtle low density in hemisphere (n = 5). The most frequent finding was effacement of cortical sulci in our study, and it was thought to be the most important sign of early acute cerebral infarction.

  2. Inflammation is present in early human tendinopathy. (United States)

    Millar, Neal L; Hueber, Axel J; Reilly, James H; Xu, Yinghua; Fazzi, Umberto G; Murrell, George A C; McInnes, Iain B


    The cellular mechanisms of tendinopathy remain unclear particularly with respect to the role of inflammation in early disease. The authors previously identified increased levels of inflammatory cytokines in an early human model of tendinopathy and sought to extend these studies to the cellular analysis of tissue. To characterize inflammatory cell subtypes in early human tendinopathy, the authors explored the phenotype and quantification of inflammatory cells in torn and control tendon samples. Controlled laboratory study. Torn supraspinatus tendon and matched intact subscapularis tendon samples were collected from 20 patients undergoing arthroscopic shoulder surgery. Control samples of subscapularis tendon were collected from 10 patients undergoing arthroscopic stabilization surgery. Tendon biopsy samples were evaluated immunohistochemically by quantifying the presence of macrophages (CD68 and CD206), T cells (CD3), mast cells (mast cell tryptase), and vascular endothelium (CD34). Subscapularis tendon samples obtained from patients with a torn supraspinatus tendon exhibited significantly greater macrophage, mast cell, and T-cell expression compared with either torn supraspinatus samples or control subscapularis-derived tissue (P shoulders with supraspinatus ruptures. This study provides evidence for an inflammatory cell infiltrate in early mild/moderate human tendinopathy. In particular, the authors demonstrate significant infiltration of mast cells and macrophages, suggesting a role for innate immune pathways in the events that mediate early tendinopathy. Clinical Relevance Further mechanistic studies to evaluate the net contribution and hence therapeutic utility of these cellular lineages and their downstream processes may reveal novel therapeutic approaches to the management of early tendinopathy.

  3. Predictive factors for early menarche in Taiwan. (United States)

    Chie, W C; Liu, Y H; Chi, J; Wu, V; Chen, A


    The rapid increase of breast cancer in Taiwan has prompted the authors to evaluate the predictive factors of early menarche among contemporary Taiwanese girls. A total of 895 four-grade girls from eight elementary schools in Taipei City and County were identified as a closed cohort from the first semester of 1993. Data were collected from self-administered questionnaires and school records. A total of 799 girls who had not menstruated in the first year remained in the group through 1994. The effects of potential predictive factors were assessed by logistic regression. Among the 799 girls followed, 69 (8.6%) had first menstruation between the fourth and fifth grades. Height, weight, body mass index and maternal early onset of menarche were positively related to the onset of menarche within the preceding year. Energy consumption during exercise showed only moderate association after being adjusted for age and weight. Calorie intake from junk food was not associated with early menarche within the preceding year. Poor interpersonal family relationships and stressful life events also showed a moderate association with early menarche. The data obtained supported the hypothesis that height, weight, body mass index and maternal early menarche are positive predictive factors of early menarche. The effects of exercise and childhood stress are less prominent.

  4. Biochemical investigation of earliness in radiation induced early flowering mutantlines of jute Corchorus capsularis L

    International Nuclear Information System (INIS)

    Islam, M.S.; Ilias, M.; Biswas, A.K.; Naznin, S.


    With the help of radiation induced early and late flowering mutantlines of jute, studies have been made to determine the biochemical factors which could regulate the induction and expression of genes for the flowering processes in this plant. Comparative biochemical investigations were done with the parameters like : plant pigments (Chlorophyl a, b and carotenoides), auxin/antiauxin, and gibberellin/anti-gibberellin type of substances. Quantitative as well as qualitative differences of plant pigments were observed between the early and late flowering lines. Extracts of early flowering lines have been found to induce earliness in the late flowering mother variety of jute (D-154). Re-isolated growth inhibitors of early flowering lines have also been found to induce earliness in the late flowering mother variety (D-154). (author)

  5. Precursors of adolescent substance use from early childhood and early adolescence: testing a developmental cascade model. (United States)

    Sitnick, Stephanie L; Shaw, Daniel S; Hyde, Luke W


    This study examined developmentally salient risk and protective factors of adolescent substance use assessed during early childhood and early adolescence using a sample of 310 low-income boys. Child problem behavior and proximal family risk and protective factors (i.e., parenting and maternal depression) during early childhood, as well as child and family factors and peer deviant behavior during adolescence, were explored as potential precursors to later substance use during adolescence using structural equation modeling. Results revealed that early childhood risk and protective factors (i.e., child externalizing problems, mothers' depressive symptomatology, and nurturant parenting) were indirectly related to substance use at the age of 17 via risk and protective factors during early and middle adolescence (i.e., parental knowledge and externalizing problems). The implications of these findings for early prevention and intervention are discussed.

  6. The association between early conduct problems and early marijuana use in college students


    Falls, Benjamin J.; Wish, Eric D.; Garnier, Laura M.; Caldeira, Kimberly M.; O'Grady, Kevin E.; Vincent, Kathryn B.; Arria, Amelia M.


    Early conduct problems have been linked to early marijuana use in adolescence. The present study examines this association in a sample of 1,076 college students that was divided into three groups: 1) early marijuana users (began marijuana use prior to age 15; n=126), 2) late marijuana users (began marijuana use at or after age 15; n=607), and 3) non-users (never used marijuana; n=343). A conduct problem inventory used in previous studies was adapted for use in the present study. Early conduct...

  7. Early Start DENVER Model: A Meta - analysis

    Directory of Open Access Journals (Sweden)

    Jane P. Canoy


    Full Text Available Each child with Autism Spectrum Disorder has different symptoms, skills and types of impairment or disorder with other children. This is why the word “spectrum” is included in this disorder. Eapen, Crncec, and Walter, 2013 claimed that there was an emerging evidence that early interventions gives the greatest capacity of child’s development during their first years of life as “brain plasticity” are high during this period. With this, the only intervention program model for children as young as 18 months that has been validated in a randomized clinical trial is “Early Start Denver Model” (ESDM. This study aimed to determine the effectiveness of the outcome of “Early Start Denver Model” (ESDM towards young children with Autism Spectrum Disorders. This study made use of meta-analysis method. In this study, the researcher utilized studies related to “Early Start Denver Model (ESDM” which is published in a refereed journal which are all available online. There were five studies included which totals 149 children exposed to ESDM. To examine the “pooled effects” of ESDM in a variety of outcomes, a meta-analytic procedure was performed after the extraction of data of the concrete outcomes. Comprehensive Meta Analysis Version 3.3.070 was used to analyze the data.  The effectiveness of the outcome of “Early Start Denver Model” towards young children with Autism Spectrum Disorders (ASD highly depends on the intensity of intervention and the younger child age. This study would provide the basis in effectively implementing an early intervention to children with autism such as the “Early Start Denver Model” (ESDM that would show great outcome effects to those children that has “Autism Spectrum Disorder”.

  8. Bipolar Disorder and Early Affective Trauma. (United States)

    de Codt, Aloise; Monhonval, Pauline; Bongaerts, Xavier; Belkacemi, Ikram; Tecco, Juan Martin


    Bipolar disorder is a chronic psychiatric disease with a high prevalence and is a major psychosocial and medical burden. The exact etiological pathways of bipolar disorder are not fully understood. Genetic factors are known to play an important role in the etiology of bipolar disorder. However, high rates of discordance among identical twins and a growing body of evidence that environmental factors such as early stress can influence the onset and course of psychiatric diseases underline the importance of additional etiological mechanisms of bipolar disorders. There has been little investigation about early trauma in bipolar disorder. The aim of this study was to review the literature on the association between early traumatic interactions like child neglect, mistreatment, abuse or early parental separation and the occurrence of bipolar disorder in adulthood or impact on the course of the disease. Studies investigating associations between child neglect, mistreatment, abuse or early parental separation and occurrence of bipolar disorder in adulthood or impact on the course of the disease were searched in the Pubmed database. More than 700 articles were sorted independently by two of the authors using predefined criteria. Only research articles, reviews and meta-analyses were selected for this review. 53 articles met the inclusion criteria. To date, four systematic reviews partially addressed our research question. Early trauma is more frequently found in the past of bipolar patients than in the general population. Studies support a harmful effect of childhood trauma on the course of bipolar disease, with more anxious, depressive or psychotic symptoms, an early age of onset and a worse prognosis. Early trauma is more often found in the past of bipolar adult patients than the general population and studies support a harmful effect of childhood trauma on the course of bipolar disease, with more anxious, depressive or psychotic symptoms, an early age of onset and a

  9. Design Application Early Childhood Education Based Mobile

    Directory of Open Access Journals (Sweden)



    Full Text Available This study aims to make learning media for Early Childhood Education in the form especially its mobile applications for Android-based smartphones. In the process of teaching and learning for Early Childhood Education is still often found constraints experienced teaching force is limited props so that learners are less eager to learn. In addition, parents also have difficulty returning to guide or teach the learning materials at home because it has no alternative instructional media. In compiling this research report author uses the Android-based Mobile Devices Applications created using the Java programming language through the Eclipse editor. Based on the results of the research, concluded that these applications can be applied in the latest version of the Android platform to its current platform version of Jellybean. Application of Learning can be used as an alternative way of learning for Early Childhood Education so as to overcome the lack of props in institutions of Early Childhood Education, can be used to be taught at home, and provide new teaching methods to early childhood so that a form of learning that is obtained is not the monotony of one form of learning how.

  10. Exemestane in early breast cancer: a review

    Directory of Open Access Journals (Sweden)

    Michael Untch


    Full Text Available Michael Untch1, Christian Jackisch21Interdisciplinary Breast Centre, Helios Klinikum Berlin-Buch, University Charité, Berlin, Germany; 2Department of Gynecology/Obstetrics, Klinikum Offenbach GmbH, Offenbach, GermanyAbstract: The adjuvant treatment of women with endocrine-sensitive early breast cancer has been dominated for the last 40 years by tamoxifen. However, the side-effects associated with this therapy have prompted a search for safer and biochemically more selective endocrine agents and led to the development of the third-generation aromatase inhibitors (AIs anastrozole, letrozole and exemestane. Promising results in advanced disease have paved the way for treating early breast cancer, and AIs are increasingly replacing tamoxifen in the adjuvant setting. Several large, randomized trials with AIs have been completed or are ongoing in women with early-stage breast cancer, documenting the significant impact that these drugs are making on the risk for recurrence of breast cancer. As a result, there is increasing and widespread use of AI therapy for the treatment of early-stage endocrine-responsive breast cancer. This review summarizes the data for exemestane in the adjuvant setting, showing that a switch to exemestane after 2 to 3 years of tamoxifen therapy is associated with a statistically significant survival benefit and is regarded as being sensitive by international and national experts.Keywords: early breast cancer, adjuvant setting, endocrine-sensitive, tamoxifen, aromatase inhibitor, exemestane, switch, IES 31, NSABP B-33, TEAM

  11. Environmental magnetic fields: Influences on early embryogenesis

    Energy Technology Data Exchange (ETDEWEB)

    Cameron, I.L.; Hardman, W.E.; Winters, W.D.; Zimmerman, S.; Zimmerman, A.M. (Univ. of Texas Health Science Center, San Antonio (United States))


    A 10-mG, 50 to 60-Hz magnetic field is in the intensity and frequency range that people worldwide are often exposed to in homes and in the workplace. Studies about the effects of 50- to 100-Hz electromagnetic fields on various species of animal embryos (fish, chick, fly, sea urchin, rat, and mouse) indicate that early stages of embryonic development are responsive to fluctuating magnetic fields. Chick, sea urchin, and mouse embryos are responsive to magnetic field intensities of 10-100 mG. Results from studies on sea urchin embryos indicate that exposure to conditions of rotating 60-Hz magnetic fields, e.g., similar to those in our environment, interferes with cell proliferation at the morula stage in a manner dependent on field intensity. The cleavage stages, prior to the 64-cell stage, were not delayed by this rotating 60-Hz magnetic field suggesting that the ionic surges, DNA replication, and translational events essential for early cleavage stages were not significantly altered. Studies of histone synthesis in early sea urchin embryos indicated that the rotating 60-Hz magnetic field decreased zygotic expression of early histone genes at the morula stage and suggests that this decrease in early histone production was limiting to cell proliferation. Whether these comparative observations from animal development studies will be paralleled by results from studies of human embryogenesis, as suggested by some epidemiology studies, has yet to be established. 38 refs.

  12. Environmental and genetic influences on early attachment

    Directory of Open Access Journals (Sweden)

    Gervai Judit


    Full Text Available Abstract Attachment theory predicts and subsequent empirical research has amply demonstrated that individual variations in patterns of early attachment behaviour are primarily influenced by differences in sensitive responsiveness of caregivers. However, meta-analyses have shown that parenting behaviour accounts for about one third of the variance in attachment security or disorganisation. The exclusively environmental explanation has been challenged by results demonstrating some, albeit inconclusive, evidence of the effect of infant temperament. In this paper, after reviewing briefly the well-demonstrated familial and wider environmental influences, the evidence is reviewed for genetic and gene-environment interaction effects on developing early attachment relationships. Studies investigating the interaction of genes of monoamine neurotransmission with parenting environment in the course of early relationship development suggest that children's differential susceptibility to the rearing environment depends partly on genetic differences. In addition to the overview of environmental and genetic contributions to infant attachment, and especially to disorganised attachment relevant to mental health issues, the few existing studies of gene-attachment interaction effects on development of childhood behavioural problems are also reviewed. A short account of the most important methodological problems to be overcome in molecular genetic studies of psychological and psychiatric phenotypes is also given. Finally, animal research focusing on brain-structural aspects related to early care and the new, conceptually important direction of studying environmental programming of early development through epigenetic modification of gene functioning is examined in brief.

  13. Early glandular neoplasia of the lung

    Directory of Open Access Journals (Sweden)

    Westra William H


    Full Text Available Abstract Although bronchogenic carcinomas progress through a very well defined sequence of metaplasia, dysplasia and carcinoma in situ, very little is known about the early progression of glandular neoplasms of the lung. In particular, the early precursor lesion from which fully malignant adenocarcinomas arise has effectively eluded recognition, at least until recently. Several lines of evidence now implicate atypical adenomatous hyperplasia (AAH as an initial morphologic stage in multistep lung tumorigenesis. Despite its small size, AAH can be appreciated at the light microscopic level and characterized at the molecular genetic level. Indeed, the genetic characterization of AAH promises to further our understanding of lung cancer development and might facilitate the design of novel strategies for early detection of lung cancer.

  14. Diastolic and autonomic dysfunction in early cirrhosis

    DEFF Research Database (Denmark)

    Dahl, Emilie Kristine; Møller, Søren; Kjær, Andreas


    cirrhosis during maximal β-adrenergic drive. MATERIAL AND METHODS. Nineteen patients with Child A (n = 12) and Child B cirrhosis (n = 7) and seven matched controls were studied during cardiac stress induced by increasing dosages of dobutamine and atropine. RESULTS. Pharmacological responsiveness was similar...... fraction was similar in patients and controls. Peak filling rate was longer in cirrhosis compared to controls (1.8 ± 0.4 and 1.4 ± 0.2 end-diastolic volume/s, p stress by 13% compared to 0% in controls, p ... indicate that patients with early stage cirrhosis exhibit early diastolic and autonomic dysfunction as well as elevated pro-ANP. However, the cardiac chronotropic and inotropic responses to dobutamine stress were normal. The dynamics of ventricular repolarization appears normal in patients with early stage...

  15. Rogue wave early warning through spectral measurements?

    International Nuclear Information System (INIS)

    We study the spectra of the Peregrine soliton and higher-order rational solutions of the nonlinear Schroedinger equation (NLSE), which we use as a model of the rogue waves in optics and in the deep ocean. We show that these solutions have specific triangular spectra that are certainly easily measurable in optical systems and which may be amenable to characterisation in ocean environments. As the triangular feature of the solutions appears at an early stage of their evolution, this raises the possibility of early detection and possible localized warning of the appearance of rogue waves. We anticipate that studying the characteristics of 'early warning spectra' of rogue waves may become an important future field of research.

  16. Early emergency prognosis and response centers

    International Nuclear Information System (INIS)

    An emergency early warning system for the fourteen nuclear generating units in the country has been developed at the Nuclear Research Institute of the Ukrainian Academy of Sciences. All units are connected to the host computer in the emergency center of the State Nuclear Power Authority in Kiew and interconnected with each other. The early warning system is to make another reactor accident of the magnitude of Chernobyl impossible. Installation of the hardware is to begin at the South Ukraine 3 nuclear generating unit in 1997; the costs of the pilot project are estimated at U.S. Dollar 40 million. After subsequent feasibility studies, the software and the hardware may be modified; the early warning system could be in operation countrywide by 1999. (orig.) [de

  17. Food Policing in Early Modern Danish Towns

    DEFF Research Database (Denmark)

    Mührmann-Lund, Jørgen


    This article explores the efforts of early modern authorities to provide food security in three different Danish towns in order to understand the goals and methods of early modern food policing. As in other European countries, urban authorities were expected as part of the regulation called ‘the...... of the capital and thus increase the military-fiscal power of the absolutist state, by providing food security and even a comfortable life. In practice, the vigilant policing of bakers, butchers and brewers proved difficult. The positive economic effect of food policing was doubted early on and was reduced...... as a means to avoid food riots at the end the 18th century. In a major provincial market town like Aalborg, the food trade was policed in a similar manner by the town council and the police, but especially the intermediate trade proved difficult to stop. In a tiny, agrarian market town like Sæby, food...

  18. Early stage malignant phyllodes tumor case report. (United States)

    Wolbert, Thao; Leigh, Emilia C N; Barry, Rahman; Traylor, Jack R; Legenza, Mary


    Malignant phyllodes tumor of the breast is an extremely rare entity usually presenting with similar clinical features with those of benign fibroadenoma. Due to its scarcity and clinical presentation, it is quite difficult for clinicians to suspect and diagnose the disease at its early stage. There is currently no consensus regarding adjunctive radiotherapy, hormonal therapy and systemic chemotherapy recommended for malignant phyllodes tumors. This report presents a case of early-stage malignant phyllodes tumor treated by lumpectomy only without adjunctive chemoradiation therapy, but with an excellent outcome. Early diagnosis and staging with high suspicion are crucial in malignant phyllodes tumor patients since they do not only improve the overall outcome of the disease after lumpectomy only but they also decrease morbidity and mortality with adjunctive chemoradiation therapy. This case report has been reported in line with the SCARE criteria (Agha et al., 2016 [1]). Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.

  19. Cholinoreceptors of early (preneural) sea urchin embryos. (United States)

    Buznikov, G A; Rakich, L


    Agonists of nicotinic cholinoreceptors (n-AChR) and 1-acetyl-4-methylpiperazine (100 microM) had no effect on early embryogenesis in sea urchins, while in the presence of phorbol-12-myristate-13-acetate (PMA) and various other protein kinase C activators, these agents induced rapid lysis of oocytes or early embryos, as a result of calcium shock. Many n-AChR ligands which do not penetrate into the cytoplasm (not being antagonists of muscarinic cholinoreceptors) protected against this cytotoxic effect. In the presence of PMA, acetylcholine and carbachol had actions which were much weaker than those of nicotine, while muscarine was completely inactive in these conditions. Thus, the surfaces of sea urchin oocytes and early embryos bear receptor structures, presumably n-AChR, which are functionally linked with second messengers which are endogenous protein kinase C activators.

  20. Early diagnosis and screening for colorectal cancer

    International Nuclear Information System (INIS)

    Laufer, I.


    The barium enema has been a neglected tool in the diagnosis of early colon cancer. With appropriate attention to technical detail, the double contrast enema is capable of detecting the smallest malignant and pre-malignant lesions. Many of these early colon cancers are found in asymptomatic patients and these lesions are curable. The goal of a screening program should be to identify by history or by fecal occult blood testing patients at high risk for the development of colon cancer. These patients should be examined by high-quality double contrast enema in the search for these potentially lethal but curable lesions. In addition, we believe that any patient undergoing radiologic examination of the colon for whatever reason, should receive an examination of adequate quality to rule out an early colon cancer. (Author)